July 22, 2014

Is The Answer Right Before Your Eyes?

Filed under: Uncategorized — Mayer A. Levitt, DMD @ 6:25 am

A few months ago, I started polling my clients about the number of patients in their practice who had dental insurance. Typically that answer was 75-80%. A recent article estimates that only 62% of Americans have some kind of dental insurance benefit. Based on that information, why is it that more patients in your practice are not fee for service?  Very simply–the perception on Main Street  is that you can’t afford to go to the dentist unless you have dental insurance.

I further requested clients to total the number of “big ticket” items (crowns, root canals, implants, etc.) performed in their practice for the last 18 months. I then asked to know how many of those procedures were performed on patients with insurance–and how did that number compare to the overall percentage of patients in the practice who have dental insurance.

Without exception–in every practice–the number of big ticket items done on insurance patients was way out of proportion. In other words, if a typical ratio would be that 75% of the patients had insurance, almost 90% of these major procedures were done on insurance patients. So although dentists are always bemoaning the “write-offs” between their published fee and the fee they receive as an in-network provider, the results clearly show that it is a lot easier to “sell” a Delta crown than a fee-for-service crown.

I have come to the following conclusions:

1. You would do more big-ticket items and more comprehensive restorative treatment for your current fee-for-service patients if they perceived that they had a better deal–a little help with the cost.

2. You would – with a consistent marketing effort – attract more fee-for-service patients from the general population if they knew that your practice had a better plan for them.

3. You should seriously consider an in-house dental membership plan.

In my next post, I will discuss the logistics of how to introduce such a plan into your practice.

 

July 8, 2014

Time to Take Action

Filed under: Uncategorized — Mayer A. Levitt, DMD @ 6:00 am

My most recent blog post referenced privacy and security actions that are necessary for a dental practice to implement in order to be compliant with the 2013 Omnibus Final Rule. That rule is scalable and flexible based on the size of the business. But knowing exactly what is necessary for your dental practice has created tremendous angst,  uncertainty and confusion in the profession.

I feel that the biggest liability for a dental practice is cyber theft. If someone breaks into your office and steals a laptop or a cell phone, under the Omnibus Rule, this will trigger a series of events. If over 500 names are in the computer, you are required by law to notify the local media and have your practice listed on the Health and Human Services website. You also have to notify every patient in your practice in writing about the possible loss of Social Security numbers and credit card numbers and other protected health information. This undoubtedly leads to many unhappy and angry patients and damage to your reputation. The economic fallout to your practice is potentially catastrophic. That is the bad news.

The good news is that if your data is encrypted, and that same breaking and entry and theft occurred, you are now exempt from the Breach Notification Rules. So to protect yourself, you must have sophisticated and coordinated systems in place including but not limited to the following.

• Encrypted practice management software.

•Encrypted email. Even if your computer is secure, your e-mail message passes through dozens of unknown servers en route to its destination.

• Staff training on the proper methods of data disposal and data protection.

• Understanding special rules for fax machines.

• Secure credit card systems. Credit card terminals must be PCIDSS (payment card industry data security standard). In order to meet those standards, you must have both a software and hardware firewall that needs to be configured properly to prevent data from being compromised.

• Business associate agreements. You need agreements in place with any vendors with whom you do business that have access to your protected health information. This is  essentially an agreement with any third-party service provider that will indemnify you – the covered entity – from liability based on their negligence. That agreement might also require the third party to have a certain level of cyber liability insurance.

• IT support. You will need significant support from your information technology team to assist in all of these technical requirements for compliance.

For most of us, trying to do all of the above is just  not possible. I would like to recommend two companies that have the expertise and the experience and the programs in place to guide you on a journey to becoming HIPAA compliant.  Both of these companies work remotely and have costs that are quite reasonable. Eric Simmons is a HIPAA Security Analyst at SecurityMetrics located in Orem, Utah. His direct telephone number is 801-995-6366. Dr. Lorne Lavine is the founder of The Digital Dentist located in Burbank, California, and is a Certified HIPAA Security Professional. Lorne can be reached at 866-204-3398 X 200.

Please open the links that I have included for both companies and read the material. I suggest that you then call each of these companies and listen to their approach. Then  make the decision on how to proceed. You absolutely can’t afford to drag your heels and put your head in the sand on an issue of such great importance.

 

June 24, 2014

Painful but Necessary

Filed under: Uncategorized — Mayer A. Levitt, DMD @ 7:58 am

HIPAA is a federal mandate first introduced in 1996 that requires a health care organization to keep patient data secure. As a dental office that stores, processes, transmits and receives, and maintains protected health information, you must be compliant with the mandate. Over the past 17 years, there have been many iterations and modifications to the original mandate. The culmination of these changes is called The 2013 HIPPA Omnibus Final Rule and was enacted in January 2013. This rule enhances a patient’s privacy protections, provides individuals new rights to their health information, strengthens the government’s ability to enforce the law, and increases penalties for security violations. The deadline to comply was September 2013.

Compliance requires a number of privacy and security actions including, but not limited to, completing what is called a risk analysis, creating a risk management plan, continuous employee training, and the implementation of updated policies and procedures. It is all pretty daunting for the typical small business. You can get dizzy and overwhelmed just trying to follow all the rules and understand what is required -never mind implementing solutions and systems.

What has prompted me to write about this topic is that I am finding in my conversations and meetings with clients that not one single office has taken ALL of the major required steps to be in compliance. The Department of Health and Human  Services (HHS) Office for Civil Rights (OCR) is the federal agency responsible for enforcing HIPAA compliance. These people take their job very seriously. If you are found in violation of HIPAA, you could be assessed large fees. I am reading about fines of $25,000 to $50,000 per day!! That can put you out of business! And if your lack of compliance leads to a security breach, the fines will be even larger.

The bottom line here is that you can’t afford to be complacent about the potential economic disaster that would result from an audit or a breach. Under the Final Rule, the general presumption is that any improper use or disclosure of protected health information (PHI) is a breach UNLESS the covered entity (your dental practice) can show that there is a low probability that the PHI has been compromised. In other words, your are essentially guilty until proven innocent.

The word is that the OCR is performing 1200 random audits a year. Computers can get stolen from your office. Back up discs or tapes somehow disappear or get lost. A disgruntled employee or patient can become a whistle blower.  Your financial exposure as a dentist could be enormous.

In my next post, based on my research, I will offer advice on where you can find reliable and professional help at a modest cost.

June 10, 2014

The Dreaded Request

Filed under: Uncategorized — Mayer A. Levitt, DMD @ 6:39 am

We have all experienced this. “Doctor – could I speak with you for a few minutes at the end of the day?” A valuable and talented team member wants to tell you something in private. Nothing good can happen from this! And sure enough, you find out that because a husband got a promotion, or a new grandchild is being born to a single mom four states away, or an elderly parent needs a caregiver, this great employee – one of the cornerstones of your dental practice – is leaving town.

As I have written many times before, in my experience, the most difficult challenge in dentistry – or any business for that matter – is to keep intact a quality, loyal, caring, and customer service oriented team. All these moving parts running seamlessly and effectively is the engine that powers a successful organization. So even though this soon to be departing staff member has graciously agreed to stay on for three weeks before leaving, it is very possible that her replacement will not have been identified and hired. Thus all of her knowledge and experience and special systems will not be able to be transferred.

Over the years, I have found that an effective solution to this situation is to create a video training manual for every position in the practice. I think it is most beneficial for the front desk. Doctors are able to train dental assistants and hygienists fairly easily because they work closely together in the back/clinical side of the office. But doctors are often quite uninformed about the intricacies of what is supposed to happen on the administrative end.

So let’s make a video in front of the computer showing how to begin the day, how to close the day, how to interact with a Patient Activator or Demand Force dashboard, how to post payments from a big insurance check, how to calculate insurance write offs, how to make adjustments, how to back up data, how to make financial arrangements on treatment plans, how to follow up on overdue insurance payments, how to print out daily/weekly/ monthly reports, etc, etc. The list is extensive to say the least. When that next front desk person is hired, I think that you can see how much easier it will be to get her up to speed on how all of  these various functions are performed in your office. No guess work – just watch to learn exactly how to perform each and every task. The same principles can be utilized for clinical jobs as well.

I also strongly suggest that when you have to contract and absorb the expense for a full day of training for new updates and improvements for your Eaglesoft or Dentrix or Practiceworks management software, that you videotape the entire presentation.

This process of video taping should not be misconstrued as a threat to anyone’s job. We hope that our great staff members will stay on forever. But life is complicated – we live in an increasing mobile society – so it is a wise and prudent business strategy to be prepared for the worst.

May 27, 2014

Be Careful With Valuable Property

Filed under: Uncategorized — Mayer A. Levitt, DMD @ 7:15 pm

In this day and age of interconnectivity and on-line search, we all know and recognize the importance of your practice website. Whether for marketing or patient verification, your website has replaced the Yellow Pages to let the world know how to find you, who you are, and what you stand for.

Two recent problems reported to me by clients have prompted me to write this post. Without going into the gory details, each client, when trying to upgrade or re-skin an existing website – using a different website developer – found out that they did not have control of their domain name.

A fresh look to your website is an absolute must these days. New artwork and different graphics can make a big difference. I am currently in plans to do this to my own website even though I did a makeover only four years ago. The one thing that absolutely can’t change – for numerous SEO reasons – is your domain name. So here are some basics that you need to know.

1. Ownership. When you own your business’s domain, you possess a superior level of control over your web presence, your practice’s branding, and the portability of your website, should you ever experience the need to move it from one host to another.

2. Expiration and Renewal. The majority of domains must be renewed once every year. A domain name that is allowed to expire can rapidly be picked up by a third party – either for their personal use or for the sole purpose of reselling it later – maybe even back to you at an exorbitant price! Develop a way of reminding yourself when your domain comes due for renewal or, better yet, consider renewing for an extended period of time rather than the typical span of 12 months. Domains that have been renewed consistently and for longer stretches of time tend to be favored by search engines like Google.

3. Trust - Entrusting an individual entity or company with the possession of your domain means knowing that the entity has your best interests in mind. Never hesitate to ask questions: Am I listed as the owner / registrant of the domain name? If important changes are required, how do I ensure that they are made? Can I be sure that everything will be set up properly and, if not, do I have the ability to have these issues rectified? A trusted partner will help you navigate the more complex aspects of domain name ownership and maintenance.

4. Contact Information. Often, a domain will be purchased and associated with a specific set of contact details, including an email address that is used for confirmations, expiration reminders, and notifications of impending changes. If your contact information with your registrar or host is out of date, you may miss vital correspondence pertaining to your domain and, therefore, your practice’s website. Perhaps you ordered the domain name from an old aol or hotmail account that you don’t use any more. All pertinent information regarding any domain name currently registered can be found using the helpful search tool at whois.sc. You can quickly view your domain’s expiration date and the name to which it is registered. Being an informed consumer, particularly when it comes to your domain, ensures a more successful web presence overall.

I have had a trusted relationship for nine years with TNT Dental. Full disclosure – I receive no compensation from this company. If you need help or advice about any of the issues I have discussed above, you won’t find nicer or smarter people.

May 12, 2014

Thinking Long Term

Filed under: Uncategorized — Mayer A. Levitt, DMD @ 9:33 am

How I wish I could be as eloquent as Seth Godin. Godin is a marketer, an extraordinary successful entrepreneur, the author of 17 best-selling books, a world class public speaker, and a committed  philanthropist. He writes a daily blog that is read by millions of people around the globe. I am a big fan, and normally start my day by reading his posts. I am continually amazed at how relevant his advice is and how sage his observations are regarding what is important to be successful in business.

The over-riding message that I hear and take away from Seth – and one which I totally embrace and share with my clients – is the need to think long term. How you must resist the temptation of taking short term profits at the expense of long term relationships.

As a dentist, if you agree with the statement that the lifetime value of a patient is significant – and if you agree that in our crowded and competitive marketplace that value is only increasing – then it behooves you and your team to think long term. Godin commented on this very topic in a wonderful post called “Thinking Lifetime – Don‘t Break the Chain” where he remarked that “a customer is never out of warranty even if his product is.”

Always ask yourself how you – if you were a patient in your dental practice – would feel by the solution offered to “fix” your problem. Whether it was a scheduling conflict, or a financial misunderstanding, or a dental insurance issue. Was it done quickly and expeditiously?  Was it fair?  Was it convenient? Was it generous? Would it have exceeded your expectations?

Empower your staff to offer solutions that are more than fair. Ritz Carlton has pioneered this philosophy and is considered the gold standard of exquisite customer service. The customer is always right. You never want to say “no”.  Be very careful about taking a “line in the sand” mentality. You never want to give a patient a reason to leave your practice.

And above all else, never abuse a patient’s trust. It takes time and effort to earn that trust. And as Seth says “while trust is expensive – trust is worth it.”

April 29, 2014

Teeth Whitening – A New Approach

Filed under: Uncategorized — Mayer A. Levitt, DMD @ 4:55 pm

 

whiter teeth button3

Full disclosure–my wife and I are both in our early 70s. So we are definitely on the back nine as they say, we just don’t know which hole. I say this because I wouldn’t want my comments to be considered indicative of  age discrimination . We both are continually amazed at how so many of our contemporaries have dark and discolored and yellowed teeth. And these are people of means. They go out to dinner, they travel, and price is not the dominant issue when they shop.

An unsightly smile definitely makes you look older than you are. Is it just my perception because I’m a dentist, or does everyone agree that discolored teeth are pretty ugly, and indicate a general lack of attention to personal appearance and perhaps personal hygiene?

Who are the dentists who take care of these folks? Why are they not sending the message? If people are paying thousands of dollars for facelifts  and nose jobs and Botox to improve their appearance, why wouldn’t they want to whiten their teeth?

I believe there is a huge untapped market for cosmetic dentistry and it is sitting right there in your office in the paper charts or computer files of your existing patients. Here is how I recommend that you get started.

• Have every staff member and every doctor wear a button that says “Ask us about whiter teeth!” I have found this to be very effective in getting the conversation started. You can easily have these buttons made up at a novelty store.

• Every staff member and every doctor needs to have a nice bright smile. You certainly can’t expect patients to whiten their teeth and accept your treatment recommendations if your own teeth don’t look great.

• Put pre-and post up photos on your website for reference. Develop a specific landing page on the site with cosmetic options that include whitening. Even better, have an iPad chairside with these photos. The clarity and resolution of photos on an iPad are amazing coupled with the ability to manipulate the images.

• Get familiar with the newest whitening options that you can offer. New formulations have greatly reduced the problem of sensitivity, and results have become much more predictable. Whiter Image Dental is a great company with an excellent product.  I also hear good things about KoR Whitening. But I am particularly enthused about GLO whitening. GLO Science Professional offers a game changing, dual teeth whitening experience available exclusively at a dental office. Teeth can get white fast in one 32 minute in-office whitening session. Then you maintain your smile anytime at home with the GLO Brilliant Professional Whitening Device. Go to their website and check out how cool this device looks. It is beautifully packaged, and there is nothing like it out there.

Taking study models and making custom trays could be a thing of the past. Whitening teeth is the building block of bigger and more comprehensive cosmetic treatment plans. It is time to create a significant revenue stream in your office. But equally as nice is the satisfaction of helping patients feel so much better about the way they look.

April 15, 2014

Achieving Success in the Practice of Dentistry – Part 10

Filed under: Uncategorized — Mayer A. Levitt, DMD @ 1:46 am

As I conclude this series on how to achieve success in the practice of dentistry, I have one more observation for you to consider. I consistently find that successful doctors have figured out a way to take a little bit more time away from their practice. That may seem counter intuitive – how can working less equal greater success? We all know that we are in what I like to call the “widget” business. You do one crown, you get paid for one crown. You do two crowns, you get paid for two crowns. You do no crowns, you don’t get paid anything.

But dentistry is not an easy profession. There is a lot of stress. We are working in a very small confined area. Our patients many times don’t really want to be there, and that can really get to you. So as a way to become rejuvenated  and combat burnout, I am suggesting to everybody that they try to take more time out of the practice. Studies show that time away from the practice will rekindle energy, and the business will actually become more productive because the doctor is in a better frame of mind. We also have to remember that we only go this way once–that our kids are only going to be young once, and that it is important to spend time with family.

So here is an amazing statistic: the worst two weeks in a dental practice for production and collection are the first two weeks of September. I see this year in and year out. More dentists want to jump off bridges in September than any other month of the year! I think it is a combination of the summer doldrums and kids getting back into the school year with their schedules not being set. So these two weeks of September routinely and consistently have the highest number of last-minute cancellations and no-shows. Don’t try and fight it. If it’s  at all possible, those two weeks might be a great time for you to take a vacation, and the practice will suffer the least.

Over the past three months, I have shared my thoughts in a series of nine posts – garnered from seventeen plus years of full time coaching – as to what I see as the commonalities of successful dental practices. Now it is time to sum things up, to  put everything in proper perspective, and to tie the loose ends together. At the risk of sounding pretentious, I would encourage you to print out the posts and read them again. See what you agree with, and what you may not agree with. See what you have already instituted in your practice, and what you haven’t. Take a look at what could be improved – or added – and then decide on a detailed plan of action.

Achieving success is not easy. If it were, we would all be there. You have to take it one day at a time. It is a marathon and not a sprint. Slow and steady wins most races. A recent Chinese fortune cookie message just might say it all: things turn out best for the people who make the best of the way things turn out.

I wish you all good luck in your pursuit of success.

 

 

April 1, 2014

Achieving Success in the Practice of Dentistry – Part Nine

Filed under: Uncategorized — Mayer A. Levitt, DMD @ 5:13 am

After writing eight posts in this series on my observations over the years of why certain doctors achieve success in the practice of dentistry – none of which relate to clinical expertise – it is finally time to discuss something related to teeth and the oral cavity! In truth, there really is no substitute for great hands and great confidence and great diagnostic ability. Some of that is God given, and those people are very lucky. But I see so many doctors who really grow into  becoming excellent clinicians with some serious commitment to continuing education that can increase their productivity. All states, of course, have minimum requirements for continuing education. I am talking about going way beyond that.

• Spending time with world class clinicians and educators like Frank Spears and Ross Nash or David Hornbrook gives a doctor  confidence and the ability to visualize cases. I hear only good things about these guys, and I see wonderful results from my clients. A major additional benefit to the learning process in formalized lectures is the socialization and rubbing elbows with other doctor attendees who are as serious as you are about improving. Often the idea sharing among the participants at the conference is just as beneficial as what is presented on stage.

• Participating in study clubs. In just about every successful practice I have been involved with, the doctor is an active participant in a well organized study club. Again, you learn not only from the lectures but from the involvement with other doctors in the club who are serious about upgrading their skills and knowledge.

• Learning new procedures like short-term orthodontics with Six Month Smiles enables a doctor to create opportunities for much more restorative dentistry. In the past two years, I have had fifteen different clients attend the Six Month Smiles  course – and they are all happy. I actually attended the course two years ago just to see what this was all about, and I can honestly tell you it was the first time in all these years that I wished I was back doing clinical dentistry. It is really pretty amazing. The room was filled with frustrated Invisalign providers!

• Promoting aesthetics. I see a lot of good results from practices that continually talk about whiter teeth. I think people in general want to look better. I think they feel it will help their life both personally and professionally. But if a doctor wants to be successful promoting aesthetics to the patient base, he or she better be very sure that their own smile looks great as well as the smiles of their staff members.

So challenge yourself to be the best clinician you can be. It is a privilege to be a “doctor” and to be held in high esteem by your patients and your community. You have earned this by hard work and perseverance over many years – but the quest for excellence is never ending. So continue on this path, and success is almost guaranteed.

March 18, 2014

Achieving Success in the Practice of Dentistry – Part Eight

Filed under: Uncategorized — Mayer A. Levitt, DMD @ 6:56 am

Successful doctors, as I’ve said in an earlier post, do a great job of offering treatment choices and have a high level of case acceptance with a focus on quadrant and arch dentistry. These successful doctors then know how to schedule treatment in a way that maximizes productivity and profitability.

Productive doctor scheduling is actually a topic where I feel that I have more expertise  than just about any other area in dentistry. I started consulting full-time 18 years ago, but prior to that–for the last seven or eight years that I was in clinical practice–I was doing some part-time consulting in a very niche area -showing  busy dental practices how they could be more productive and more profitable through scheduling techniques developed in my own practice. This would involve an analysis of current production per hour in a practice that was pretty busy, followed by a six hour seminar with their entire  team, teaching them how to increase their production. There is, you know, a big difference between being busy and being profitable. Obviously it would be beyond the scope of a blog post to give all the specifics of how to do this. But here are some basic principles of scheduling that I frequently see in a successful dental practice:

• Realize – as simple as it seems – that there are only so many available hours in the day, and so many days in a week. Once the time goes by, you never get it back. So you have to try to maximize every hour of every day.

• Have a consistent 12 to 15 minute morning huddle at the beginning of the day. I really do believe that practices that have a morning huddle do 15% better than those that don’t.

• Do not save designated time blocks for emergencies. Emergency time can be determined at the morning huddle every day. At the huddle, identify the three best times based on the doctor’s schedule that day as to where an emergency could be seen. Those are the times that are offered to an emergency patient who calls. That emergency is always side booked.

• Do not do definitive therapy for emergency patients.  That is the surest way to get behind.  Palliative treatment is what is indicated.

• Do not place a procedure in the primary schedule unless it has been diagnosed by a doctor exam  and financial arrangements have been made with the patient.

• Seat every patient requiring local anesthesia  in a room 20 minutes before the doctor  will be starting that actual procedure. The doctor leaves the patient he or she was treating,  takes a quick few minutes to deliver the anesthesia to the patient who was just seated, and  then returns  to the original treatment room to finish the dental procedure.

• Stop scheduling defensively. I see a lot of sloppy scheduling where much too much time is allocated to a procedure. This of course may be a defense mechanism by the front desk if the doctor is always running late.

• Delegate delegate delegate–where ever possible to highly  trained dental assistants.

• Stay on time–the best schedule in the world can be blown up by the doctor. The doctor absolutely has to know  when to “punt”.  In a football game, if it’s the first quarter and you have 4th down on your own 30 yard line and three yards to go, the obvious move is to punt the ball away. There is plenty of time left in the game to score. With that same yardage situation and only a few minutes left in the game, you don’t punt. You go for the first down or else the game is over. Metaphorically, when there is a pulp exposure in the middle of a prep temp impression visit for a crown, or when your impression fails because of gingival bleeding – this is the time to punt. Finish up what you can in the allotted time period, and re-schedule the patient for another day to finish the procedure. Cut your losses. Don’t be tempted to extend that appointment and get 30 to 45 minutes behind for every other scheduled appointment and keep those patients waiting.

Running  late and behind schedule on a consistent basis is just not acceptable. Working into the lunch hour and past the normal end of the day gets pretty old. Clearly the doctor must be aware of the time. Productive doctor scheduling is an absolute must to insure a successful dental practice.

 

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