Let’s talk about Result Control.

As you may recall, last time I wrote about “Cost Control.”
Now, let’s talk about Result Control.

Most of you have, or will be, within the next 2–3 years, making investments of $50,000 more in technology, digital x-rays, Diagnodent, lasers, clinical charting software, monitors, patient education software, Cerec, electric hand pieces, endo equipment and so on.

This can easily come out to over $12,000 per treatment room.

For starters, you want to make sure that you don’t pay too much.

That’s where spec-ing out what needs to be done and competitive bidding come in. Many of these items are bought at the same time (especially digital x-rays, monitors, intra-oral cameras and clinical charting software).

We’ve helped clinics save $10,000s of dollars by getting competitive bids. Moreover, and probably more importantly, getting expert help in planning your technological upgrades can make sure that they actually work well for you.

When your hygienists’ time is worth over $120/hr. and your time is worth over $500/hr. you don’t need glitches. Interrupting your work flow can be very expensive!

Today I’m focusing on “Result Control.”

As an owner you want to get a return on every investment you make. In fact, the whole idea of good management is to get the biggest return on the resources you have: your time, your money and your skills. What organization would spend thousands of dollars without having a clear idea of the outcome they want in return? Upgrading just for the sake of upgrading is insanity. So, as you make these investments what outcomes are you planning on?

My favorite example of this is intra-oral cameras.

Over 50% of dentists now have intra-oral cameras and half of those cameras are used fewer than five times per week. Very poor result control. If you purchase intra-oral cameras, you are presumably doing this so you can better inform the patient so the patient will make better choices which results in more case acceptance. Better case acceptance means more production. This should show up in increased crown and bridge (for example). Therefore, if you buy intra-oral cameras and your crown and bridge doesn’t go up, you didn’t get result control. It’s a pretty good bet they aren’t being used. So, to get them used, do the following:

Do Clinical Calibration with staff so they know to what end you want this educational tool used. Have a meeting in your practice to talk about when you feel it’s in the patients’ best interest to crown a tooth and when you don’t. When is a composite indicated vs. a crown or vs. an amalgam? Who are good candidates for implants and who aren’t? When are x-rays really needed? How about fluorides? If you haven’t worked through these issues with the staff, they’ll be pointing the intra-oral camera around but only vaguely knowing what they are trying to do. Check out the article on Clinical Calibration posted on the Dental Economics Magazine website.

Be very sure your cameras and monitors are ergonomically set up. And, don’t ask the hygienists to share a camera. You’ll do far better paying for two cameras that are actually used than one shared camera sitting in the hallway or lab.

Track how many times your intra-oral camera is used per day or per week. If you’re not measuring this, it’s probably not being used enough. When you first get the intra-oral cameras, ask the hygienists to keep a tally of when they’ve used it. Over 2/3 of the adult patients should be shown something. It doesn’t always have to be something bad. Showing patients what’s good is helpful too. You like it when you go to the Doctor and hear good things too, right? Anyway, the more the patient knows (and people learn through what they see) the more they appreciate what you can do for them.

Put this all together in a set of goals:

As a result of this Patient Education Technology (e.g., intra-oral cameras) we will see an increase in patient acceptance by two crowns per week. Therefore, we believe that there will be $8,000 more per month in production (that’s great result control).

We will use the intra-oral camera on 70% or our adult patients. This will be tracked on the daily schedules by each hygienist. The exceptions would be patients who have other problems that are not easily visualized by the camera, a patient due for full-mouth x-rays, the patient arrives late or there is some other mitigating circumstance.

Digital X-rays: When digital x-rays are installed in your treatment room, there will likely also be capabilities such that your hygienist can set up her own appointments, enter treatment plans, enter progress notes, enter today’s charges, use the intra-oral camera and use patient education software.

In most practices that have paid for these technological capabilities, only two or three of the above are performed regularly. What is the plan for your office?

Entering treatment plans, setting up the next appointment, entering today’s charges, all take your hygienists’ time. However, digital x-rays help save the hygienists’ time. No running to the processor, no mounting, etc.

What are the expectations of how the team will use the extra time? Your hygienist simply must have the training so that she is completely comfortable with the software so she can perform these functions. Then, it’s likely the patient will arrive at the front desk with all the information already available to your administrative staff.

Then the administrative team can do what they do best—work with the patient to make their dentistry as comfortable and affordable as possible (financial options) and commit them to treatment. That should result in more treatment done, right? Measure it!

A Subtle Change That’s Very Expensive:

Many offices reserve 50 minutes for standard adult recall hygiene appointments. Often when all of this new technology is introduced, the hygienist will feel they need more time. It doesn’t seem like a big deal to increase hygiene appointment lengths to 60 minutes but that results in one fewer patient seen per day on average. Not only does this reduce the hygienist’s production by over $120 per day— it reduces demand for the Doctor’s services by over $300 per day (Many dental offices produce $400+ per exam so any decrease in hygiene flow can really take the wind out of your sails.) Fifteen fewer hygiene visits per month all of a sudden can mean $6,000 less treatment per month. That’s a very negative bang for the buck for your investment in technology!

Another solution is to add more technology! For example, automated or voice activated perio charting. Or, a digital pano. It takes just 8 seconds—even less than digital full-mouth x-rays (in situations where it’s clinically acceptable).

These technologies can help your hygienists maintain their visits per day capacity even while increasing their productivity per visit. However, it’s clear that hour long hygiene appointment lengths are becoming increasingly common. You may be fighting a losing battle if you keep these lengths so tight that the hygienists won’t buy into or really employ the technology you paid for.

So, what do you do? In a larger office a possibility is to hire a hygiene assistant so they can keep appointment lengths at 50 minutes. However, I’ve seen offices hire this assistant and still have appointment lengths go to an hour and so the bottom line is hurt. Again, if you add a hygiene coordinator/assistant, you have to have result control.

For many of you the best course of action would be to allow the hygienist the additional time but make sure they use the technology. That’s your quid pro quo. “We now provide digital x-rays to save you time. I really need you to use the intra-oral camera, the Diagnodent, etc.”

Then, since you’ve subtly cut into your hygiene capacity, you have to add additional hygiene time to counteract that.

It will all work out if your hygienists are presenting the treatment. Your case acceptance will go up and that will more than counter the reduced patient flow per day per hygienist. If you added hygiene time then you’ll keep your flow up and allow room for growth.

I’ve seen mistakes in the above cost offices thousands of dollars directly and many thousands more indirectly.

CAD/CAM, Cerec:

I’ve never been able to talk a client into or out of a Cerec machine! I feel that most of the time this decision is made at a gut level. That’s fine. That’s your business. However, it’s my business to make sure that if you buy a Cerec you get bang for your buck.

First of all, before you make this very expensive investment, ask yourself, “Is there somewhere else I can get a bigger return on my dollar?” I’ll argue that there are many smaller investments you should make first as you ramp the practice up such as: Diagnodent, automated endo, intra-oral cameras and perhaps non-technology items such as better signage, advertising, training a treatment coordinator, and getting you and your team significant continuing education.

Before you buy the Cerec, “Count Crowns.” That is, for a month or two keep tally of how many patients for which you feel the Cerec would have been the right solution.

Most of my clients tell me that there are some cases that are better suited to Cerec than others. I’m not a clinician, it’s up to you to make your own judgments about that based on discussions with your colleagues or authorities you respect. Then, once you buy the Cerec, make sure that you are employing it as much as you planned on and see that your lab expenses really do decrease.

Another subtle cost of a Cerec machine is that, at least initially, it takes longer to do crowns.

Many Doctors I’ve observed with Cerec will initially have to spend 2–2 1/2 hours per unit. Obviously, if your time is worth $500 per hour, you don’t save enough on the lab to cost justify that extra hour (or even 1/2 hr) in getting a crown completed (most Doctors take an hour for a conventional prep and a half hour for seating— 1 1/2 hour total).

So if you do 20 units per month and the Cerec machine takes you an extra half hour, that still “costs” you $5,000 per month in capacity. Now hold on Patterson folks, before you call me, hear me out. The answer here is additional training. There are excellent post purchase sources for training on Cerec to bring the procedure time down. If you buy a Cerec machine and don’t plan on training your staff to help you use it, well, you’re going to have poor result control. With the correct experience and training, I’ve seen many Doctors bring their single unit Cerec times down to 1–1 1/2 hours.

I am simply astonished to see that a Doctor will spend $100,000+ on a piece of equipment but flinch at the idea of an extra couple thousand dollars in training to really come into song with it.

Speaking of training, that’s also very true for all the technology that you’re going to put in your and the hygienists’ room. After an initial 3–4 days of training, arrange for follow up training in three months. In a larger clinic, I think it makes sense to have a trainer on board for a day or two as everyone is using the clinical charting and other matters. It really helps that there is someone right in the building who can show you how to do things. Then, given you have adequate demand, this can be a very good business investment. Also, just as in paper charting you have to decide as a group how you are going to chart. There are a lot of choices and you have to pick the configuration for your office. This takes some time and training support.

So, as with so many things, it’s best to begin with the end in mind. What are the outcomes you intend to get? And, how are you going to measure them? Before you go out to purchase the technology, make it absolutely clear to the staff that you need their commitment to use it! Prioritize your expenditures and tackle them in order of where you can get the biggest bang per buck. In this way your practice builds up more and more profits and momentum.

Don’t buy technology because “everyone else has it” or even if “no one else has it”! Buy it because you know the outcome you want for your office. And by the way, just “an up-to-date image” is not enough if you are serious about your bottom line. It has to be for go, not just show.

You'll find lots more information like this, free for the reading, on our website’s News page, going back to 2005. As usual, I offer my free 20-minute consultation whenever you have a minute to talk. 952 921 3360. Bookmark this page or our website for later reference.

’til next time...

Beyond the DOW: Recent Economic Survey of Dentists
I recently completed my fee, wage and economic surveys for the Upper Midwest. Over 300 practices responded.

33% of the Metro practices surveyed said they were up this year, 46% were down and 21% even. For Outstate offices (including the edges of North and South Dakota, Iowa and Wisconsin) the outlook was a little better. 41% of the practices said they were up, 28% down and 31% even.

17% of Metro Area practices felt the economy is not a factor at all but 73% felt the economy had a “moderately negative” effect. 27% of Outstate offices said the economy hasn’t affected them at all and 70% said “moderately negative”.

29% of Metro Area offices have given or plan to give raises this year and 41% said they won’t. In Outstate offices 54% have given or plan to give raises this year with 24% saying that they do not plan to give raises (the rest variable or not sure).

There is no question that the current economy is having an impact on practices. Just three years ago “5% growth” was more or less the rule.

I believe in management. Whenever we see Doctors take actual steps to improve, they do improve! Things just don’t come as easily as they might have in previous years.

Feel like talking about your situation? Got some ideas? I have a standing offer of a free 20 minute consultation that allows you and I to get to know each other and share information that will be beneficial to both of us. Call me at 952 921 3360.

’til next time...

From our newsletter back in July of 2006
Don’t Let Your Office Manager Retreat!
I thought this subject worth repeating...

At a certain point when the Doctor’s practice is large enough (or Doctors are practicing a group) there comes a time when they want a true office manager. They want someone to handle all the non-clinical aspects of the practice… especially staff hassles (scheduling vacation hours, interviewing, disciplining and generally calming the waters).
Yet, we see many office managers who have “retreated” (physically and figuratively to an area removed from the action). Perhaps they started at the front desk and were promoted to the office manager position. They get involved in the practice numbers (bookkeeping, payroll, insurance processing, credit follow up) and after a while are so busy managing numbers that they’re not managing people. Their front desk skills may have even gone dormant and they might be all but invisible to the treatment staff. Then, the staff hassles and other business matters end up back in the Doctor’s lap.
How does this happen? Often the Doctors are their own worst enemy in this regard. They set someone up to be an office manager but at the first unpopular decision (let’s say the manager did not grant your senior hygienist her preferred vacation time) the staff person does an end around and goes to the Doctor directly. It’s at that point you determine whether or not your office manager is going to be a true office manager or a bookkeeper. Do you stand behind your office manager… knowing there will be some flack but knowing that they will be empowered to do what you want them to do, or do you back down and try to be a “Nice Guy” and end up being a nice guy or gal with lots of management hassles you don’t want?
Often office managers do not take the cultivation of their supervisory skills as seriously as they do the numbers. They need to get to courses and read about leadership. They need to get out from behind the desk and walk around the office. This way they can listen to the staff’s problems and requests so they can grant resources as well as give direction. The office manager has to nail down Doctor decisions that need to be made and make sure those decisions are communicated throughout the office so that everyone feels they are in the loop.
Office managers focus on just getting through each day (like we all do). However a good office manager is future focused. Their job is not just to handle the day to day, it’s to help the practice reach its goals. Does your office manager know what your goals are? Do they have a strategy for reaching those goals? Are they reaching beyond the day to day duties each day to implement the gradual worthwhile changes that will help your practice excel? Are they actively looking for ways to cut your expenses? Are they totally familiar with computer software so you’re leveraging every application you can? Are they getting a reputation for making sure that decisions made at staff meetings are followed through and people responsible for the various systems are held accountable (and rewarded or not according to their performance)?
Comments or a story you'd like to share? Give me a call at 952 921 3360, email or post a comment. Visit our website for more.

’til next time...

Delta gets snout rapped in Rhode island

Delta gets snout rapped in Rhode island

As reported in DrBicuspid.com on July 2nd, a new law in Rhode Island prohibits insurance companies from limiting the fees of dental procedures that they do not cover. Nationally, Delta Dental has been attempting to implement a new feature of its Premier and PPO provider organization contracts that require dentists to honor their contracted fees for services that are not covered by a subscriber's plan. This includes dental work performed by participating dentists even if not covered because the patient exhausted their annual maximum.
For years now in Minnesota, Doctors have had to take Delta write offs even after the maximum was reached. Fees on non-covered services haven't been subjected (yet).
None of us like the idea that Delta limits fees for non-covered services (like veneers and bleaching). For one thing, how do you set a fee for such procedures when there can be such a wide range of materials and lab costs?
There are many other states where Doctors can get their full fee (not have to do Delta write offs) once the patient's maximum has been met. The idea is that the insurance helps cover the first $1,500 or so but after that the patient is responsible. When talking with other management consultants and hearing about their strategies with Doctors in other states, they have been more willing to accept PPO discounts because they can get their full fee once the insurance maximums are reached. I think all of you heard the argument that Delta and other insurance companies should have their maximums increased to $5,000 to have the equivalent coverage of what they had 20 years ago or so. In this context it's almost good that the maximum hasn't been moved up.
The Rhode Island legislature voted for this because they felt that it was unfair to patients who didn't have insurance coverage to in fact subsidize (indirectly) patients who had insurance with big write offs. Also, they felt that could affect access for patients. Rhode Island has neighboring states where the fee schedules are not as low and Delta write-offs are not as much. That gives incentive to new Dentists to not practice in Rhode Island.
Hopefully, this marks a turning point in Delta’s ability to continue to implement these policies nationwide. Maybe some day we can turn it back in Minnesota.
We have more news, free for the reading, on our website. If you have something on your mind, give me a call at 952 921 3360.
’til next time...

You Are Going to be Spending $50,000+ So Don’t Blow It!

You Are Going to be Spending $50,000+
So Don’t Blow It! 

According to our 2009 survey, as of this year more than 50% of dentists (54%) now have digital x-rays. Bringing computing to the operatories entails considerable expense. Usually as digital x- rays are added, other technologies are added or upgraded too such as intra-oral cameras, patient education software, and digital record keeping. Financially speaking, this often comes out to over $12,000 per treatment room.

The pace of bringing digital technology to the operatories is increasing. Many of you will be making these investments over the next three to four years.
Since we have and will have many clients who will be investing over $50,000, $100,000 and up in this technology, I have two main suggestions to get more bang for your buck:

1. Get professional help in specs and get bids for the equipment— “cost control”
2. Commit to additional training so you get “result control.”

In business, costs are inevitable. A consistent theme of my advice to clients is that you have to have “result control.”
That is, if you buy intra-oral cameras, you want to make sure they’re used. Half of intra-oral cameras are used less than five times per week.
Almost every office with intra-oral cameras struggles with getting them to be part of the hygienists’ routine (and the hygiene department is where they can have the greatest benefit in helping the patients understand their problems and value your solutions).
Lots of offices have the capability to do chartless record keeping but less than 10% are truly chart free. With this technology in the treatment rooms the hygienist (for example) can post charges, set their next appointment, use the intra-oral camera, enter the treatment plan and use the patient education software. However, usually only two or three out of these five things are routinely done. Most dentists have neither the inclination or the time to keep up on computer software and hardware. I have seen many installations where there was no competitive bidding whatsoever. Or, once the equipment was installed it was glitchy... the digital x-rays would go down in one room now and then, the intra-oral cameras wouldn't work well, there would be server problems, wires and cables in the way, poor monitor placement, etc. With technology the devil is in the details: video cards, cabling, monitors, monitor position, support, warranties, digital x-ray choices, etc.
There are reputable and competent technology installation firms out there, such as Erickson Technologies 651-452-6758 and Sunset Dental Technologies 612-326-8693. However, many clients have used the local “computer guy” or just bought the hardware from the software vendor or supply company.
I recommend you check out Ted Takahashi with T2 Consulting 952-891-5177. Ted does not sell anything and makes no commission or "finder fees" on any technology recommendations. What he does do is draw up the specs so you can get competitive apple to apple bids. He knows what works and he’ll help you pick the right stuff. And, furthermore, you'll be assured that the installation will be truly functional from day one. He has planned over 750 installations nationally, and he is based out of Eagan, Minnesota.
If you're about to make a $50,000+ purchase, I strongly recommend you talk to Ted and ask him directly this question: “Why should I hire you?” Anyone that is selling you equipment will tell you that Ted’s services aren’t necessary that they’ll make sure you get a good deal and the specs are right anyway. I’ve had clients save many thousands of dollars by making sure with a new facility or facility upgrade that they had competitive bidding. Don’t let the suppliers take your business for granted! There almost always is some bargaining room if you go through a bidding process. You need someone in your corner who knows the technology.
I've made a special partnership arrangement with T2 consulting for an 8% reduced fee for active APM clients. As always, we stand behind our work and guarantee you'll be satisfied. For more information, go to our website and see Mr. Takahashi’s article, “The Chicken or the Egg...which comes first?”
Read more at no charge at our website where you can also take advantage of my free, 20 minute consultation. This is a strictly professional offer without pressure to sign up for anything more. It’s chance for you and I to get to know each other and we both stand to benefit. Go to our site or call 952 921 3360.
’til next time...

Keeping you informed

Keeping you informed

When you are an Advanced Practice Management client you are automatically plugged into the data base and experiences of 250 Upper Midwest offices.

Our clients tell us the number one reason they hire us is "for an informed third party perspective" and we are very serious about keeping you well informed.

So, we continue to add to our website. On it we have data on Fee, Wage, Overhead and Technology surveys as well as our articles and seminars. We are soon going to add an area for "Resources" where we will list vendors that we know to be reliable.

’til next time...

Is Midwest Dental a viable transition option?Most often, when you think of multi-location group practices, “Metro” and “Park” come to mind. However, Metro and Park have now combined (as American Dental Partners affiliates) and have 57 practices. Midwest Dental, out of Mondovi, Wisconsin has 67 practices (42 in Wisconsin, 10 in Minnesota, 9 in Illinois, 4 in Iowa and 2 in Colorado).
I recently talked to Sean Epp, the Managing Director of Development* for Midwest. Midwest Dental’s business model is different than the other conglomerates because it’s based largely on one- and two-man practices. They see their model as a traditional practice.
For some dentists, Midwest Dental can be a viable transition option. They often employ the selling Doctor so it’s a possibility if you want to sell your practice but still would like to work for a while. Since the big merger a while back there hasn’t been a lot of news out of Park and Metro Dental. They still maintain separate websites. At one time I thought we’d see a diaspora of Doctors and patients but we haven’t seen that happen.
’til next time...
Contact Sean Epp at www.Midwest-Dental.com 

The McGill Advisory quotes me extensively

This is a subscription-only newsletter, well respected in the dental field. Their June 2009 issue quoted me at length about participating in managed care.

What they said: “Almost all practices will benefit more through better management than by [participating in] managed care....”

I couldn’t have quoted myself better.

I can answer your questions about participating in managed care. A free 20-minute consultation is available by calling 952 921 3360.

And many of our newsletters cover the subject. They’re available, free for the reading, on our web site, advancedpracticemanagement.com.

Speaking of our newsletters, another issue is coming up in August. Check the site often for the latest news from the team.

’til next time...

Management by Fear

—in the Summer issue of The Profitable Dentist.

Explore seven situations with me in this article about the role of courage in making management decisions in your practice. It's a short, easy read that could make an enormous difference, even in your everyday practice.

As I say in the article, “When you are in the thick of things, it’s hard to remove yourself and know if you are being objective. In general though, playing it ‘safe’ is probably more dangerous than doing what may, on the surface, look risky.”

Find the issue in at The Profitable Dentist web site: www.theprofitabledentist.com

Or read the article alone at our Advanced Practice Management site: advancedpracticemanagement.com. In the left column you'll find a number of articles I've written. Look for the last listing under The Profitable Dentist. You can download it for later perusal, too.

Lots of Minnesota dental news is in our

Bulletin for the First Quarter of 2009.

Dental Dow Jones, Is an 18% finance charge illegal?, and many other topics are covered, including my advice: Don't buy the $250 manual that is being pushed by some companies in mail solicitations.

Who, What, Why, and When? Get the answers on our web site... free, no log-in, browse when you have a spare minute. Back issues of our Bulletins are there, too.

When is a free consultation really free?

When you give me a call for a chat. We can talk for 15 to 20 minutes about what’s on your mind. Before you call, check out the testimonials on our web site from dentists who called me and are glad they did. Real dentists, real practices, real names and photographs. I'm sure you'll recognize at least a couple of fellow dentists. 952 921 3360

’til next time.

Delta Dental is in the news

It’s a topic that comes up often, doesn’t it? But in the same breath as $2.8 million lawsuit against them?

The Star Tribune reported on 4/27/09 that The Smile Center has filed a $2.8 million lawsuit against Delta.

The Smile Center (Dr. Ed Silker and company) has five locations around the state. They take on quite a bit of Medical Assistance.

Delta said it withheld money because the clinic provided significantly more services per patient than other clinics serving poor Minnesotans.

Is it possible to take Delta to court and win?

Any Doctor who was, has or will be “audited” and been asked to refund money to Delta will find the outcome of this contest interesting.

Delta comes up often in our newsletter, free for the reading, on our website.

And if you're considering a consultant, test the water with a call to me. Free, 20 minutes, no obligation. Just a chance to find out more.

If you're not quite ready even for that, keep an eye on our website. You'll find hundreds willing to vouch for our honesty and integrity. And lots of trend spotting and ready advice anyone can use... gratis.

Just in case, my number is 952 921 3360.

’til next time...

Profitable Dentist Seminar, Destin, Florida

We had a great time in Destin, Florida, 

at the Profitable Dentist Seminar.

Shelly Ryan and I presented the “What Do You Say When”

Show and everyone had a blast.

Just goes to show that learning needn't be boring. We had 

great music in a fast-paced Game Show setting that had 

everyone moving and cheering, vying for prizes which 

included cash pay-outs and... chocolate.

Shelly presented multiple-

choice questions that 

were easy but critical to 

every dental office’s 

success. She quickly 

explained why one 

response was 

better than the others, without interrupting the hectic excitement.

You gotta see the video at our website.

(Look for the “What Do You Say When” logo.)

This seminar can travel! Book us for your event.

Shelly Ryan has over 20 years of experience in dentistry as a Chairside Assistant, Financial Coordinator and Office Manager. As a consultant with Advanced Practice Management, she helps coach over 250 dental teams.

Welcome!

Thanks for visiting. I have lots to share with the dental practice community.

Visit my Web site to see how I've helped many already successful dentists get more satisfaction, peace of mind and, yes, practice growth and greater income.

You'll find newsletters, movies, testimonials and free, practical advice. You may also take me up on my offer for a free, 20-minute consultation. Hey. Why not?

Visit this blog often as I share my stories and client experiences from my many road trips. I’ll also be announcing seminars... seminars unlike any seminars you or your staff have ever attended before. Really. Watch the video highlights!

’til next time...