practice-whisperer

Top 10 Ways to Control Overhead and Improve Profitability

Mon, 22 Jan 2024 16:09:55 GMT

Work Smarter, Not Harder

With the current economic market, it has never been more imperative to assess our business practices and find ways to counter the rising costs of overhead expenses as well as stagnant insurance fees. The beginning of the year is an optimum time for you and your team to identify improvements in efficiency and overhead, helping to ensure the health of your business throughout 2024.

Here are a few suggestions that can make a noticeable difference in time savings and profitability:

1) Price-shop Instruments – Same quality, pay LESS

The interesting part about an industry as small as dentistry is there are only a handful of manufacturers, but a significant number of vendors. With a little bit of research, you can locate the same exact item and pay different prices depending on who you order from.

For example, Berman Instruments. This company provides instruments made of the same quality as other high-quality, nationally known vendors, but at a fraction of the cost. You buy directly and therefore get double savings. Many of our instruments are not half or less of what we used to pay before, which is great for those often-replaced instruments like scalers and explorers.

They do not advertise much, so you are not paying for that additional expense, which is why they are not as well known. If you are not familiar with this organization, here is a link to their products for comparative purposes:

https://bermaninstruments.com/

2) Modify In-House Financing

Many offices provide both 3rd Party Financing (ex: Care Credit) and in-house financing, as well as a % discount for patients who prepay for their treatments. If you are allowing a patient to do both simultaneously, you are really taking a double hit. If this is the case, I’d recommend you make the options mutually exclusive. This minor change can save you a lot of money over time.

Here’s why. There is a cost to the business for financing the expense of treatment. You must wait for the money and assume the risk of potential losses from default accounts. It does not make much sense to allow patients to get a discount on top of that as well.

Here is how such an offer can be presented to a patient:

"Mrs. Jones, we can absolutely obtain financing for your treatment for as low as $99 a month.
Or if you would prefer to pay for your treatment in full, many patients appreciate the 10% ($500) savings that comes with that option.

What sounds like the better option for you?"

Other opportunities for improving financing effectiveness might be:

· Increase Minimums (if a patient wants to pay out more than 6 months, have a minimum of say $1000 in financed care)

· Reduce more costly payment options (ex: cut the 18-24mo CareCredit option)

· Move long-term payment options to 3rd party administrators that pass on some of that cost to the patient.

3) Reduce Cost and Time with Supplies Tracking

Are you or your team member spending time shopping from multiple suppliers to try to get your costs down? While the idea is great in concept, the time spent often eats into most if not all savings you could get.

There is an alternative option that allows you to order everything from one platform to save time and automatically reduce your costs. This also makes it easier if you have a transition in who is ordering.

I met the owner of ZuSo recently, and the concept and platform are impressive. I love their goal of helping private practice stay private. It also helps that they have an average savings of over 1% of collections for offices, which tends to be 15-20%, while also saving time. Time and money are both important, it is best when you can save on both.

https://zusodental.com/saveonsupplies

Additionally, look into creating what is commonly called a formulary, which is basically a list of all the approved items to purchase. This prevents purchasing supplies that are far higher in cost (like an assistant wanting masks that are a different color, but not looking at the brand being twice the price). While DSOs can get some small pricing improvements, one of the main things that keeps their pricing down is a formulary and inventory control.

4) Switch Merchant Service Companies

Merchant services are companies that process the credit card transactions that an office collects. There is little regulation in this industry, hence you can end up with some companies charging up to 10x as much as others. With a little effort, you can potentially locate a lower-priced vendor that is more transparent.

Be aware there are different pricing structures that companies use; some are more cost effective than others despite how the reps might present their pricing structure. Flat rate is the simplest to understand, but you will pay a higher rate. Interchange Plus is the most transparent and will save you the most money, but your rate will fluctuate month to month slightly depending on the cards you process. Always stay away from tiered plans because they promise low rates but that only applies to the most basic non reward debit card and the truth is that most cards process at a higher rate than advertised.

Also avoid contracts that auto renew and make sure you read the fine print about fees that come out once or twice a year but don’t show up in all statements.

Always get a guarantee in writing that your rate will never change. Many companies will sign you up at a low rate and slowly creep up your rate over time.

For example, we switched to Apex Payment Solutions, which is run by a dentist and offers a lower expense for this basic service. The good news about switching companies like merchant services is that once you are done you will likely never notice a difference, except to your pocketbook. If you are paying more than around 2.1% credit card transaction fees, you might want to investigate switching your merchant service company.

Apex has been great for us for years, with multiple people saying they cannot beat what we have:

https://share.hsforms.com/1THCNRkjIQle8PDeR0jlouQ4tz5w

5) Dental Labs

There are many labs around the country that provide basic services like crowns. As you know, the price of the same crown can range from $50 - 500 per unit across different labs. Unfortunately, the quality of the restoration does not always match the price. Our office has tried different labs over time, and I’m pleased to say that our crowns today are coming in with higher quality and less necessary adjustments than ever before. Best part is I am paying less for our crowns now than ever. It may take some searching to find the right lab for you, but it can be well worth the effort! An all-zirconia crown can easily be under $100, made in the US. With restricted in-network fees, keeping these costs down is incredibly valuable. But even OON there is no reason to pay more than necessary.

6) Improve Marketing

A HubSpot study found that companies that increased marketing spend experienced a 126% increase in leads and a 27% increase in revenue, while those that cut marketing had a decrease in leads and revenue. During Covid, we maintained our marketing expenditure while many others decreased or dropped the investment, and we had over $400k revenue growth for the year.

One of the aspects that holds back an office from growth and profitability is maintaining a healthy new patient flow. Many offices will experience natural attrition of 15-20% annually, which is around 20 patients lost per month for a single dentist. Well planned and executed marketing efforts serve to bring in more patients, replenish losses and help grow the office further.

Now, the challenge is making sure the money one puts into marketing is an investment instead of an expense. The investment needs to be worthwhile and effective. Some effective tips for marketing:

• Target your ideal, high-value patients, so you aren’t wasting funds on areas unlikely to respond. Patients for hygiene or cosmetics are hard to generate ROI.

• Quality drives quality. Cheap mailers and large discounts bring low end patients.

• Track campaign results with ROI connected to the production patients spend. Many companies can do this for you now and prove their results.

• Get a call tracker to make sure you are not losing all those marketing dollars on missing phone skills and losing opportunities.

These will help you make sure the efforts and budget you put into marketing translate into a great return on investment as well as a lower overhead. There are a few good marketing companies out there, and many flops (I have tried way too many). One example marketing provider that has proven consistent results over years, and that provides tracking for proof of their effectiveness and ROI, is illustrated here:

https://patientnews.com/free-consultation24/

7) Re-evaluate Dental Insurance Systems

Dental Insurance is often completely misunderstood by many dental teams, even those who have worked in the industry for years. The insurance industry is highly complex and often not clear or transparent about their policies. Here are a few areas that are commonly misunderstood and often result in lower revenue for the dental office:

Non-Covered Services are those that will never be covered by an insurance policy. A common example is veneers and a less common example would be fluoride for an adult. In over 40 states an insurance company is not legally allowed to force a dentist to take a discounted fee on these services; yet the EOB will often not accurately show this fact. Offices that aren’t clear about which services are “non-covered” and subsequently accept a discounted fee are losing legitimate revenue. Understanding the specifics in your state can save your practice thousands a year in unnecessary write-offs. You can find your state law on non-covered services here:

https://dentalinsuranceguy.com/resources/#state-regulations

Upgraded Services. Many dental services come with different options. For example, you could get a standard crown from a lab with average esthetics, or you could get a custom shaded crown from the same lab for an added cost. Any added cost for an upgrade like this would be the responsibility of the patient, above and beyond the "negotiated" fee of the insurance company contract agreement. Understanding how to manage these upgrades and coding options can bring the office significant savings by correctly billing the patient for the upgraded services rendered.

For more information on upgrades, check out this online CE course:

https://dentalinsuranceguy.com/courses/providing-upgraded-and-cosmetic-services-in-network/

Complete Documentation. Finally, many offices struggle with getting reimbursement from insurance companies for legitimate services rendered. Often the problem is due to a lack of correct documentation when preparing and submitting a claim. Insurance companies often require information that dental offices do not naturally capture. Understanding what information is important can mean the difference between dealing with dozens of crown and SRP denials versus obtaining ready approvals and reimbursement with less time spent and happier patients. If you are having more than a 1% denial rate on these services, the attached link contains several courses which will pay for themselves within a few days:

https://dentalinsuranceguy.com/courses/#premium

And if you just want a free intro video to what is and is not possible and the most common myths in the industry, check out this short free course:

https://dentalinsuranceguy.com/courses/dental-insurance-myth-busting/

7) Consider Outsourcing

With current recruiting challenges finding reliable, qualified team members, outsourcing may be a necessary step for an office. The key is to make sure you know how to evaluate what you need as well as if outsourcing that process is worth doing.

Outsourcing a task that is normally a team member role can be useful if that company can provide the service more effectively and less costly than the incumbent on payroll. Again, like marketing there are good companies and flops in each arena.

Also keep in mind that outsourcing expenses should still be captured within the payroll section of your P&L, as they are basically remote employees or contractors. This way you can also evaluate if it is worth maintaining their services or replacing them should you find someone to potentially take that task back.

If you would like a full breakdown of how to evaluate a dental insurance biller, check out this article:

https://dentalinsuranceguy.com/resources/articles/should-you-outsource-your-dental-insurance-billing/

8) Improve Clinical Efficiency

In many cases, the ability to do more work in less time in dentistry is not about working faster. It comes down to working more efficiently, which saves time and money. Often changing the order or steps in a procedure or system can improve efficiency without much change at all. As a common example:

Many offices during a crown appointment have the assistant fully set up the room, get a temporary template impression, sign informed consent, get a pre-op x-ray, etc. before calling the doctor into the room. Then after anesthetic the patient must sit there another several minutes getting numb, which is a waste of chair time.

If instead, you have the assistant focus initially only on getting ready for anesthetic and getting the doctor to come numb as soon as possible, then the other steps can be done while the patient is getting numb and better utilize that time. This can often cut the crown appointment time down by 10-20 minutes, which is better for the office and the patient.

Learning to look at every system or procedure in a different way can lead to being able to do more in the same amount of time without sacrificing any quality. We need to remember, in dentistry, we are selling our time and expertise more than any specific “service” like that crown.

Always be thinking: “how can I do this differently to better utilize time, or to remove one more step from the system?”.

9) Raise Fees or Drop Networks

At the beginning of the year many businesses look to adjusting their pricing to reflect increased costs. In dentistry this could include both service fee increases as well as dropping network participation. Fee increases tend to run in the 3-10% range depending on where your fees are currently and what the service and supply cost increases are for the office.

If you have not checked your fees recently, you really should. A free online database for fees in each specific area can be found here: https://fairhealthconsumer.org/

Most private practices tend to stick to the 70 ^th to 80 ^th percentile, which is what this website tracks. If you are much below the fees listed here, might be time to implement a larger fee increase for the year.

When in-network however, fee increases do not make as much of a difference due to the capped fee schedules. In this case, there is greater risk involved. Dropping an insurance network to get higher fees can either help a lot, or it can destroy an office. The key is making sure to handle this process correctly and make sure the office is ready to handle everything surrounding a change in network status.

If you are wondering whether dropping networks is right for you, check out this in-depth article that starts a whole series on how to handle insurance.

https://dentalinsuranceguy.com/resources/articles/dental-insurance-participation-part-1-ffs-vs-ppo-are-you-an-apple-or-an-orange/

10) Learn to Read What Your P&L is Telling You About Your Business

Often, dentists tend to look at P&Ls as a tool for their CPA and not something they should pay too much attention to and analyze. I have been guilty of glossing over my P&Ls in my earlier year of running a practice. However, when set up correctly a P&L can tell you almost everything you need to know about the current health of the business, what sections need improvement, and how to plan growth and improve profitability. It helps to first start with the basic categories and what the industry expectations of each are for your office as a percentage of collections:

Payroll 20-25%

Rent 7-10%

Marketing 3-10% (depending on speed of growth goals)

Labs 6-8%

Supplies 4-5%

To answer the most common questions that come up:

Payroll is for all non-doctor pay, outsourcing and temps, payroll taxes and expenses, benefits, and bonuses.

For loans, only the interest payment is an office expense, whereas the repayment of principle is considered part of the profit of the owner/office by the IRS.

Keeping these numbers and categories in mind can help you evaluate how your office is functioning and which areas to focus on for improvement.

Summary

Work smarter, not harder! None of these options require doing dentistry any differently. By simply taking time out to educate yourself and your team in a few of these areas can pay off handsomely over time.

Insurance Fraud Defined

Wed, 27 Sep 2023 17:24:31 GMT

Insurance Fraud Defined

Insurance Fraud

So I want to address something that keeps coming up as misinformation in the dental circles. Fraud is basically defined as misrepresenting information for financial gain. Common examples are:

1) Billing for something you did not do

2) Billing for something more than you did

What often is misunderstood is that billing cash patients at a different rate is also fraud, and is also against ADA code of conduct for all dentists.

As an example:

“Mrs. Jones, you need a crown. The normal price is $1500, but since you are paying in cash it will be $1000.”

This is Fraud, the most basic definition of it. It is not about Mrs. Jones, but about ALL other insurance patients if you put $1500 on your claim forms. In this example your normal fee is $1000 and that is what MUST be represented on claims forms. Your normal fee is what you would charge a cash patient. You MUST treat all patients the same regardless if there is 3rd party involvement or not.

Now, what is also misunderstood is what is NOT fraud.

Billing for something you did, on the day you did it….this is NEVER fraud.

Now, that might seem like a silly statement, but here is the common misconception out there.

“Insurance company A pays the crown code on seat date, therefore it is fraud to submit it on prep date.”

INCORRECT!

Insurance is only dictating when they will PAY the claim.

Again, like the above cash patient, you need to treat ALL patients the same. That includes how many x-rays you take, what procedures you do, how much you charge, and when you bill procedures.

It is common, normal, acceptable and IMO better to charge ALL crowns on the day you prep them. For the insurance companies that pay on seat date, great, put a narrative in on what day that is scheduled. You have now satisfied the information they want to see. The crown is likely to be cemented before they even process the claim anyway.

Hopefully this gives you a better understanding of what FRAUD is, and what it is not. Protect yourself, but don’t go overboard.

Claim Reviews with Dental Insurance Consultants

Wed, 27 Sep 2023 17:24:08 GMT

Claim Reviews with Dental Insurance Consultants

Here is a “live” case study that may be helpful to you on the business side of dealing with insurance.

I ended up having a SRP claim denied twice. So I had to talk to a dentist reviewer on the third try. The reviewer was pleasant to talk to, but was obviously trained on how to fight with every possible come back. He just picked the wrong person to try to disagree with.

So here is a basic outline of how to fight these on the phone and what to be prepared for:

1) X-rays – there was minimal, but obvious vertical attachment loss in places, so I got him first to agree to seeing that. If they want to fight this, you fall back on the true definition of perio, which is from your clinical attachment loss (CAL).

2) Reviewer – “There are only 4mm pockets on the top….and “only” a couple of 5-6mm pockets on the lower.”

I started talking about clinical attachment loss shown, and since we do have good measurements of gingival margins (GMs) it was easy to get him to see the CAL. I also got him to agree that the AAP and periodontists define perio by CAL, not pockets or x-rays. Every quad when counting CAL has multiple teeth with problems that justify SRP.

3) Photos – we did not talk about this since we had clear photos, but it always helps to have pictures of the perio probe in place showing not only the depth, but also the blood.

Now, the one failure in this case that caused the conversation to last even a couple minutes was not marking GMs on every tooth. He did bring up swelling in tissues and possible pseudo-pockets. We had enough measurements of GMs to get undebatable CAL, which closed the case and had him agree to approve treatment. You should make sure to mark literally everything, including zeros. This will remove the ability for them to argue pseudo-pocketing.

Moral of the story: your perio chart is everything. Fail to get every point, especially bleeding and Gingival Margins to have accurate CAL, and you will deal more with denials. Have a FULL perio chart and there is not much to debate. The most common concern I see when someone sends me a perio chart they want my help with is the lack of full data, most specifically the GMs. Remember, without a baseline GM, clinically it is impossible to determine CAL, which is what is required by the AAP to come up with a diagnosis.

When talking to reviewers, remember they are dentists. You can have whatever opinion you want about them with what they do, but you will get farther being professional over being rude. The entire conversation with this reviewer was pleasant and he nicely at the end agreed to approve the case. These dentists potentially can help you, getting upset with them (or them upset with you) is not the way to go.

Remember insurance companies are after the low hanging fruit, specifically offices that are easy to deny due to missing information or lack of pushing back. Push back and they will go after another piece of lower hanging fruit. We have submitted over 300 cases of SRP this year, and this is only the second case of perio that went past submission #2.

If you are interested in more ways to get paid by insurance on legitimate claims, I have an online CE course that goes into a lot more detail: “Understanding Insurance and PPOs.”

https://practicewhisper.com/courses/

Delaying Actions in Dentistry

Wed, 27 Sep 2023 17:23:41 GMT

Delaying Actions in Dentistry

Are delaying actions worth doing?

I learned a few years ago to stop offering delay tactic services. I avoid doing build ups if the patient is not ready for a crown. I stopped doing fillings to save crowns unless I know for certain it is a long term solution. If I treatment plan a posterior root canal, the crown is always included.

Why?

Because when you offer a patient a way out of what they really need, they will almost always take the easy way. But when the problem comes back worse, they won’t often remember you were just trying to help them. They seem to only remember your work failed.

“This crown did not bother me till you touched it.”

“Your filling (build up) is bad because I always get food caught between my teeth now, no I don’t remember you telling me it needed a crown”

“You did a root canal last year and now the tooth is broken and useless.”

Patients have short memories.

When you stop offering temporary treatments as much, interesting things happen:

Treatment acceptance magically goes up as well.

Patients are happier

Patients find a way to pay more often than not

Your stress level goes down

Can you find exceptions to this? Of course. You must always use your best judgement in every case. At the same time, it is helpful to ensure you are not unintentionally giving your patients an “out” that will cause you and them more stress and heartache later.

If money is the problem, find a solution like financing. Often doing temporary work can be worse than doing nothing; either for the dental health or your mental health.

No good deed goes unpunished….

Learn to Live Life

Wed, 27 Sep 2023 17:23:15 GMT

Learn to Live Life

Dentistry is hard, running a business is harder. The level of responsibility and stress we all deal with can be high, not to mention the toll on our bodies as well.We all need to learn to live more and work less!

A few years ago this was extremely tough for me. I felt like every time I was away from the office I was losing money. The office was a ball and chain holding me back from doing anything but work. Stress at the office was high, I worked at home as well, and I was never able to actually relax on vacation. Any of this sound familiar?

What I had to learn over time was that none of it was worth it. And more importantly, none of my fears that stopped me from living were valid.

Once I stopped taking work home, my stress levels went down, but things still magically got done (just forced me to be more efficient at the office).

When I started scheduling days out of the office ahead of time for vacation, my income never went down. It actually went UP! The days I was in the office just got busier, but less working days => less payroll cost => more profit.

Now, do I plan vacations in the busiest months of the year? No, but that also coincides with when most other people take vacations too. So I can enjoy my vacations more when things are less crowded. Same reason I actually love not working Mondays, I am free to do anything with no one in stores or on the road.

In the past I would have apologized for not having a regular tip in the last two weeks, I was in Florida with my family. Now though, I understand I should not have to apologize for living my life. Neither should you!

What are you doing to make sure your job does not get in the way of your life, family, freedom, and goals?

How to Make an In-house Specialist Successful

Wed, 27 Sep 2023 17:22:48 GMT

How to Make an In-house Specialist Successful

This has been a hot topic in recent years. As a background, I have had endo, surgery, and perio in my office for about 9 years now, with a variety of different providers. I firmly believe this type of model is only going to grow in the future. It is an amazing way to provide great value to both the doctors and the patients.

The basic idea is having a Provider come to the office to do procedures that the Host does not do. I am going to refer to the traveler as a Provider, because it can be either a specialist or a general practitioner that focuses on specific procedures. So why would either party do this non-traditional arrangement?

For the host, it helps bring in additional income to the practice with minimal additional cost, which helps stem the tide of lower reimbursement and growing corporate and competition concerns. It also brings more convenience and value to the patients, who are going to often comment on how great this is for them; this can help greatly with patient retention over time. Our current society is all about convenience of one stop shop models; just look at Super Target, Walmart, Amazon, etc.

I can also tell you from experience that the patients end up getting the treatment they need far more often. When we brought services in the office, we noticed a 4x increase in patients getting their treatment completed vs referring them out.

For the Provider, this becomes the ultimate lifestyle business that gives you unlimited freedom. First, the cost to building an office build in today’s world is often $500,000 and up. With a traveling business all you need are mobile equipment and supplies, often bringing you well under 20% of the start-up cost. You also remove the traditional fixed overhead costs of maintaining an office: rent, utilities, and maintaining the building and built-in equipment. About the only costs you will ever have with this model is your variable costs of supplies and assistant. What this translates into is a business where you do not lose money when you are not working. This is what is called a lifestyle business because you can plan your business around your life, instead of your life around your business. Want to take a vacation or break? Great, do it without the usual stress of needing to pay for the home office you are leaving behind.

Due to this being a non-traditional approach many concerns often arise from dentists. Most concerns about this practice model come from misinformation or lack of knowledge, because there are solutions to almost everything. You just need to think outside the box since the concept is non-traditional. Here are the most common concerns and ways to solve them:

Fees – If fees are not high enough it can cause a lot of issues on both sides (Provider and Host)

Solution – The Provider should be out of network. This gives you far more control and better ability to treatment plan quickly and easily. I run a mostly PPO office and this is rarely a problem, the few times it is there are simple ways around it.

Scheduling – Can be specific days or week/month, or flexible As-Needed for patients. Depending on the specialty, one or the other option could be better.

As-Needed allows the host to have more flexibility to schedule patients, the provider has less concern about a specific office needing X amount of work to come in. It is also far easier for the provider to build up an office base like this. However, As-Needed takes more organization on the part of the Provider to manage locations and does require more locations in general to run efficiently.

Specific days takes longer to build because the Host has less ability to schedule around patient needs, and therefore is harder to get Host offices onboard. It is easier for the Provider to organize.

Either set up though requires good communication. The Provider should give the Host team a full fee schedule that also includes how long to schedule for each procedure.

Home Offices – A home office makes this arrangement far less worthwhile for both Host and Provider. For one, the Provider loses the overhead gain that you can get from travelling, which as mentioned at the beginning is one of the biggest reasons this model is a win for the Provider. Second, the home office is always the baby that gets the most attention, which means the Host will play second fiddle (and they will often feel it).

Solution – The most successful way to travel is to do it as your full-time model because as a business model you end up with almost zero fixed overhead. Your only costs are when you are working, which gives you amazing flexibility and profitability.

Skill of the Provider – absolutely this an issue. However, this is an issue with every dentist owner, associate, or referral in the world. Which makes this no different comparatively with any other type of setup.

Enough Patients – This is a problem if the specialist only has a handful of offices, and/or if they try to book specific days of week/month. This is another reason the most successful setup for travelling is not having a home office. When you are starting up you have no fixed costs to worry about needing to cover financially until your income takes off. Once you have a stable base of offices this problem no longer matters.

Post-op Care – Who does them if the specialist is not there every day?

Solution – If they come on a regular basis, the Provider can do these, but it does take time. However, most post op patients are not that difficult and with a little training and knowledge the Host should easily be able to manage a vast majority of these. For the few patients that they cannot, the Provider can easily see the outlier cases at a nearby office they are at that day. All it takes is a little communication with the traveling provider.

Scare/Fear Tactics:

When looking into this concept there is a subset of specialists who will try to scare anyone away from this model. There is really no reason for them to feel threatened by this model. To the specialists this is no different than another specialist setting up an office near them. A new provider is going to end up taking just as many patients away from you whether they have a fixed location or a mobile one. So, let’s shine some light onto these scare tactics to clear up the misinformation:

Fee Splitting? This arrangement is NOT fee splitting in any sense of the term. The payment arrangement is not much different, if at all, then having a normal associate. You pay them by a percentage of their production/collections just like any other dentist associate in an office. The only way to consider a traveling arrangement fee splitting would be to call every associate dentist in the country illegal as well. Fee splitting is very specific: a referral provider paying the referring provider a split of the fee they get from a patient. In a traveling model, the host dentist is the one paying the provider, exactly like any other associate.

Emergencies – There is a concern that the safety of traveling providers can be an issue, less for the provider and more for the host facility. First, the Provider needs to be solid on their emergency prep and to have all their emergency gear with them. This is no different than having your own fixed facility. The nice part is all emergency equipment now comes in mobile variety, you just need to make sure you bring it inside with you for easy access. For the Host facility there are a few things to manage, but they are quick and inexpensive to add on if the Host does not already have them in place. Last is training. The Provider is likely to have trained people just like they would in a home office, but the Hosts may not. This just brings another opportunity to the Provider to bring value to the Host. Train the Host teams yourself and solidify your relationship as well as protect the patients. Whether you charge for it is up to you, but Host offices are required to have emergency training renewal every year anyway for which they will have to pay someone to do.

Now that we have discussed the common concerns, let’s discuss the different traveling models:

Wisdom Teeth / Implants – This is the easiest model to add for the Host. Treatment plans are simple, patients either want it or don’t. There is no need for consults prior with the surgeon unless the patient wants or there is a specific medical concern. This is the no-brainer add on for travelling dentists.

Endodontics – This one is simple to set up as well. Easy treatment plans, patients often want to get scheduled, and it is not much of a change from normal GP work for the team. The one concern is patients in pain now and specialist may not be available for a few days, which is simple to solve. Patients are aware of infections and the need for ABs for a few days to clear up infection prior to surgery. Anyone with acute pulpitis the Host can learn to pulp teeth, which should take minimal time. The Host can just refer the patients who cannot wait; but in my experience, they are less than 5%.

For a travelling endo though, retreats make up a huge portion of the work, GPs doing this that aren’t fully comfortable with retreats are going to likely struggle as Hosts are going to have a much harder time keeping them busy. I have had a GP endo in the office for years every week, and he was the easiest Provider to keep busy year-round.

Periodontics – This is a little more complex. There are multiple more codes to manage and patients rarely want perio treatment even though they need it. It still can work out well, but in my experience periodontists do far better with the implant side than the disease side. Consults also are a must in many cases, especially on the disease side, because treatment planning is not as cut and dry as wisdom teeth, implants, or root canals. The upside though is that periodontal treatments are often the highest cost per procedure, so you don’t need as many to make a very busy practice.

Orthodontics – This is the most complex one, only because cases can linger for 1-2 years, unlike every other specialty where your typical case lasts a single visit or up to 3 months. However, it can also be one of the most successful because it can be the most effective at keeping patient retention for the Host.

Due to the nature of how Ortho works, they must be set a specific day instead of coming as needed. A big concern can be what happens when the orthodontist needs to move, which is why the contract for this needs to be well thought out. This is the one specialty where the idea of having a home office is actually a good idea. Often orthodontists will do this to expand into a new area or town, which can work out very well with far less up-front costs. A home office also provides stability for the Host because they know it is a lot harder for the Provider to just move. And even when a Provider does change, a new one will be there to take their place.

The alternative option is to have the Provider set up a multiple associate model, so they are the ones needing to find replacements when a dentist moves on instead of the Host, which makes this far easier to get offices on board. If you are interested in managing ortho feel free to reach out and I can get you in touch with some people who do this effectively.

How does one setup these models?

The most common arrangement for these is 50/50 split of host to provider. In reality it is just a 50% of adjusted production setup. Often both Provider and Host will split the cost of larger items like implants, bone grafts, membranes, etc.

The host typically provides supplies they normally have (anesthetic, gauze, needles, etc.), chair space, scheduling, collections and insurance management.

The provider typically brings specialist equipment and supplies, as well as their assistants.

If the arrangement above changes with who is providing something, the compensation percentage changes as well. As an example, if the host provided the equipment and assistants, they typically keep 60% instead. The split is all about responsibility, management, and risk.

Conclusion:

I hope this sheds some light on this practice model. I have run this model for 9 years now with a variety of providers across that time. I have seen all the failures and successes, which typically have the same story behind them. An organized Provider is essential to make this model work. The Provider needs to be punctual, highly communicative, and run an organized business in everything from scheduling to billing. The Host needs to realize there is some up-front concerns to manage and to keep an open mind during the process. If both Provider and Host walk into these arrangements with the right attitude, the result is an extreme Win for both dentists as well as the patients.

If you have any questions or concerns about this concept, I would love for you to reach out to me. I fully believe this model is such a win for all involved and expect it to grow in the future that I am happy to help.

Can Patients Choose Not to Use Their Dental Insurance?

Wed, 27 Sep 2023 17:22:16 GMT

Can Patients Choose Not to Use Their Dental Insurance?

Insurance often is a massive headache for many offices. However, it does not have to be. Don’t get me wrong, it will always be an annoyance, but insurance handled well should not stress you out.

If you are a network provider, you know that your provider agreements require you to file claims with the insurance carrier. I am not suggesting you breach these contracts; however, the patient is the higher authority. It is our obligation to let patients know what their payment options are.

Thanks to HIPAA/HITECH regulations you now have the ability to have a patient opt out of filing their health insurance.

If a patient elects to opt out of their insurance you should have them sign an election to self-pay form. By signing the Election to Self Pay the patient is stating that they have chosen to opt-out of their insurance and by doing so, you will not be filing a claim with their insurance company.

The most common reasons for doing this is to avoid insurance companies from dictating the treatment. Anything that the patient wants that is not feasible to do under massively reduced fees (veneers, cosmetics, nitrous, sedation, hybrid pros, etc.) the patient can opt to not involve insurance at all. This allows you to find a mutually beneficial relationship with the patient and completely prevent insurance from ever getting involved in the future. These laws are federal in nature, so the only thing to be concerned about is federal plans (Medicaid, TriCare, GEHA), in which if you are in-network you either follow the fees or you refer the case out. All other PPO plans you can use this form.

The conversation with the patient should go something like this:

Team Member: Mrs. Jones, we verified your insurance benefits and they will not pay for X treatment at all (or insurance will not allow us to provide you the level of quality you want).

Most patients tell us they don’t want to sacrifice quality just to satisfy the insurance company’s random rules. You have the option to not involve insurance or we can try to refer you to someone out of network that can do this work for you. What would you prefer to do?

Team Member: Mrs. Jones, most patients with insurance with unfeasible restrictions like yours choose to not involve the insurance company and choose instead to sign up for a membership plan instead. Would you like more information on this?

THEN

Patient: Sure, how do we do that?

Team Member: If you choose to opt out of us involving insurance, there is a simple HIPAA form to sign that outlines this process. This will allow us to provide the quality care you want and deserve.

If you would like a sample copy of this form, you can find it under the free forms download page, insurance section here: https://practicewhisper.com/forms

Associates and Invisalign (Or any aligner treatment)

Wed, 27 Sep 2023 17:21:42 GMT

Associates and Invisalign (Or any aligner treatment)

I see a lot of questions and misunderstandings about how to compensate associates who work on Invisalign cases. Here is a short attempt to try to shed some light on this dilemma from both the business and associate side.

Overhead Costs – when an associate gets paid on a procedure, there is a general overhead from supplies and labs as well. The most common is a crown, in which an average PPO office might get $700 for the crown and pay $150 lab fee, which is a 21% lab fee. Now when you look at Invisalign, a typical $5000 case, with $2000 lab fee including retainers, which is a 40% lab fee. Double the overhead cost.

Lengthy Timeframe – Another concern is, unlike crowns, Invisalign takes months or years to complete, with multiple steps. If you pay an associate for the full procedure when a case starts:

Are they going to be around to complete it?

What if someone else ends up doing some steps?

Are you okay paying someone months ahead of when the work will be done?

Paying for the total case just has too many flaws.

A better solution I am going to suggest is split Invisalign into its component parts. Pay on each as they are completed. This will remove all the typical issues surrounding paying an associate on a lengthy case. Think of an implant: you pay on the extraction, grafting, implant placement, abutment and crown all separately.

Example:

Invisalign full case – $5000

Clincheck – $500

Attachments – $500

IPR – $250

Attachment removal and Retainers – $250

Refinement/Midcourse correction – $250

Maintenance Visit – $100

One point is when you add up these fees, they should add up to your fee minus lab cost.

Internal Tracking Codes – I recommend that you embed internal tracking codes …. That way for each visit your team can know exactly what to setup for and it becomes easier to track where you are in a case. Plus, each visit has a fee attached that goes towards associate production and is paid like any other procedure. No special work required once you set the codes.

Ledger Accounting – The simplest way to do this is charge a corporate provider fee (not individual provider) for the full case, and that is how you track patient costs. Each visit that has the provider fee attached gets adjusted off that day, so the patient is not charged double.

This process can be a lot more realistic and fairer to both the associate and the office.

Is Losing a Patient Always a Bad Thing?

Wed, 27 Sep 2023 17:21:13 GMT

Is Losing a Patient Always a Bad Thing?

So today I had a cash patient of 7 years walk out. He has not seen the hygienist in 18 months, when he was just under the state requirement of an exam in 12 months. It has been 2.5 years since his last full exam or x-rays. I have only seen him for limited exams in the last 18 months, specifically for broken teeth, which he did not want fixed.

His complaint today was he did not want to pay for an exam or x-rays. I nicely had to tell him legally there was nothing I could do without them.

Now, occasionally I might comp x-rays for a great patient or extenuating circumstances. However, this patient has 2 broken teeth that have needed crowns for 2 and 7 years. In the total 7 years I have seen him, he has only had 2 fillings done, 6 years ago. He has not referred anyone. He is a nice guy, and did not cause a scene leaving, but there is nothing that makes me feel value in doing things for free for him. No judgement of course, we never know what may be going on in the life of any individual.

Am I sad to see a patient walk out? Sure. He clearly needs dental care.

Do I care from a business perspective that this patient left? Nope

You want to make sure to avoid giving away too much time and mental energy on the patients who will never reciprocate it. Some people can be energy vampires or black holes. They are unhappy at life and the only way they have found to cope is to bring everyone around them down as well. Not only are there legal liabilities, but they can bring the team down and prevent you from taking great care of everyone else.

Instead, devote that energy and effort into taking better care of the patients who value you, your team, and the services you provide. We can do our best for every patient, but not every patient will accept, and that is okay.

Can Patients Choose Not to Use Their Dental Insurance?

Wed, 27 Sep 2023 17:20:42 GMT

Can Patients Choose Not to Use Their Dental Insurance?

Insurance is often a massive headache for many offices. However, it does not have to be. Don’t get me wrong, it will always be an annoyance, but insurance handled well should not stress you out.

Thanks to HIPAA/HITECH regulations you now can allow a patient opt out of filing their health insurance where the situation warrants.

If a patient elects to opt out of their insurance, you should have them sign an “Election to Self-pay” form. By signing the “Election to Self-Pay” the patient is stating that they have chosen to opt-out of their insurance and by doing so, you will not be filing a claim with their insurance company.

The most common reasons for an opt out is to avoid the insurance company dictating the treatment. Any procedure that a patient wants which is not feasible to do under massively reduced fees (veneers, cosmetics, nitrous, sedation, hybrid pros, etc.) the patient can opt to not involve insurance at all for that procedure. This allows you to find a mutually beneficial relationship with the patient and completely prevent insurance from ever getting involved in the future.

These laws governing HIPAA and the ability to opt out are federal in nature, so the only thing to be concerned about is federal plans (Medicaid, TriCare, GEHA), in which if you are in-network you either follow the fees or you refer the case out. All other PPO plans you can use this form.

The conversation with the patient should go something like this:

Team Member: “Mrs. Jones, we verified your insurance benefits and they will not pay for X treatment at all (or insurance will not allow us to provide you the level of quality you want).

Most patients tell us they don’t want to sacrifice quality just to satisfy the insurance company’s requirements. You have the option to not involve your insurance carrier for this procedure and pay us directly, or we can refer you to someone out of network who can do this work for you. What would you prefer to do?”

Team Member: “Mrs. Jones, many of our patients who see the benefit in a medical procedure yet whose insurance plan has restrictions like yours choose to not involve the insurance company and choose instead to sign up for a membership plan instead.” This is common and perfectly legal. Would you like more information on this?

THEN

Patient: Sure, how do we do that?

Team Member: If you choose to opt out of us involving insurance, there is a simple HIPAA form to sign that outlines this process. This will allow us to provide the quality care you want and deserve.

You can find a sample copy of this form under the free forms download page here, in the Insurance Documents section:

https://practicewhisper.com/resources/forms/

I Have an Amazing Employee, But….

Wed, 27 Sep 2023 17:20:06 GMT

I Have an Amazing Employee, But….

They generate huge drama….

They are rude to patients ….

They don’t get along with team members …

They have no interest in learning, growing, changing….

They are negative….

They are always late …

Whatever you fill in after the “but” is the problem and the true measure of that employee as a member of your team.

While I hear this intro often from dentists about one or more members of their team, what they really mean is that “I have a problem employee who is a very difficult human being, even though they have skills that many others have and almost anyone can learn.”

If you have one of those employees, the most important thing to realize: skills can be trained, personalities often are fixed. And your “amazing, but” employee will not likely change.

Dentistry is mostly a customer service industry. People don’t really WANT dental work done; they need it done. We are often dealing with anxiety, fear, and just plain not wanting to be in the office. Due to this, customer service is #1 in treating patients well. Skills don’t matter if they come wrapped in a package of negativity. Being a team member with a genuine heart for helping others is job quality #1.

Remember, every interaction your team members have with patients is a representation of you. Are those interactions ones you proud of or not?

Every interaction your team members have with other team members are also representations of you as the leader. Are those interactions ones that promote a healthy team dynamic?

Most dental offices are small, less than 20 people. The people we work with every day we often see as much or more than our own families. Are these people you want to spend that much time with?

Some people aren’t cut out for this profession, and that is just fine. I would not be much good at many other jobs myself.

-Show me a person who has great job skills, but no people skills….and you have someone who will always be a difficult employee who negatively impacts the patient experience and overall teamwork.

-Show me a person who has minimal job skills, but great people skills and a willingness to learn and grow…. you have someone who with some training will become an amazing employee.

-Show me a person who has both great skills and a great positive attitude….and you have someone who always has a job and is rarely looking for another.

So next time you think: “I have a great employee, but…”, go back and really think, is this a person who displays the values I want or not? Are they going to be an asset long term? Or is the “but” going to be a constant problem?

Your team is like a garden. You will occasionally get weeds. Don’t let the weeds choke out the flowers.

Owner vs Associate – Part 1

Wed, 27 Sep 2023 17:19:29 GMT

Owner vs Associate – Part 1

I get private messages every day, and it is interesting that occasionally I get both the owner and the associate messaging me about the same thing.

The associate is complaining that the owner isn’t providing enough work for them to do, and as a result isn’t getting paid enough. While conversely, the owner is complaining that the associate’s compensation package is higher than average and therefore doesn’t understand what the associate could possibly complain about.

They are not speaking the same language. Usually neither party sees the bigger picture.

Here is the thing, it all boils down to the importance of understanding what the other one wants/needs, as well as what YOU can do in your role to contribute to the win-win outcome.

Owners

Most full-time associates generally expect to earn approximately 150k+ per year, which is on average 12,500/month. If you have agreed to pay them 30% of collections/production, this means the office needs to have enough patients for the associate to generate $42,000 in potential collections per month.

So, you need to work this equation backwards. In order to satisfy this associate and help him/her achieve this level of earnings, you either need to be providing two full hygiene columns of patients per dentist, or generating 50-75 new PPO/Cash patients per month per dentist.

The income generated by Medicaid and HMO patients is so much lower and therefore will need two to three times as many patients to reach the goals.

If your business is not generating this level of patient treatment or new patient activity, then you will naturally have challenges with any associate you might bring on board. Therefore, as the owner, you’ll need to analyze the situation and introduce some changes … more marketing, expanded hours, etc. And of course, as the owner, you need to provide coaching for your associate … how best to communicate with patients, present treatment in a way that increases acceptance, and how to be more efficient clinically. You also want to make sure your team knows how to effectively maximize insurance and collection rates.

If that level of activity/collections isn’t possible, then you must ask yourself the question whether your business can sustain a full-time associate.

Associates

This does not mean the problem is all on the side of the owner. As an associate dentist, YOU must make the most of the opportunity presented from patients you see. Associate dentists traditionally produce 1/3 less revenue than owner dentists from the same patients. The lower revenue per patient often comes from lower treatment acceptance, under diagnosis, and not spending as much effort with relationship building with patients. The reasons are often because associates typically do not invest as much into learning how to communicate with patients. As a result, an associate will often miss the potential treatment opportunity to help their patients the best way possible, which effects their own revenue opportunities.

The better you can communicate the concerns with the patient and how those concerns match the patient’s goals, the higher your treatment acceptance will be. Across the country dentists range from $300 in treatment per new patient to well over $1000. The dentists (owners or associates) on the higher end know how to quickly relate to patients, and educate the patient in a way that is important to them (which does NOT mean talking about treatments). And to you associates, this difference can make a huge impact on your income.

This isn’t necessarily about diagnosing more, it is about getting more of what you do diagnose accepted. Although if you are under-diagnosing treatment, that can impact it as well.

Win Win

In short, for both parties to meet their compensation goals, they must work the challenge together.

Owners – You should WANT to pay associates MORE money. Since associates are paid on a percentage, the more the associate does, the more the owner profits as well. Therefore, your job is to ensure there is both a strong flow of patients, as well as guidance or training opportunities for your associate in communication and leadership, treatment planning, education and acceptance.

Associates – your job is to develop relationships with your patients AND team, link dental concerns to the patient’s values and desires, as well as effectively sell them on the benefits of prompt treatment. You want to be constantly learning how to be a better clinician (quality, efficiency, treatment acceptance, diagnosis, etc.) as well as how you can appropriately and effectively contribute to the level of collections for the business. Much of the level of income you earn is actually in your hands.

When the interests of both parties align, you end up with happy owners and happy associates. When the interests of either party fail, both sides are unhappy. And most often BOTH sides are failing.

So, owners and associates, what are YOU going to commit to TODAY to make the situation better for both of you?

Do Clinical Notes Belong to the Doctor or Patient?

Wed, 27 Sep 2023 17:18:53 GMT

Do Clinical Notes Belong to the Doctor or Patient?

The body content of your post goes here. To edit this text, click on it and delete this default text and start typing your own or paste your own from a different source.You are likely familiar with the rules that when a patient requests records, you are required to provide them. The doctor is required to hold the originals, but also required to provide the patient with a copy upon request.

Clinical notes are only for the doctor, right?

Sadly no, they are considered part of the PHI and if requested must be provided.

Now, here is the pearl: “Only provide what is requested.”

In a vast majority of cases, the patient only cares about the x-rays. The next doctor only cares about the x-rays and perio chart. Don’t send what isn’t requested.

This does mean that you should monitor what goes into clinical notes. If you are offended that the patient does not like nachos, notate that somewhere else that is not required to send. Most management software programs have pop up notes or other way to keep notes on patients that are not part of the “record”.

Transferring Records

I have tried this several ways, but the easiest way to handle records transfers is through the patient directly. You want to avoid a “he said / she said” with another office that could make you look bad. If you email the patient what they want directly, you avoid potential conflict and you make it easier on the team. No need to track down the next office’s contact information.

Transfer Fees

You are legally allowed to charge the patient for records transfers. How much depends on your specific state rules, they range between $5-100. A good rule of thumb is to charge a fee to clear balances, but not to charge patients who are in good financial standing with you. Best practice is to end your relationship on a positive note if possible.

You are not allowed to hold records hostage if a patient owes you money, beyond getting them to pay for the records transfer fee.

Think Long Term

How you handle records transfers can make a difference. I cannot count the number of patients anymore that have left my office, only to return later because the grass was not greener on the other side. Once they see the differences, often they tend to become some of your better patients if you handled the transfer well.

Harsh Truth About Treatment Acceptance

Wed, 27 Sep 2023 17:18:20 GMT

Harsh Truth About Treatment Acceptance

As we start a new year, many re-evaluate what they are doing and look to improve for the coming year. Today let’s talk about what we have more control over than we realize: treatment acceptance.

Years ago, I used to believe that most treatment acceptance had to do with how our recommendations and financing options were presented to patients by the treatment coordinator and that cases would be accepted or lost based on the skills of the closer.

Of course, that could not be further from the truth!

Our treatment coordinator has a little control, but the harsh reality is a vast majority of the acceptance or non-acceptance of our treatment plans is on US, the dentists.

The good news is that means we have the most control over being able to improve acceptance as well!

So, as you are reading this, do you know what your treatment acceptance percentage is? Do you know how many of your patients accept any recommended procedure on their plan? Or how many dollars of those presented are collected?

If you don’t keep track of this information, you might be surprised at where you are. I know I was. When I first started tracking my treatment acceptance rate, it was horribly low. It went up significantly when I started watching it regularly and making changes in the way I discussed treatments with patients. I could see instant results. When you focus on every case that gets away you can start to see trends in your own presentation style and identify techniques that work and those that do not work.

Are you conveying to your patients the urgency of getting treatment now vs 6 months from now?

Are you figuring out the patient’s WHY, and linking treatment recommendations to their priorities and needs?

Do you know that most reasons people give you for not accepting care (have to talk to spouse, don’t know my schedule, don’t have the money) are typically the patient telling you that they have not bought into the problem?

Patients need to accept the problem before they will accept the solution. A key learning point for us is that just because we see something as a problem, even when we show it to the patient, it does not mean it becomes a problem for the patient.

Ex: 80 y/o Mr. Jones comes in with a missing #19.

You can talk all you want about the problem with a missing tooth. However, to him, that tooth may not matter as it has been gone for 30 years and he has survived just fine without it. It is not a problem for HIM. While his wife, Mrs. Jones, has hated her missing #5 forever, and is pleased to finally see a solution.

So, when presenting problems to the patient, it helps to also ask the patient “how much of a problem is this for you?” If they say something like a 1 (on a scale of 1-10) then you will be wasting your time talking about the solution. You need to stay on the problem first.

The spouse, schedule, and money might be an issue, but the likelihood that they are the main issue is low. These are common excuses patients give because they are external and therefore gives them a graceful way out of the office without the embarrassment of saying they did not understand the treatment, or they did not like something in the office. The rare cases these are truly the primary concerns, the solutions are often simple.

Now, just like our patients, all these techniques and presentation options do not matter if you don’t understand the problem yourself. I know I didn’t realize for years that my practice had a treatment acceptance problem until I started tracking the data. I believed my treatment acceptance was a lot higher, until I saw the harsh reality.

Have you checked your treatment acceptance rate recently?

How about your unscheduled treatment list?

Knowledge is power.

Office Tension: Dentist Vs Hygienist

Wed, 27 Sep 2023 17:17:48 GMT

Office Tension: Dentist Vs Hygienist

Dental office tension tends to come in two main varieties: dentist vs hygienist, and clinical vs administrative. Interestingly, “Dentist vs. Hygienist” tensions can be the most damaging. Good news is, it can also be more easily managed than with other team members.

So, where does this tension come from? Do any of these scenarios sound familiar:

1) The hygienist sees the patient first, does a great job finding all the problems, spends a lot of effort and time educating the patient on what the patient might need (co-diagnosis)….and then the dentist comes in and tells the patient everything is fine.

2) The dentist comes in while the hygienist is with a new patient, and sees the hygienist already cleaning. But on the x-rays there is calculus everywhere and obvious bone loss.

3) The dentist spends a lot of time discussing restorative work with the patient, answers all the questions, and leaves the room. Then the patient turns to the hygienist and asks, “do I need all this?”, and gets an answer that is anything but “absolutely!”

Hopefully none of these are familiar to you, but unfortunately, they are commonplace in a lot of offices. So why do scenarios like this happen?

Often it is just a lack of communication. The dentist thinks the hygienist should understand everything they do, and the hygienist is following the treatment planning they learned from their previous dentist.

So, dentists, let’s face facts. The joke we tell all the time is all too true. If you get 4 dentists in a room, you will get 5 treatment plans for the same patient. None of us work exactly the same way, so much of dentistry is a combination of art and experience. There is no absolute textbook on treatment planning because we all deal with humans who are all unique and in different stages of dental breakdown.

So why would we ever think that a hygienist should understand our unique thought process for treatment planning if we have not spent a good amount of time discussing it with them? If other dentists cannot agree, wouldn’t it be fair to say our hygienists don’t stand a chance without some calibration discussions?

And this lack of understanding of why we diagnose the way we do; might that also have something to do with why the hygienist does not instantly support our treatment recommendations when we leave the room?

And then when the hygienist does spend a lot of time pinpointing a patient’s dental concerns and the possible treatment needed, can’t we imagine the frustration that would happen if we come in and don’t at least support what they said? Does not mean we have to agree with the outcome, just support the reasoning for why the discussion happened.

“Mrs. Smith, Donna pointed out the concerns about your teeth of X. While it may not need treatment now, she is correct that this is a concern we want to monitor.”

Now hygienists, this does not mean the problem is all on the dentist side. Clear communication is a two-way street. Your job is to support the dentist to the patient, just like it is our job to support you. When a patient turns to you and asks if the treatment we just talked about is necessary, you need to be able to say instantly: YES!

If you cannot, then you need to put on a smile, do it anyway, and ask us about it later.

It all comes down to communication; respectful communication on both sides.

-Dentists needs to support what the hygienist told the patient

-Hygienists needs to support what the dentist told the patient

– It is the dentist’s job to explain their treatment philosophy as much as possible to the ENTIRE team.

– Hygienists, it is your job to ASK if you are unsure about why we are doing something.

Both sides need to get on the same page with treatment options, when to treat, when to discuss, etc. A great technique for getting and keeping on the same page, is to debrief recent cases with your hygienist reviewing the treatment plan, patient questions, and outcomes.

Remember, we are all here to take the best care of our patient, as a TEAM. And the best teams are the ones who communicate well and often.

Choosing to be Positive or Negative

Wed, 27 Sep 2023 17:17:10 GMT

Choosing to be Positive or Negative

One interesting phenomenon about brain function is that our minds will far more readily process and remember ideas that we intentionally focus on. Our brains are wired for survival mode, instant “fight or flight” responses, always being prepared for the risks and challenges in life. This means that our natural state tends to lean more toward the negative, always looking for the next obstacle. To be prepared for the next challenge.

However, when our instant reflex for every challenge in life is a negative, our ability to be creative, productive, and make sound decisions is heavily reduced. While being prepared is important, being optimistic and positive is more important to being able to generate innovative, healthy, and long lasting solutions and outcomes.

Staying positive requires active intention, so here are a few ways to help stay in the right frame of mind:

1) Surround Yourself with Positive People – emotions are more contagious than any virus

2) Help Others – the feeling you get from acts of kindness boost your happy brain chemicals (dopamine, oxytocin, serotonin, endorphines).

3) Show Gratitude – making a habit of thankfulness will not only make others around you happier (and help point #1), it will also train your brain to focus more on the positive actions you see.

4) Diet and Exercise – the better we feel physically, the better you can feel mentally

5) Develop Hobbies You Love – All work and no play make for a dreadful day. Set aside an hour a day to do something you love to do. (preferably beyond television!) Allow your brain time to relax and unwind.

6) Be Mindful of Your Thoughts – This is not a Jedi trick. Just realize that every scenario in life has a positive and negative way to look at it. Do you choose to see the challenge or the opportunity in the situation? Glass half full or half empty? Intentionally looking for the good in life, the silver linings, will go a long way to helping retrain your brain.

So, are you going to choose to focus on positive thoughts, actions, content, outcomes? Or do you choose to focus on negative content and outcomes like the news, social media, or politics?

Hygienists vs Dentists? Take a Step Back Instead

Wed, 27 Sep 2023 17:16:24 GMT

Hygienists vs Dentists? Take a Step Back Instead

We’ve reached an inflection point with the COVID19 crisis … when and how do we end the quarantine period and get back to work. We still don’t have all the medical answers, and a vaccine will be many months before it would be ready.

The dental profession is caught up in the controversy … to open or not to open …. That is the question!

If we were only concerned about our personal health, we would lock our doors and just stay home. But that really isn’t the case is it? We have sworn an oath to serve the oral health needs of the public. So how do we reconcile our dilemma, and move forward?

What we must do during such an uncertain period is to step back and understand / weigh the competing risks, then forge a path forward. Seems to me there are three “health risks” we must assess and balance:

1. Dental Health of our patients and the community we serve (our oath as providers)

2. Team Health (our oath to each other)

3. Office Health (source of our jobs)

You can think of these things like the heart, brain, and lungs of our professional life. When all 3 are healthy and in alignment, life is good. When one is suffering, the whole body suffers. If one dies, they all die. And this is the part we need to remember, it does not matter how healthy you keep two of the parts if you let one part die, all 3 die.

So, let’s suspend a focus on either the hygienist or the dentist, and instead look at each part of the overall system we are all part of.

The Health of The Patient

We took an oath as dental professionals to take care of the oral health of our patients. Dentists generally treat the teeth, and hygienists are specialists in the periodontal health. We are both a part of the system to care for the patient. Are we not failing our patients right now?

Yes, many dentists are still taking care of emergencies, but dental disease just gets exponentially worse. Insidious germs in the mouth take hold and build toward more significant problems.

With hygiene, especially perio, there are two possibilities:

A) Perio treatments can wait months, and therefore have as minimal importance as we fear patients believe, or conversely

B) We realize treatment of periodontal disease is highly important to preserving the overall health of the patient, and dentistry cannot keep waiting

What about the oral-medical connection with diabetes, heart disease, Alzheimer’s, cancer, etc.? Head/neck cancer is not being diagnosed.

Can we really stop caring for our patients any longer? Can we really let oral health issues cause more infections and a weakened immune system? Are we not the “first responders” for the mouth?

The Health of the Team

This is the concern of many of the hygienists and other team members. Obviously, we all want to be safe. Let’s think about a few points:

1) Don’t we already have the highest infection control standards outside of a hospital OR?

2) Because of our already high standards, OSHA/CDC have not yet seen the need to increase their standards for dentistry.

3) We have been exposed to other respiratory viruses with the same exact transmission pathway as COVID-19 for a century. Have dental offices ever been known to become hot spots for other viruses?

No one in the office wants to get sick. However, this virus is not going anywhere. Vaccines are a year away. Experts all expect a majority of the population to get infected regardless of what we do. Flattening the curve is about slowing down the spread, it was never about elimination of the virus.

Aren’t we safer in our own offices, with the incredible level of infection control, than we are at Walmart? Or the open nail/hair salons? Or the restaurant where we pick up our food?

Health of the Office

Finally, we need to remember the third component, the entity that provides us all a place to work and earn a living. This part is currently on life support.

This recent quarantine period has severely impacted most dental offices. Revenue has all but dried up. It takes a sufficient number of patients to generate sufficient income to pay for the many fixed expenses that a small business generates. While payroll costs are certainly less, the expenses for building leases, utilities, bank loans, insurance, maintenance and other bills have not stopped. The longer the period where a small business is not generating income, the closer it can come to defaulting, and for some, heading toward bankruptcy. It is not healthy to the community when small businesses go “out of business” and employees lose jobs.

The longer mandatory closures remain in place, the more likely this part will die, taking down everything with it.

We also have to realize that in times of recession like we are in, demand for dentistry is going to be down. When we do open again, revenue collections for the office are going to be down.

In order to preserve the business part of our system, many owners face hard choices in the short run such as reducing less critical services, cutting team members, or lowering team compensation or bonuses. No member of the team is irreplaceable. Some dentists are exploring models for offices without hygienists at all (Comfort Dental) due to costs or hygienists that don’t want to return. Most dentists love their hygienists, but there are compromises that need to be considered in times of struggle.

We need to make sure we are working together and coming up with solutions that work for the total system, even though that may require sacrifice from individual parts.

Balance the Risk

Given the inter-relationship among all three parts, we must balance out the risks to allow each part to survive. There is no perfect answer. Staying closed for months is not an option. In order for the whole to survive, we need to make some difficult choices with the understanding that compromises have to be made.

We must appreciate the team we have, which means communicating with them regularly. We need the voice of both dentists and hygienists.

Dentists need to realize that many of our hygienists are distressed and fearful from all the news, much of which is overly dramatic. They need to hear your voice, reaching out with more calm, logical information.

Hygienists need to realize that many dentists are not good at starting difficult conversations. This is an opportunity for you to work WITH your dentist to get team fears out on the table and come up with ideas and solutions. Both sides should reach out and communicate with each other.

During that communication, we should be planning ahead what we can do to be as safe as possible when we reopen. Maybe add some inexpensive safety protocols such as screening patients, keeping patients out of the waiting rooms, having air purifiers, etc. Maybe we modify our procedures like going back towards hand scaling instead of ultrasonics. Each office is going to find a unique plan that works for them, but the only plan that works involves the team input.

Some team members are still going to be uncomfortable going back to work. This is okay, as long as you communicate with the team and realize that the health of all three parts of the equation need to be maintained. The office still needs to function and see patients. Delaying opening is not an option anymore.

Some team members may realize that this virus is not going away for an extended period and dentistry may no longer be the career path for them, this is okay too. With the potential short-term decline in demand for dentistry and the overall recession, jobs are likely to be scarcer for a time anyway.

What I suggest for everyone is:

Do not join the chorus of naysayers. We need to advocate responsibly for our patients and our profession as a whole.

Spend your social media time to reaching out to patients, be a voice of compassion and reason, because right now most are only getting fear. Solidify those patient relationships.

Focus on reading/watching content that is positive and uplifting, instead of media and political negativity.

THIS is the time that we should be coming together as a team, communicating, working on solutions. Find positive ways to help and maintain a balance in all three parts of our life!

How Can Dental Offices Absorb the Cost Increase of PPE?

Wed, 27 Sep 2023 17:15:07 GMT

How Can Dental Offices Absorb the Cost Increase of PPE?

As our dental offices begin to re-open, another challenge has begun to emerge; the response to COVID-19 is massively driving up costs, while production is artificially held down. Many offices are reporting PPE costs 10-30x higher than they were a few months ago, with no end in sight for a return to normal. While it is rare to see a dental office completely fail, there are many offices struggling under the impact of all these unforeseen changes and their associated financial implications.

There are a variety of options available for a dental office to consider for managing the new costs associated with PPE requirements.

Raise Fees

The simplest answer is to raise fees across the board to cover the cost increase. This is a great option for OON or FFS offices. Most offices in the country however are heavily insurance based, therefore raising fees is not an option. So, let’s discuss some alternative options.

Drop Insurance Contractual Relationships

If network discounts and rules are the problem, one commonly discussed route is to drop some or all your network contracts. This action would enable an office to set fees in response to external dynamics and fluctuating expenses. The challenge with this option is maintaining their patient population. Patients are often reluctant to go out of network, and this behavior becomes even more pronounced during a recession.

Charge an Added Fee

The ADA just announced their determination that the insurance code #D1999 for “preventive miscellaneous fee” should be used as an “enhanced infection control” fee. Now, many who have already tried this option have received a denial from the insurance company. Understand this: The ADA makes the coding rules, not insurance companies. Insurance companies have the right to say what they will pay for, but not how codes are defined. YES, you can charge more for added or upgraded services. You can do it in network. We have been doing this successfully for years.

The downside of an additional fee is how it is presented and what patient reactions will be. If you lose 10-% of patients, it will likely be worth it. Losing more and maybe not. Some insurance companies ARE accepting this code for enhanced infection control services and subsequently paying for it. Some of the Delta Dentals have this option available, funding $10 per visit, see here: https://www.deltadentalct.com/dentist/dsp and https://www.deltadentalnj.com/dentist/dsp

Membership Plans

With many patients losing jobs and subsequently their insurance coverage, we will naturally see a lot of people seeking other options. Membership plans can be a great way to attract non-network discount patients who can make up the difference. If your office already has a membership plan, you can easily add the PPE cost into it.

If you want to learn how to set up your own membership plan, this course offered by Chris Phelps and Drew Byrnes is awesome and currently discounted heavily: https://www.membershipmastercourse.com/dig

Remove Other Expenses

If you have been offering a “free” warranty on your work, you could instead offer this protection through a 3rd party company. Dental Warranty is a well-known company that offers long-term protection as an option for the patient. They will cover work up to 5 years anywhere in the US and remove that burden from the office, so you no longer need to conduct free replacement work that was not due to procedure errors.

Miscellaneous Approaches

Modify an employee bonus program to reduce payouts or recognize a different variable.

Modify your in-house financing program (increase minimums, add an admin fee, etc.)

Start charging or increase charges for appointment cancellations.

Incent more prepay payments to minimize or avoid cancellations and no shows almost completely.

Stop accepting certain credit cards (AmEx) which cost more; or add a CC surcharge.

Summary

There are a variety of ways to manage the increased costs of PPE without impacting your bottom line. Find what is right for your office and take action. Please comment below if you have run across any additional actions which could be helpful for others to consider.

PS.

If you are interested in more details on how to manage upgraded services while in-network with insurance companies check out the CE course that explains in detail how to do this legally:

Understanding Insurance and PPOs – https://practicewhisper.com/courses/

Risk and Balance

Wed, 27 Sep 2023 17:13:55 GMT

Risk and Balance

Let me tell you about a young teenager who was driving home one day. He tried to be as safe as possible, leaving well before rush hour. He drove defensively as taught. When coming within a few freeway exits of home, he started changing lanes to eventually get off a few miles ahead. There were only a few dozen cars in sight on the entire 5 lane freeway. While changing from one lane to the next, the car behind did not want this teenager in his lane and sped up, clipping the teenager at 70 miles an hour, and sending him off spinning into the center median. Upon impact the car flipped 180 degrees, landed on the back corner, completely sheering off the rear passenger tire. The car ends up facing oncoming traffic when it reaches a halt.

Thankfully, the teen survives the incident, but with a totaled car to say the least. The car was an ‘89 Oldsmobile, which was built out of almost pure steel and as heavy as a tank. There could have also been other entities involved with protecting this teen that day.

Now, this teenager could have sworn off driving completely. He could have looked at the statistics that 1 million people a year die in car accidents. He could have let fear take over his life and therefore missed so many other opportunities that popped up in the 20 years since.

Instead, this teenager went on to become a dentist and devote his life to helping others. He learned to understand that all aspects of life come with risk. We take a risk every time we get into a car to drive. We take a risk every time we go to the office and treat patients. We take a risk every time we hop on a plane to fly. We take a risk in almost everything we do.

Life is all about balancing the risks with the potential opportunities or rewards. There are very few things in life that don’t come with some type of risk, whether that is driving a car, flying in a plane, or working in healthcare.

Current aspects of the coronavirus bring on new risks we are not used to balancing. They cause us to all re-evaluate our opportunities in life and what the change in risks mean for us. This can often lead to fear. Fear of the unknown. Fear of those risks we have never faced. Fear that we might need to re-evaluate prior choices.

The best part about dentistry is we have been equipped and trained for decades in the best infection control outside of a hospital OR. All you have to do is look at any other healthcare facility to understand that dental offices are exponentially more prepared than anyone else in healthcare with infection control. This is why dentistry has never been a source of respiratory infection or other viral spread: SARS, influenza, H1N1, Ebola, other coronaviruses, etc. And even during Covid-19 many dentists have been treating emergency patients for months with no spread either. We may be the most exposed profession because of proximity and procedures, but exposure does not mean chance of infection because of our levels of infection control.

Many great hygienists and dentists want to go back to treating their patients; to taking care of the oral disease that has so many connections with overall health. They are choosing to decide that the reason we got into dentistry to help people is still the reward that is worth the risk. These providers should be respected for agreeing to manage the risk that comes with providing that care.

Some in dentistry may choose to not take on this new risk and decide to pick another career. Regardless if the reason is family at home, medical concerns, or just deciding the balance is no longer in their favor; that is their choice to be respected as well.

The challenge is that some in the profession have begun to attack others for their choices. They have chosen to attack the very dentists and hygienists they used to call colleagues. They have chosen to publicly slander the profession with claims that have no evidence.

This virus is here to stay. There are no cures or vaccines coming this year. The risks are what they are and aren’t changing.

What we should all remember is life is about balance and everyone is going to weigh the risks differently. If we choose that the risk vs reward is not acceptable anymore, then changing careers or just waiting silently are perfectly acceptable choices.

If you are unsure what to do, this article may help you see all the aspects and help you with forming your decision: https://practicewhisper.com/hygienists-vs-dentists-take-a-step-back-instead/

Those team members who are in offices that are not communicating or not managing the risks, it may be time to search for a new office. The good news is that many dentists are doing the best they can with the circumstances and supplies available. There are also plenty of offices right now looking for good team members and now may be the best time for a change.

Those who chose to face the risks, to find a balance in life, should be celebrated. Not slandered. Let us all come together and support each other, regardless if that individual’s decision is to go back to work, silently wait, change offices or change careers.

For this provider, who used to be that teenager long ago, I chose to accept whatever new risk we now face. I am thankful that dentistry has a history of never being the source of respiratory spread. Even so, we have still implemented new precautions based on team concerns and local factors.

Our profession is essential and has been pushed aside long enough.

Whatever you decide, as long as you weigh the risks then all blessings to you for your decision. Just please make sure to respect the decisions of others, respect the profession, and avoid attacking others or the profession in the process.

Is Dentistry Still a Profession Worth Pursuing?

Wed, 27 Sep 2023 16:39:12 GMT

Is Dentistry Still a Profession Worth Pursuing?

There’s no denying dentistry is difficult at times. During the initial phase of the 2020 global pandemic, when dental offices were shut down and considered “non-essential” for months (only to reopen to a different patient flow and new expenses), many in our profession began to ask themselves one question: “Is it all still worth it?”

This question continues to echo behind the scenes.

I will admit I have wrestled with this question a few times in the past. Some years back, I even reached a point where a sales letter sat on my desk for months, reminding me I was just a phone call away from giving up the office. Even now, a part of me wonders about our profession’s future. And it’s not because of new technology, corporate dentistry or insurance reimbursement rates. To be candid, it’s because our profession feels marginalized at times.

Most of us have heard patients say they hate going to the dentist. While we’re used to that sentiment by now, the sting of being considered “non-essential” last year still remains. And we all know “do-it-yourself” dentistry options are on the rise, as if it’s not really necessary to go to the dentist.

Then there’s the list of stressors associated with owning a dental practice, which has grown. It includes:

Whenever you work in health care, there are times you must deal with high stress situations and challenging people. On any given day, this can be patients, vendors and teammates. We must combat concerns about the work/clinical environment at every turn. Hiring and keeping hygienists also emerged as a new challenge in 2020.

There is a continued shift toward reducing the level of insurance reimbursements for the work we do. In a predominately insurance-based practice, can we actually still make a profit?

New PPE requirements, patient changes, team changes and increasing expenses have taken their toll on profits and compensation. Patient volume remains at 80% of pre-COVID-19 levels and likely will stay that way for the next several months, according to data from an ADA Health Policy Institute (HPI) survey collected the week of January 181.

More than $400,000 in student loans accompanied by 8+ years of lost income to repay them can sometimes feel overwhelming, bringing the question of a dental education’s worth to the surface.

Physical. And of course, we all know the long-term physical demands on our bodies from the repetitive, un-natural positions we often “pretzel” ourselves into to treat patients.

Given all the challenges, emotions and perceptions, what can we hold on to that ensures us our chosen profession still offers a viable, rewarding and lucrative path for the future? There are many positive touchpoints we all should recognize and celebrate.

We Are Essential Providers

Despite the rocky start during the initial stages of the pandemic, we finally emerged victorious. In the eyes of the Centers for Disease Control and Prevention (CDC), the government, our own teams and now the public, we are seen as an essential service. As a result, shutdowns are something we should never experience again in dentistry. We garnered CDC evidence that dentistry is not affected by viral spread, and we still enjoy the highest level of infection control of almost any industry.

This all affirms the value of the public service we provide to our communities. It is up to us to continue to champion and market the value of the services we offer, which hasn’t always been one of our strong suits.

The Opportunity to Help People One-on-One

Every day, dentists help people meet basic needs: to eat and to be both disease and pain free. Many industries come and go, ebb and flow, but dentistry always will be necessary. And dentistry tends to maintain or even improve during recessions (with the right planning and adaptation). As a prevention-oriented field, people need us even more when they don’t come regularly. What’s better than helping people every day, and making a good living doing it?

Fill a Universal, Perennial, Lifetime Need

Teeth are here to stay. Dentistry is a product, a service and a skill that has and will continue to stand the test of time. While techniques may change, oral hygiene and teeth will always provide professionals with opportunities and income anywhere in the world. Dentistry is a skill that will never be replaced or go out of style. And it is a service needed by humans of all ages.

A Respected Profession

Even though many people will tell you “they hate going to the dentist” and joke about their fear of the dental chair, a 2019 poll from MoneyWise lists dentists as among the most respected professionals in the U.S.2 That is an important point to let sink in.

Medical doctors are also highly respected. Do we really think their patients can’t wait to come in for their procto, gyno, colonoscopy, biopsies and other medical treatments? Most people are reticent to go to any doctor. Medical procedures of any kind are generally uncomfortable and at times frightening. That doesn’t reduce the respect patients have for those educated in the art and science of treating and healing people in need.

The patients who verbalize their dislike of dentistry while sitting in my chair are indirectly telling me something even more important. Yes they dislike dentistry, but their appreciation of me as a dentist and as a person allowed them to overcome their fear and choose to come to our office for treatment. That outlook has allowed me to see these patients and their comments in a different light and to appreciate the incredibly positive side of working with people who are (naturally) fearful of what we do.

Top Job, Top Pay and Flexibility

U.S. News & World Report ranks jobs yearly, and in 2021 dentistry came up as the No. 9 best job in the country and the No. 11 best paying career3. We have a high annual salary that keeps growing and an almost non-existent unemployment rate4.

One of the other points from U.S. News & World Report? Dentistry has higher-than-average flexibility. There are multiple career paths available within the field. There’s much more flexibility in terms of the hours and days worked than with most other professions. And I may only be speaking for myself on this, but having flexibility and freedom is far more worthwhile than any amount of money!

Reducing Stress

When you are part of an industry, it can be difficult to keep perspective. Stepping back and visualizing a more global picture can help. It’s important to ask yourself, what would you do if you weren’t a dentist, and how does that field compare to dentistry?

Our stress levels can be high, but they are average when compared to other careers. Life is stressful, work can be stressful, and kids can be stressful. The good news is much of the stress the average dentist goes through can be mitigated. There are many ways to reduce our normal stress levels in dentistry.

Finding Your Passion

What about earning a good living—a profit—with all of today’s challenges? Every business has challenges in this COVID-centric world. And some will fail. Dental industry professionals are just in the process of working through our challenges. While we need to adapt, there is still a good living to be made.

If you follow any career path for financial reasons, there’s a good chance you’ll come to dislike it over time. If you’re thinking about becoming a dentist, make sure you’re choosing a career you will enjoy. There is almost no amount of money that will make a career you dislike better. And when you enjoy what you do, it doesn’t really seem like work.

I have a similar message to veterans of the profession. If you aren’t happy, is it because of a specific challenge with dentistry or have you lost your passion? The good news is there are solutions for either scenario. I have been through both!

I’ve been interested in dentistry since I was young. I shadowed and worked within the field for years while growing up, so I had a good idea of what dentistry would be like after graduation. I was still not fully prepared for all I would come across.

There is nothing more satisfying than helping people. I would be hard pressed to find many other careers that have the same potential for self-fulfillment and pride as what I get to do every day. I have had strong ups and downs in my career, but each valley has led to a higher peak in the end.

A Rewarding Career

Dentistry is still a great profession for many reasons and can be extremely worthwhile. It is not always an easy road, but it can be a highly rewarding one. I still love what I do every day, despite the challenges!

The question I would have any dentist or potential future dentist ask themselves is this:

“Do you enjoy thinking about dentistry and helping other people, and do you strive to constantly learn more?”

If so, then the brightest parts of your career may still be ahead of you! There is a light at the end of every tunnel, as long as you find the right path.

References

Nordlund, Scott. “Americans Say These Are the Most Respected Professions.” MoneyWise, 20 November, 2019, https://moneywise.com/a/the-most-dishonest-profession.

“HPI: Patient confidence in returning to the dental office increases.” ADA News, 21 February, 2021, https://www.ada.org/en/publications/ada-news/2021-archive/february/patient-confidence-in-returning-to-the-dental-office-increases

“100 Best Jobs.” S. News & World Report. https://money.usnews.com/careers/best-jobs/rankings/the-100-best-jobs.

“Dentist Overview.” S. News & World Report. https://money.usnews.com/careers/best-jobs/dentist

The Myth of Informed Consent

Wed, 27 Sep 2023 16:37:34 GMT

The Myth of Informed Consent

We eat, breathe and sleep the need to obtain informed consent from our patients. It is the basis of ethics as well as legal protection. However, how many of us are truly getting informed consent? (And I don’t mean the signed sheet of paper!)

In dental school, I was trained to not only provide my patients with every treatment option, but also to describe each option in detail. The longer I practice dentistry, though, the more I see an underlying flaw in this approach. The problem is more pronounced now that everyone is wearing masks and we tend to focus more on the eyes. You can actually see them glaze over when we talk about the clinical details of various treatments.

Is it wrong to think that describing treatment details has value to patients who are trying to make a decision? What background or knowledge do we expect them to have to make a truly informed choice about whether to have a root canal or a tooth removed?

What a dentist considers the most rational explanation for a given treatment often sounds like nonsense to patients. That’s because of the difference in perspective, experience and knowledge of dentistry. Patients can easily understand, though, whether they simply want to keep a tooth or be done with it.

After listening to their options, patients usually ask, “What would you recommend?” Even though you’ve just provided a detailed explanation, it just doesn’t resonate. All options sound complicated, making it difficult for patients to make a choice. I argue the problem lies in how we approach the conversation and how the options are commonly presented.

Choices, Choices

Having choices causes indecision, especially if patients don’t fully understand each choice. Ever have patients say they want to see the financials between two options before they decide? In most cases, this indecision is a red flag that we didn’t engage patients on their level enough for them to truly make a choice.

I’m not saying money doesn’t matter, but typically when money becomes the deciding factor, it is because patients are not sure they need the treatment or they don’t really understand their options. I mean, how many patients genuinely want us to cut down two healthy teeth to construct a bridge, when implants are an option?

When patients are unsure about a choice, they fall back on what they do understand: money. Therefore, they often pick the less expensive option regardless of their ability to pay or what’s truly best for them.

Cases where money is truly a factor are easy to spot because patients will say something like, “I really want option one, but I just cannot afford that, so I will go with the alternative option that is less expensive.”

Start With Outcomes

Instead of offering every choice or option, I start by guiding patients to what might be best for them by discussing outcomes, not treatments. I try to avoid “labeling” treatment until they have decided what outcome they want. Here’s how I talk to patients about various options:

It is not a partial, but a removable set of teeth that come out every night. It may wobble when eating certain foods and adds bulk to the mouth.

It is not a bridge, but a solution that does not move and requires turning a 1-2 tooth problem into a 3-4 tooth problem. It is also more difficult to keep clean.

Implants are not screws, but replacement teeth that function, feel and look like natural teeth.

Instead of discussing a filling versus a crown on a borderline tooth, I talk about expected lifespan: “Would you prefer a fix that might last a couple years or one that lasts over 10?”

The point is, bring the conversation to your patients’ level. What outcome are they going to get? Remember, patients are seeking solutions, not treatments.

True Informed Consent And The Benefits

You have true informed consent when patients fully understand the expected outcome and how it fits into their life. This approach increases treatment acceptance, decreases post-treatment dissatisfaction, and often leads to patients accepting more ideal options.

Once they have accepted the treatment option that fits best into their life, that’s when you go over clinical “consent.” Remember, outcome consent comes first.

This approach has greatly increased my treatment acceptance rate, decreased my team’s post consult questions, and has allowed me to work on more interesting and fun cases (instead of the cheapest option). I am more fulfilled and enjoy dentistry far more than I ever have!

It is a true blessing and honor to have new patients thank me almost daily for explaining things in a way that is understandable and real to them.

Achieving Cost Savings in Your Dental Office

Wed, 27 Sep 2023 16:33:51 GMT

Achieving Cost Savings in Your Dental Office

Last year this was one of the most read and re-read article I wrote.

Most of us prefer to spend our limited time each day on clinical dentistry, and as a result may at times allow some business focus to slide. Over time our lack of attention can lead to higher costs than necessary and may even impact our ability to provide for our family. Re-evaluating the business for improvements in efficiency and overhead is an important exercise to conduct at least annually to maintain a healthy business. The changes post Covid have made it even more imperative to assess our business practices and find ways to counter the rising costs of PPE and other overhead expenses.

Here are a few suggestions that can make a huge difference:

1) Instruments – Same manufacturer, pay LESS

The interesting part about an industry as small as dentistry is there are only a handful of manufacturers, but a ton of vendors. With a little bit of research, you can locate the same exact item and pay different prices depending on who you order from.

I met one of the owners of the Berman Instruments company last year who is local to Dallas and have found them great to work with. This company provides instruments made by the same manufacturer as other high-quality, nationally known vendors, but at a fraction of the cost. You buy directly and therefore get double savings.

I have ordered several different items through them and they are all high quality. I wish I had heard about this company earlier, but they do not advertise much. Best news is this means you aren’t paying for their marketing budget either.

Berman Instruments – Diagnostic, Surgical, Endo, Operative, Hygiene instruments and Cassettes.

Website: https://bermaninstruments.com

2) Supplies

The fastest increasing cost in a dental office has been PPE supplies and for most offices there is easy money to be saved with supplies. Now, I have always been against buying through multiple different suppliers due to the added time cost (dentist time or team salaries). This is why it is great when you can find a supplier that pretty much guarantees you the lowest price.

Crazy Dental is a part of DC Dental, which is one of the major suppliers in the country. The model of this club is to provide us with everything we need at lower prices than anyone else. I have ordered through them for a year now and been very happy with their service.

As an added bonus, I got permission to allow anyone to use the special discount code they gave us for an additional 10% off their already low prices:

whisper10

Crazy Dental Price Club

https://www.crazydentalprices.com/

2) Modify In-House Financing

Many offices provide both 3rd Party Financing (ex: Care Credit) and in-house financing, as well as a % discount for patients who pre-pay their treatments. If a patient does both, you are really taking a double hit. If you find yourself offering both simultaneously in the office, I’d recommend you make the options mutually exclusive. This minor change can save you a lot of money over time. Here is how such an offer would be presented to a patient:

“Mrs. Jones, we can absolutely obtain financing for your treatment for as low as $99 a month.

Or if you would prefer to pay for your treatment in full, many patients appreciate the 10% ($500) savings that comes with that option.

What sounds like the better option for you?”

There is a cost to the business for financing the expense of treatment. You must wait for the money and assume the risk of potential losses from default accounts. It does not make much sense to allow patients to get a discount on top of that as well.

Miscellaneous other modifications for financing might be:

– Increase Minimums

– Add an administrative fee

– Reduce more costly payment options (ex: cut the 24mo 15% CareCredit option and only offer the 12mo or less)

– Move long-term payment options to 3rd party administrators (team time is valuable)

3) Treatment Warranties

Most dentists will “stand by their work” in terms of replacements within a short period after installation at “no cost” to the patient. Although we know this additional work does have a cost for the dentist in terms of materials, lab fees, and time.

Many dentists do not think about having a written “warranty” program because they feel that there are no guarantees when working in the mouth. While this is true, patients often expect work to last for a lifetime unless you specifically educate them that dental work does not last forever. Explicit dental warranties are more about educating patients on the expected lifespan of a restoration, than they are about giving a “guarantee”.

An alternative and potentially improved option is to allow another company to take on that burden, pay you to redo any work needed, and get the patient to pay for the additional expenses. (happily).

Companies like Dental Warranty allow offices to offer an extended warranty on their high expense treatments. Somewhat like an insurance policy, the patient pays for the warranty insurance, and in turn gets the security of knowing that any replacements necessary will be fully covered anywhere in the country for much longer than most dentists will offer on their own work. This can be a lot of peace of mind for patients, especially those who have made a significant investment and/or if they travel or move often.

For the dental office, this can reduce the expense of replacement work over time. It also can allow the office to receive additional revenue up front, which can balance out the cost increase of PPE and other supplies.

Resource:

brad.titensor@dw-corp.com

4) Merchant Service companies.

We switched last year to Apex Payment Solutions, which is run by a dentist and offers a lower expense for this basic service. The good news about switching something like merchant service companies is that once you are done you will likely never notice a difference, except to your pocketbook. This group has saved us a lot and has been easier to work with!

Resource:

Zak@apexpaymentsolutions.com

5) Dental Labs

There are many labs around the country that provide basic services like crowns. As you know, the price of the same crown can range from $50 – 500 per unit across different labs. Unfortunately, the quality of the restoration does not always match the price. Our office has tried different labs over time, and I’m pleased to say that our crowns today are coming in with higher quality and less necessary adjustments than ever before. Best part is I am paying less for our crowns now than ever. It may take some searching to find the right lab for you, but it can be well worth the effort! If you are paying more than $100 per zirconia crown in-network, I highly suggest you look for another option.

6) Re-evaluate Insurance Billing

Non-Covered Services are those that will never be covered by an insurance policy. A common example is veneers and a less common example would be fluoride for an adult. In 38 states an insurance company is not legally allowed to force a dentist to take a discounted fee on these services; yet the EOB will often not accurately show this. Offices that aren’t clear about which services are “non-covered” and subsequently accept a discounted fee are losing legitimate revenue. Understanding the specifics in your state can save your practice thousands a year in unnecessary write-offs.

Upgraded Services. Many dental services come with different options. For example, you could get a standard crown from a lab with average esthetics or you could get a custom shaded crown from the same lab for an added cost. Any added cost for an upgrade like this would be the responsibility of the patient, above and beyond the “negotiated” fee of the insurance company contract agreement. Understanding how to manage these upgrade and coding options can bring the office significant savings by correctly billing the patient for the upgraded services rendered.

If you would like to know more about insurance, you can find the popular online, on-demand CE course “Understanding Insurance and PPOs” here:

Summary

Work smarter, not harder! None of these options require doing dentistry any differently. By simply taking time out to educate yourself and your team in a few of these business areas can pay off handsomely over time.

There are a lot of changes that have come over this last year. With some effort and smart choices, you can come out as a stronger, more profitable office.