October 20, 2014
A few weeks ago, my wife and I went on a “bucket list” trip to Berlin and Normandy. We traveled to Berlin to view the transformation of the city from the horrific times of Hitler and Natzi Germany to the welcoming and passionately transparent atmosphere that exists today. Beautifully designed memorials to the Holocaust, built in the most prominent areas of the city, insure that the sins of the past will never be forgotten. We traveled to Normandy to see the D-Day beaches and the American cemetery. When you actually view the 80 foot cliffs above the beaches that were heavily fortified by the entrenched German soldiers, it is hard to believe how these brave Americans – part of the “greatest generation” as described by Tom Brokaw – were able to advance.
What we didn’t know about were the hedgerows. A hedgerow is a fence or barrier formed by a row of closely planted shrubs or bushes. In Normandy, these hedgerows separated one small farm from another. Many of these shrubs were very think and dense and often 20 to 30 feet in height. The American war machine was ill-suited to this maze of tiny enclosed fields and sunken lanes. The Germans turned the hedgerow complexes into deathtraps by covering every road and trail with machine gun, mortar, and anti-tank artillery fire. Eventually the allied forces prevailed, but the hedgerows were a major impediment to the eventual success of the invasion.
For some reason, as I was viewing all of this, it occurred to me that,metaphorically speaking, we as dentists create our own hedgerows, our own obstacles, that prevent or certainly interfere with our ability to grow and prosper. Five examples immediately come to mind.
1. Patient unfriendly hours of operation – 8:30 to 5 Monday through Thursday is what I see more often than not. You will exponentially increase your income by offering some early and some late options for appointments. The needs of the patients need to be balanced with your own personal life. It is not a one way street.
2. Limited payment options – people love and understand budgets. That is how they live their lives. The need is more necessary than ever to employ a dedicated, talented, and compassionate staff member who can sit down with a patient and navigate the intricacies of out-sourced financing while coordinating payments with sequenced treatment plans.
3. Failure to delegate – doctors are always complaining to me that they “don’t have enough time”. I realize that there are only so many hours in a day. In my experience, the most successful doctors are the ones who have figured out how to absolutely delegate EVERYTHING possible in order to have the time to pursue what only they can do. You may have to leave your comfort zone on this.
4. Consistently running behind schedule – a favorite topic of mine. You have to figure this out. There is no compromise position. It is not an acceptable level of customer service to keep patients waiting.
5. Weak or zero Internet presence – In this day and age, successful practices attract 30-35% of new patients from Google or Facebook. It must be a top priority to create or upgrade your website so that it positions prominently in your geographic area, is current, informative, and conveys the distinctive personality of the practice.
As you can see, none of these five suggestions requires changing or enhancing your clinical expertise. There is no need in this case for expensive continuing education courses. These are basic principles that apply to any business. So cut down your hedgerows! Eliminate these easy- to -overcome obstacles that are unwittingly preventing your practice from reaching the next level of productivity and profitability.
October 1, 2014
For as long as I can remember, solving the inherent conflict between the front of the office and the back of the office is a monumental challenge. The larger and busier the practice–the more treatment rooms and providers–the more complex the solution. The goal, of course, is to create a consistent, smooth flowing on time schedule where nobody has to wait.
Sprinting up and down corridors to deliver messages is good cardiovascular exercise but not very efficient. There are other options. Physical hardwired light panel communications systems were a good start, but these systems are quite expensive and pretty basic. Many offices decided to wear headsets or walkie-talkies or earbuds, but all of these are very clunky and intrusive. The major dental management software companies decided to get their hat in the ring by incorporating instant messaging via computer as an add-on service. But this also is very basic–has privacy concerns–and I have heard from many doctors that the Dentrix messenger–called Dentalink–is quite fragile and inconsistent.
Enter BlueNote Communicator. Based in Lewisville, Texas, BlueNote is a small independent software developer that has been in business since 2004. Their focus is on providing innovative intra-office communication products for dental and medical offices. Armed with a simple mouse and the power of BlueNote Communicator, you can create the perfect intra-office communication system for your practice. BlueNote runs over your own network – no server or Internet connection is required – and it is simple to download and install. You can customize up to 60 lights that can be activated with a single click. Popup Alerts and Tones are used to alert each computer that a Light has been activated or has changed. These visual and audible cues can be controlled at each computer to create the perfect balance of form and function. Each user has complete control over the notifications for each light. Another great feature is that BlueNote uses the latest industry standard encryption algorithms to secure all data transmitted and stored by BlueNote Communicator Lights.
The cost of $795 to purchase their latest product called Blue Communicator Lights is amazingly inexpensive. There are no monthly fees, per doctor fees, setup charges or per computer license fees. You can also try the full version of the software free of charge for 30 days to evaluate the program and see how it works. That purchase price includes setup assistance, along with software upgrades, phone support, and e-mail support for one year.
You can go to their website and read the many positive comments from satisfied offices. You can also call Shelly Salinas, the customer service rep at BlueNote, at 469-648-0172 for more information. I personally have a number of clients using this product, and they all give it rave reviews.
September 15, 2014
A significant part of my work week is spent assisting and advising dentists who are buying or selling a dental practice. I would like to share my current observations.
• By and large, it remains a seller’s market. There are definitely more dentists looking to purchase a practice than dentists wishing to sell a practice.
• Because of that supply/demand ratio, I see practice valuations continuing to increase.
• Financing for practice transitions has never been easier. 100% financing of documented practice valuation is the norm. Banks have realized that very few dental practices ever fail, and so they are lining up to compete aggressively for your business. And we all know that when banks compete–you win.
• The Federal Reserve has been your friend. Monetary policy that has kept interest rates at historically low levels has stimulated acquisition activity by making borrowing costs so cheap.
• Prior to this low interest rate environment, it was often difficult for a buyer to be able to afford and take on the debt of both the dental practice AND an office condo or stand-alone office building. Sellers would usually be required to offer a lease to the buyer, and become the landlord. Now, it is almost cheaper to buy than to rent, so buyers actually want to own the physical location and build their own equity.
• There is still a premium to a seller if he or she has stayed current with new technology. Upgraded practice management software and advanced computer networking also guarantee a practice valuation at the higher range of the spectrum.
• There are numerous interesting and innovative ways to enable a win/win transition.
My message to buyers is that you should be prepared to pay a little more than you thought in order to buy a quality practice. That increased cost is easily offset by the availability of ten to fifteen year amortization schedules with low fixed rate financing that still allows a great return on your investment. My message to sellers is to get your house in order if you want to receive top dollar for your practice.
As always, I welcome your comments and thoughts.
September 2, 2014
In a post written on July 8, 2014, I referenced two companies that could assist your dental practice with the daunting and time consuming process of becoming HIPAA compliant. Today, I would like to add another recommendation for your consideration.
MedSafe has been providing compliance solutions for health professionals for over twenty years. What I find attractive about their model is that they offer their services on site. A MedSafe compliance consultant will come to your office and work face to face with your team. That could allow you to have your security risk analysis done with your IT person right there with you. They would also offer on site representation if and when you were ever audited by regulatory agencies or private payers.
As a MedSafe client you have easy on-line access to their website where you can download various essential forms such as business associate agreements, vendor confidentiality agreements, staff confidentiality agreements, and breach notification letters. These documents are automatically updated as regulations and policies change. MedSafe also serves a dual function of providing OSHA training and annual updates and certification. This service, of course, is totally separate from the HIPAA compliance program, but it is nice to have that opportunity for one stop shopping.
To find out more information about MedSafe and their pricing, you can contact Julie Sementa at 781-237-9700 Ext 124.
The overriding message I am trying to convey to all of my readers is to take this mandate to become HIPAA compliant seriously. So please make the calls – get the information – and then make the decision to commit to a program that will keep your practice safe and let you sleep nights!
August 18, 2014
My last two posts explained and justified my recommendation for considering the introduction into your practice of a formal structured plan that will benefit patients who do not have dental insurance. If you agree with my analysis and decide to implement such a plan, here are my suggestions for getting the word out.
• You need to tell EVERY patient every day that your office is now offering this new exciting opportunity–and that includes patients who have dental insurance. Patients with dental insurance have friends, acquaintances, and relatives who do not have insurance. These patients with insurance will spread the word. They become your emissaries and ambassadors. The message and information you are delivering to your patient base has to be concise and clear and obviously all staff members need to be trained on the specifics. There has to be a definite plan as to which staff member delivers the information and when. This has to be carefully orchestrated.
• I recommend a very large sign to be hung on a prominent wall in the reception area. This sign should be professionally designed by a graphic artist. It is an announcement of the plan, but no details. ” No dental insurance–no problem. Ask us about our very own in-house membership plan.”
• I suggest reserving a prominent space on the Home Page of your website to announce the plan. Again–no specific details. “Call us to learn how you can take advantage of our members-only dental plan.” Tracking the calls should be easy because prospective patients are clearly interested and calling because of their curiosity about your plan.
• Create an e-mail blast to your patient base announcing the new plan. Again–no real details should be provided. You are hoping that your patients will call the practice for information. Most every practice these days uses some kind of program like Patient Activator, Demand Force, Lighthouse, or Smile Reminder that allows you to easily e-mail your patient base. You should also in time consider sending out an electronic newsletter with a greater description and many more details of your in- house dental benefits plan.
• I am more and more impressed with the power of Facebook. But before I would recommend a post on Facebook announcing your plan, I would hope to see you accumulate a minimum of 500 Likes. Ask every patient over the next six months to Like your page from their phone while they are in your office. This is so easy. Once you have reached this “critical mass”, then you should put a few posts on Facebook talking about the benefits of your members only plan.
I have always been a strong advocate for internal marketing= marketing to your existing patient base. There is very little expense to any of these five strategies. The key is to be consistent with the internal promotion and the clarity of the message. As always, I welcome your comments, ideas, and feedback.
August 4, 2014
In my last blog post, I offered my observations on the disparity between insurance patients and fee-for-service patients regarding their commitment to undertaking comprehensive restorative treatment. I concluded that offering an in-house dental membership plan for your patients without dental insurance would stimulate existing fee-for-service patients to initiate treatment while also attracting new fee for service patients to your practice. Here are the basic parameters of such a plan.
• Patients pay in advance–in full–for a one year membership that includes two prophys, two exams, and a set of BW X-rays. The total cost of those basic services is discounted by about 20% from your published fees. So for example if the normal fee for those services would be $325, these same services are offered at $260.
• While enrolled in the plan, the patient can purchase any dental service that you provide for a discount from your published fees–usually in the range of 15-20%.
The calculation is that even though you are receiving less money from your fee for service patients for these procedures, they will be agreeing to do more of the procedures. In other words, isn’t it better for you to do ten crowns at a fee of $1050/crown rather than two crowns at $1300/crown? Adopting such a plan does not need to alter your current business relationship with the dental insurance companies you work with. There is nothing “illegal” about offering your own membership plan. However, there are many extremely important details that need to be addressed during set-up to keep it from appearing like insurance and/or a dental discount plan which are regulated by state governments. And as long as the fee that you charge is more than the fee that you receive from Delta Dental, Delta should have no issue with you.
I realize that while it would be possible to do this “on your own”, I am strongly recommending a company called Quality Dental Plan to help you be successful right from the start. Quality Dental Plan was started by Dr. Dan Marut in 2009. The company currently works with over 400 dental practices nationwide. QDP Is more than just an in-house dental plan or dental membership. It’s a complete system for getting patients into your office, accepting treatment, and referring many others. Essentially what QDP does is give you a systematic approach to creating, implementing, and maintaining an in-office patient benefits system. QDP gives you an easy-to-follow recipe and from there, unlimited support along the way from the QDP administrative team.
QDP has been developed and refined since its inception by conducting market research, hiring PR experts, copywriters and designers as well as soliciting feedback from patients, dentists and staff. The best part is that you remain in complete control of all fees and services. There is no third party involved. Once people pay your office for their QDP membership, they will want to use the benefits they paid for, so treatment plan acceptance goes up.
I feel comfortable suggesting that you call Dan and his team at 888-960-1221 or email them at info@QualityDentalPlan.com and get the details yourself. Their fees are extremely modest. The training they offer on how to sell the plan, how to track it with your management software, how to handle renewals, what to say and what not to say, makes the price worth it. Why reinvent the wheel when the wheel already exists?
Next time–in my concluding blog on this topic–I will offer my own ideas on how to successfully market a membership plan.
July 22, 2014
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
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
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
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.