Probably the biggest fear is “the needle” and especially the three to four hour discomfort and ill effects of a mandibular block. The STA System by Milestone Scientific (an acronym for single tooth anesthesia) is something I am really excited about. This is a computer-controlled local anesthesia delivery system that allows you to anesthetize one tooth with no collateral numbness. Using Dynamic Pressure Sensing (DPS) technology enables a technique friendly, highly predictable onset of profound single tooth anesthesia using a virtually painless technique to any tooth for any procedure. It is an intraligamentary injection that is computer-controlled allowing you to administer anesthesia below the patient’s pain threshold. The onset is very quick allowing work to begin almost immediately for endodontic and restorative procedures.

I am particularly enthused above the marketing potential of this technique. Here is your conversation: “Bob-we need to schedule a visit to fix this broken tooth on your lower right side. I know how much you hate being numb for hours, drooling over yourself, biting your lip, and not being able to talk on the telephone. I have a fantastic new technique that will allow me to only  numb up the one tooth that is broken and not your lip and tongue. If I am able to do this for you, would you promise to do me a favor and tell three people about your experience?”

Do this procedure and watch the amazement on the face of your patient. I guarantee you they will become huge emissaries for your practice.

Hold a team meeting to announce you are introducing a plan that will allow all staff members to earn more money based on increases in production and collection. This plan is not for eternity. I suggest that you commit to nine months, and then re-evaluate at the discretion of the doctor.

The plan rewards the staff as a whole – it is not an individualized bonus. The mission is to create a team working well together and not to create animosity or an atmosphere of competitiveness if one individual receives a bonus and another doesn’t. Plus it is often difficult to measure individual performance for non-income producing staff like dental assistants.

Major point – the plan is NOT based on profitability. It is based only on production and collections because these are the areas that staff can influence. “Profitability” decisions are not decisions that staff are involved in, nor do we want them to be involved. Profitability can only be controlled by the doctor. For example: the team busts their butts to collect and produce — performance data goes way up. But the doctor decides to perhaps hire another staff member, or buy a necessary -in his mind- piece of equipment, or invest in some new technology. He reports to his staff that his  “profitability” is down or remains the same because of increased costs. You know that argument doesn’t play very well! In their mind, the practice would have been profitable if the doctor hadn’t spent any money. Then there would be money for a bonus for them. Therefore I feel you incentivize staff by measuring only what they can control.

The bonus plan is set up to be paid monthly — not quarterly. You want to have a measurable and immediate cause-and-effect relationship between increased performance and getting a reward.

The starting point — the entry-level to begin comparing performance — is to   use an average of the last four months of production and collection totals. I weight collections twice as much as production because you can’t pay a bonus with receivables!  The formula is P+C+C divided by 3. So if we are going to start the bonus program in May, the target number to exceed will be calculated by adding up the formula for January through April and then divide by four. That number is the goal — the target — to exceed. That number represents what is currently happening in your practice and what you want to improve. When you have hit a plateau, you don’t pay a bonus for maintaining current levels.

For every dollar collected over that number, the staff gets paid twenty cents. So as an example, if the office collected $5000 more than the target — and there were five full-time employees — then this staff would split $1000. Full-time and part-time employees will get pro rata shares of the bonus money based on the hours they worked. The bonus money is paid in the first pay period following the end of the month and is taxable to the employee.

We will be using a four month rolling average. So the target for June will be an average of the last four months (February through May). As performance hopefully increases as a result of the incentives, the target number will be increasing and is a bit more difficult to achieve going forward. Very important — if the office does not hit the target, you cannot pay a bonus for the following month until that shortfall is met.

The target number is a known entity on day one of the new month. I advise doing an update every 10 days or so to let staff know where they stand. You can post the updates in the staff lounge. You will be amazed at how everyone perks up and tries harder when the goal is in sight.

So I hope you will give this a try — you have nothing to lose. You only pay a bonus when performance data improves. Please feel free to call me if you have any questions about the mechanics.

PS — Another advantage — in my experience, the team seems to police itself. Ineffective or  lazy team members get the word from the hard-working folks that they better step it up. How nice that you the doctor don’t have to play nursemaid any longer!

In this fragile economy, it is hard to justify staff salary increases. But it has been this way for eighteen months – and there is definitely some frustration building up on the part of staff since it has been a long time since anybody got a raise.

The time to institute a bonus incentive plan is when you are at a plateau. A lot of dental practices are struggling to stay at production and collection levels achieved in calendar year 2008.

A bonus incentive plan is the perfect motivator to get all of your staff members to actually do the jobs they are being paid to do – except at higher levels of performance. Tasks like keeping the daily doctor schedule packed and productive, making proper collection arrangements, confirming Hygiene schedules and staying focused on re-activation of overdue patients, and following through on all aspects of dental insurance.

When there is a money incentive dangling in front of the staff, there is more of an immediacy and urgency to perform their jobs well – to go the extra yard-to put in the extra effort. When staff only get an hourly salary – when they perceive that there is nothing in it for them – why do today what you can do tomorrow?

It is my opinion and experience over the years that a properly constructed bonus incentive plan – introduced at the right moment – almost always works to stimulate growth. In my next blog post, I will outline the details.

Here is an idea that has had some success – warranty your dental treatment. Post the following information on a large sign in the receptions area.

WARRANTY

We are very proud of the dental services we provide and we stand behind our work. We will replace any defective filling with an equivalent restoration FREE for up to two years after it is placed. We will replace any crown that needs replacing for up to five years with an equivalent crown at NO CHARGE.

IMPORTANT

This warranty remains valid ONLY if you come in for your regular 4 to 6 month cleaning visits including examination and x-rays as recommended by the doctor.

In reality, you are probably doing this anyway even if it isn’t written down. So why not get some mileage out of this? When dental treatment is completed, the doctor must inform the patient that the work is guaranteed PROVIDED the patient returns for regularly scheduled continuing care visits with the hygienist. And the hygienists who are seeing all of these patients on continuing care also repeat the terms of the warranty when scheduling the next continuing care appointment.

The key to success is for the doctor and all staff to consistently reinforce this policy so that the patients truly understand the value of not missing a hygiene visit. I’ll be willing to bet you will see some good results.

An over the top, customer friendly, state of the art bathroom is such an easy and good way to make a positive statement about your dental office. It should be spotlessly clean and well lit – not dark and dingy. Of course, it needs to smell good. Use designer quality fragrant soaps. I would not scrimp on excellent fixtures including a  large mirror. A wicker basket of paper hand towels is a nice touch – not the typical towel dispenser that has a tendency to get jammed. And be sure to provide an assortment of small toothpaste samples, floss, and mouthwash.

Obviously, the maintenance of an elegant bathroom requires a serious commitment from the staff. Create a schedule whereby someone is required to police and tidy up the bathroom every few hours during the business day.

Don’t miss out on the opportunity to hang a few pieces of cosmetic wall art as you market to this captive audience. And for sure – more than anything else – you want to use Charmin or similar quality 2 ply toilet paper. Anything less sends the wrong message – thin, cheap, cost saving.

Spoil your patients with elegant bathrooms and luxurious toilet paper. It is easy to do, and the impression you send is priceless.

In each of these unfortunate situations, the interactions and communications between the doctor and the disability insurance companies has been a nightmare. The fine print in the policies and the “definition” of disability becomes contentious. In each of these three cases, we have had to resort to hiring expert legal advice to force payment from the companies. It appears the insurance company is very happy to take your premium dollars year after year, but then do everything possible to embarrass you and discredit and contest a legitimate claim. You in fact become the enemy.

The statistics say that dentists at age 35 face almost a one in four chance of suffering a disability lasting 90 days or longer at some point in their career. It is imperative to seek expert advice when you purchase your disability coverage. These real life situations have taught me the value of the necessity to coordinate the benefits from multiple policies, and perhaps consider legal advice from disability experts other than the insurance agents who sell you the policies. And don’t overlook the tax advantages of purchasing the policies personally rather than through your dental company so that the disability dollars are tax free.

1. Quarterly income and expense statements (P & L) that are easily understood and serve as a legitimate business tool to help manage the practice. Observing “what happened” at the end of twelve months is no way to run a business. Controlling or at least understanding your overhead is always important, but it is especially critical in the current difficult business environment.

2. Aggressive treatment for deductions with a solid understanding of the nuances and miracles of depreciation. You want creativity.

3. Tax planning and advice. I constantly hear gripes from doctors about being “hit” with huge tax payments come April 15th. If the only service you are receiving from your accountant is the preparation of a tax return, you are not being well served.

4. Coordination with pension planning, estate planning and wealth management. Everyone has to be on the same page because the rules are constantly changing.

5. Lots of experience with other dental practices and knowledge of appropriate overhead and profit percentages.

Working with a bright and knowledgeable accounting professional is one of the most important business decisions you can make. Be sure you have one on your team!

I think we as dentists should take his comments as an important “wake up call” as to the way we market our practices. The current trend is to spend lots of money on web-site development in order to create an excellent Internet based message, search engine optimization programs and pay per click programs so that prospective patients can find our site, print ads, radio ads, direct mail – all of these mediums are designed to help us attract more new patients. These days five percent of annual collections is a low to acceptable line item in your budget for marketing.

But what if we decided to spend a significant portion of that money rewarding existing patients? We all agree that a personal recommendation is a much stronger referral that someone kicking tires on line. In a recent Nielsen article, it was stated that 90% of consumers surveyed said they would trust and act on the recommendation from someone they knew. So if we were to spend our money in a bunch of interesting ways that would make our existing patients feel special and appreciated, it seems logical that our referral rates could sky rocket.

Here is your topic for the next staff meeting – “If we had the money, what could we do for our patients of record that is so outrageous, over-the-top, and noticeable, that it would force them to talk about us?” I would love to hear your ideas. I plan to accumulate responses and pass on the best ideas in another post.

The biggest contributing factor I see to messing up a perfectly scheduled day is when the doctor decides to perform definitive therapy for  an emergency patient. The doctor must resist that temptation. Treat emergencies as emergencies by offering treatment to relieve pain. Placement of a temporary filling, writing a prescription, making a referral to a specialist, taking a tooth out of hyper-occlusion – whatever it takes. That is your responsibility when an emergency patient is squeezed into your busy day. The mission is to spend no more than ten minutes getting someone comfortable, and then getting them re-scheduled for the proper amount of time on another day for definitive treatment.

Once you have kept someone waiting more than ten to fifteen minutes in your reception area or even worse in a treatment room with a saliva ejector hanging out of their mouth, they begin counting up your faults. Don’t give them that opportunity. Don’t be greedy. Take perfect care of your scheduled patients. That is how you stay on time.

The huddle is twelve to thirteen minutes in duration. I suggest that the doctor does not lead the huddle, but attends and actively participates. Actually in the ideal world, the doctor arrives to the office first and hands out coffee to the staff as they arrive! The huddle is led by staff members on a rotating basis. Topics to be covered include:

• When are the three best times to see an emergency that day based on the doctor’s schedule. If this is decided at the huddle, then there is no need to bother the clinical team after the day has started.

• Which hygiene patients are scheduled for a doctor exam, and at what time during that continuing care visit will the exam get done. Again, this is based on the complexity of the doctor’s schedule. I recommend that continuing care patients be seen by the doctor every other time. Of course if a diagnosis needs to be made, the doctor will see that patient.

• Who are the new patients — who referred them – and are there any special considerations for these new patients based on the telephone intake slip.

• Fine tune the doctors schedule for ultimate patient flow. This attention to detail can add hundreds of dollars of production every day.

• Discuss whether any patient on the schedule today with a lengthy appointment and a history of lateness or forgetfulness needs a second reminder call.

• Be aware of financial arrangements/collections/co-pay responsibilities.

The last thing I suggest is that the person who is in charge of leading the huddle is also responsible — just before the meeting ends — to tell a joke. This gets everyone smiling as they head out to do battle for the day. There are lots of jokes online — and sometimes it is more hilarious observing someone struggling to tell the joke than the actual joke itself. As always I appreciate your feedback with what works for you.