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 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!

The All-Time Top 10 Outrageous Cancellation Excuses

Speaking of downtime, a few years ago we surveyed offices for their patients’ most outrageous cancellation and failure excuses.

10.) “Tooth hurts really bad but have to go hunting.”

9.) “The cat turned the alarm off.”

8.) “My mother passed away.” (3rd time in 10 years).

7.) “Too many bears. I’m not leaving the house.” (Duluth patient)

6.) “My teeth look fine. I’ll call you when they aren’t white any longer.”

5.) “Eclipse might hurt my baby. I won’t go outside.”

4.) “Did I make that appointment…really?”

3.) “I found a dead squirrel on the road on the way to my appointment and needed to bring it to the police department so they could properly bury it.”

2.) “My dog ate the reminder card that was on my refrigerator.”

1.) “I thought my appointment was yesterday.”

Dying for Dentistry — and — Little Things result in Big Gains

Dying for Dentistry

Our man, Matt, heroically tried to make his consulting appointment on January 7th and got caught in a snowstorm in Southwestern Minnesota.

At 10:30 in the morning, he was told by the Highway Patrol they probably wouldn’t get to him until late at night or even the next day.

However, miraculously, his wife rescued him from 160 miles away. It was a Google rescue. Go to our About Us page to watch the story that aired on Fox 9 News on February 10th.

Little Things = Big Gains

When we take a close look at practices that are experiencing good growth, we sometimes find that growth is generated by or can be explained by significant big events such as: adding an associate, a new facility or extensive remodeling, a significant Continuing Education event, or change for the better in personnel.

These dramatic events can change the chemistry or capacity of a practice, the motivation of the Doctor and/or the team and result in growth.

Staff wages are the major overhead item, so it certainly makes sense to go slow with raises if your practice isn’t growing. I’ve often said that the staff’s compensation should be linked to how the practice does, not just to the economy or the consumer price index (which by the way was up 1.8% in 2009).

However, we find that most of the time growth comes from a number of small improvements that cumulatively have a large effect. This is what management is all about...catching every little bit of wind you can in your sails.

I've provided a number of examples in our latest newsletter, our February Bulletin.

’til next time...

Leadership and Staff Raises

Leadership and Staff Raises

In our recent economic survey we asked area Dentists if they plan to give staff raises in 2009. 41% of Metro Area and 24% of Outstate offices said, “No.” Only 30% of Metro and 54% of Outstate dentists will give raises in 2009.

Staff wages are the major overhead item, so it certainly makes sense to go slow with raises if your practice isn’t growing. I’ve often said that the staff’s compensation should be linked to how the practice does, not just to the economy or the consumer price index (which by the way was up 1.8% in 2009).

Even if you’re not giving raises, you should at least give your staff recognition, direction and hope. That’s leadership.

“Look, we’ve had a flat year but I want to let you know that I do appreciate your efforts (giving specific recognition to each staff person). And, I do need your help in the coming year because despite the economy we intend to press on and make the practice better all the time. Once we’ve gotten a string of 4 to 6 months that shows growth then we’ll revisit the wage situation and consider raises at that time.”

Wage increases should be based on these three major factors:

The market rates for wages. (See the Advanced Practice Management Surveys).

How the practice is doing (practice growth and profitability).

Individual merit.

Smart Wage Decisions:

I believe it’s best to take a look at staff wages as a percentage of collections at least once per year for the sake of determining how much will be available for wages and raises.

If your total gross wages were running at about 25% of collections, for example, last year and they are 23.5% now (because your collections grew) then you are in a position to give raises.

If staff salaries have crept up to 26% or 27%, then it’s time to hold off until your practice revenue catches up.

Using this very simple method, you can keep the biggest chunk of your overhead (staff wages) under control.

Incentives:

About one third of dental practices have team incentives. When they work they can work beautifully. They can really pull a team together and lead to greater production. Some of you have been burned by incentives or are jaded about them. The key thing is that if you have set up an incentive with the staff for practice growth you have to have a plan for growth.

You, as the leader of the practice, have to quarterback that plan. Incentives are not indicated and will fail if the staff is at each other’s throats, there is no realistic plan to grow the practice and the Doctor doesn’t do his/her part to lead by example.

Agree? Disagree? How do you handle leadership and staff raises?

Post your comments!

Then give me a call at 952 921 3360 to discuss these or other issues in your practice. Please call with confidence. I consider this a professional-level discussion.

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’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...