Tuesday, December 27, 2016

The ABCs of a Successful Dental Practice (Part 3 of 3)

Welcome to the final installment of the “The ABCs of a Successful Dental Practice.” As we close out this blog post series, I want to impress upon the reader that there are approximately 200 key performance indicators (KPIs) that should be monitored and evaluated monthly through dental practice analytics. 

With that said, and as an owner/operator, I am all too familiar with the time constraints we face as professional colleagues and friends. However, analogous to a pilot who is commandeering a beautiful Boeing 787 aircraft, while monitoring critical KPIs (air speed, jet fuel, altitude, etc.) from the cockpit, it is critical for today’s “dental businessperson” to possess the knowledge and business acumen to navigate their operation while soaring to new heights. This begins with learning how to diagnose your business through the use of KPIs and any corrective actions required to stay on budget and meet or exceed your goals and objectives. I refer to this process as “keeping your finger on the pulse.”

The following recommendations are based upon more than 35 years of business and clinical experience as a clinician, owner/operator, project manager, practice management consultant for solo and large-scale dental organizations and five-star hospitality customer service mentor, as well as completion of a rigorous Master of Business Administration curriculum with an emphasis on health care. As I stated in the previous post, these suggestions are more than simply anecdotal thoughts or ideas. They are based upon the science of business.

In this blog post, we will focus on the letters “R–Z,” presented in the hopes that each respective reader will glean a pearl or two.

Recall: A well-designed dental recall system will ensure that at a minimum, 85 percent of active patients (active is defined as any local patient who is seen in your office within the past 18 months) are scheduled for continuous treatment somewhere within your dental practice at all times. Yes, 85 percent (the national average is 42 percent). In other words, each respective patient should have an appointment in your office at any given time, hygiene or restorative. The most successful marketing and greatest potential to grow your business is through your existing patient base and by learning to ask for internal referrals. People buy from people whom they like, and they also refer their friends and colleagues to people whom they like.

Your patients have already chosen you and/or your associate, and now it is up to you and your excellent and highly trained team to maintain this relationship. Every dentist should know how to access the number of active patients and percentage scheduled from their practice management software. If not, ask your front office staff to show you how. This is a critical metric that should be monitored monthly. If we can’t diagnose the problem, we can’t treat it.

Scheduling for your success: Maintaining a consistent and smooth flow of patient appointments while meeting daily production goals (dentist and dental hygienists should have daily production goals tied into an annual budget) is one of the most challenging issues that your front office personnel encounters. By incorporating 10-minute blocks of time, required time per procedure (based upon your top 25 Code on Dental Procedures and Nomenclature procedures), per clinician, a short-call/VIP list and learning to schedule to 70 percent of daily goals before lunch is at the heart of developing predictable and consistent patient schedules that ensure financial health for your business, while decreasing stress for all. There is no quicker way to burn out a team, destroy employee morale and induce anxiety than to “put the patient anywhere in the schedule.” Remember, being busy does not translate into being successful. Scheduling for your success is an art and science and should be respected as such.

Treatment planning: One of my mentors, Dr. Bill Robbins, taught me to call it the way I see it, and that there is no such thing as “we will just watch it.” In other words, do not pre-judge your patients, and try to evaluate if they can afford your proposed dental treatment. Call it the way you see it! Your treatment plan is predicated on the condition of the patient’s oral cavity, not yours, and seldom are there two patients who present with the same needs.

In today’s dental economy, it is my experience that the most successful way to gain patient acceptance to your proposed treatment is through the use of intraoral cameras and by involving the patient in what is commonly referred to as “co-diagnosis.” For example, ask your patient, “Mrs. Jones, what do you see?” as you display a fracture or an area of occlusal decay on 42-by-50-inch screens at the 6 o’clock position of your treatment room. Then listen and say nothing. Let the patient answer. Silence is golden. Then, send the patient home with pictures of his or her teeth, soft tissue, calculus accumulation, etc. By the way, most patients will gladly accept your treatment recommendations because you are no longer having to sell your services. Now you need to have your financial coordinator provide financial options so he or she can convert the case right? Excellent systems are the key.

Uniformity: Providing a consistent product and service that creates value for each and every patient is one of the biggest challenges facing any business. As dentists, we are the primary revenue producers, and unfortunately, we seldom serve on the front line and interact with the patients when they are paying for our services. Your financial coordinator or whoever collects monies on your behalf needs to be trained and supported with proven financial systems to protect the financial health of your business. If the patient deserves continuity of care, then the business owner deserves uniformity of payment. However, without proven systems, your financial health will be jeopardized.

Voicemail: National data suggests that 80–87 percent of new patients who call today’s dentist and are greeted by voicemail will hang up and go to the next dentist on their list. That means that you will lose 80 to 87 of every 100 prospective new patients if your practice’s unanswered calls go to voicemail during regular business hours.

We need to teach our team members to smile, answer the telephone within two to three rings, and make all patients feel welcome and believe they have called the finest office in their community. Case conversion begins with the first patient touch point, and that is usually the telephone. Two weeks ago, a colleague of mine called his office nine times and informed me that on all nine instances, his call went to voicemail. Enough said?

Website: The days of expecting patients to call to make an appointment or walk in your dental office are gone. Print media is on a continual decline and is expected to continue. Print media that promotes your services based upon price only serves to promote dentistry as a commodity, which leads to patients believing a dentist is a dentist is a dentist. There is a place for print marketing (your best patients, approximately 20 percent of your business). However, after tracking hundreds of clients’ data sets, it is minimal at best. When today’s consumer needs a dentist they will find them through referral (from a friend, family member, coworker, employer insurance, etc.) or turn to the world wide web.

However, just having a website is not sufficient. Today, consumers (including new and existing patient base) are glued to their smartphones, tablets and laptops. The typical user is continuously checking their email, updating their social profiles, searching for a destination (your office) and, on average, spending five to six hours per day navigating their device. According to Pew Research, 64 percent of American adults now own a smartphone of some kind, up from 35 percent in spring 2011. The ability to “stay in touch” has changed from a luxury to a necessity for all types of users. We are truly a people “on the go.” Patients expect you and your website to be great. If you don’t have a website, you don’t exist, and if you have a website and the consumer doesn’t like what they see they will bounce (bounce rate) right off of your page and move to the next.

X-rays: A full-mouth series of X-rays (FMX) and a panoramic X-ray, or cone beam computed tomography, for new patients are still the standard of care. I see more and more colleagues failing to order the appropriate images (because insurance won’t pay for it) necessary to evaluate the head and neck area for which we possess tremendous knowledge. The panoramic X-ray has fantastic value, and when displayed and presented to the patient on large screen monitors, it serves as a wonderful education tool that builds rapport, value and trust. The ability to evaluate the patient for intra-osseous pathology, elongated Styloid processes, internal carotid plaque, temporomandibular joint disorders, sinus pathology and much more warrants acquiring a beautiful panoramic X-ray. With respect to FMX or bitewings, we need to hold our team accountable for acquiring diagnostic images so we can do what we do best. I see hundreds of images that would not pass the test in dental school for either the dentist or dental assistant.

Yearly budget: As we close 2016, there is no better time to prepare your annual or yearly budget and start off the new year with clear financial goals and objectives. I am fortunate that I had the pleasure of developing budgets for years with Hilton Worldwide global hospitality company, and so I am accustomed to same. With that said, and if you need help, reach out to someone who can help you (a bookkeeper, certified public accountant or colleague who is experienced in preparing a realistic budget). Creating a well-thought-out budget is the first step to accomplishing your financial goals while creating a blueprint for 2017.

Zest: Dentistry is a profession that enables each of us to serve our patients and colleagues, as well as give back to our community and family. Let your zest be the inspiration that helps lead your team to a successful and happy new year in 2017.


Friday, December 23, 2016

Three Tips for Establishing Trust in the Workplace

The foundation behind every relationship is based on the principle of trust. Not only am I talking about in personal relationships, but also in our workplaces as well. If people trust you, they believe in you. Even if you make a mistake or act in a negative manner toward them, they won’t hold that action against you because they “know you.” They would understand that is not typical of your behavior and most likely try to help you with whatever the problem was. 

On the flip side, if someone doesn’t trust you, everything you say and do will be under scrutiny. Behind all your actions, there will be doubtful motive, and until the trust is established, there is no relationship at all.

As dentists, we are leaders in our offices, and leaders must be trusted. If you have a team member who is doubtful of your intentions, he or she will not implement your practice ideas and philosophies. He or she instead may say negative things behind your back to other team members — and even to patients. You can imagine the cascading, detrimental effects this can have on your business. If you don’t have a trust-based relationship with your patients, they will most likely not move forward with any treatment recommendations you may have; and if they do, they likely will find fault in your work, even if it was done pristinely.

Trust is a core concept that every successful business attains. Here are three ways you can establish a trusting rapport with your team and patients:
  1. Never overpromise. At times, people have the best intentions and try to do more than what is within their realm of capability. We allow ourselves to be talked into things because we want people to like us, and we want to help, or sometimes we just may carry too much bravado. Regardless, if you are not sure you can do something — don’t do it! In fact, I always tell my team under promise but try to over deliver.
  2. Say what you mean. When you talk, communicate clearly and accurately. Sometimes people tell “white lies” because they feel they will avoid offending someone or confrontation. Maybe they will embellish a story to make it seem more glamorous and exciting, or to try and gain more credibility. Life is just way too busy to try to keep up with these fallacies. Eventually, you get caught, and then feelings get really hurt, and you lose all your credibility.
  3. Honor your word. If you say you’re going to do something, make sure you do it. Once in a while, you may legitimately not be able to do what you said you would. Make sure this is discussed with those affected, and reschedule. If you don’t, you will lose trust with people, and you will begin to lose faith in your own integrity. If you can’t keep your word to yourself, this will eventually have a heavy negative impact on your everyday sense of happiness and overall well-being.

The bottom line is: Be true to your word, to yourself and others. If you believe in yourself, you will have strong core values that can help you build strong relationships with people that will bring success in every aspect of your life.

Pamela Marzban, DDS, FAGD

Wednesday, December 21, 2016

Behind the Wheel of Your Practice

I am an unabashed car enthusiast. I love cars. I read about them, dream about them, love getting behind the wheel of them and wish I could afford to race them. Car ownership is a huge expense, so I buy something that is great and keep it for a long time. The last two cars I owned I had for 17 and 13 years, respectively, eventually changing vehicles because I was ready for a new one.

We bought an all-wheel drive Toyota minivan for my wife to drive. She loved being up high for visibility, and I was duly impressed with my first all-wheel-drive experience. With the proper winter and ice tires, in Calgary’s winter, the car was stable and safe.

So it was my turn to get myself a new car — only my third new car in more than 30 years. With my children now in their late and mid-teenage years, getting in and out of the back seat of my two-door, rear-wheel-drive coupe was a challenge, so I decided I wanted a four-door, all-wheel-drive sports sedan. I wanted it roomy, comfortable, safe and fast. There is a large array of vehicles in this category, and I decided to look broadly at offerings from Japan, the United States, Germany, the United Kingdom and Italy.

Going through the test-driving experience was fun and instructive. Some dealers were indifferent toward me (Cadillac) as if they were not sure they wanted me to buy their car. There was no enthusiasm. Too bad, because my dad loved Caddys.

I had a bad experience at Porsche. I looked at its Panamera with googly eyes. I loved that car and the experience driving it. But it seems that you get a base car no one wants, and then every little thing, including the key fob, was an extra cost. I was confused by the options and said to the salesperson, “I am interested in this car; can you sit down with me and work out what it will cost to get the car that I want?” He said that all the information is listed on the website and I should go there to view it. Really? For a car that I later learned was going to cost CA$176,000? Needless to say, I did not buy that car and the experience with that salesman really left me feeling sad and disappointed. I still feel that way today, more than one year later.

Audi, Jaguar, Infiniti, Lexus, Maserati, BMW and Mercedes-Benz all had great salespeople who made me feel welcome and let me have lots of time with the cars in the dealership and on the road. They clearly wanted my business. But Lexus, Maserati and Mercedes rose to the top, based on a number of emotional factors and some real car experiences that got my blood pressure to rise in anticipation.

Maserati had incredible performance but was really loud, and the noise level was annoying after 30 minutes behind the wheel.

Lexus had customer service excellence down to a science. The car was exceptionally quiet, and that sound system in the car — it was great. But it did not have the performance to match the others. It was good, but it was not exceptional.

The Mercedes-Benz had the best of all of those worlds and was the surprising (to me) choice that I made. I have enjoyed this car since then, and I am happy with my choice. It is the total package: great dealer customer service experience, exceptional performance, quiet inside but an incredible sound system, four doors, all-wheel drive, luxury beyond my desires. It may be the last car I own, as I intend to keep it for the next 15 to 20 years.

It’s not about the car. It’s the moments, the experiences, one moment stacked on another that is what constitutes a great ride. I found that to be true in my personal situation.

What about our practices? What moments, what experiences, the moments stacked onto the next, constitute a great office? How are we greeting our patients, talking with them, building our relationships with them, in addition to providing them with exceptional dentistry that is creating long-term, loyal, happy patients who pay, stay and refer?

I think these questions are worth taking the time to ponder and discuss with our teams. I’ll introduce that at our next team meeting.

Happy holidays, everyone.

Larry Stanleigh, BSc, MSc, DDS, FADI, FICD, FACD, FPFA

Monday, December 19, 2016

The ABCs of a Successful Dental Practice (Part 2 of 3)

As we know, there are myriad systems, processes and strategies required to operate a highly successful dental business. In this blog post, we will continue with the letters J–Q, presented so the dental practice owner can familiarize him or herself with some of the common threads found in highly prosperous dental practices across the United States (solo, small group or big-box dental chains). These tips are presented to help business owners increase their profitability while decreasing stress, creating accountability and leading to a more balanced lifestyle. 

As mentioned in my previous blog posts, the dentist is the primary revenue producer and should be chairside 95 percent of the time (as should the dental hygienist). As a result, it is vital to ensure that each team member is trained to perform his or her responsibilities, reinforced with proven systems, operating manuals and protocols for every conceivable patient/team interaction.

There is no substitute for excellent training and continuous education for all dental auxiliaries and non-clinical team members. Our clinical skillsets are no longer the differentiator in our success. The keys to today’s business success begins with embracing a service excellence culture that results in a patient-centric environment and engaged employees.

The following recommendations and/or suggestions are based upon more than 35 years of combined practice management, clinical mastery, project development and five-star hospitality customer service experience (the latter as a major hotel executive), as well as knowledge gained through the completion of a rigorous Master of Business Administration program, incorporating all facets of business. These recommendations are more than simply anecdotal ideas. They are based upon the science of business.

Job descriptions: Job descriptions serve different purposes for the employee or employee candidate and human resources department. Well thought-out job descriptions help organizations increasingly understand the experience and skill sets needed to enhance the success of any company. They assist in the hiring, evaluation and termination of employees. A well-prepared job description should serve as a basis for interviewing candidates, orienting new employees and finally evaluating job performance. There are no outside companies that can provide you with “cookie-cutter” job descriptions that are sufficient for the dental business owner. Each job description should be customized by office and position to fit within the culture of the business and should be reviewed annually by the owner/human resource manager.

Key performance indicators (KPIs): There are more than 200 meaningful KPIs that should be measured on a monthly basis to evaluate the success of any dental business. Unfortunately, the concept of “what gets measured gets done” is neither taught nor discussed in the conventional dental school curriculum. Analogous to a metabolic chemistry panel used by our medical colleagues to determine a patient’s general health, the astute and informed business owner should learn to evaluate the overall “business health” of their respective practices through what I refer to as a “Business Panel 200.” The use of quantifiable metrics with recommended corrective action should be incorporated into every dental business in the country. The most predictable way to become successful in today’s dental economy is to maximize your productivity, increase your collections and implement proven systems that are guaranteed to produce excellent outcomes.

Location: There is no substitute for a well-researched dental office location, existing or new. The average neighborhood changes every 10 years, and it is incumbent for the dental practice executive to be familiar with the socioeconomics of his or her respective patient base. If your office is located in a poor location, it may be time to relocate your practice or change your business philosophy. The savvy businessperson will obtain a demographics site analysis ($400 to $500) every two to three years and evaluate the number and location of homeowners (by ZIP code and carrier route), apartment dwellers, dental competitors, traffic flow, average income per household, average number of household members, average age per household (baby boomers born between 1946–64 have more expendable income), insurance dependency and much more. For example, it is difficult for a practice built upon treating edentulous and geriatric patients to survive in a neighborhood saturated with young families with an average age of 35 and with three children per household. Your business philosophy (level of quality, service and price) needs to match your customer profile, or you may experience catastrophic results. It starts with knowing what your patients want and where they live.

Marketing: When most business owners think of marketing, they think of print media or print advertising. Historically, many dental business owners have turned to ink campaigns when they want to acquire new patients or increase their business volume. Unfortunately, print media results are the poorest and most expensive method in which to acquire quality new patients (QNP). I don’t wish to degrade or demean any advertising company. However, the data is irrefutable and the return on investment is predictably dismal. If you want to increase your QNP, then identify your existing quality patients (approximately 20 percent of your customer base) and create an internal system that empowers and rewards your employees when they ask for referrals. For example, during your morning huddles, each team member could select one or two patients for whom they are in rapport with and ask for a referral. Once your team is armed with learned active verbal skills (some call this scripting), your internal marketing outcomes will reign superior. The beauty of a well-trained team of professionals built upon five-star customer service is the superior results and benefits for all parties, including the consumer/patient. Too many dentists are attempting to compete on price, and this can be a recipe for disaster.

Remember, everything we do can be considered a marketing effort. The most successful and powerful marketing strategy begins with building rapport that leads to value, value that leads to trust, followed by trust that leads to increased case acceptance and QNP.

Number of new patients per month: A well-run dental business should expect to see an average increase in annual production and collections of at least 8–10 percent. In order to accomplish this, it is important to grow the patient base through acquisition of new patients, as well as with cohesive systems that lead to increased case acceptance. To offset the attrition/churn rate (departing patients), the average dental practice needs to acquire 25 to 30 QNP per month for a single clinician/single dental hygienist operation. Are you tracking this information? This is one of 200 KPIs that should be monitored monthly. Remember, diagnosis is the key to delivering beautiful clinical dentistry with excellent business outcomes.

Opportunity cost: Opportunity cost refers to the benefit that a person could have received, but gave up, to take another course of action (sometimes by doing nothing or the same thing over and over, expecting a different result). Stated differently, the opportunity cost of attempting to self-learn the business of dentistry may conservatively cost the owner $750,000 to $1,500,000 over a 25-year career and/or bankrupt the gifted dentist before he or she ever realizes what has happened.

Production: Production can be one of the most misleading KPIs and is routinely measured at full fee for service without taking into consideration insurance adjustments (by carrier and plan), marketing adjustments and numerous other adjustments. Adjustments are different from write-offs, yet in most instances, they are lumped together, resulting in inaccurate data that leads to an incorrect diagnosis and ultimately the wrong corrective action. All production adjustments should be separated by categories and reported accurately.

Quadrant dentistry: The majority of dental school curriculums teach single-tooth dentistry without regard for the well-being of the patient and/or dental businessperson. Unfortunately, most dental school programs lack the money, time or faculty to prepare new graduates for the business of dentistry, yet alone clinical competency. With that said, and through mentoring, most dentists can achieve their goals and objectives. A few of the benefits delivering quadrant dentistry include fewer appointments for the patient, increased production and collections for the business, increased cash flow, decreased burnout of all team members, decreased equipment and facility maintenance, fewer insurance claims, improved clinical outcomes and much more.

Stay tuned for the final post in this series, in which I will provide additional tips on how to increase your efficiencies while ultimately leading a balanced lifestyle.

Change is inevitable. It can be logical or forced. There are marvelous and gifted dentists and surgeons who have suffered tremendously as a result of insufficient knowledge in the business of dentistry. A comprehensive education in every aspect of your business is paramount. The business clinician who can master excellent business and clinical skills will always have a place providing wonderful dental care with reduced stress.

Duke Aldridge, DDS, MBA, MAGD, MIC

Tuesday, December 13, 2016

There Is No Plateau, Period

A few weekends ago, I had the pleasure of returning to Cleveland, Ohio, where I lived a few years back. (I like to forget the four years of dental school horror that paralleled those fun years in the snowbelt.) I was actually nearby for an orthodontics continuing education course and used the opportunity to recharge the batteries. And to no one’s surprise who knows me, I got some serious self-reflection and personal/professional growth opportunities out of it. Because that’s what I do.

After sneaking into the dental school to check out my old digs — and finding 20-plus students setting denture teeth on a Sunday afternoon (ah, yes, the horror; thank you, removable lab techs everywhere for your service to this profession!) — I pulled a last-minute self surprise and got a courtside ticket to see my beloved, World Champion Cleveland Cavaliers. I think that perma-grin on my face was the same one I had when I came down Christmas morning as a 5-year-old to find my first bicycle under the tree.

I got there 90 minutes before tipoff — just me and the security staff. And LeBron James. Yeah, that’s right. Playing three to four games a week and practicing daily with the team (not to mention his family, brand and entrepreneurial outlets) just wasn’t enough. He was out there sweating. Moving. Learning. Adjusting. Perfecting his craft. The guy who is one of highest performing individuals in any profession, period, was using what time he had before busting his butt for four quarters to work on a specific shot sequence. One after another, after another. Like clockwork. Once I picked my jaw off the floor at the size, skill and impressiveness of it all, I realized a couple things:

  1. James appears to be not OK with status quo. To him, there is no plateau, period. Sure, he was gifted with the genetics and innate strength and ability of a superhuman. But to see the focus and energy he put into a 45-minute shooting session was unreal. Most of his teammates came out close to game time, an hour later, and spent their time goofing off, playing “horse” with the ball boy or tossing underhanded heaves from half court. James was wearing headphones, grinding. It reminded me of the days in the office when we do much the same. I know I’m not OK with status quo. I hope and assume that many in my profession feel the same as well. Learn. Adjust. Perfect your craft. That’s partly what we took an oath on all those years ago as denture-setting dental students. Critique yourself, your work and your presentation skills. Your leadership methods. Spend your career doing it. Don’t ever stop. Hit the plateau, and set your sights on a brand new one. You, your team and your patients will be better for it. 
  2. James is still human. After the grind session, he was ready and willing to high-five every little kid whom he neared. Smiles. Fist bumps. He gets it. It’s all about connection in life, in everything, with everyone, even in dentistry — even more so in dentistry. Patients don’t come into my office asking to see my diploma or transcript from dental school. They don’t care which associations I’m a diplomate of. They want to know I’m going to take good care of them, to provide them with honest, affordable dentistry to the best of my ability, all while showing them respect not unlike being a part of my family. That’s it. It’s time we all see that. No more treatment planning by scaring someone into your professional superiority or speaking in a foreign language, basically, spitting out every bit of dental encyclopedia filler we know. Sit down face-to-face with your patients and learn about them as the people in your chair. Ask them open-ended questions: “Do you have family in town?”; “What do you do for a living?”; “What do you enjoy doing in your free time?”; “What truly matters to you in life?” Treat the person, not the disease. You, your team and your patients will be better for it. 

There are no plateaus, period. So keep grinding. And enjoy the process along the way.

Donald Murry III, DMD

Tuesday, December 6, 2016

Giving Back through Operation Bright Smiles

On Nov. 11, Veterans Day, my practice held its latest outreach event, Operation Bright Smiles. My staff and I opened our office doors with the intent of treating as many veterans as we could for free throughout the business day. You all may know that I have given back through Dentistry from the Heart for 10 years, but my staff and I felt like we needed a change. I think that organizing Operation Bright Smiles was also a creative way to re-energize my team members.

Before I go on, let me give you a bit of my backstory. I know some of you are avid readers of this blog and have been for a long time, but what you may not know is that I’ve had many people tell me I have a “servant’s heart.” I think what shaped me was watching my dad being active in Rotary Club when I was a kid. I also got my ability to talk to anyone from my mom. But the biggest impact on this was the promise I made while taking the Florida Board of Dentistry exam to become licensed. It was the most grueling test I had ever taken, and I said that if I successfully made it through the test, I would use my talents to serve. Well, I passed (you needed a three out of five to pass, and I got a 3.1), and thus the basis of this event and other initiatives I’ve participated in over the years was formed.

This is how the day went: The first person was in line at 4:30 a.m. My team arrived at the office at 5:30 a.m. and fired up the grill. Local restaurants donated food for volunteers, and both breakfast and lunch were served. We began to see patients (on a first-come, first-served basis) at 6:30 a.m.

By the time 9:30 a.m. came around, we had checked in 102 patients and were turning potential patients away. I have eight rooms in my office, and each one was filled with someone providing a service. Ten University of Central Florida pre-dental students and 10 vocational technology assistant students were on hand, along with 10 additional non-dental volunteers.

I also contacted a couple of removable labs to help with a possible flipper or denture repair. I talked with two endodontists who said they would do a couple of root canal treatments each if someone presented with that need.

Work was completed in shifts. Shifts were from 7–11 a.m. and noon to 4 p.m. During the break, everyone was able to have lunch together. My brother-in-law owns DJ equipment and was outside entertaining. My sister owns a hair salon, and she and a couple of her staff members were outside as well, cutting hair.

We cleaned, we filled, and we pulled for 10 hours straight, even through the shift change. We saw all 102 patients. We were exhausted, we were thrilled, and we were spent, but we were also thankful. I have never heard so many volunteers thanking patients in my life. I couldn’t tell who was more thankful to be there. 

In addition, the dentists, hygienists, hairstylists and cooks, as well as the DJ and oral surgeon, continued to tell me throughout the day that it was just great to be there. The patients were thankful, too.

Since the event, I have received more thank-you emails. I had a patient call in a couple of pizzas to be delivered to the office for lunch. Another patient came in with a homemade cheesecake. Others have sent thank-you cards.

Everyone is ready to chip in again next year. So, in about 360 days, look for another blog post, tentatively to be titled: “Recapping the Second Annual Operation Bright Smiles Event.”

John Gammichia, DMD, FAGD

Thursday, December 1, 2016

Taking Accountability as a Team Leader

If you’re anything like me, the past few weeks have been a whirlwind of catching pee. Yes, you read that correctly — catching pee. We’re in the middle of potty-training boot camp over here. So, no, maybe you haven’t had an equivalent couple of weeks. Then again, you never know. Oh well. I have your attention now, don’t I?

My business partners and I also have been nose-deep into projects at work. Beyond the second mesiobuccal canals and socket preservation grafts, we’re systematizing our entire operation. It’s way overdue but much needed. We are in (getting ready for) expansion mode, and as we sit back and evaluate where we are and where it is we’re going, it is becoming clear that we have a ton of work to do. To expand to more locations, or even just to increase the size or profitability of our single practice, it is absolutely necessary to have mastered basic systems and a flagship model to replicate. Though we are a successful and mostly efficient operation, there’s so much more to get done before we’re there. It’s a fun experience but a humbling one. It reminds me so much of the days/weeks/months and even first few years out of dental school — you don’t know what you don’t know!

For every little spicule of your practice operation you nail down, you uncover something deeper. I have the sneaking suspicion this trend will continue until the day I put down that handpiece —obviously, it will be wireless, solar-powered and self-sterilizing by then — for the last time. Heck, I hope the trend keeps up! It’s what provides us with the internal driving force to continue bettering ourselves, our staff and the service we provide for our patients. Why stop learning or trying to be better at every aspect of what we do? I, for one, never want to, and I hope you’re in agreement. Our job is no fun without a challenge (says 32-year-old me)!

But with this increased observation, calculation and tinkering, we must remind ourselves of something rather important: Leadership is required in making such adjustments to our (and our staff and patients’) way of life. What’s needed to ensure success is a similar leadership quality to monitoring a potty-training toddler. The first few times (days — heck, who am I kidding?) he relieves himself on the carpet, couch or cabinets, it’s not his fault; it’s my fault for not providing him with the knowledge, confidence and environment to do as he’s supposed to. Then, over the course of the next few days/weeks/years — after which I have empowered him with such ability and he chooses willingly to pee on the cat — it becomes his fault. And only then can I rightly correct him. He’s now accountable for his own actions. (Though the cat probably deserved it.)

The same goes for your staff members. If you want them tracking proposed and accepted treatment plans on a daily basis but have failed to show them how and have not given them the time to do so, or have neglected to explain how exactly you want these plans to be tracked, you have no one to blame but yourself. Similarly, if you have an employee who has been on the job for 60 days and forgets to turn off your porcelain oven over the weekend (phew, I’m a lucky man on that one; that could have been bad), you better not come in Monday morning yelling at her. Instead, note the importance of turning off the oven and how to do this in your operations manual, schedule a five-minute workshop with your assistants to show all of them how to turn it off and assign the daily duty to a specific individual. Ask your staff members to sign off that they understand how to turn off the oven. Then, and only then, are they accountable for their actions and, as such, are now fair game to be coached appropriately.

I implore you (I am doubly speaking to myself) to look at yourself — and at your practice, per se — “in the mirror,” not “through a window.” In other words, make sure that you’re holding yourself accountable for the actions of others because you’re their leader.

First off, doing this hopefully will prevent the ever-present angry dentist moments that your staff dislikes. But also, it will give you a chance to reflect on yourself as a leader and how you’ve set your team up for success in everything it does. You can prep the prettiest crown, torque in an implant your oral surgeon would be proud of or straighten the worst set of chompers ever, but if you can’t lead effectively, you’re doomed.

Donald Murry III, DMD

Wednesday, November 23, 2016

Is the Specialty of Orthodontics Dying?

Has anyone else heard that the specialty of orthodontics is dying?

I was speaking to my local orthodontists, and they introduced me to this idea: Clear aligners have changed everything. Whether you love them or not, you can’t deny that they are the wave of the future (if not already the wave of the present). At the very least, they are not disappearing anytime soon. 

Why would clear aligners kill the specialty of orthodontics? Quite simply, because in the majority of cases, technology has advanced to the point that you no longer need your local orthodontist to complete the case. In other words, advanced software has made it so that you — the general dentist — can treat most cases.

To describe the technique simply, the general dentist can take all impressions and records. You submit the case. The manufacturer’s team of orthodontists and technicians evaluate and treatment plan the case. They manufacture the needed trays. Then, finally, you deliver the clear aligners to your patient. All orthodontic considerations have been addressed by the manufacturer’s orthodontists and technicians using their software. What is missing from the scenario? Your local orthodontist.

One of the cornerstones of a dental practice is that only the doctor can diagnose each case. But that does not mean that you have to diagnose alone. What if you had a team of orthodontists diagnosing along with you? Let’s assume for a moment that this team of orthodontists knows more about orthodontics than you do. Additionally, the team members use a computer database containing hundreds of thousands of completed cases (maybe even over a million). This is the kind of support that enables you to complete many cases yourself.

Remember, these are the same steps your orthodontist performs when he or she uses clear aligners.

It is no secret that general dentists already perform more orthodontic procedures than ever before. Not only are clear aligners being used, but other, relatively fast orthodontic techniques are available to the general dentist as well. In short, those who choose to treat orthodontic cases have several options. You may not like some of those techniques, but there is no questioning that they have simplified orthodontic treatment for the general dentist.

How do patients feel about all of this? Well, I’ll let you in on a little-known secret: Patients don’t like to wear braces, so the acceptance rate for clear aligners is quite high. As for the final result, I have heard that the vast majority of patients are satisfied with the final outcome. Not everyone, but the vast majority. Of course, any orthodontist can tell you this is the same for conventional braces placed by a specialist.

It’s ironic, isn’t it, that the first recognized dental specialty may be the first to become obsolete?

Another point to consider. For those of you who use CAD/CAM to make crowns, you’ve already eliminated the role of the dental lab tech. Now orthodontists. Who’s next?

Andy Alas, DDS

Wednesday, November 16, 2016

The ABCs of a Successful Dental Practice (Part 1 of 3)

Unless you graduated with a finance, accounting or human resources degree, the operations and financial requirements required to run a successful business in today’s economy may seem daunting to you. You are not alone. I believe that the dental school curriculums have failed the “business dentist,” and way too many excellent clinicians have suffered as a result thereof. 

There are myriad systems, processes and strategies required to run a successful business. During part 1 of this blog series, I have taken the opportunity to provide a snapshot of the ABCs of a successful dental practice.

Analytics: Never underestimate analytics. If you are not evaluating your numbers on a monthly basis, you are undervaluing your career investment and probably leaving $500,000 to $1,500,000 on the table.

Business: Knowledge is power, and you owe it to yourself to take the time to increase your business acumen. For example, do you know what key performance indicators (KPIs) should be monitored on a monthly basis? If not, take the time and learn so you are equipped with the necessary information for the balance of your career.

Consultant: More than 90 percent of dentists could reap substantial benefits if they hired a mentor/dental analyst who has “walked in their shoes” as a clinician and business owner. Choose wisely, as your return on investment should net you 10 times their fees.

Dental hygiene: In the average general practice, the hygienist should account for 25–33 percent of your daily production.

Demographics: A well-prepared demographics study incorporates your patient’s average age, income, the number of children per household and your patient’s education level. It also incorporates the number of homeowners, apartment-dwellers, the location of the competition, and estimated five- and 10-year growth by carrier route.

Embezzlement: Don’t think it can’t happen to you. Do you have a foolproof system to ensure your day sheets are equal to your deposits? In the banking business, the teller doesn’t go home until he or she balances to the penny. How about looking into the backgrounds your front office personnel who are responsible for your money?

First impressions: More than 90 percent of new patients will formulate an opinion based upon their first impression. Is your office in order? Do you inspect your office weekly? Do you check out the windows, ceiling tiles, restrooms, uniforms, employee hygiene, dental lights, baseboards, floors, plants, etc.? I recommend that next week, you take a few minutes to lay in each dental chair and ask yourself, “What does the patient see?” Are there improvements that can be made? Maybe you and your team can develop a list at your next monthly meeting.

Growth: Conservatively, your business should be growing 5–8 percent per year. If you are not, then get help. You need a diagnosis by someone other than yourself to develop a business treatment plan before it is too late. Turn to an expert who has walked in your shoes

Handoffs: For continuity of care, it is imperative that your entire team understands the importance of mastering patient “handoffs,” or a transfer of responsibility to convert the case for the patient’s and team’s benefit. Just like a football team that practices the “down and out,” your personnel should master the “handoff” or transfer of information from one team member to the next. If you don’t know how to perfect this communication technique, then get help. If you want to operate at the highest level while providing the highest level of customer service, it is imperative that this responsibility is cohesively shared by all.

Intraoral cameras: If you and your dental hygienist are not using intraoral cameras with big-screen monitors on every patient, you are doing yourself, your team and the patient a disservice. When you incorporate intraoral cameras on a regular basis, your case acceptance will soar. Intraoral cameras, large screen monitors, co-diagnosis (“What do you see on the screen, Mrs. Jones?”) and printed color pictures of the patient’s dentition (your recommendations) will move more dentistry than the best clinical treatment you can ever provide. The visual component elicits emotion, and emotion is how the consumer/patient makes his or her buying decision. There are more than 40 uses for the intraoral camera.

Stay tuned for next month’s part 2, in which I will look at additional tips that can be incorporated as a checklist of how to improve your dental practice/business. Change is inevitable. It can be logical or forced. I have seen way too many colleagues fail to heed the above recommendations while continuing to resist change, ultimately committed to doing the same thing over and over expecting a different outcome. It is OK to seek guidance from experts in the “business of dentistry” and from those who have “walked in your shoes.” After all, we don’t hesitate to enroll in clinical continuing education programs.

A comprehensive knowledge of every aspect of your business is paramount. The business clinician who can master excellent business and clinical skills will always have a place providing wonderful dental care with reduced stress and a balanced lifestyle.

Duke Aldridge DDS, MBA, MAGD

Monday, November 14, 2016

The Importance of an Accurate Dental Claim Form

The claim form (dental or medical) is a legal document, just like any document presented to a bank, a court or a mortgage company. It is vitally important that the doctor who provides the treatment, and the person who prepares the claim form to submit to the carrier for reimbursement, understands the claim form must accurately represent who received the care, who provided the care, the services provided using the most accurate code currently available from the CDT or ICD-10, and the fee that will be accepted as payment in full for the services provided … as well as several other things.

The bottom line is that everything on that claim form must be accurate. Having dealt with several questions from doctors and their business staffs, the one question that always sends chills up my spine is: “How can we get around this?” They question this as if there are shortcuts or some mystical way to be reimbursed more than is possible given the policy’s restrictions and limitations. Reimbursement for treatment provided hinges on the condition being treated and the coding that best describes the service provided, nothing else … certainly not what the carrier will reimburse. The doctor and staff need to completely and thoroughly understand the codes and how they are to be applied. The team must also realize that just because a code exists to describe a service provided, it may not be paid by the carrier due to limitations and restrictions established by that specific plan.

Ignorance is no excuse; ask a dentist who is also a convicted felon about the ignorance defense. Code for what you do, no more and no less. Do it accurately using the best code to describe the service provided and report the fee that represents what you will accept as payment in full for the service provided. This practice policy will protect and defend you every time.

Roy S. Shelburne, DDS

Interested in learning more about coding? Register for the Dental to Medical Cross Coding Webinar Series, available for purchase in the AGD Online Learning Center.

Friday, November 11, 2016

A Triage Training Exercise

We were abruptly awoken from our sleep in the middle of the night. We were needed near the front — and fast. Our mobile dental clinics were designed to be packed up and moved in less than 30 minutes, and we were soon on the road. My dental assistant driving, I was navigating us to our destination of the Field Ambulance hospital.

Attack helicopters and A10 Warthog tactical attack planes were circling overhead in the distance, firing on the enemy as we rumbled over and around rolling, sandy hills. Then we heard a series of bang-puff sounds, like the sound a bag of flour makes when it hits the floor and releases all of its contents. We looked at each other with that knowing fear and immediately put on our gas masks.

We arrived at our destination, and our fears were confirmed. The enemy, losing the battle, deployed chemical weapons in desperation. We were ordered to get into our safety environmental suits, which we did without hesitation. We were briefed about what had happened and what we were to do, but we already knew what our roles would be.

Earlier that year, we had received training on what we would do in a chemical warfare environment. With our extensive general medical knowledge and expertise in the orofacial region, I was to be deployed outside the surgical tents, receiving the incoming soldiers and civilians (collateral damage), and be in charge of triage. I would be the primary dentist deciding who we could save now, who could safely wait while more urgent injuries were cared for and who we would be unable to save. The sweat of anticipation and fear built up rapidly across my forehead.

We did not have to wait long before they came in waves. At first, it was primarily soldiers who came in. The damage was ghastly. But our roles were critically important, and you just focused on the role, knowing that you were saving lives. We injected narcotic pain killers in those who were in great pain. No sooner than we would clear the area of the injured to be treated when more arrived. Eventually, as the hours wore on, some civilian victims caught in the battle, made it to our field hospital, and we treated all who came.

Six hours later, the flow of incoming people stopped. It was “over” for now. We went to the decontamination area, where we undressed, showered, cleaned and put on fresh clothes. Exhausted, thirsty and hungry, we made our way over to the command center for our debrief.

In the weeks after Iraq had invaded Kuwait, and a growing fear that the world would intervene in what was later known as the First Gulf War, we were busily preparing for the worst. Everyone knew how Iraq and Iran had used chemical weapons in the recent past, sometimes on their own people. We did not want to be caught unaware.

The story above describes a practical training exercise, a very realistic one. The images of those hours haunted my thoughts and my dreams for months afterward, and in my case, no one was really hurt. It was all amazing makeup, props and acting. But we performed well, and if the real thing had happened, we would have been ready to do our best to save as many people as possible. I am thankful and grateful this scenario never came to be.

To this day, in Canada, in the United States and around the world, our defense organizations work hard to prepare their personnel to be able to ensure we continue to be free. In the past, millions of men and women have fought and paid the ultimate sacrifice so that we may enjoy the freedoms we have today. In Canada, on Remembrance Day, at the 11th hour of the 11th day of the 11th month, we will remember them.

May the scenario told above never happen. May we continue to enjoy our freedom. And let us all show our gratitude that we live in a perfectly imperfect democracy that works hard to ensure we remain free.

Larry Stanleigh, BSc, MSc, DDS, FICD, FADI, FACD, FPFA


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