What is a Lack of Confluence?

What We Have Here Is a Lack of Confluence: As you know, the outcome you can get for your patient is so often a matter of their choices, not “just” your clinical skills. Put another way, if you could give your patients a magic pill that would have them understand, value and act on Dentistry to the same degree you would, it would do more for them than if you took a magical pill to further enhance your clinical skills.

In every practice there is a gap between what you can do for patients and what they choose to have done. This can lead to frustration, compromised care and tens of thousands of dollars in lost income per year.

It may give you some comfort that you’re not alone. This is common to all health care. Just looking at pharmaceuticals:

• According to Reuter’s, 22% of prescriptions are not filled, 28% are first time prescriptions (this was a study based in Massachusetts of 75,000 patients).
• From Consumer Reports (2007) in a large study of over 79,000 people, fully 3/4 who got a prescription in the previous 12 months said they had not filled a prescription, skipped a dose, forgot to take a drug or had taken less than the recommended treatment.
• Furthermore, 25%–50% of the people with diabetes, high blood pressure and high cholesterol stopped taking the medications as directed within a year.

All of this costs millions and millions of dollars and immeasurable loss to people’s health. In medicine the term they used to use was “patient compliance.” Nowadays, the phrase used is “confluence.”

Once you and your staff really own the fact that patients’ choices are critical to the quality of the care you can deliver, you will automatically start investing more and more of your energy and time into patient communication and other items that will help to positively influence their behavior. This affects your decisions regarding Continuing Ed, the technology you use (buying that intra-oral camera or CAESY for example), and even the staff you choose (obviously you want staff people who convey a positive attitude, communicate well and enthusiastically believe in your/their Dentistry).

There is just as much or more range of services delivered per patients between dental offices as number of patients seen. If you want to produce more, you have to see more people or do more for the people you see. For most of you, doing more for the people you see is the quickest and most satisfying way to growth. That growth gives you the resources (income) you need to further invest in the practice (e.g., practice advertising, website, technology, staff, etc.).

The care should drive the numbers, not the other way around.That is, if you and your staff have “Clinically Calibrated” so you’re in agreement about what criteria calls for the various sorts of treatments (everything from crowns to x-rays), the numbers will move! This approach is the opposite to using “quotas” where the numbers drive the recommendations.

Patient confluence is important but as important is making sure that you and your staff are presenting your best options in the first place. Ironically, more patient care is not delivered because of providers’ fear of rejection than actual patient rejection.

Want More New Patients? Cover the phones! Tips for a healthy hygiene department

Want More New Patients? Make Sure Those Phones Are Answered During Lunch!:

We surveyed about 100 clients in our database asking this simple question, “Do you answer the phone during lunch hours?” About 15% said they didn’t.

We then sorted the data out. Offices that answered the phone during the lunch hour averaged 20 new patients per full-time Dentist per month. Offices that did not answer the phone during lunch hours averaged 14. Enough said?

Is Your Hygiene Department in a Slump?: In my travels over the Upper Midwest over the years, I’ve often compared the Doctor’s procedures vs. the hygiene procedures as the difference between a Main Menu and a “Bar Menu”. The Dentist often has access to a myriad of different procedures which has its advantages in keeping the schedules full and, more importantly, affecting his/her productivity.

If your hygiene department has a more limited menu (i.e., the “bar menu”), it becomes even more critical that your hygienists are delivering these small-scale services consistently. By small-scale services, we’re talking about laser/periodontal procedures, x-ray coverage, in-office fluoride applications, delivery of site specific antibiotics and cosmetic procedures such as whitening. Make no mistake, a gap in delivery of any of these services can make a big difference with patient care as well as hygiene productivity.

All productive up-to-date hygiene departments have one thing in common: they deliver a wide range of services consistently. 2012 might be an ideal time to schedule a Clinical Policy Summit with your staff about practice protocols specifically for hygiene related services.

A crude but simple way to measure the range and depth of Hygiene related services is “Production per Hygiene Visit.”

Metro Area
	5%ile	AVG	75%	95%ile
Prod/Hygiene Visit	$108	$139	$147	$165
Outstate Area
	5%ile	AVG	75%	95%ile
Prod/Hygiene Visit	$93	$123	$136	$160

Check out your Hygiene Production per patient visit (it’s right there on your “Manager Report”)

Practice Values Continue To Be Strong in a Weak Economy

Shea Practice Transitions reports that practice values continue to stay steady if not increased slightly from 2010 through 2011. Shea Practice Transitions reports over 50 practice sales during that period of time, with some interesting statistics. Of these, the average practice collections were over $775,000. The average patients per practice equaled 2,005. Over 95% of the practice sales were sold in cash transactions. The average price per patient record was over $180. The practices sold from a range of 31% of annual gross collections to 78% of annual gross collections. Over half of these practices sold for over 60% of their gross, and over 10% of the practices sold for over 70% of gross. The average practice took approximately 8 months to sell.

The above are simply averages; however, somewhat enlightening. Naturally all of these practices are in different geographic locations, facilities, patient compositions, overhead structure, as well as many other fluctuating variables. Nevertheless, what these statistics do point out is that there is still an excellent market for practice sales (including practice buy-ins). So, don’t sell yourself short. Make sure you get proper value for your practice. Contact Kevin Shea at: www.sheatransitions.com or sheainfo@sheatransitions.com

Make Hay While The Snow Flies!

Since I grew up as a farm kid, I’m big on being aware of the seasonable variations.*

For example, most of you already know that August is the single, biggest new patient month of the year (big on kiddie prophies with the back to school rush). May and September are typically lighter months in our area. Doctors, that’s a good time to plan your Continuing Ed or vacations. Beats sweating about the schedule.

We’re now coming up on the biggest crown and bridge months of the year: December, January and February. It’s the “Insurance Effect.” Anyone that’s putting off treatment now should be committed to an appointment next year. Don’t let it dangle with, “We’ll get back in touch with you later…” Some people use the Year End Insurance/Flex Letter. If you don’t mail these, these can at least be used as a handout. Some practices have good success with this and others not so much. If you haven’t tried it before, it’s worth a shot. Call our office for a copy, 952 921 3360.

Since more and more offices are using automatic confirmation, you can use the same service to blast out a notice about year-end benefits. I saw a practice do this with Demand Force. For very little cost, they stirred up some business.

So, light up those intra-oral cameras, get out the visual aids and get the staff and yourself psyched up! This is the time of year where more of your patients will choose to upgrade their dental health if you are on your game.

“Non-Covered” Services:

We still get a lot of questions on this topic so here are some key points.

Non-Covered Services such as cosmetic services: If an office places an anterior crown (such as all porcelain) for aesthetic/cosmetic purposes, this is a non-covered service and should not be submitted to the insurance company. Submitting it could imply that it is not cosmetic and is likely that you would be required to reduce your fee to the allowable amount by the insurance plan. Not submitting to the insurance company allows you to bill and collect your whole fee.

Maximums: Anything submitted beyond the maximum is still subject to the “allowable amount.” For example,

The Dentist completes two restorative crowns at $1,000 each. The patient’s maximum is $1,000. The allowable amount is $900 per crown. Even though the insurance plan only covers $1,000 of the $2,000 treatment plan, the dentist is still required to reduce the fee on both crowns after the maximum is reached. In this situation the Doctor would write off $100 per crown.

This logic also holds true for things like “waiting periods,” “prior conditions” and “frequency limitations.”

Alternate Benefit (Covered Services): This is when the insurance plan alternates a “covered service” to support the lowest reimbursement or another similar service. For example, The dentist completes a Posterior Composite at $250. The insurance plan alternates the benefit to an amalgam with an “allowable amount” of $120. The dentist collects the difference of $130 from the patient.