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.

The Growth of Multi-Location Group Practices

Like Arby’s?

Years ago we thought the trend would be franchise practices in retail settings. It hasn’t exactly happened that way but there has certainly been a growth of multi-location group practices.

In most cases, the model is less formalized than say an “Arby’s.”

Of course, there are the more “corporate” type of large clinics in multiple locations, such as Metro (37) and Park (23).

But, if you look at the recent activity in the Midwest, what you see are groups such as Midwest Dental and Heartland (word is Heartland is coming to our area). Midwest Dental owns more than 77 upper Midwest practices. Heartland (centered in Illinois) has about 300.

Then there are smaller multiple location groups such as Main Street Dental (5 locations in southern Minnesota) and Family and Cosmetic Gentle Dentistry (12 locations) in the Metro area.

There are other niche-type practices such as The Smile Center (7) and Emergency Dental Care U.S.A. (7 Nationally).

Midwest Dental and others are eager to buy and they’re growing. Heck, Heartland Dental even owns a corporate jet! You have to be making some serious moola to have one of those. Let’s take a look at how some of these groups do it.

It Starts with Goals:

You hear it from me every year. Now it’s time to reflect on the past year. Note your accomplishments and challenges. Outline your goals for the coming year. Write down what you’d like to see happen. Share them with us and we’ll help you make them happen.

Most of our clients with written goals reach most of their goals. It costs so little and it can be so rewarding. Just take an hour right now and do it.

The Latest Word on Practice Overhead:

KDV* has just released its bi-annual general practice overhead survey. It’s a sample of 70+ full-time, mature practices. As such, it’s the best and most detailed information of its kind available for our area. Some highlights:

• Average Net Income was $259,842. This was down from the $275,302 average in 2008. KDV said this marked the first decrease in 25 years of preparing these statistics.

• Overhead as a percentage of fees received increased a point to 65%. So the average net is now 35%. What is yours? Remember, average is not necessarily your aspiration.

• Staff gross wages are still about 26%-27%. If you can’t clearly compare your statistics to the industry standards and don’t have a clear look at your bottom line, we can help. Get QuickBooks Pro really working for you. No serious business owner would go without clear financial reports. This overhead survey is a very valuable perspective to help you in budgeting. It will be posted online at AdvancedPracticeManagement.com on the “Surveys” page. You’ll also find other useful information there on the current Dental Economy, Technology and Insurance Participation.

Our Fee surveys are also online and were recently updated in October.

* Davich, Wilson and Morrow, who have been doing these overhead surveys for 25 years, merged with KDV (KDV.com).