What You Need to Consider Before Hiring an Associate for Your Dental Practice

Dr. Jonathon Everett

Any time you make a hiring decision, it has the potential to have a major impact on your practice as a whole. Your new hire will be seeing patients and can help you boost your income, grow your practice, or even transition into retirement if that’s what you want.

There are a lot of things to consider when hiring an associate, and this article will explore some of them so you can make an informed decision.

Experience

The first thing to consider is the experience of the associate you hire. Depending on the reasons for hiring, you may want someone with years of experience under their belt. If you are planning on transitioning to retirement or reducing your workload, you may want to stick to seasoned professionals so you have someone who can step in and take over if needed. Alternatively, if your intention is to grow your practice by attracting new patients, you might choose to find someone young who can grow with your practice.

It’s a good idea to give some thought to the qualities and experience you want before you start collecting resumes and referrals. Having a clear set of criteria will help you narrow down your choices.

Work Load

Another thing to consider is whether you have enough work to support an associate if you continue working full time. A good rule of thumb is that you need approximately 2,000 patients with hygiene booked four to six weeks in advance to support an associate’s salary while they build their practice. Be realistic about your ability to support a new associate, and realize that you will probably see a dip in profits for the first few months.

Long-Term Goals

Another consideration is what your intention is for your practice. If you are seeking someone who will eventually buy your practice, allowing you to retire, then you need to make sure that the person you choose is:

  • Interested in owning their own practice one day
  • Financially stable and secure

The closer you are to retirement, the more important the financial security of the associate you hire becomes. It’s important to be up-front about your wishes and to do whatever you need to do to ensure that the person you choose is in a good position to fulfill their obligations to you when the time comes.

If you are years away from retirement and are simply looking to grow your practice, then financial security at the moment may not be an issue. You might still want to ask about future plans to get an idea of potential associates’ goals and ambitions, but you can do it in more of a big-picture kind of way.

Compatibility

Even if you are planning on staying with your practice for only a few years, it is very important to consider your compatibility with your new associate. You will be working together closely and it is important to consider personality, work habits, demeanor, and the associate’s general attitude toward patients and treatment.

Every dentist has their own way of doing things. If you hire someone whose views of patient care are diametrically opposed to your own, this is a good way to end up dissatisfied. Take the time to have a serious discussion about what you believe, and get the opinions of potential associates.

You will also want to ensure that your new associate has the temperament and drive to build a profitable practice. It won’t do you any good to bring someone on who won’t make the effort to attract new patients.

Taxes and Benefits

One of the biggest considerations to keep in mind when you are hiring a dental associate is what their employment status will be. You have three basic options. You can hire the associate as an employee, bring them on as an independent contractor, or make them a buy-in partner. There are benefits and risks associated with each.

Hiring an Associate as an Employee

The first option is to hire your new associate as a full-time employee. Doing so will require you to provide benefits and pay federal (and possibly state and local) payroll taxes. Make sure you understand the financial responsibilities associated with hiring a full-time employee. If you already have employees, such as administrative staff and hygienists, you probably have a system in place to deal with payroll and taxes, which may make this option preferable to the alternative.

Hiring an Associate as an Independent Contractor

If you do not want to bring on a full-time employee, you may want to consider bringing on your new associate as an independent contractor. Such agreements typically require the associate to pay a fee to use your office space and resources, as well as a percentage of their profits. Specific contracts can vary greatly so you will have to determine what works best for you. Typically you would not be required to provide benefits to a contractor, and you would not have to worry about payroll taxes since you would provide them with a 1099 form instead of a W-2.

Making a Partnership Agreement

The final option is to bring on a new associate as a partner. This option might be best if you are hiring someone with an established practice with the intention of selling your practice to them in the (relatively) near future.

A typical contract might require the associate to put a sum of money into your practice as an investment while specifying bonuses and profit-sharing agreements. You might also include a time-frame for the buy-out of the business as well as specific terms for the buy-out.

Compensation and Employment Terms

The final thing you should consider is the specific terms of your new associate’s employment. If you are hiring the associate as an employee, you will need to discuss salary, benefits, and any profit-sharing or bonus agreements. It is also a good idea to document your expectations in terms of job performance and responsibilities. The same is true of partnership agreements.

If you hire your associate as a contractor, you should have a written contract specifying the terms to which you have agreed. Make sure to spell out the associate’s duties and financial obligations in full.

Conclusion

Hiring a new associate is a big decision. However, if you go about it in a thoughtful and deliberate way, you will be sure to choose someone who can help your practice thrive.

Dr. Jonathan Everett received his Doctor of Dental Surgery from the University of Washington and completed his undergraduate studies in biochemistry at Washington State University.

A member of the American Dental Association and Academy of Operative Dentistry, Dr. Everett strives to continue providing the most advanced and clinically-proven dental care available in the region. Dr. Everett is the recipient of the International Congress of Oral Implantologists Award.

How to Train Your Staff to be Compliant with Accessibility for Ontarians with Disabilities Act (AODA)

During the next several weeks, DOCS will be providing you with tips on how to interact and communicate with patients who have specific disabilities.  We recommend that you print each email and add this training to your regular staff meetings.  Each week we will be discussing a different disability with tips on how to interact and communicate with your patients to help you develop accessibility standards that will fit with your office.

The Accessibility for Ontarians with Disabilities Act (AODA) is a law in Ontario that allows the government to develop specific standards of accessibility and to enforce them.  Recognizing the history of discrimination against persons with disabilities in Ontario, the purpose of this act is to benefit all Ontarians by developing, implementing and enforcing accessibility standards in order to achieve accessibility for Ontarians with disabilities with respect to goods, services, facilities, accommodation, employment, buildings, structures and premises on or before January 1, 2025.

The patient service standard requires you to identify, remove and prevent barriers for people with disabilities in key areas of daily living. Barriers keep people with disabilities from fully participating in activities that most of us take for granted.  The patient service standard is the first to come into effect under the AODA.

The next four standards have been combined under one regulation, the integrated accessibility standards regulation

  • Information and communication
  • Employment
  • Transportation
  • Design of public spaces

This regulation is now law and the requirements currently in regulation are being phased in between now and 2021.

Who are people with disabilities?

When we think of people with disabilities, we tend to think of people who use wheelchairs and who have physical disabilities that are visible and obvious. Disabilities can also be invisible.  AODA defines disability as:

a.  Any degree of physical disability, infirmity, malformation or disfigurement that is caused by bodily injury, birth defect or illness, and without limiting the generality of the foregoing, diabetes mellitus, epilepsy, a brain injury, any degree of paralysis, amputation, lack of physical coordination, blindness or visual impediment, deafness or hearing impediment, muteness or speech impediment or physical reliance on a guide dog or other animal or in a wheelchair or other medical appliance or device

b.  A condition of mental impairment or developmental disability

c.  A learning disability or a dysfunction in one or more of the processes involved in understanding or using symbols or spoken language

d.  A mental disorder

e.  An injury or disability for which benefits were claimed or received under the insurance plan established under the workplace safety and insurance act, 1997

What are barriers?

A barrier is anything that keeps someone with a disability from fully participating in all aspects of society because of their disability.  We are going to discuss 5 barriers that you may or may not have considered

Attitude

This is the most difficult barrier to overcome because it’s hard to change the way people think or behave.  Some people don’t know how to communicate with those who have visible or invisible disabilities.  For example – assuming someone with a speech problem has intellectual limitations and speaking to them in a manner that would be used with a child.  Forming ideas about the person because of stereotypes or a lack of understanding.  Some people feel that they could offend the individual with a disability by offering help, or they ignore or avoid people with disabilities altogether.  Attitude is a major barrier that is within our power to change.

Architectural or Structural Barriers

These barriers may result form design elements of a building such as stairs, doorways, the width of hallways and even room layout.

Information and Communication

These barriers can make it difficult for people to receive or convey information.  For example, a person who is deaf cannot communicate via standard telephone. Things like small print size, low colour contrast between text and background, confusing design of printed materials and the use of language that isn’t clear or easy to understand can all cause difficulty

Technology (or lack of it)

This may prevent people from accessing information.  Everyday tools like computers, telephones and other aids can also present barriers if they are not set up or designed with accessibility in mind.

Systemic Barriers

These can result from an organization’s policies, practices and procedures if they restrict people with disabilities, often unintentionally, for example a clothing store with a “no refund” policy and no way for someone in a scooter to enter the change room

Take some time to identify some of the barriers that may exist in your office.  Discuss as a group how to help your patients overcome the barriers.  If you would like to receive a sample copy of a policy regarding communicating with patients with disabilities, send an email to sandie@dentalofficeconsulting.com with the subject line, “disability policy.”  If you would like more information about Health and Safety Policies and Awareness Training, feel free to contact us at 905-336-7624 or visit our website at www.dentalofficeconsulting.com.  Next week we will provide general tips on how to provide services to patients with disabilities as well as procedures to follow when dealing with patients who have vision loss.

Ref:  Access Ontario, Accessibility Standard for Customer Service Training Resource.

Tips on How to Interact and Communicate with Patients who have Mental Health, Learning or Language Disabilities

Mental health disabilities are not as visible as many other types of disabilities.  you may not know that your patient has a mental health disability unless you are informed of it.  Examples of mental health disabilities include schizophrenia, depression, phobias, as well as bipolar, anxiety and mood disorders

mental health disabilities.  A person with a mental health disability may have difficulty with one, several or none of the following:

  • inability to think clearly
  • hallucinations (e.g. hearing voices, seeing or feeling things that aren’t there)
  • depression or acute mood swings (e.g. from happy to depressed with no apparent reason for the change)
  • poor concentration
  • difficulty remembering
  • apparent lack of motivation

If someone is experiencing difficulty controlling his/her symptoms, or is in a crisis, you may want to help out.  Be calm and professional and ask your patient how you can best help. Treat a person with a mental health disability with the same respect and consideration you have for everyone else. Be patient.  Be confident and reassuring.  Listen carefully and work with your customer to try to meet their needs.

How to interact & communicate with patients who have intellectual or developmental disabilities.

People with intellectual disabilities may have difficulty doing many things most of us take for granted.  These disabilities can mildly or profoundly limit the person’s ability to learn, communicate, socialize and take care of their everyday needs.

As much as possible, treat your patients with this type of disability like anyone else. They may understand more than you think, and they will appreciate that you treat them with respect.  Don’t assume what a person can or cannot do. Use plain language and speak in short sentences. To confirm if your patient understands what you have said, consider asking the person to repeat the message back to you in his/her own words.  If you cannot understand what is being said, simply ask again.  Provide one piece of information at a time.  Be supportive and patient.  Speak directly to your patient, not to their companion or support person.

Learning Disabilities

The term “learning disability” describes a range of information processing disorders that can affect how a person acquires, organizes, expresses, retains, understands or uses verbal or non-verbal information.

 Examples include dyslexia (problems in reading and language based learning)

dyscalculia (problems in mathematics)

dysgraphia (problems in writing and fine motor skills).

It is important to know that having a learning disability does not mean a person is incapable of learning.  It means that they learn in a different way.

Learning disabilities can result in different communication difficulties for people

they can be subtle, such as difficulty reading, or more pronounced.  They can interfere with your patient’s ability to receive, express or process information.

You may not know that a person has a learning disability unless you are told

tips on how to interact & communicate with patients who have learning disabilities.

When you know someone with a learning disability needs help,  ask how you can help.  Speak naturally, clearly, and directly to your patient. Allow extra time if necessary – people may take a little longer to understand and respond.  Remember to communicate in a way that takes into account the customer’s disability.  Be patient and be willing to explain something again, if needed.  Some people have problems communicating because of their disability.  Cerebral palsy, hearing loss or other conditions may make it difficult to pronounce words or may cause slurring or stuttering. They may also prevent the person from expressing themselves or prevent them from understanding written or spoken language.

Speech or language impairments. 

Don’t assume that because a patient has difficulty speaking that they have an intellectual or developmental disability as well. Ask your patient to repeat the information if you don’t understand. Ask questions that can be answered “yes” or “no” if possible. Try to allow enough time to communicate with your patient as they may speak more slowly.  Don’t interrupt or finish your patient’s sentences –  wait for them to finish.

Tips on talking to patients with disabilities over the telephone.

Speak naturally, clearly and directly.  Don’t worry about how the person’s voice sounds.  Concentrate on what they are saying. Don’t interrupt or finish your patient’s sentences.  Give your patient time to explain or respond.  If you don’t understand, simply ask again, or repeat or rephrase what you heard and ask if you have understood correctly.  If a telephone patient is using an interpreter or relay service, speak naturally to the customer, not the interpreter. If you encounter a situation where, after numerous attempts, you and your patient cannot communicate with each other due to the patient’s disability, consider making alternate arrangements.

A trip to the dentist should be a positive experience for all patients regardless of whether they have a disability.  Start practicing these helpful tips when dealing with patients with disabilities and you will be ready to make your patients’ dental experience as seamless as possible. For more information on compliance with Ontarians With Disabilities Act, send and email to sandie@dentalofficeconsulting.com with your inquiry.

Make a Connection and Close the Sale

Today’s dental patients are much more sophisticated about how much they know about dentistry and how they make decisions about their dental health. With dental offices popping up practically on every corner, it’s not the billboards, bells and whistles that will attract and retain patients, it’s making a human connection and developing a long term relationship. 

Most dentists have heard this message before and know it to be true, but successful dental offices get busy and it can be difficult to be performing a molar endo while 3 hygienists are waiting for checks and you have just had an emergency patient arrive.  Dentists can’t be ubiquitous.

Practices that have a dedicated Treatment Coordinator are experiencing 25 – 50% more case acceptance, which results in higher profitability and reduced stress.  The role of a Treatment Coordinator will help to increase the case acceptance and bottom line profits while the doctor is doing what he/she does best, perform dentistry. 

Patients make decisions based on emotion and then justify them with logic. 

Studies have shown that 85% of case acceptance is based on emotional decisions of the experience at your office and how it makes the patients feel.

The role of a Treatment Coordinator is significant in demonstrating value to patients.  True value is a combination of real value that relates to the treatment and the patient’s perceived value that is based on emotion.  Many dental problems are asymptomatic, so the patients don’t feel symptoms and therefore don’t feel a sense of urgency to have anything done.  The Treatment Coordinator can take the time to translate the clinical terms they didn’t understand into lay terms and connect the treatment plan to their life.  She can then review the benefits of the treatment as well as the risks and consequences of not having the treatment completed.  Most importantly, she can make the financial arrangements at the time of booking the treatment and follow-up with the patients’ insurance companies to speed up the process.

The process of sending out a predetermination and waiting for a response from an insurance company is an intentional tactic to slow down the claim and allow the patients ttime o change their mind about completing treatment. Insurance companies depend on this so that more profits stay at the insurance companies and the claims experience remains low. That is why insurance companies intentionally take 4 – 6 weeks to send their ‘approval’ to the patient.  It is critically important for the Treatment Coordinator to stay in touch with the patient during that time period to help the patient understand that the treatment is for the patients’ health and that your office cares about them as a person.  It is recommended that she contacts the patient two weeks after sending out a predetermination and stays in touch to help circumvent the obstacles that insurance companies will use to discourage the patients. 

Don’t let treatment acceptance walk out the door via a 3-5 minute exit when they could have been escorted to a consult room with a Treatment Coordinator who has the dedicated time to discuss, answer and overcome objections to the treatment and make arrangements for the treatment to be affordable.
 

Patients need to see the value of the services and to be able to make that emotionally based decision, while maximizing their insurance benefits and have access to financial arrangements that fit with their budget.  That’s where a dedicated Treatment Coordinator can help.  She will pay for her own salary many times over by making the connection and ‘closing the sale’.

Today’s dental patients are much more sophisticated about how much they know about dentistry and how they make decisions about their dental health. With dental offices popping up practically on every corner, it’s not the billboards, bells and whistles that will attract and retain patients, it’s making a human connection and developing a long term relationship. 

Most dentists have heard this message before and know it to be true, but successful dental offices get busy and it can be difficult to be performing a molar endo while 3 hygienists are waiting for checks and you have just had an emergency patient arrive.  Dentists can’t be ubiquitous.

Practices that have a dedicated Treatment Coordinator are experiencing 25 – 50% more case acceptance, which results in higher profitability and reduced stress.  The role of a Treatment Coordinator will help to increase the case acceptance and bottom line profits while the doctor is doing what he/she does best, perform dentistry. 

Patients make decisions based on emotion and then justify them with logic. 

Studies have shown that 85% of case acceptance is based on emotional decisions of the experience at your office and how it makes the patients feel.

The role of a Treatment Coordinator is significant in demonstrating value to patients.  True value is a combination of real value that relates to the treatment and the patient’s perceived value that is based on emotion.  Many dental problems are asymptomatic, so the patients don’t feel symptoms and therefore don’t feel a sense of urgency to have anything done.  The Treatment Coordinator can take the time to translate the clinical terms they didn’t understand into lay terms and connect the treatment plan to their life.  She can then review the benefits of the treatment as well as the risks and consequences of not having the treatment completed.  Most importantly, she can make the financial arrangements at the time of booking the treatment and follow-up with the patients’ insurance companies to speed up the process.

The process of sending out a predetermination and waiting for a response from an insurance company is an intentional tactic to slow down the claim and allow the patients ttime o change their mind about completing treatment. Insurance companies depend on this so that more profits stay at the insurance companies and the claims experience remains low. That is why insurance companies intentionally take 4 – 6 weeks to send their ‘approval’ to the patient.  It is critically important for the Treatment Coordinator to stay in touch with the patient during that time period to help the patient understand that the treatment is for the patients’ health and that your office cares about them as a person.  It is recommended that she contacts the patient two weeks after sending out a predetermination and stays in touch to help circumvent the obstacles that insurance companies will use to discourage the patients. 

Don’t let treatment acceptance walk out the door via a 3-5 minute exit when they could have been escorted to a consult room with a Treatment Coordinator who has the dedicated time to discuss, answer and overcome objections to the treatment and make arrangements for the treatment to be affordable.
 

Patients need to see the value of the services and to be able to make that emotionally based decision, while maximizing their insurance benefits and have access to financial arrangements that fit with their budget.  That’s where a dedicated Treatment Coordinator can help.  She will pay for her own salary many times over by making the connection and ‘closing the sale’.

Is Your Dental Office Compliant with the Canadian Anti-spam Legislation (CASL)

~~Effective July 1, 2014, there is another new legislation that has a direct affect on dental offices. It is the Canadian Anti-Spam Legislation (CASL).  The CASL creates a new set of specific rules for email communications and marketing.  This new legislation affects any message that encourages commercialism, that includes communications through social media, text, and email.

What is spam?
Spam can be defined as any electronic commercial message sent without the express consent of the recipient(s). Spam is also used as the vehicle for the delivery of other online threats such as spyware, phishing and malware.

What is the intent of the new law?
The intent of the new law is to deter the most damaging and deceptive forms of spam from occurring in Canada. Spam includes more than unsolicited commercial messages. It has become the vehicle for a wide range of threats to online commerce affecting individuals, businesses and network providers. It can lead to the theft of personal data to rob bank and credit card accounts (identity theft); online fraud luring individuals to counterfeit websites (phishing); the collection of personal information through illicit access to computer systems (spyware); and false or misleading representations in the online marketplace.
Businesses are victimized by the counterfeiting of business websites to defraud individuals and businesses (spoofing). Network providers—recognizing that spam represents 75 to 90 percent of all email traffic—are forced to invest ever-increasing resources to prevent spam from entering their networks. Once established, spam slows networks down, and spam-borne viruses and other malicious software (malware) are used to operate networks of “zombie” computers (botnets) without their owners’ knowledge. These network attacks threaten the stability of the Internet and online services.

How does this new legislation affect dental offices?

If you communicate with your patients through email, text messaging or social media, you now must have express consent to do so.  You may already have implied consent since you have been communicating with your patients and have an existing business relationship.  Implied consent lasts 2 years from the last contact of business.  Implied consent, however, is not enough.  You need to obtain express consent from your patients to continue communicating using these methods.  Once you have express consent, it lasts forever.

What if you don’t have express consent?

Don’t worry, it’s not too late.  It is important to note, that although the CASL legislation is in effect as of July 1, 2014, you have until July 1, 2017 to convert implied consent to express consent.

Here are some recommendations to obtain express consent.

1. Prepare an email to all of your patients who have provided you with their email addresses or who have agreed to text messaging.  Request that each patient confirms with you whether they wish to continue communicating with via email, i.e. “opt in” or “opt out” of further email communications.  You must make it clear that the patients have the option of withdrawing their consent at any time. This is a very important aspect of providing consent. * see sample below *

2. Keep a list of the patients who have opted in.  Be sure to record the date that they consented.  You could save this list on an Excel spreadsheet.  Although this is time consuming, it is a very important step. You need to have proof of your patient’s consent in case you need to defend a complaint.

3. As each of your patients come in for their dental appointments, ask them to sign an express consent form if they wish to communicate by email. Keep the signed consent forms on file, or if you have a chartless office, scan the consent form into the documents section of the patient’s chart.

4. When new patients come to your practice, include express consent on your new patient registration form.  For a sample of a new patient registration form that includes express consent for email communication, send an email to sandie@dentalofficeconsulting.com with the subject line, “new patient registration form.”

5. If you are using a service such as Smile Reminders or Demand Force, they most likely have taken care of this issue on your behalf, however, check with your representative to make sure that you are compliant with this new legislation.

Below is sample wording that you may wish to use on the email or on the written consent form:

Express Consent for Email, Text, Social Media Communication

To comply with the Canadian Anti-Spam Legislation (CASL) that is in effect as of July 1, 2014, our dental office would like to have your express consent to continue communicating with you and providing you with important information  from us.  We are committed to never sending spam emails and our privacy policy will always protect your electronic information.

If you decide to opt in and continue receiving emails, please know that you may opt out at any time and withdraw your consent.

Please click on one of the links below and in the subject line tell us your preference by simply typing Opt In or Opt Out. 

Yes, I consent to receiving valuable information from ______Dental Office

No, thank you. I wish to opt out of future emails from_______ Dental Office

 For more information on our privacy policy, feel free to request a copy at your next visit, or visit our website at _______________ .

This legislation will require that dental offices take the time to obtain the appropriate consent forms to enhance the communications with patients who choose to be communicated with electronically, but it will be worth the effort.  This intent of this legislation is to protect your patients and your business against online threats.  For further information call 1-866-433-8499 or visit the Government of Canada website. 

How to Fill Your Hygiene Schedule and Keep it Full – Five Simple Steps

One of the biggest challenges that plagues most dental offices is downtime in the hygiene schedule.  Even now when there is increased access to contact patients through email, text messages, holes may still remain in the hygiene schedule.  This is a common problem that requires a common solution. 

Dentistry is a relationship business and human contact remains the most important motivator that helps patients to keep their appointments.  I have client who rarely experienced no shows in his restorative column, yet just two weeks after implementing an automatic email system, he had 3 no shows in one day.  That was highly unusual and distressing to the doctor.  The patients that didn’t attend the appointment were loyal patients who were used to receiving a call from the office.  Although these are great systems and increase the efficiency of the practice, it’s not for everyone.  It’s important to know your patients’ preferences and not become too reliant on emails and text messages.

After careful observation of the challenges that my clients’ offices face, it is my opinion that one of the biggest contributors to patients not showing up for appointments is email complacency.  Contacting a patient by email certainly saves time for the receptionist or hygiene coordinator, but emails are easier to ignore, impersonal and much too easy to delete.

What works best is a combination of emails and telephone calls.  I have several clients who have employed hygiene coordinators, even on a part time basis.  One of my clients hired a hygiene coordinator 2 days per week and increased their hygiene production by as much as 30% within two months.  The dramatic and proven results were achieved by having someone dedicated to making outgoing calls.

If you want to fill your hygiene schedule and reduce no shows and short notice cancellations, follow these five simple steps:

  • Use the telephone.  Make outgoing calls for continuing care every day.  If you don’t have the resources to employ someone to make these calls, then restructure the administrative activities to provide quiet uninterrupted time for the receptionist to make the calls.  Provide her with specific scripting to make the calls effective.  In two hours of focused time, she should be able to make a minimum of 25 calls per day.
  • Manage your patients’ expectations. How the appointment is scheduled in the first place will determine whether or not the patient will show up for the appointment.  Use positive wording to help the patient see the value in the appointment and place the responsibility of keeping the appointment on the patient.  If you would like examples of positive scripting for scheduling appointments, send an email to sandie@dentalofficeconsulting.com with the subject line, “appointment scheduling scripts”.
  • Do not refer to a dental hygiene appointment as a “cleaning.”  A cleaning is something that can wait. It’s not an important appointment in the patient’s mind.  How you speak to patients will help the patient to view the appointment as an important therapeutic appointment vs. a “cleaning” that can wait.  Dental hygienists are regulated health care professionals who perform therapeutic services that affect your patients’ overall health. That is the main message that you want the patient to understand.
  • Implement a hygiene downtime policy.  If a hygienist has a cancellation in the middle of the day, there is nothing that she can do to control that and it’s not fair that she shouldn’t be paid.  Provide a guideline of what the hygienist is expected to do during the cancellation downtime.  The receptionist could run off a list of any patients who are on a perio program or any of the hygienists patients who do not have a scheduled appointment. She can use the downtime effectively by calling her perio patients, or anyone who is due for a continuing care appointment.  When patients hear directly from their dental hygienist, that is a strong message to the patient  that this is an important therapeutic appointment.  If you would like a sample hygiene downtime policy, send an email to sandie@dentalofficeconsutling.com with the subject line “hygiene downtime.”

  • Create the expectation that the patient has made the patient has made the appointment with the intention of keeping it.  Ask them if they require a courtesy call instead of a confirmation call.  When the patient makes the appointment, they are essentially making a confirmed appointment.  When making the “confirmation” call, say to the patient, “This is your courtesy call. You have an appointment with Diane on Tuesday at 9:20 am.  We are looking forward to seeing you then.”   Don’t ask the patient to call you back to “confirm” that they received the call because this annoys the patient and it implies that there is an intention not to show up.  This is very negative messaging and it really tells the patient that you don’t trust them.  You expect your patients to trust you, you need to trust them and create the positive expectation that they will arrive for their appointment.

Control your hygiene schedule and don’t allow it to control you. Provide dedicated time for someone to focus entirely on the hygiene schedule and you will see dramatic results in a short period of time.  Add value to the hygiene appointment.  Patients are motivated to return by how they feel when they are at your office.  Exceptional customer service means delivering a wow experience every time.  Consistency is the key. Even if you are running behind and not having the best day, your patients should never feel your stress.  Keep your hygiene schedules full by following simple tried and true methods.  If you require further information, please don’t hesitate to contact sandie@dentalofficeconsulting.com.

Total Recalls

Total Recalls

Hygiene coordinators do not have an easy job. It’s tough calling people and constantly facing the apathy of patients who don’t value hygiene appointments, because after all, it’s just a cleaning, it can wait! If you continue doing things the same way, you are very likely to get the same result. I was in an office last week where the hygiene coordinator asked me a very valid question – “How many times are we supposed to call people before we stop?” Great Question!! It made me stop and think that the methods that we are using are not working, so now what? Let’s try something different.

I asked this lovely lady to show me some examples of how many times she had called patients. First, we looked at the recall list where next to each name I could only see L/M,  L/M, L/M, L/M, (left message). I understand that it is difficult to reach patients through the day and everyone seems to have voicemail, so the path to least resistance is to leave a message and wait for the patient to call back. We know that doesn’t work, so don’t repeat it. I also noted in the patient’s record that  the first call was made in April, the second in May, the third in September, the fourth in November. The problem wasn’t in the number of calls made, but the length of time between the calls. By the time the fourth call was made, the patient was  already 7 months overdue for his/her recall. Why does that matter? Because, if

2 or 3 or 7 months can lapse between telephone calls, it is not urgent or important for the patient to call you back and by then your patient has forgotten about the first telephone call.

New Strategy  Now for something completely different.

3 Steps for Total Recall Success

Step 1. – Make the first telephone call using the following wording:

“”Mrs. Smith, this is Sandie from Dr. Jones’ office. You are due for your dental  hygiene appointment and I’m calling to schedule that for you. When you get this  message, would you please call me back at ___________. I look forward to speaking with you. Have a great day. “

Note in the computer record – call no. 1 placed.

Step 2 – within one week of the first call, call again using the following wording:

“Mrs. Smith, this is Sandie again. I left a message for you last week. Dr. Jones  has asked me to call you to schedule your dental hygiene appointment. Could you  please call me back as soon as possible at _______________. Thanks so much and I’m looking forward to speaking with you.”

Note in the computer record – call no. 2 placed.

Step 3 – within the next week after the second call

After the third call and if there is still no response from the patient, send him/her the attached letter:

“Mrs. Smith, this is Sandie from Dr. Jones’ office.   Dr. Jones has asked me to

call you. Could you please call me back as soon as possible at _______________.

Thanks so much and I’m looking forward to speaking with you.”

Dear Mrs. Smith

Dr. Jones has reviewed your dental chart     and noticed that you are overdue for

your continuing care appointment. Regular examinations and hygiene     appointments

are necessary to maintain good dental health and prevent more     complicated problems

from occurring.

Preventive dentistry results in saving     you time and money.   Most dental  

 conditions are easier to treat when diagnosed in the early stages and     result

in less complicated and costly procedures becoming necessary. Please call me at

________ to schedule your     appointment. If you have any     questions, please

 do not hesitate to contact us.

Sincerely,

Sandie

Dental Hygiene     Coordinator

All 3 calls should be made within the same month. There should be no time lapse between. That’s the difference.

Using this 3-step strategy helps patients to realize that dental hygiene appointments are not ‘just a cleaning’ – they are very important steps to oral health . If patients don’t hear from you for one or two months between calls, you are sending them a message that it’s o.k. to wait. Doing so, puts your hygiene recalls months behind and makes it difficult to catch up. This is further reinforcement that it’s o.k.

 to wait, it’s not a big hairy deal.

Ideally, no patients should leave your practice without a prescheduled appointment, but if they do, help them to see that this is an important and valuable dental appointment.

Preventive dentistry will save them time and money in the long run. It is our job, as dental professionals, to help our patients see the value in keeping their appointments.

It is never a matter of pestering patients, it’s a matter of doing our jobs!

How to Be an Encouraging Dental Office Manager and Help Employees Feel Empowered, Informed and Invaluable

A good manager helps people do their best.  But that’s hard to achieve if employees, for whatever reason, feel anxious in the workplace–more worried about surviving than thriving. Even at the best dental offices, you can’t eliminate uncertainty.  There are too many forces beyond our control that can affect business–from the weather to the economy to changing technology. However, you don’t want to eliminate healthy caution.  One reckless employee can bring down a dental office. It’s important to reduce unproductive fear, the anxiety that keeps people from doing their best work. That sort of fear distracts employees, saps their energy, and leads to discouraging attitudes.

Every manager has the power to help people gain the confidence and energy to do their best and create an environment in which people feel “EN-couraged” every day. You can make this happen by helping people feel empowered to solve problems, informed about important issues,  and invaluable to the organization. An effective office manager will help employees to feel empowered, informed, and invaluable.  This doesn’t happen overnight and one person can’t single-handedly transform the culture of the office, but he/she can certainly have a positive  impact.

Encouragement spreads from the top down.  Encouraged employees tend to be the top performers and that makes encouraging behavior very contagious. When you genuinely involve your staff in problem-solving, you help them feel empowered, and that’s when they give you their best, most creative ideas.

At your next staff meeting, start by taking as many ideas as possible.  Do not make critical comments, just write them all down and include them on the agenda. Then get the group to help you evaluate and discuss each one.  That way each employee gets their voice head and you won’t have to be the one pointing out the problems.  In fact, you can set a positive tone, encouraging people to solve those problems, which is exactly what you had in mind in the first place.

Helping employees feel well-informed is an important part of creating an encouraging workplace.  People need to trust that they’ll be kept “in the loop” about important developments.  Otherwise, don’t be surprised if they always imagine there’s something sinister afoot. Informed employees are more relaxed, more confident, more productive.  Honest communication can put a lot of fears to rest.  Encouraging managers keep people informed.  Employees know they’ll be entrusted with important information, because open communication is the rule.  It happens informally, every day, whenever managers interact with employees.

An effective manager won’t try to solve all the problems either.  That sort of environment’s no fun for employees and it’s no fun for managers, either, who find themselves consulted on every small decision.  When employees feel invaluable, they make their own decisions, use their best judgment, and solve problems.  People feel valued when their managers show genuine, unqualified appreciation. It’s the difference between employees who are afraid to make a move and people who get things done even when the pressure’s on.

An important part of being an encouraging manager is setting a confident and positive tone. Your employees take their cue from you.  Involve people in problem-solving, hold regular meetings and express appreciation every day.

The manager must also feel empowered, informed, and invaluable. Employees want to feel their manager’s part of the team that’s steering the office.  It is important that the manager to takes ownership of the policies and procedures of the office, explain the reasoning behind them and productive ways of working within them. That gives employees the encouraging feeling that the manager is in control and if provides a sense of comfort and reassurance to employees.

There’s another way managers can set an encouraging tone in the workplace and that is demonstrating cooperation and mutual respect in their dealings with one another. To do their best work, employees need to feel that everyone’s on the same team, working towards a common goal.

To help people feel empowered, encourage them to participate fully in problem-solving, demonstrate your respect for their opinions, and be sure to put their good ideas into action.  People feel most empowered when they see themselves making a difference.

To help people feel informed, set a tone of honest, open communication.  Keep people “in the loop,” with regular updates on common goals and important issues.  Make sure employees know what’s expected of them, what they must do to succeed and how their performance will be measured.

To help people feel invaluable, let them know you recognize and appreciate their initiative.  Maintain an adult, mutually respectful relationship with every employee.  Most important, don’t be shy about telling people–often–that you value them and their contributions.

As an effective manager, you have the power to create an encouraging workplace, full of confident, comfortable people doing their best work. You do it by helping employees feel empowered, informed, and invaluable. Help to free up your employees to do their very best work.

Ten Steps to Improve Cash Flow

Why is cash flow so important to dental offices?  You need to have money in the bank to pay the bills, including payroll.   Collecting the fees for the services that you have rendered must be done at the time of service.  After all, you have performed the service  and made an irreversible change to your patient’s tooth or teeth.  You cannot repossess the dental work if the patient refuses to pay.  There are no businesses in the world that provide service and don’t expect to be paid, except for dentistry.   Once your patients get into the habit of leaving your office without paying or paying late, it can be almost impossible to get them to start paying on time. 

There are three basic ways to improve your cash flow :

1.  Speed up cash receipts from patients

2.  Slow down cash payments to vendors

3.  Reduce expenses

Step 1 Require immediate payment (or commitment to pay)  

It doesn’t matter as much about how much you bill – it does matter how much you collect. Dentistry is expensive to many patients, so have a policy where every person either pays or has a commitment to pay through financial arrangements. The ideal situation from a cash flow standpoint is to require payment at the time of service.  When was the last time you have been billed by a restaurant, or a dry cleaner, or a post office or a hairdresser and didn’t pay at the time of service?

Step 2 – Encourage the use of debit or credit cards .

You get your money more quickly, the patient is not subject to interest on their credit card since they will be reimbursed within 30 days. You don’t have to worry about the co-payment because you have already collected it. The merchant fees to credit card companies is minimal but worth it to improve your cash flow and it is a business expense.

Step 3  Manage the accounts payable.

Always pay your bills on time, but don’t pay bills sooner than you have to.  Every invoice that you receive  has a due date. If your vendor has agreed to finance your purchase for 30 days for free, then take full advantage of that. You hang on to your cash longer, which has a positive effect on cash flow.

Step 4 – Make sure that your invoices are correct .

 A lot of companies make mistakes. Make sure that your incoming invoices are correct . Ensure that your outgoing invoices (account statements) are also correct.  If your account statements are incorrect then you are providing an opportunity for the patient to delay payment to you.

Step 5 – Invoice upon delivery

If the patient does not pay the full fee at the time of service; send an invoice immediately, that day.   If you did the dentistry at the beginning of a month and you don’t send out account statements until the end of the month that negatively affects cash flow.

Step 6 – Bill more often. 

When prioritizing their outgoing bill payments, patients have a tendency to think that paying the dentist is a low priority (when compared to gas, hydro, etc.).  They sometimes assume that the dentist is rich and can afford to do without the patient’s money. Stay on top of your accounts receivable even if you have sent a statement at the time of service.  If the patient has not paid their bill in 30 days, send an account statements and put on the dunning message “Payment is due upon receipt.”. Identify your late payers and take action immediately to get them to pay.  Keep pushing, nicely but firmly, until payment is made. 

Step 7 – Give an incentive for prompt payment .

If a patient wishes to prepay in full for a crown or a bridge or implant and not use a credit card, you may wish to offer a professional courtesy to thank the patient for paying in advance. The professional courtesy should be no more than 5%, which is approximately the cost of keeping it on your accounts receivable.  If the patient does wish to prepay by using their credit card, then you may still offer a professional courtesy, but reduce the amount to 2 or 3%.  Write this into your financial policy and discuss it with your patient. Remember, do not call it a discount!  If your patients think that you discount your services, they think that you were overcharging all along. 

Step 8 – Budget Your Cash Flow

A cash budget that has sufficient cash flow can help you take advantage of business opportunities and avoid nasty surprises.  It is an estimate of your cash position for a particular period of time.  By estimating your cash inflows and outflows (expenses) during a given period you can project your cash flow needs.  Schedule your payments to vendors so that they are made when there is plenty of cash to spare.

Step 9 – Manage your expenses  

Only spend money when you absolutely have to. With the exception of consumables, i.e. dental sundries, try to make capital items last as long as possible.  Implement an inventory tracking system that will help prevent over ordering and waste.  If you are in need of a large capital expenditure item, you may wish to defer that expense until you have cash in hand – perhaps from a large cosmetic case that you are expecting payment for.

Step 10 – Manage Your Accounts Receivable. 

If you are not keeping an eye on your accounts receivable you are missing a terrific opportunity to improve your cash flow. No matter how much you love your patients, some of them don’t understand how important it is to you that they pay their bills on time. Always keep track of your accounts receivable and don’t allow accounts to go to 60 or 90 days. If any accounts do go to 60 days, send statements more frequently, i.e. every two weeks, then every week, followed with a telephone call.  Keep in mind if the patient has been reimbursed by the insurance company, or even if the insurance company pays you directly, that payment will have been received within 30 days, with the exception of social services programs.  If your patient has not paid you in two months or more, they don’t have any intention of paying you.  

 Improving your cash flow will improve the financial health of your practice.  Dentistry is a relationship business and it is important to have a healthy financial relationship with your patients so there are no surprises and awkwardness. The front desk coordinator must be confident in her ability to expect payment at the time of service and talk to patients about making comfortable financial arrangements.  Dentists also have bills to pay and need to support their families and staff.  If you wish to receive a sample of a Financial Policy and Procedure, please send an email to sandie@dentalofficeconsulting.com with the subject line Financial Policy. 

Is Committing Insurance Fraud Helping or Harming Your Patients

Is Committing Insurance Fraud Helping or Harming Your Patients

Based on the calls that I receive from doctors , as well as analysis of my current and past client base, I have discovered that approximately 50% of dentists who have contacted me have experienced,  or are currently experiencing, some level of fraud or embezzlement in their offices.  The alarming statistic leads me to wonder how many dental offices are experiencing this at some level and either don’t know what is happening or may be aware that something is wrong but don’t want to take action due to the fear of repercussions from the fallout.  It’s important to note that in all cases, the offices accepted assignment of benefits.

This explains why I don’t always get a warm fuzzy welcome from some staff members when I am hired as a consultant to analyze the practice.  If an employee is hiding something, she does not want a ‘consultant’ snooping around and asking her questions.  Although I am never looking specifically to find fraud, it always rears its ugly head when I ask questions about obvious discrepancies in the management reports.  In one case, it was the reaction of the manager that provided me with a clue that I might have stumbled onto something.  She became very agitated and red in the face when I asked her a very benign question.  Judging by her bizarre behaviour, I decided to do a little more digging before I reported my findings to the practice owner. It’s no wonder why she didn’t want a consultant coming into the practice.  She was hiding a lot and committing outright fraud.

The Robin Hood Syndrome

There is a saying that the road to hell is paved with good intentions.  The person responsible for the actions  was  a long-standing employee who may not have started out to commit fraud.  She may have been thinking that she was doing something good to help the patient receive his/her full benefit entitlement. By changing the codes to help the office or the patient receive 100% of the fees and not to have to deal with the copayments, was doing something good for the patient.  After all, insurance companies are the richest financial institutions in the world and the poor dental patient who couldn’t afford treatment otherwise.   Now the perpetrator has become the  ‘heroine’ to the patient, because the patient did not have to pay the insurance copayment.  There is also a sense of unfairness or entitlement whereby the perpetrator will justify her actions because, in her mind, the patient needed the treatment and it should have been covered.

How does she do it?  It may seem counterintuitive to describe how easily fraud can be committed, but the intent of this article is not to help the perpetrator, because she already knows how to do it and has been getting away with it.  The following examples are intended to help the dentist know what to look for if he suspects something is going on and then what actions he should take.

Here are some examples based on actual cases:

Over Billing

A client was contacted by an insurance company to verify the payments that were made for an orthodontic case.  The former office manager, who had been terminated from the practice, was creating invoices for the insurance company for double the amount of the treatment because the patient only had 50% coverage for ortho. Long after the patient had completed the treatment, the manager continued to submit claims for ortho and other false claims to the patient’s insurance company. The result was that the doctor had to reimburse the insurance company $16,000 and write a letter of apology, even though he had no knowledge of these claims being submitted. In the eyes of the insurance company, the dentist is responsible for all claim submissions

Changing Codes

A receptionist was changing the codes on the insurance submissions.  For example, if the patient had coverage for 3 units of scaling and the hygienist only coded for 2, she would change the code so that more money is received at the practice.  She would also add an extra surface to a filling or code for procedures that were never performed. The submissions for procedures that were never done were all for soft tissue procedures like perio surgery because insurance companies do not request x-rays for soft tissue procedures and she knew it.  She made improvements to the practice production and received a nice healthy bonus, but at what cost to the dentist.  The doctor in this case had to pay back in excess of $20,000 to several insurance companies.

Changing procedure codes is one of the most serious crimes that can be committed.  The chart is a legal document and it must contain and accurate and complete record of the treatment that was performed.  Changing codes to lead to the doctor and the hygienist losing their licenses.

Professional Courtesies and Write Offs

In this case, the perpetrator would enter write offs to correct procedural errors instead of following the appropriate steps to make adjustments to accounts accompanied by full explanations as to why the account needed to be adjusted.  Some of the dental software programs make it difficult to correct an entry, so following the path of least resistance, it may be easier to write it off or delete a transaction.  The perpetrator did not want you to know how many mistakes she is making which would make her look incompetent.

The danger of this scenario is that it may be tempting to write off a transaction that was a cash based transaction and won’t be missed.  When a staff member is facing her own personal financial crisis, it may be too tempting to put her hand in the cookie jar to get herself out of an immediate situation. If the employee’s hand is in and out of the cookie jar too often, eventually she will help herself to a cookie.   It may only be a small amount at first, but if it is easy to do and she gets away with it, this could lead to finding ways to take larger amounts and bigger cookies.  Account write offs must require authorization by the dentist accompanied by an explanation about why the account is written off.  Typically account write offs are only done once per year.

Using Someone Else’s Insurance Benefits

In this case, the perpetrator knew that ‘Patient A’  had not used all of his/her benefits, and ‘Patient B’ needed treatment, so ‘Patient A’s insurance company was billed. The perpetrator would know that the claim would be covered and not challenged by the insurance company. It’s important to note that both patients were members of the same family and ‘Patient B’ did not have insurance benefits.

Who Are the Victims of Insurance Fraud?

Victim #1 – The Patient

The patient is victimized by his/her insurance benefits sometimes being maxed out.  If a patient realizes that something is wrong with their insurance benefit entitlement and it is the result of what is happening at your office, they will blame you,  because you are the dentist.  The victim will not know, or care, that you have had a dishonest employee working for you who did these acts without your knowledge or consent.

Over-utilization of insurance benefits will result in employers not purchasing dental benefits for their employees.  Dental insurance is the most costly component of a group insurance benefits plan.  If the costs for the premiums rise due to the inflated utilization rate that was created by false claims, employers are likely to drop dental benefits from their employee benefits packages.  When employers are faced with economic stresses, paying premiums for dental benefits become too cost prohibitive to sustain.  The patient is now victimized a second time because they lose their employer paid benefit.

Victim #2 – The Doctor

If insurance companies launch an investigation and the doctor is aware of some problems that exist, but does not act on them, he/she is considered the prime suspect. In other words, the insurance company will assume that the doctor is responsible and his hands are dirty.  Some insurance companies can, and will, deny any future claims that come from your office.  You are considered guilty until proven innocent and even then, you are still guilty.

The doctor will also be expected to pay the insurance company back all payments that were received from fraudulent claims.  That can become an administrative nightmare to sort out which claims were legitimate and which were not , costing the doctor both time and money.

In some cases the doctor may have his/her license suspended or revoked if they knowingly allowed insurance fraud to occur and did nothing about it after it was discovered. You are responsible for the actions of your employees because it is assume that they work under your direction.

Victims #3  – Collateral Damage

If the doctor and or hygienist loses their licenses, who will treat the patients?  Also, the jobs for the remaining staff are in jeopardy making them victims as well.  A lot of honest, hard-working people can become the collateral damage of the perpetrator’s misguided actions and the doctor’s career can be ruined.

What should you do if you suspect or detect fraudulent activity?  The most important advice that you can receive is get professional help – don’t try to do it all yourself.

Follow these steps:

1.   Contact a forensic investigator to begin an investigation without  the knowledge of any of your employees.  If the investigation shows that fraud has occurred he will guide you through to let you know what your next actions should be. If no fraud is detected, that would be good news. An experienced fraud investigation service that I recommend is Prosperident.

2.  Perform a complete backup on your computer system immediately. Offsite backups are best and most dental software companies provide this service.

3.  Contact an employment lawyer who specializes in employment law.  I recommend Mariana Bracic from MBC Legal. Believe it or not, terminating an employee is harder than you think, even if you think you have cause for dismissal. The perpetrator will have to be terminated, but it must be done carefully so that you aren’t faced with further legal problems from a wrongful termination claim.   It is important to have proper employment contracts in place as well as an employee policies manual.  Employment law in Canada protects the employee and not the employer.

It is interesting to note that every office in these examples accepted assignment of benefits, which is another good reason for becoming a non-assignment practice.  Within the next few years, insurance companies will force the issue because they only want to deal with their subscribers to the insurance.  If your practice is assignment based and insurance driven, your practice is at risk. It’s important to treat the patient according to their clinical needs and not their insurance benefits.

If you suspect that fraud is happening in your office, don’t wait, take action quickly and get professional advice.  The risks consequences of not taking action far outweigh any disruptions that may occur.  Perform frequent and random checks to ensure that the services you are actually performing are the same services that are being billed. Watch the observable behavioural of your employees.  In every case presented, it was the unusual or overly defensive behaviour of the employee that tipped off the dentist that something was wrong.  Remember, that writing off copayments, providing professional courtesies to cover copayments, overbilling and changing codes is not helping the patients, it’s hurting them.  Fraud is fraud.