Is Sterilization a Hot Topic at Your Office?

By now, most dentists and denturists have read the story that was reported on CTV news about a Burlington dental office being temporarily closed down by Public Health due to sterilization concerns.  Letters were sent to the patients encouraging them to get tested for HIV and Hepatitis. Although the shutdown was temporary, the long-term effects of such a closure can be devastating to a dental practice and create collateral damage to the rest of the dental community.

Does your office have an infection control Officer?

Patients and employees are only safe from infectious processes when everyone consistently follows good infection control protocols. The purpose of the Infection Control Program (IPAC) is not to reduce the individual responsibility that each healthcare provider has, but to provide leadership for all employees throughout the office. Through policies, procedures, and evaluation processes, the Joint Health and Safety Committee (JHSC) or Health and Safety Representative (HSR) must act as a central contact point for all infection control information and channel that information in a manner that will create the safest environment.

It is recommended to select a clinical staff member to become the Infection Control Officer to be the contact person for the JHSC or HSR. The Infection Control Officer would be responsible to maintain written infection control procedures, which should be available to all employees. The JHSC or HSR would provide guidance for the prevention of incidents through other established informational channels within the dental office, such as email communications, posted memos and staff meetings. When problems arise, the Sterilization Officer should provide specific direction to a department or departments that details corrective actions that are deemed necessary. The JHSC should meet regularly, and maintain copies of the meeting minutes. If a Ministry inspector does comes to your office, provide him/her with a copy of the minutes.

The purpose of the Infection Control Officer or Committee is simple; to prevent and control infection. The Infection Control Officer/Committee is designed to provide clear direction to help everyone create and maintain a safe environment. When writing your procedures, determine which areas require only cleaning and which require disinfection. Train staff on the difference between cleaning and disinfection. Audit the disinfection and cleaning systems and make changes as needed. Once you have chosen the cleaners and disinfectants, ensure that staff read and follow all label directions.  If you have questions, contact the chemical manufacturer.

Planning

Successful prevention and control of infection requires careful planning. The Infection Control Officer/Committee should be actively involved with the planning and implementation of new procedures that pose a potential infection control risk. For example, provide guidance for the implementation of a new procedure. Its role in the planning process is to examine the proposal, identify potential areas of concern, and recommend a course of action that provides the best method of infection control.

The Officer/Committee also may provide input into the selection of chemicals used to manage the environment, such as detergents and disinfectants. It may also provide input into the selection of equipment used to process instruments and accessories.

Monitoring

The Infection Control Officer/Committee also monitors infectious processes within the dental office. They track infections and incidents that have the potential to cause infections. They review infection control statistics in an effort to minimize risk, identify problem areas, and implement corrective actions.

When infections do occur, the Officer/Committee should undertake investigations to determine the cause of the problem and recommends the necessary education or changes in protocols.

Evaluating

Along with monitoring specific incidents, the Infection Control Officer/Committee also looks at the bigger picture as it continually strives to improve processes within the facility. This is demonstrated by the regular review of infection control procedures for all departments. The Officer/Committee may also be called upon to evaluate procedures and provide input regarding products and protocols.
Updating: Perhaps one of the biggest challenges that all Infection Control Officer/Committees face is keeping current. The constant advancement of medical technology introduces changes at all levels within the dental office, new bacterial strains complicate and challenge older infection control practices, and new research often requires re-examination of established procedures. The Infection Control Officer/Committee’s purpose is to provide guidance and leadership through these changes. This requires that all members of the team strive to keep abreast of changes within their area of expertise. By keeping current, they can assist the Officer/Committee as it works to manage its facility’s infection control policy.

Educating

Finally, as an integral part of its leadership, the Officer/Committee must take an active role in staff education. The education process should address at least two specific areas. The first area should be that of general infection control education. This is usually accomplished through an annual education program designed for all employees. This program is designed to provide the groundwork for general infection control protocols, which create a safe environment for both patients and employees.

The second educational need that the Infection Control Officer/Committee addresses is the need for updating. In the constantly changing healthcare arena, the Officer/Committee must find a way to communicate changes and updates to the other staff members. This is usually done through staff meetings, or published Officer/Committee communications like meeting minutes. Whatever the method, the goal must be to create a smooth flow of information to all employees. Both of these educational roles should focus on creating awareness of infection control and developing the appropriate skills necessary to function effectively on the job.

At DOCS we have recently updated our Infection Control Policies and Procedures (IPAC) to be compliant with the latest protocols. For more information feel free to contact us by email at sandie@dentalofficeconsulting.com or susanmcdocs@gmail.com
or call us at 905-332-2326.

Does Your Office Have an Infection Control Committee or Representative?

Everyone knows that infection control is the responsibility of all dental office staff. Patients and employees are only safe from infectious processes when everyone consistently follows good infection control techniques. The purpose of the Infection Control Program (IPAC) is not to reduce the individual responsibility that each healthcare provider has, but to provide leadership for all employees throughout the office. Through policies, procedures, and evaluation processes, the Joint Health and Safety Committee (JHSC) or Health and Safety Representative (HSR) must act as a central contact point for all infection control information and channel that information in a manner that will create the safest environment.

It is recommended to select a clinical staff member to become the Infection Control Representative to be the contact person for the JHSC or HSR. The Infection Control Representative would be responsible to maintain written IPAC infection control procedures, which should be available to all employees. The JHSC or HSR would provide guidance for the prevention of incidents through other established informational channels within the dental office, such as staff meetings. When problems arise, the committee should provide specific direction to a department or departments that details corrective actions that are deemed necessary. The JHSC should meet regularly, and maintain copies of the meeting minutes. If a Ministry inspector does comes to your office, provide him/her with a copy of the minutes.

The purpose of the IPAC Infection Control Committee or Representative is simple; to prevent and control infection. The Infection Control Committee is designed to provide clear direction to help everyone create and maintain a safe environment. When writing your procedures, determine which areas require only cleaning and which require disinfection. Train staff on the difference between cleaning and disinfection. Audit the disinfection and cleaning systems and make changes as needed. Once you have chosen the cleaners and disinfectants, ensure that staff read and follow all label directions. If you have questions, contact the chemical manufacturer.

Planning: Successful prevention and control of infection requires careful planning. The IPAC Infection Control Committee should be actively involved with the planning and implementation of new procedures that pose a potential infection control risk. For example, provide guidance for the implementation of a new procedure. Its role in the planning process is to examine the proposal, identify potential areas of concern, and recommend a course of action that provides the best method of infection control.

The Committee also may provide input into the selection of chemicals used to manage the environment, such as detergents and disinfectants. It may also provide input into the selection of equipment used to process instruments and accessories.

Monitoring: The IPAC Infection Control Committee also monitors infectious processes within the dental office. They track infections and incidents that have the potential to cause infections. They review infection control statistics in an effort to minimize risk, identify problem areas, and implement corrective actions.

When infections do occur, the Committee should undertake investigations to determine the cause of the problem and recommends the necessary education or changes in protocols.

Evaluating: Along with monitoring specific incidents, the IPAC Infection Control Committee also looks at the bigger picture as it continually strives to improve processes within the facility. This is demonstrated by the regular review of infection control procedures for all departments. The IPAC Committee may also be called upon to evaluate practices and provide input regarding products and protocols.

Updating: Perhaps one of the biggest challenges that all IPAC Infection Control Committees face is keeping current. The constant advancement of medical technology introduces changes at all levels within the dental office, new bacterial strains complicate and challenge older infection control practices, and new research often requires re-examination of established procedures. The IPAC Infection Control Committee’s purpose is to provide guidance and leadership through these changes. This requires that all members of the team strive to keep abreast of changes within their area of expertise. By keeping current, they can assist the Committee as it works to manage its facility’s infection control policy.

Educating: Finally, as an integral part of its leadership, the IPAC Committee must take an active role in staff education. The education process should address at least two specific areas. The first area should be that of general infection control education. This is usually accomplished through an annual education program designed for all employees. This program is designed to provide the groundwork for general infection control protocols, which create a safe environment for both patients and employees. Information such as standard blood borne pathogen education, etc. is covered in these programs.

The second educational need that the IPAC Infection Control Committee addresses is the need for updating. In the constantly changing healthcare arena, the Committee must find a way to communicate changes and updates to the other staff members. This is usually done through staff meetings, or published Committee communications like meeting minutes. Whatever the method, the goal must be to create a smooth flow of information to all employees. Both of these educational roles should focus on creating awareness of infection control and developing the appropriate skills necessary to function effectively on the job.

Bullying and Harassment

Zero Tolerance for Workplace Bullying and Harassment

We hear a lot about bullying and harassment these days, especially when it involves cyber bullying using social media. We also know the devastating effects that may result from excessive bullying. As the victim of workplace harassment, I know firsthand how bullying can affect your life and your health. At that time, I was not aware of my rights and felt powerless as it was a David vs. Goliath scenario. Now employees have the right to feel safe at work and it is a mandatory requirement for employers to prevent violence and harassment in the workplace.

According to the Ontario Ministry of Labour, this winter there will be more targeted safety blitzes at workplaces. Workplace Violence  is targeted for February and March 2013. Given the significantly increased likelihood that your office will be met by an OHSA (Occupational Health and Safety Act) investigation, it seems prudent for you to be aware of your obligations, and to ensure that your policies, procedures and practices are up to date. The fines for non-compliance are hefty and in some cases can lead to prosecution.

Employers have the responsibility to provide a safe workplace for their employees under the requirements of Ontario’s Occupational Health and Safety Act (Bill 168). Amendments to this act help protect workers from violence and harassment in workplaces. The amendments to this act require us to do the following:

  • Develop and communicate workplace violence and harassment prevention policies and programs to workers
  • Assess the risks of workplace violence, and take reasonable precautions to protect workers from possible domestic violence in the workplace
  • Allow workers to remove themselves from harmful situations if they have reason to believe that they are at risk of imminent danger due to workplace violence

Employers should not tolerate the harassment or degradation of another employee by an employee or the employer. This may include:

  • any type of degrading comments about any staff member a form of direct harassment
  • rudeness, neglect or indifference by any member of the staff.
  • threats of physical violence
  • bullying
  • intimidation of another worker
  • the use of profanity in any professional setting is unacceptable

Your employee policies manual should include a statement like the following

“The harassment or degradation of another employee by an employee will lead to disciplinary action, up to and including immediate termination for just cause on the grounds of gross misconduct. We consider gossip and any type of degrading comments about any staff member a form of direct harassment and it will not be tolerated. The use of profanity in any professional setting is unacceptable. We will not tolerate rudeness, neglect or indifference by any member of the staff.”

Workplace violence is interpreted as unacceptable behaviour includes any incident in which there is:

(a) the exercise of physical force by a person against an employee, in the workplace, that causes or could cause physical injury to the employee,

(b) an attempt to exercise physical force against an employee, in a workplace, that could cause physical injury to the employee,

(c) a statement or behaviour that it is reasonable for an employee to interpret as a threat to exercise physical force against the employee, in a workplace, that could cause physical injury to the employee

(d) an attempt to threaten or assault a client or visitor to the workplace while on company premises; or

(e) an attempt by an employee to threaten or assault a client, co-worker or other individual in circumstances relating to the employee’s execution of his or her duties, whether on or off company premises.

““Unacceptable Behaviour” means physically or psychologically aggressive behaviours including but not limited to:

  • hitting, kicking, punching, pushing, shoving, slapping, pinching, grabbing, biting

  • carrying or brandishing weapons of any sort

  • throwing objects at an individual with a view to cause physical injury or fear

  • destruction of workplace or co-workers’ property

  • threats of violence

  • intimidating behaviour that causes the recipient to have a fear of physical violence

  • obscene or harassing telephone calls.

These are just some of the examples that need to be considered when establishing a policy against Workplace Violence and Harassment. All employers in Ontario should have a Workplace Violence and Anti-Harassment Policy in place and your policy must be posted in a visible area of your office for your employees to see. If you would like more information about this or would like a sample policy, please feel free to send me an email to sandie@dentalofficeconsulting.com, with the subject line – Workplace Violence.

Why do you need a Workplace Violence and Harassment Policy? Because it protects employees and employers.

Author: Sandie Baillargeon

Insurance-Fraud

Who Are the Victims of Insurance Fraud?

Victim #1 – The Patient – (who is victimized twice)

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 – Guilty Until Proven Innocent

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, 4, 5… – 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.

Author: Sandie Baillargeon

What to Expect if Your Office is Inspected for Compliance with the employment Standards Act (ESA)

The Employment Standards Act, 2000 (ESA) is a that law establishes minimum employer obligations and employee rights with respect to rates of pay, hours of work and overtime, vacations, public holidays, leaves of absence and more. Every province has similar laws in place to protect employees. The ESA applies to all employees and employers in Ontario and compliance with this law is mandatory..

The ESA is enforced by employment standards officers who visit businesses throughout Ontario to help educate employers on their obligations and ensure that employees’ rights are being protected.

Employment standards officers proactively visit businesses even if no complaint has been filed by an employee. These officers will help you correct areas where your business is not complying with the ESA.

Employment standards officers usually provide advance notice of a visit. They will review your records and speak to you and your employees. If there are issues of non-compliance, they will discuss these with you and depending on the nature of the violation, they may provide an opportunity to correct them before taking enforcement action.

Each year, hundreds of prosecutions are brought against employers for violating the ESA.

Some prosecutions have resulted in fines and/or court orders of tens of thousands of dollars or more.

Where the employer is an individual, rather than a corporation, he or she can also face jail time. In addition, directors of corporations can be held personally liable for their company’s violations and can also face monetary penalties and jail sentences. In the long run, these penalties cost businesses much more money than compliance. Some names of convicted employers and directors are posted on the Ministry of Labor’s website.

The role of an Employment Standards Officer is to conduct inspections and investigations.

Employment Standards Officers travel all over the province to inspect workplaces. These inspections make sure employers are complying with their responsibilities under the Provincial Employment Standards Act. Officers focus on standards such as:

Posting the Employment Standards poster in the workplace and distributing it to employees,

Ensuring that wage statements are timely and accurate with no unauthorized deductions

Accurate record keeping

Proper hours of work and eating periods

Accurate overtime pay

Adherence to minimum wage

Public Holidays and Vacation Pay standards

Restricting Temporary Help Agencies from charging fees to employees.

The inspectors will typically give an employer 10 days written notice when that inspection will take place. This gives the employer an opportunity to make their records available. It also gives the Ministry of Labour time to do their preparation. They will check the legal name of the business, whether it is still active, and look at their claims and inspections history. They will also check to see if the workplace is unionized.

Workplaces are selected through a variety of methods. These may include third party information, local intelligence, or just through random selection as part of a sector-specific enforcement blitz. In some cases they may also re-inspect a workplace to ensure that past violations have been corrected.

What should you have prepared?

During an inspection the Employment Standards Officer will take a look at a number of records which may include; schedules, time sheets, payroll ledgers and wage statements. The notice that they send out to employers also indicates important information about the Employment Standards poster.

What to expect during the inspection

The procedure is that they arrive at the workplace and meet the employer or their authorized representative. They review a variety of documents that relate to the Employment Standards Act. Beginning with an employer interview to determine compliance with the ESA. The inspector will take time to answer any questions an employer may have about their responsibilities.

During the inspection, they will ask the employer to show them where in the workplace they have posted the Employment Standards poster to make sure the poster is correct and it’s in a conspicuous place for the employees to see.

Employee Interviews

The inspector will also interview employees selected at random. If the inspector has reason to believe that there is not going to be adequate privacy to properly interview employees, he/she will make that known to the employer and let the employer know that they require a place that is comfortable, and that is isolated from the rest of the workforce or work environment.

Documents needed

During the inspection some documents are going to be required from the employer to prove the various standards are being complied with. The inspector will then use the documents provided by the employer to perform a test audit. The test audit involves the selection and review of payroll and other records. They randomly select employees to determine that at least the minimum standards are being met.

When the test audit is finished, if they find there is compliance with all standards that were inspected, they will then issue an inspection report which outlines the steps that they took and the findings they have made. The file is then closed.

What if problems are discovered?

If problems are found at the inspection and if it’s been found that an employer has contravened the Employment Standards Act, a full-audit or self-audit may be conducted for a set period of time.
If it is determined that the employer has contravened the ESA they may take enforcement actions such as: issuing a ticket, issuing a Notice of Contravention or in some cases recommending a Part Three prosecution under the Provincial Offences Act.

When the audit is completed, the employer is asked to voluntarily comply and correct any of the issues that were identified during the inspection. If wages are owed to employees they will ask the employer to pay those wages. If the employer does not comply voluntarily, they will issue an order to pay for the amounts that are outstanding.

When the inspection is completed, the officer will provide the employer with an inspection report which is required to be posted. The employer is asked to complete a Notification of Compliance indicating the dates upon which compliance has been achieved. When the notification of compliance form is returned to the officer the inspection is closed; however, the employer can be identified for a re-inspection at a later date to still ensure compliance.

To learn how your dental office can become compliant with the ESA, Henry Schein is sponsoring a free seminar on November 17, 2015 at the Scican Learning Centre, 1440 Don Mills Rd., Toronto beginning at 5:30 pm. To register for the free seminar please contact Susan McGuire at susanmcdocs@gmail.com or speak to your Henry Schein rep.

source: Ministry of Labor website

Author: Sandie Baillargeon

Hygiene Schedule

What to Do with Downtime in the Hygiene Schedule

Dental hygienists have a strong relationship with your patients and although there is an abundance of hygienists who are looking for jobs, it is important that dentists don’t take for granted the value of the patient- hygienist relationship. In most cases, the patients will see the hygienist more often than they see the dentist and for a longer period of time. There is more time to develop a relationship and patients become loyal to their hygienist based on trust. This is the type of relationship that you want your hygiene team to develop and maintain.

Some dentists pay their hygienists for their downtime and some don’t. Dental hygienists, like all employees, have financial obligations, like mortgages and living expenses, and they require a predictable and dependable income. The doctors who don’t pay anything for downtime can be assured that the hygienist is likely spending her downtime looking for another job or thinking about how to set up her own dental hygiene clinic and be her own boss.

Imagine if hygienists do set up their own independent practices, dentists could see 30% of their revenue walking out the door. In addition to this, studies show that 65% of restorative work is generated from the hygiene department. There is nothing that would stop an independent hygienist from opening a practice one block away, and although she would be restricted from directly soliciting patients, it wouldn’t take long for patients to find her. You may be able to replace the hygienist, but how do you replace the patients that could follow her? Think about how much time and money that would have to be invested into marketing and advertising to rebuild from the patients that you lost. Losing customers is economic suicide because you would also lost any potential referrals .

If a patient cancels in the middle of a day, there is very little that a hygienist can do to prevent that from happening or controlling it. It is not fair for the hygienist to have to suffer financial loss because she cannot control the behaviour of the patient. This does not, however, mean that you need to pay an employee to do nothing during the downtime. There are a lot of activities that can keep her busy.

Start by implementing a hygiene downtime policy and provide your hygienists with the tools to get the job done. The policy should provide one hour of grace time at full hygiene rate . Clinical rate may be paid up to a maximum of 1 hour of time in an 8-hour day where patients have short cancelled/schedule is not filled. This time is to be used productively, i.e. sharpening instruments, restocking operatories, making whitening trays, etc. If you there is more one full hour of downtime, the hygienist may be offered an administrative rate, such as half of their regular rate to assist in calling patients to schedule appointments or do administrative tasks as directed in order to be eligible to receive the compensation. If she does not wish to participate in administrative tasks, she may opt out of these duties and the downtime in excess of one hour would be unpaid. The administrative tasks would include calling patients on the continuing care list to make sure that the days are fully scheduled and confirmed. It is important to provide the hygienist with specific telephone skills to assist her with her calls. Remember that dental hygienists are trained in clinical skills and don’t usually learn telephone skills in school.

Here is some suggested verbiage:

“”Mrs. Smith, this is Sandie from Dr.Smith’s 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. “

Prescheduling hygiene appointments in such a way that reduces the likelihood of short notice cancellations can help to avoid this problem. If you wish to receive a copy of Appointment Scheduling Policy and Procedure, please feel free to send an email to sandie@dentalofficeconsulting.com with the subject line “appointment scheduling policy.”

It’s in everyone’s best interest to keep your hygiene team productive and happy. Give your hygienists the opportunity to build and maintain their own schedule and provide them with the time, tools, training and technology to get the job done.

Do not refer to a dental hygiene appointment as a ‘cleaning’. By referring to the appointment as a “cleaning” it minimizes the value of the therapeutic service that you provide and it becomes less important to your patients. As valuable members of your dental health care team, dental hygienists have a distinctive clinical and educational role to play in promoting good oral health for a lifetime. The relationship that your hygienist establishes and maintains with your patient is the foundation of a successful practice.

Author: Sandie Baillargeon

Turn Your Customer Service Experience into Memorable Moments

Everyone can make a difference and create memories for your patients to keep them coming back. Put your personal signature on everything that you do. Today, think about something that you can do for your patients to make them feel special to keep them coming back.

Here is the story of Johnny the Bagger. Johnny is a nineteen year old grocery store bagger who has Down’s Syndrome. He wanted to do something special for his customers, but didn’t think he could do anything special. Every night when he came home he would try to find a ‘thought for the day’. If he couldn’t find a saying that he liked, he would just make one up. When Johnny had a good idea for the thought for the day, his father would print multiple copies off the computer and cut out each quote and signed his name on the back. When customers were finished shopping, Johnny would bag their groceries and put his thought of the day and say “Thanks for shopping with us”. This young man who had a job that most people would not think is important, he made it important by creating a special memory for his customers.

One month later the store manager noticed that Johnny’s line was 3 times longer than anyone else’s The store manager quickly announced that they needed more cashiers and to open more lanes. When more lanes were open nobody would move to the other line. They said, “that’s ok, we want to stay to wait for Johnny’s thought for the day” One woman said, “I used to shop at your store once a week, but now I stop in every time I go by because I want to get Johnny’s thought for the day. It was a joy to watch Johnny delight the customers. Johnny transformed the store. Whenever the flower department would have a broken flower they would pin in on an elderly person as they came by. Now everyone is talking about their store and their customers are coming back and bringing their friends.

A wonderful spirit of service spread throughout the store, all because Johnny chose to make a difference. Johnny’s idea wasn’t as innovative as it was loving. It came from the heart – it was genuine. Great customer service comes from the heart.

Remember that “walk the talk” service starts with the first few seconds of the first contact. You only have one change to make a good first impression. So, greet your patients warmly. Talk less, listen more. Make it your goal to understand your patient’s needs and expectations rather than merely talking your way into a sale. Listen to everything the patient says as if there was a test at the end. Set a personal goal to become an expert on the services you offer. The more you know, the better your service will be.

Eliminate the negatives. Make a conscious effort to minimize the use of negative words and phrases in your service interactions. Patients do not appreciate words like: can’t, won’t, don’t, not, no, and sorry. You need to look for every opportunity to say: can, will, do, yes, you bet, and absolutely! Always, always, ALWAYS thank customers for their business. Tell them how much you appreciate their choosing your office for their dental services they need. Remember, it’s the patient who’s paying your salary.

Great patient service is selfless act and not a tactical decision.

What can you do today to make your patient experience memorable?

Author: Sandie Baillargeon, courtesy of the Simple Truths Publishing

Turn Your Accounts Receivable into Accounts Received

Do you go to your hairdresser or grocery store and leave without paying? Does any business do this?

Collecting money at the time of service is mandatory to keep your business running. All of your team members needs to be on board with this concept. They have to believe in the value of the services that you are providing and that there is a financial value also.

To keep your business viable, there should be no accounts that are outstanding for 90 days- in fact, there should be no accounts outstanding more than 30 days! .Bank managers consider 90 day accounts to be uncollectable and Statistics Canada states that if your accounts are over 90 days outstanding, you are running at a 15% loss. Logic indicates if you have an actual loss, you will require an equal or greater amount of new sales just to offset the loss. That means that you must have a method of attracting and retaining new patients at a rate that is at least equal to or greater than your financial loss

Example – Based on total revenue of $1,000,000. If you are running at a 15% loss due to uncollected and uncollectable accounts, you must generate $150,000.00 in new revenue just to offset the loss

Think about this, if your patients have received dental services and have not paid you in 3 months, there is no intention of paying you – ever. Also, once an irreversible change has been made to the tooth, the dentist must complete the service. It doesn’t matter if the patient has no intention of paying for the service.

Cash flow is necessary to pay your bills, including your staff costs. Expect your patients to pay for the valuable services that you provide. Confidently say, “how will you be taking care of your bill today?”. You are not offering free dentistry – are you have bills to pay.

Author: Sandie Baillargeon

Tune Up Your Practice Management Systems

Accounting systems and financial statements provide you with valuable information about the financial health of your practice. It is important to know what the numbers mean, how they affect your practice and what you can do to make improvements .Numbers with context, meaning and action plans are the keys to long term sustainable success.

Erosion of practice management systems may occur silently and go unnoticed. Dental management systems must be responsive to the changing market place and proactively direct the actions of the people within your office. Recognize the hidden signals, identify the causes, and correct the breakdown of your systems quickly to protect your practice from long term effects of economic downturns. Uncover inefficiencies that may exist, discover opportunities for improvement and take action now!

The Appointment Schedule

The appointment schedule is the beating heart of your practice. When the schedule falls apart, everything else follows. Having warm bodies in the chairs receiving treatment is the only source of revenue generating activity in your practice – everything else generates expense.

Is your staff taking proactive measures to prevent no shows and short notice cancellations? If you have just two cancellations per day in your hygiene columns, your practice could be losing between $72,000 – $96,000.00 per year.

Often I will hear receptionists say, “well, everyone is sick” or “it’s just the time of year, what are you going to do?” . Good question! What are you going to do? Maintaining the appointment schedule is challenging, but it is the job of the team to focus and work on the schedule to get it filled. The alternative is much worse.

Practice Collections – Turn Your Accounts Receivable into Accounts Received

It doesn’t matter how much you are charging if you don’t collect the fees for your services at the time of service. Accounts that are over 90 days outstanding are considered noncollectable. After all, the patients who still owe you money 3 months after they have received your services, have no intention of paying you. That doesn’t mean that you should write off all of your 90 day accounts, it simply means that someone needs to focus on this process and be accountable for the results.

Identify one team member take control of the accounts receivable,. If there are accounts that have been outstanding for over 90 days, make those accounts a priority. The key to collections is everyone on the team needs to believe in the services and the fees and collect the fees at the time of service

Elevate Your Hygiene Department

Most cancellations and no shows occur in the hygiene schedule because your patients don’t see the value in dental hygiene appointments. When you tell patients that they need a “cleaning” appointment, there is no sense of urgency and patients think that it can wait – “it’s just a cleaning!”

Dental hygienists are not teeth cleaners!! They are highly trained, registered, regulated dental therapists, who prevent disease, promote healing, improve the overall health of the patient, etc. You must believe in your own value before your patients will.

Hygiene coordinators must change their semantics to reflect the value of the hygiene appointment. Never say to a patient, “I’m just calling to remind you that you are overdue for a cleaning”- saying the word “just” it minimizes the value of anything else that you have to say so the patient has stopped listening.

Here is some scripting that they can use:

“Mrs. Smith, you need to return in 3 months. Will you please reserve the time in your schedule, as I am reserving this time for you. If you would like a courtesy call, our receptionist, Jane, will be happy to call you two business days in advance of your appointment. If you do need to change this reserved appointment, will you please give Jane a call at least two business days in advance of your appointment and she will be happy to find a more convenient time for you.”

Overhead Expense Control

A well run dental practice should operate at between 50-60% overhead expenses (based on gross production before taxes). Monthly dental sundry costs (consumables) should not exceed 5% of monthly production and staff costs should range between 20-25%.

The best way to decrease expenses is to increase revenue. The best way to increase revenue is to have patients booked in the schedule, who keep their appointments, value your services and who are on active recall. When you increase the revenue and collections of your practice, all of the benchmarks for success will align.

Human Resources Management

A good human resource performance management system with clear goals and measurable objectives will increase accountability and help your employees feel connected and committed to your success. Striking a balance between being involved with your team members enough so they feel your direction and support isn’t easy Employees want to be treated as people first and workers second.

One easy way to stay connected and keep the lines of communication open is to conduct daily (starters). Hold daily morning huddles at the same time every morning to ensure team communication that results in achieving production goals or system improvements. When you regularly connect with your team members, your environment will become motivating and encouraging. Happy employees affect the bottom line

The key to improving your bottom line and increasing your profitability is a three step process:

1. Empower yourself by keeping your eye on the numbers. Establish an operating budget and focus on what is most important to you and your practice. When you see a system that is slipping, take proactive measures to correct the system now.

2. Empower your patients to make good informed decisions. Reinforce the value of your services by using powerful communications. Confidently recommend treatment that is patient specific, patient centered and not insurance driven.

3. Empower your employees. Provide them with the time, tools, training, technology and trust to help them commit to your patients, your practice and their own personal fulfillment.

To make sure that your management systems are running at maximum efficiency and effectiveness, check them often and look for the hidden signs of erosion. Make any necessary adjustments quickly and your practice will run like a well-oiled and well maintained machine that will reward you with many years of sustainable growth and profitability.

Sandie Baillargeon is a leading authority on how to increase the effectiveness of medical and dental business systems. Ms. Baillargeon is author of two text books, Dental Office Administration and The Canadian Dental Office Administrator, published by Nelson Canada. Sandie is the owner and operator of Dental Office Consulting Services, which specializes in dental business planning, staff development, consulting and continuing education seminars.  Visit her website at www.dentalofficeconsulting.com or contact her directly at (905)332-2326.

Author: Sandie Baillargeon

Top Five Tips and Traps When Processing Predetermination

Interference

Insurance companies will use many different tactics to slow the payment of the claim and to prevent the claim be paid at all. The psychology behind the predetermination process is such that if the patient has to wait for four to six weeks, he/she is most likely to not follow through with the treatment. This is especially true if there is an out of pocket expense to the patient. Insurance underwriters include the predetermination requirement in the insurance policy in order to deliberately discourage the subscriber from having the treatment that he/she needs.

These tactics are deliberate attempts to keep the money in the hands of the insurance companies. Insurance companies are in business to make large profits and they do not care about your patient’s health. Dental insurance is considered a living benefit, which means that if a subscriber has dental insurance, they are most likely going to use their benefit. This differs from most indemnity based insurance plans that only pay out a claim based on catastrophic loss or death. So the insurance companies must find specific ways to slow down the frequency of payments going out while continuing to collect high premiums from employers. How they do that is by including a predetermination process, having a missing tooth exclusion clause, limiting the frequency of coverage for emergency exams, continuing care appointments, scaling units, annual maximums and deductibles, copayments, and anything else that they can impose limits on.

Insurance adjudicators will do everything necessary to decrease the utlization rate of the insurance plan. The simple logic behind it is the more money that flows in from employer premiums and the less that is paid out in claims, the higher the profit margin for the insurance companies.

Many dental conditions are asymptomatic and if the patient is not in pain, he/she is not compelled to move forward with the treatment that they need. If the patient has to wait for four weeks after receiving the diagnosis and treatment plan to see if their insurance company “approves” , the patient is less likely to complete the treatment, but at the very least, payment of the claim has been slowed down considerably, leaving more money in the hands of the insurance company.

Traps

1. Allowing the patient to think that the treatment is not needed unless the insurance company approves.

2. Sending the predetermination by snail mail only

3. Assuming that you will receive an answer from the insurance company

4. Assuming that the patient will contact you immediately

5. Not staying in touch with the patient during the lag time

Your dentist is overcharging

Tips

1. Send the predetermination by EDI and by snail mail simaultaneously. Include the estimated lab fee and let the patient know that whatever percentage th

2. Manage the patients expectations. Contact the patient one to two weeks after the predetermination has been sent.

3. Include as much information as possible, i.e. date of the extraction, what other teeth are missing in the arch, initial placement, etc. Send a cover sheet that includes that information. For a sample cover sheet, send me an email at sandie@dentalofficeconsulting.com with the subject line “cover sheet”.

4. Schedule the appointment 3 – 4 weeks after sending the predetermination. This hels the patient to understand that the treatemnt is still required. Make financial arrangements with the patient.

5. Send a letter of appeal and look at any of the alternative benefits. Clearly explain to the patient what the alternative benefits clause means and

You are your patient’s advocate because you really do care about your patient’s health. Insurance companies only care about profit and your patient is only a number to them. As dental professionals, it is our job to assist our patients in understanding their benefit and helping them to receive the reimbursement for what the benefits that they deserve and have paid for. Don’t let insurance companies manipulate your patients and interfere with their care and the doctor patient relationship. Follow the tips in this article and most importantly, stay in touch with your patient during the lag time. Dealing with dental insurance benefits is a reality for all dental offices. Understanding their tactics and knowing how to avoid the traps will help you to assist your patients and increase the case acceptance at your office.

Author: Sandie Baillargeon