Thursday, October 31, 2013

Video shoot for the SSC symposium in Jan.

Dr. Akin representing The CSC. The video will run during the SSC symposium in January. 

Monday, October 28, 2013

Getting pricey! The high costs of discounts and courtesies

By Rhonda R. Savage, DDS

Dr. Sam Stevens had a heart of gold. He loved working with his patients and really disliked having to deliver bad news. One day, his long-time patient, Fred Simms, came in for an emergency appointment. He’d broken a tooth and desperately needed a buildup and a crown. Dr. Stevens said, “Fred, we’ll just do this for you for $800, instead of our normal fee of $1,200.” In the next operatory, Vanessa, in the chair to get her crown done, heard the comment. She’d saved for seven months to afford the crown. She turned to the assistant and indignantly said, “Really?! What about me?” 

Having practiced for 16 years, I know that doctors can let their “nice gene” get in the way of patients’ financial arrangements. It’s important to realize, however, that if patients compare notes, they’ll have hurt feelings. In addition, the routine extension of courtesies and discounts can affect your bottom line.

How can giving away dentistry affect your bottom line? 

Here’s an old study by Eastman-Kodak:

If you’ve ever wondered how much your business must increase in order to keep an even keel after cutting prices, here are some figures from Eastman-Kodak’s research department:

Assuming an anticipated profit of 25% (or a 75% overhead) on selling price, a 2% cut in that selling price means you must increase your volume of sales by 8.7% to make the same profit obtained before the price was lowered.

A 3% cut means a 13.6% increase in sales is necessary.
A 5% cut means a 25% increase in sales is necessary.
A 7.5% cut means a 42.8% increase in sales is necessary.
A 10% cut means a 67% increase in sales is necessary.
A 15% cut means a 150% increase in sales is necessary.
A 20 % cut means a 400% increase in sales is necessary.

To reverse the process, or increase prices:

A 3% increase means the same profit on 90% of sales volume.
A 5% increase means the same profit on 83.5% of sales volume.
A 7.5% increase means the same profit on 77% of sales volume.
A 10% increase means the same profit on 71% of sales volume.
A 15% increase means the same profit on 62.5% of sales volume.
A 20% increase means the same profit on 55.5% of sales volume.

These calculations didn’t make a lot of sense to me early in practice. Over time, I realized the cost associated with courtesies is high because of the associated fixed and variable overhead costs, which continue marching along. You can’t assume that if you do 5% more dentistry, you’ll make up for a 5% courtesy. Will it cost you the 20% off your net? 

Not necessarily so. This depends upon your mix of services, the laboratory you choose to use, or if you do your porcelain in-house with CEREC or E4D. Other expenses vary from practice to practice: staff overhead, fixed costs, and your ability to be efficient with your production (quadrant dentistry or treatment in multiples). Practices that take Medicaid patients and/or participate in PPOs can be profitable; it’s important to consider the courtesies, however, as they can impact the bottom line.

Do you have an office policy regarding discounts or courtesies?
If you’re accepting PPO reimbursement, or the patient is paying with CareCredit or a credit card, Miles Global does not recommend extending a courtesy. Instead, consider offering courtesies to a senior or other patients at an even more reduced rate (2-3% courtesy), if at all. 

We recommend no more than a 5% courtesy for patients across the board, if they pay with cash or are seniors paying cash. 

However, many doctors do not offer a cash courtesy and their patients still schedule for treatment.

Patients accept your recommendations because of the verbal skills of the entire team. Does your patient hear a consistent message throughout the office? Do you create value at the time of diagnosis? Does the patient understand the advantages of the treatment and the disadvantages if the patient postpones? Are you focused on verbal skill training? Can the staff talk for the doctors? 

To train your team, consider obtaining our Verbal Cue cards and Linda Miles’ book, Dynamic Dentistry. Best yet, consider ateam retreat with Miles Global on the beautiful Royal Caribbean line, March 22-26th, 2012, and learn from the master of verbal skills, Linda L. Miles!

Verbal skills, connecting with the patient, and excellent case presentation are incredibly important, but let’s focus on courtesies and discounts.

Does a courtesy increase case acceptance? For some patients, especially in this economy, a discount can incentivize the patient to schedule and complete treatment earlier. To create a sense of urgency, let the patient know that the fee and courtesy are valid for the next three or six months only. 

There are a number of areas you need to consider within this topic:

1. Be careful: If you’re in contract with an insurance company, you may be contractually obligated to extend the same courtesy to the insurance company.

2. We see kind-hearted dentists getting involved with courtesies, discounts, and giveaway dentistry, even to those patients who can afford it. With this situation, staff thinks: “Great, there goes my raise (or bonus).” This is especially true if the team isn’t getting raises or reaching the bonus level. If this is the case, resentment builds as well as frustration. Morale will go down, and with that, productivity.

I find employees love to give, but consider asking them to help select families in need and give to those families. 

3. If you’re in a partnership relationship, I recommend setting a cap on the “giving” because one dentist, who gives a bunch away, affects the bottom line of the practice. Resentment builds in the partnership and staff/patients feel the tension. I enjoy facilitating communication between partners as well as working with solo dentists in these matters, and we do this often. Our goal is to increase productivity, efficiency, communication, and morale in the office.

4. Back to courtesies: Rather than a percentage, consider a lump sum discount. As an example, for a $10,000+ case, allow your front staff to offer a $500 courtesy if they pay cash or upfront. If the case is $1,000, offer a $20-$50 courtesy. Have a courtesy/discount policy in writing at the front desk and let them handle it!

Doctors: Don’t talk finances at the chair. Is it time to turn off your “nice gene”? With all due respect, I recommend you pass this responsibility to your experts at the front desk. 

If the patient asks about a courtesy or a discount, say, “Fred, my expert at the front desk takes care of all of this. I know just enough to be dangerous, especially with finances and insurance. Did you know there are over 3,000 insurance plans out there? Sarah, up front, can help you with these arrangements.” Fred responds, “Sure, Doc, but if I pay cash, can I get a discount?” To which you say, “Fred, Sarah will help you with this. She’s our expert and knows all about the finances. If I talk about it, I do it wrong and get into trouble! She’ll get you all taken care of.”

Is it time to look at the practice with a fresh set of eyes? Run a full adjustment report and have a frank discussion as a team about the office financial policies. As with any change process, it will most likely be three steps forward and two steps back. Agree to be coachable and allow others to say, “Gee, Doc, you’re falling back into old habits again.” The doctor’s job: Say, “Thank you. I’ll try to do better!” 

The bottom line: Routinely giving away dentistry and/or discounted dentistry can hurt your bottom line!

Monday, August 26, 2013

“What Should Our Hygiene Production Goal Be?”

When I start working with a new client, I start by analyzing their dental hygiene business and provide an overview of what their opportunity for growth is.  One of the main questions I get from these clients is:  “How do you determine what our Hygiene Production goals should be?”  I have found most dental practices will set a random number on what they feel is in line with industry standards. However, these industry standards are usually based on inconsistent data. For example: The industry standards do not take into consideration if there are different fee schedules, or if the numbers are based on the gross revenue vs. adjusted revenue. Also consider, some offices do not credit the hygiene team with the same procedures as the others.

Your hygiene production goals need to be based on the needs of your specific practice, and your practice alone. And keep in mind, you can use industry information as a comparison; but it is important to understand the variables that exist behind those figures.

Here is the simplest way to figure out your Hygiene Production Goals.  In fact, I would encourage you to develop your annual plan based on these figures, so you can ensure you are targeting the right goals each day, week and month.

What is the breakeven point for hygiene?  Your breakeven point is what you need your hygiene team to produce each month to cover your hygiene overhead, and provide a 30% profit margin.  As you may recall from my earlier blogs, your hygiene team should produce 3-3.5 times their salary and benefits.  With that being said, the easiest ways to figure out your break-even amount is to take your hygiene compensation, plus the all benefits paid to your hygiene team; and then multiply that total by 3.5. If you are unsure of the amount of benefits paid, you can estimate it is around 20% of your total hygiene compensation.  (20% is based on the current benefit trends found in most dental groups across the country.)

Here is an example:

You pay your dental hygienist $40/hour.  In September, she will work 8 hours/day for 20 days; making her total compensation $6400/for the month.  If you add in benefits at 20%; your total hygiene compensation and benefit expense will be $7680.

Now, take your total hygiene expense $7680 and multiply it by 3.5.  This will provide you the total revenue needed to provide a break even, yet profitable margin for your practice.  In this example, this hygienist must produce a minimum of $26,880, or $168.00/hour. 

Please note, the $26,880 needs to be the money youcan collect.  This is especially important for the groups that accept multiple PPO plans.

Look at historical data.  Once you have your breakeven or baseline production goal identified, you should look at your production trends from the past year.  If your hygiene team is producing above your break-even point, then you will rely on your historical data. 

I like to look at the previous calendar year when looking at historical data.  As you know, there are certain months that trend lower than others; and this data is extremely helpful in setting realistic goals.

Set your goals with a little stretch.  In fact, I would encourage you to plan for a minimum 3% organic growth each year.  This growth should not include the fee schedule increase.  But it may include an increase in hours, and of course production per hour.

Taking time to set accurate and meaningful production goals for your hygiene team will help you confidently hold your team accountable for what you know the business needs.  Remember, hygiene is intended to bring you a healthy profit margin to your practice.

Need help setting your production goals?   Please email to set up a strategy call.

Monday, August 12, 2013

Newest Member of the Capital Study Club Extended Family!

Megan Avery Paige

Dr. Mike Montalbano sent along information on this local LVI event. This is an opportunity to learn more about neuromuscular dentistry right here in Baton Rouge.  

Monday, July 29, 2013

Systems for success: Five ways to manage overheads

Dr Roger P Levin shares his top tips on how to keep expenses and other dental practice costs at a minimum



In a slow economy, sound financial management can be the difference between a profitable dental practice and a struggling one. Uncontrolled overhead, such as expenses and other costs, can devastate a practice’s cashflow. Dentists spend most of their time providing patient care, so it can be difficult for them to know when expenses — salaries, supplies, rent, insurance etc — are exceptionally high. Excessive overhead not only jeopardises the success of the dental practice, but threatens the financial security of the dentist as well.
The proper analytical tools can make dentists aware of correctable deficiencies before they turn into major problems. Levin Group recommends the use of key practice indicators (KPIs) to monitor the health of the practice. Overhead is a critical KPI that should be reviewed weekly to see if the practice is on track to meet its financial goals.
By using KPIs, dentists have the ability to look closely at their practice’s overhead, monitor expenses and make decisions on how to drive profitability. A practice with well-controlled overhead can focus on increasing its cashflow from production. No matter how many times practices cut expenses, overhead always seems to creep back up. Levin Group recommends these five tips for managing overhead.

1. Follow where the money goes
Practices need to track collections, purchases and expenses — from staff salaries to dental supplies — preferably through accounting software. Record how much the practice spends in each overhead category every month. Following a budget brings discipline to financial decision making. When offices fail to track expenses, cash tends to disappear. Dentists who budget their expenses control their overhead and achieve better financial results.

2. Take inventory
Do you know your current level of supplies? When was the last time a staff member took inventory of all supply closets? By taking stock of materials, many practices discover extra supplies that will carry them for months. By reviewing inventory on a semi-annual basis, a practice can maintain a steady stream of supplies, avoid overages and shortages, and exercise stronger control over expenses.

3. Order supplies as needed
Automatic ordering of supplies can lead to inefficiency, misuse of office space and outright waste. For example, a year’s supply of gauze pads gathering dust in a storeroom is not helping the practice provide better quality of care. In fact, unused inventory decreases the practice’s cashflow and may hinder the dentist from making necessary purchases.

4. Benchmark performance
What supplies did the practice use in the previous years? What was the practice production and how did it affect the use of inventory? Will this year’s performance surpass last year’s? Benchmarking against past performance and using KPIs can help the practice accurately order required supplies.

5. Collect 99% of fees
Overdue account receivables siphon cashflow and profitability away from the practice. Dental practices deserve to be paid for the work they perform. Instituting an effective collection system maintains a practice’s financial viability.
The following protocols will help practices reach the 99% target:
• Collect initial payment upfront. This prevents collections problems from arising and reduces the need for billing patients later. Train front desk personnel to ask for payment before patients leave the office.  
• Follow any payment schedules exactly. If patients are unable to abide by their payment agreements, treatment should be postponed. This may sound harsh, but patients who complete treatment without making payments become major collection headaches.
• Provide several financial options. Present several payment alternatives, such as cash, credit card and outside financing. You want patients to be completely aware of all options, especially outside financing during a recession.

Overhead is a necessary part of running a practice, but eliminating unnecessary expenses can ensure the practice’s financial health. Many dentists and their teams fail to look at overhead as an opportunity to reduce costs and improve financial performance. These five tips can help your practice control overhead, manage expenses and increase profitability.

Thursday, July 25, 2013

Does your practice have" Emotional Intelligence"?

Dentistry has seen a significant shift in how the different generations make decisions about their dental care. We have moved from the days of Doctor telling the patient they “have “a problem and “need” a procedure to fix it to the Traditionalist (born between 1922-1946) who respected the Dr. and they said yes based on respect for the expert.

Today we have Baby boomers who are the “me” generation always needing to know whets in it for them and make sure the value is there before they say yes…. to Gen X--latch key kids who demand to be involved in why they need it and say yes based on emotion more than logic, to Gen Y patients who expect “instant results”. Adapting to the generational diversity of the patient base accepting that all of them expect to be shown how the dentistry fits into their life. Today’s thriving dental practices realize that 85% of their success with patient loyalty, patient referrals, patient longevity and case acceptance are based on their team’s “emotional intelligence” and how they relate and connect with people. 15% is based on the actual technical ability or skill.

Our social and emotional intelligence is comprised of our understanding of our own self in how we relate to people combined with the ability and tools for reading others. We use the mixture of many tools in our dealings with people and our relationships are driven by how we handle our words which make up 10% ,our tone of voice which is 30% of a message and our non verbal body language which comprised the majority of our message or listening.

Today’s column is the first of a multi part series on Emotional Intelligence in the dental practice. Today we will cover Body language and the power of positioning in seating for you to achieve optimal connection for one more YES from your patients. A lot of unnecessary friction is created in team and patient situations due to lack of thought about seating and body positions.
The 'science' of where people sit in relation to each other, and on what and around what, is fascinating and simple for the dental team to adapt to. Below are a few guidelines of sitting position, table choice, and the power of changing your check out options and adding or using a consult room for private case presentations.
Clinically, sitting the patient up when communication is needed or requested deepens their trust for you. Sit at equal level, knee to knee, eye to eye to get them to open up and learn more about them. It also will cause them to retain more of what is said and show the importance of your message. Always sit them up for explaining their exam or a procedure in response to their question.
Administratively, the ideal is to have a sit down place for the 3-5 minute check out with a low desk for writing and paper work. This causes the patient to not leave without checking out and a chance to discuss their visit in the clinic and answer their simple questions.
The other option is to have a private consult room for patients of major need who need further discussion or financial arrangement’s in private. They will be more open with you, share their objections which you need to know and make better decisions when their privacy and care is honored. It makes them feel their needs are important enough for you to take the time and not rush them.
How we sit is important as well to make them feel comfortable and creates a cooperative environment. Sit at a diagonal angle of approx 45 degrees to them for all conversation. If there are challenges due to f equipment, furniture or available space. An angle between these two extremes is best - somewhere in the range of 30-60 degrees technically speaking. Be careful with “standing over them” or “talking down toward them” or speaking when you are not looking at them. This will create barriers to rapport and sometimes cause irritation or tension.
Make sure your eye contact is not a STARE but a easy movement of your eyes moving from their left eyebrow to their right down to their chin in a triangle motion. This makes them feel at ease with you and they won’t feel intimidated or judged and shut down the connection. Make sure your arms are open and not crossed to show openness, smile the entire time and keep your face neutral with non judgmental expressions when they offer their story or information.
Be aware of personal space when pulling your chair up to theirs. Do not sit so close together that personal space will be invaded. Conversely sitting too far apart will prevent building feelings of trust and open private/personal discussion.
Round tables are better than square or oblong tables for one on one meetings. Obviously this works well because no-one is at the head of the table, which promotes a feeling of equality The term 'round table' has come to symbolize partnership, collaboration and fairness, etc., for a long time. Theory suggests that when someone sits around a table the person sitting on the right will generally be the most open and aligned to the speaker.
These communication tools seem simple but are extremely neglected in the dental practice for many reason. Take the few minutes to think, plan and practice new positions and assess if your patients are responding differently. Stay tuned for the next series on the Eliminating Jargon for clear communication about dentistry.