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.

The truth about getting new patients on the internet

Getting New Patients from the Internet (continued): In the “old days” of dental advertising, we had the hassles of dealing with decisions regarding which Yellow Pages to be in and Yellow Page ad design, and negotiating rates. Or planning direct mail campaigns (demographics, offers, mail lists). Those mediums could be plenty expensive but they weren’t all that complicated to figure out.

Internet marketing is a whole different ball game. It can be less expensive (or not!), but it certainly is more complex. Every day you and I are getting bombarded by pitches for SEO, SEM, and this or that great new Internet marketing scheme. I know that getting new patients is important to you so you better believe that we at APM are keeping our eyes open as to what is working, what is not and what the industry trends are.

You have limited amounts of time, energy and money to spend on advertising (not to mention doing dentistry and keeping your patients and staff happy), so we understand that dealing with the nuances and sorting through the hype of Internet marketing can be overwhelming. I’m hoping these articles will help.

Souping Up Your Internet Presence: Stage I – Establishing Your Google Places Page & Cleaning Up Directories: When a potential patient searches for a dentist in your area, they are most likely doing a Google search for “dentist in Your City” or “cosmetic dentist in Your City.” Their results will list three to eight dentists’ in the local proximity who best match their search keywords. Clicking on the links for those dentists will take them to their Google Places page, a miniwebsite of sorts listing contact information, office hours, photos, driving directions, areas of specialty and, most of all, credible reviews from actual patients.

An absolutely essential first step is to claim and enhance your Google Places page, complete it with information, photos, videos, if available, and then to collect reviews. Some Doctors have multiple Place Pages, for example, and that does not help you get found and, in fact, can hurt you. There is often inaccurate information on these directories. We’ve seen completely wrong phone numbers, old addresses and many long-established practices that are virtually invisible when you try to find them on the Internet. So the first step is getting your presence in the multiple directories straight. This also includes adding pictures and other content on your “Place Page.” A very important part often is getting patient reviews posted.

Then, we want to submit your practice information to the search engines and directories that are getting traction in your area so that your information is consistent across the board and you have the best chance to be featured in this suggested list of dentists. We correct inaccurate information, eliminate duplicate listings which dilute your presence and help you to establish a consistent and broader footprint across the web. We call this first stage “Cleaning Up The Directories,” a very detailed but absolutely necessary task.

Stage II - Website Enhancements: The footwork of “Stage I” will increase your visibility in the local directories and get you impressions and, hopefully, clicks through to your website. Then, once they get to your website, it’s a matter of engaging the potential patient and moving them to make an initial contact by e-mail or phone.

A lot is involved, whole books have been written about this. Best practices for effective websites include having a call-to-action on the home page, pictures and bios of the doctor(s) and staff, video brochures, patient testimonials, and before and after pictures. This also may include introductory offers such as free or low cost whitening, a low cost complete kid’s check-up, or other type of offer similar to what you would see with direct mail advertising.

Different than the SEO methods that were popular a few years ago to load each page with all of your keywords, effective websites today strategize a purpose for each page and align the keywords, content, tags and descriptive code with that message. As they say, “Content is King.” This is also an important part of Stage II.

Stage III – Widen Your Internet Footprint: Once the housekeeping is in order, you can start expanding your presence on the web by adding content and through blogging and social media (Facebook, Twitter) or through paid advertising (such as Google Adwords Express or Pay -Per-Click) and special advertising promotions (Groupon, Living Social). With a little organization and persistence, your efforts will pay great dividends in expanding your presence on the Internet and attracting potential patients who are looking for a great dentist!

Putting It All Together:

New directories are constantly coming on to the scene and existing directories update and cross check information sometimes sending bad data around like a virus. Most practices need at least some directory work. You should be checking your listings periodically to make sure they are still accurate. You may have paid your website company to help you with directories at one point, but it’s been our experience that they are often like bad painters. They’ll throw some stuff together but not really pay attention to the details and therefore, some potential patient traffic is lost. Or, you may be already getting a decent amount of traffic to your website but the website itself needs work. Perhaps it doesn’t really reflect the nature of the office (i.e., it looks too “cookie cutter” or too “Plain Jane”) and doesn’t really give the patient a reason to e-mail or call you.

The devil is in the details. Just the technical nuances in getting the directories straight, the organization of the website and its pages optimized, pictures uploaded, patient reviews, etc. can be a daunting task. But again, it helps to have your priorities. For example, it doesn’t make sense to have a graphically beautiful website if the directories are haphazard and you get very few impressions. And, it doesn’t make a lot of sense to spend time on Facebook and doing blogs if you don’t have your website in order so that as you get interest, people can learn more about you in such a way that they’ll want to become new patients.

Our clients work with the whole gamut of website providers…everyone from their sister-in-law to the big generic companies like Officite and Prosites. It’s been our experience that website providers are happy to take your money each month and not really do much. That’s why we brought Kelly Larson on board. Her job is to “ride herd” over website companies and to keep us and you absolutely up-to-date on what is really working in Internet marketing.

I’ve met people with more technical knowledge of HTML programming. I’ve met others who are great graphic designers. I’ve certainly heard from others who are great sales people. I’m approached about new Internet marketing schemes almost every week. I have not yet met anyone who really knows as much as Kelly Larson does in terms of the nitty-gritty of all this, focused on getting new patients through your door. Whether you are just getting started or already have a sophisticated Internet presence, she can give you a push and help keep you ahead of the competition.

The Mystery Shopper

Has a mystery shopper called you yet?
We’re getting reports from many clients that they’ve been called by the “Scheduling Institute,” Jay Geier’s group. Mystery Shoppers will call posing as a patient. The patient is usually asking for a fee on a crown, or saying they just moved to town looking for a Doctor, or want to know if the practice takes kids, etc.

This is the Scheduling Institute’s way of finding prospects. The Scheduling Institute has a detailed and extensive program focused on the initial patient phone contact with the office.

Surprise! Almost every office they call earns a 0 on a scale of 0 to 5 for handling calls effectively. Therefore, Dentists are told that they stand much to gain by subscribing to their program… that new patients can go up by 30% or more with thorough staff training.

There is much that the Scheduling Institute recommends that we agree with, but not all. We’ve been doing “Mystery Shoppers” ourselves for over 25 years. We agree with Jay Geier on this…doing things right can add to your new patient flow. Like the Scheduling Institute, we find that most often the initial phone contact with patients is a matter of screening, warning and indoctrination.

For example, there is often way too much focus on insurance and x-rays. Even very competent, well-meaning front desk people can present a bureaucratic and cold presence.

However, before you sign up for a $5,000 program, let me assure you that we can help you and your staff with this. In some cases, we feel that the Scheduling Institute is too aggressive, maybe not “Midwesternly” enough. So, if you got “0 stars” call us and we’ll help. If you don’t know what your rating is and want a “Mystery Shopper,” we’re happy to do it for you. Just call and we’ll make arrangements to ensure patients’ and shoppers’ first contact with your office is first class.

We want the “Mystery Shopper” not to be the Secret Police though. We want to work with your staff… not to catch them doing it wrong but to catch them doing it right!

Trends to watch

Trends: Matt, Shelly, Robyn and myself make over 600 onsite visits per year. Here is an informal list of trends that we are observing:

1) Multiple location group practices (e.g., Midwest,Heartland). See our previous newsletters on this. (They are online at www.AdvancedPracticeManagement.com under “Dental News.”)

2) More GP’s doing ortho. For example, about 22% of offices now offer Invisalign.

I remember my travels to Outstate MN over 20 years ago when lots of GPs did ortho but that faded. It’s coming back now with the new technology and approaches.

3) Technology in the Operatories: Over 60% of Dentists have digital x-rays and in-operatory computer monitors. Add to that Laser Caries Detection (45%), Intra-Oral Cameras (65%), Patient Education Technology and Lasers.

This technology can easily run $14,000+ per operatory and that’s in addition to your clinical delivery equipment (chairs, dental units, etc.). So, you have to get “Result Control.” See the article on this at www.AdvancedPracticeManagement.com.

4) More Delta Participation: In 2004, provider Delta Premier participation was down to about 81%. Nowadays, 87% of area practices are with Delta Premier. With Delta continuing it’s domination of the dental market, it can be quite challenging for Doctors to be outside the network.

Another 31% of Dentists are with a “Delta within a Delta” (Delta PPO). In our opinion, many practices with Delta PPO do not need to be with Delta PPO… and it costs them thousands. Essentially, their Delta write-offs are almost doubled and there isn’t enough gain (in our opinion) to make up for the write-offs. Likewise for Met Life.

Other PPOs such as the Premier Group, Health Partners, etc., pay fees more akin to regular Delta Premier and, if an office is running efficiently, the bottom line can be fine.

5) The Internet as a Source of New Patients: I’ve seen several instances this year where the Internet had overtaken the Yellow Pages and other sources (e.g., Direct Mail) in the number of new patients brought into offices. This is not universal. In some places Yellow Pages are still pulling. Visibility (signage) remains a very major factor. Of course, so are patient referrals which still account for 50+% of most office’s new patients.

6) Treatment Coordinators: A treatment coordinator is usually a hygienist or an assistant who presents treatment all the way from the x-rays through to the financial arrangements. The most ready model for this is orthodontic offices who have had treatment coordinators for years. The Doctor looks at the treatment plan, the treatment coordinator goes through it with the patients, holds their hands and works out the financial arrangements.

It’s easy to hire a hygienist and plug them into your operations. Developing a treatment coordinator is a little more tricky. It is a less defined job description. It takes a unique set of skills (a good dental background with good communication skills) and can be hard to work into your routine if you are not used to it. However, when we see offices with treatment coordinators, they do well.

This is by no means a comprehensive list but the trends mentioned are worth your attention.