Dentistry's Business Secrets

September and October can be a slow time in the dental office schedule.  After a summer filled with child check-ups, everyone returns to school and the schedule lightens.  The combination of hectic back to school schedules and the expense of school supplies, clothes and fall sports leave many families without time or financial resources to visit the dentist.  Summer is an expensive time with increased child care costs and vacation expenses for many families.  The credit card bills from that vacation in July are now due which squeezes the budget even more for many families.

My practice experiences this slowdown every year so we take steps ahead of time to combat this tendency. It can be difficult in the busy months of summer to find time for additional marketing, but a few simple steps have helped us to avoid too much of a decline in the early fall months.  In August, we check through our overdue recall and outstanding treatment plan reports.  Patients with an overdue recall are sent a postcard which is followed up by a phone call a couple weeks later.  Patients with an outstanding treatment plan are offered a discount if they schedule during the month of September or October.

These months also afford an opportunity to highlight a special promotion such as free whitening.  Online advertising and social media are great outlets for getting the word out about a new promotion or special.  Google Places allows status updates which can run for 30 days to highlight a new product or promotion.  Twitter and Facebook provide easy updates to current patients and potential new patients, but you must remember to use location specific keywords in these updates.  Blogs provide easy content updates to highlight special events as well.

I have found these fall months to be a great time to take a vacation.  Popular vacation spots are less crowded and more affordable, as families have headed back to school.  Closing the office for a week or two provides the added benefit of creating a more efficient schedule in the weeks surrounding the vacation.  This is also an effective means by which to control payroll overhead if your staff is paid on an hourly basis.

What steps does your office take to avoid slow production times?

          With so many competing dental product suppliers and material choices, how do we determine what to buy and from whom to buy these items?  One highly effective method is to research dental equipment and materials by attending a lecture sponsored by CR Foundation, available via www.cliniciansreport.org.  One such seminar supplied me the reference guide, Cutting-Edge Products for Clinical Excellence, outlining hundreds of product choices and contact information for the particular company manufacturing or supplying each product.  I consulted this list for many of my initial material choices in my current dental practice and continue to revisit it from time to time.  This outline simplifies the initial ordering process by centralizing a vast network of dental manufacturer contact information in one source.  It also serves to reinforce all the materials you will need to complete every dental procedure you will be offering in your practice.  The least beneficial time to discover that you need a dual-cure cement on hand is when the post is ready to be cemented.

          Gordon J. Christensen Clinicians Report, formerly CRA Newsletter, is a periodical edited by Dr. Gordon Christensen, a pioneer in dental industry research.  Clinicians Report offers an online subscription option with full search and cross referencing capabilities of the past 30 years of CR test results.  This provides dentists the ability to search specifically for any product they are considering and consult issues related to its testing.  When opening my current dental office, I ordered two years of back issues of CRA Newsletter and made purchasing decisions based on my research.  This is a very practical tool as it eliminates manufacturer bias and reports only those findings of our professional peers.

As we enter the second half of the dental benefits’ year, it is important to check remaining insurance maximums when calculating patient co-pays.  Many dental insurance companies provide a $1,000 maximum which can be reached quite quickly.  Often, dental patients are not aware of how low this maximum is and will not be keeping track of how much of their benefit maximum has been used.  In order to ensure the proper collection of a patient’s co-pay and maintain goodwill with your patients, a quick check of the patient’s remaining benefits should be conducted prior to presenting the patient with an estimate.  Patients may have received treatment in the office of a dental specialist and used most of their dental benefit amount there.  Some dental insurance companies provide year to date benefit usage information through online benefit systems or faxes, thus facilitating the verification process.

One of the biggest mistakes made in today’s dental practice is that of calculating inaccurate pre-treatment estimates.  Not only is this bad for your production/collections ratio, it can also tend to leave a very bitter taste in the mouth of patients who assumed their bill was paid in full, only to later discover that they are left with a weighty balance after insurance reimbursement.  The best advice I can offer to prevent this practice breaker is to get their bill right the first time!

This year, my practice has transitioned to advertising exclusively online.  I have decreased the overall marketing budget while still attracting new patients each month.  This blog contains several entries on what we have done to increase the optimization of my practice websites and our overall Internet presence.  My first suggestion is to sign up for free local business listings with the major search engines, including a Google Places  listing.  One avenue that brings consistent traffic to my websites and patients to my office door is participation in online dental directories.  A well optimized website and online presence can make a great difference in the number of new patients a dentist sees.

The forums at DentalTown have been a helpful source of information in running my practice.  The message boards contain a large variety of topics including dental practice marketing, dental website design, dental practice management, dental insurance, restorative dentistry, cosmetic dentistry, endodontics and periodontics.  Dentists ask questions and give advice to one another.  DentalTown contains a compilation of press releases, industry news articles and opportunities for continuing education.  Dentists must register to become a member.

My dental office has been participating in social media through Twitter and Facebook for several months now.  Facebook, in particular, has been a good way to keep up with my current patients.  This month I have used these venues to promote a Ladies’ Month promotion which has attracted new patients as well. 

Email marketing through a service like Constant Contact provides dentists with an easy and inexpensive resource for sharing information with patients.  We ask our patients if they would like to opt-in to receive email reminders and newsletters from our office.  We send out e-newsletters to all of our patients several times a year.  My office also sends email reminders to patients with overdue recalls or pending treatment plans.  Email marketing helped us to promote our Ladies’ Month event as well.

I recently contacted TouchPoint Autism Services to inquire about information for dentists and parents regarding dental care and treatment for patients with an autism spectrum disorder.  With the diagnosis of autism on the rise, most dental offices will have several patients on the autism spectrum.   Therefore, I thought it might be helpful to share this information with other dental health practitioners.

Autism Speaks has designed a colorful and descriptive fifteen page Dental Guide for patients with autism.  The guide covers  proper techniques for brushing and flossing, as well as how to find a dental office and prepare for the first visit.  One of their suggestions is that individuals with autism may benefit from a visual schedule depicting the daily toothbrushing process.  This guide also provides a visual schedule for a trip to the dentist office.  As an added bonus, the last portion of the guide provides information to dentists about how to prepare the office and staff for treating a patient with autism.  The guide includes a three page health and sensory questionnaire for patients with autism that can be used to assess how to best treat a specific patient. 

An occupational therapist at TouchPoint offered the following recommendations for dentists treating patients with autism:

• Provide prediction:  Tell the patient what you are going to do or how you are going to touch them before you do.
• Provide firm touch.
• Leave the xray drape over the patient for the duration of treatment for sensory input.  A weighted blanket is often calming to an individual with autism.
• Distract the patient with something else like a visual toy or a video while doing something unpleasant.
• Place your hand on the forehead while working in the mouth to provide pressure.
• Complete some oral motor exercises or massage to reduce sensitivity.
• Some patients may tolerate a vibrating toothbrush rather than a regular toothbrush
• Experiment with different toothpastes. People with autism may be intolerant to certain tastes.
• Avoid wearing strong smelling perfume or aftershave when treating the client, as many people with autism are hypersensitive to smell.

TouchPoint also pointed us to another guide for dentists working with autistic patients.  This guide highlights the following information.  Explain to the patient in short statements what will be happening during the appointment.  Some individuals with autism take information very literally so avoid phrases that might be confusing. Allowing the patient to see the instruments and know what they will do before their usage can  help.  Some patients may be soothed by pressure from touch, but inform the patient where you will be placing pressure prior to touching them.  Verbal praise should be used throughout the appointment whenever possible.  Enlist the parents help in giving suggestions for what will be helpful and harmful in working with their child.  As mentioned earlier, the Autism Speaks’ guide provides a questionnaire that may be helpful in attaining this information.

The National Institute of Dental and Craniofacial Research (NIDCR) also provides information on practical oral care for people with autism.  The NIDCR outlines information on behavioral, communication, health, sensory and oral issues that may present during a dental visit and tips for how to handle each of these areas. 

About TouchPoint Autism Services

For more than thirty-five years, TouchPoint Autism Services has been a
premier provider of services for individuals with autism spectrum disorders
and their families. Our name reflects our desire to be the single touch
point for services to individuals with autism throughout their lives – a
place where families can always expect to receive quality services and
compassionate care and support. Services that are provided include: Adult
Programs/Support, Clinical Therapies, Consultation, Evaluations/Assessments,
Family Support, Individual Support, Residential Services, Parent Training,
and Training for Professionals, Support Groups, Training Services, and
Workshops/Seminars.

Operating your business within the framework of a more condensed schedule can yield maximal productivity in fewer hours and fewer workdays.  I am reminded of a statement offered by my childhood dentist, “I can produce as much in 25 hours per week as it would take most dentists 35 hours to produce.”  The data bear out that dentists operating within a highly efficient, compressed work schedule tend to be more productive and ultimately more profitable.  Dentists utilizing a three day work week often out produce those laboring four or even five days per week.  The explanation for this is that these three day practices are operating more efficiently.  There are fewer openings in their schedules, and waiting lists of patients help to ensure that.  Schedule compaction not only fosters greater hourly productivity, but also enhances profitability through overhead reduction.

The elimination of additional days per week of hourly staff pay and associated variable costs can reduce overhead and directly flow to your bottom line.  Less time at work permits periods of rejuvenation necessary for most dentists to side-step the all too frequent reality of occupational burnout.  A dental school instructor related an anecdote of once dining with colleagues, each sharing numbers of annual practice production, in an attempt to go one better than the others.  On the contrary, my friends and I often try to outdo each other by actually scheduling the fewest number of workdays per year.  Net income being equal, the true victor in terms of practice success may be the dentist achieving this income result via the fewest labor hours invested. 

 Operating your practice on a three day work week offers multiple variations of workday selection, provides patients with multiple appointment time options and helps prevent workplace boredom.  For example, a doctor may choose to work Monday, Tuesday and Wednesday of one week and Wednesday, Thursday and Friday of the next.  Vacation time can be worked into the six day chasm between weeks, eliminating the necessity to close the practice for an entire week.  When the doctor elects to open early on Monday and Friday and close late on Tuesday and Thursday, patients will always have convenient scheduling options.  Patients can choose appointments on any day of the week, early morning, through the lunch hour or after work, even though the practice is only open three days any given week.

 Another option for the doctor is to open the practice the same three days every week.  Whether the doctor chooses M-W, T-Th, or W-Fr, the resulting five day break between patients regularly seems adequate to reduce professional burnout.  The downside to this type of regularity in the schedule is the difficulty it imposes on patients to find convenient appointment times.  Any three day work week also encroaches on a doctor’s ability to treat dental emergencies in a timely fashion.  For these reasons, a doctor may elect to open Monday through Thursday one week and Tuesday through Friday the next.  This schedule affords the doctor a four day weekend every other week and permits patients to be seen in a prudent manner through convenient appointment times.

Limited time promotions can be a great way to attract new patients and re-appoint current patients during typically slow months.  The month of February often shows a slow down in my dental office schedule.  Patients wanting to take advantage of their remaining dental insurance benefits and time off around the holidays fill the office in December.  January can be busy with restorative treatment for patients who were waiting to access their new calendar year dental benefits, but in February the schedule can become more sparse.  National Children’s Dental Health Month, sponsored by the American Dental Association in February, provides a great opportunity for running an in-office promotion for children with appointments that month.  February is also a good month to send dental hygienists and dental assistants into area schools to educate children on dental health and provide personalized goodie bags with information about your office.

In the month of July, my office will be running a Ladies’ Month promotion.  We have secured giveaways from a local spa and Mary Kay representative.  We plan to offer door prizes and a drawing for free whitening each week.  Women tend to be busy during the summer months trying to juggle summer vacation plans so my staff thought it would be a good time to offer our patients a little pampering.  If this promotion is a success, we will expand our offerings next year.

Our business cycle has demonstrated the tendency for slower periods during September and October each year.  To stave off this trend, we prepare in advance with discounts for patients with an outstanding treatment plan and postcard reminders for patients with overdue recall appointments.  These techniques have helped to even out the schedule during a time of the year that formerly proved problematic.

Online opportunities for advertising patient promotions make it quicker and less expensive to get the word out regarding new promotions in your dental office.  A Google Places listing allows businesses to update their “status” regularly and this tool can be used to highlight a new promotion.  MerchantCircle and Yelp offer similar opportunities to highlight a special offer or promotion.  If you are active in social media through Facebook and Twitter, these platforms can be used to get the word out to current and potential patients as well.  All of the above mentioned online advertising opportunities do not cost anything beyond the labor to set up and update the accounts.

If you are feeling more ambitious about promoting your special offers and you are willing to pay for the promotion, consider sending an e-newsletter through a service like Constant Contact.  Dental patient e-newsletters can be sent to all current patients who have opted in to receive newsletters from your office.  An e-newsletter can be sent any time you are running a new promotion.  You can opt to bypass the cost of using an email marketing company and send out notices from your office’s email account, but for a relatively low cost an email marketing company offers email templates and statistical reporting.  Another paid option for marketing a new promotion is a limited time Google Adwords campaign with an ad specifically designed to highlight your dental patient promotion.

Please feel free to comment with any practice promotions that have been successful in your office.

One of the first steps dental offices should take in increasing their online presence is to sign up for local business listings with the three major search engines.  Google’s Local Business Center has been renamed Google Places and is the most important listing of this kind.  Local business listings populate the Google Maps that are displayed when a search query includes a city name and business type.  Nobody quite knows what determines which businesses get priority placement on Google Maps, but having a complete Google Places profile and several patient reviews seems to help.   Yahoo! and Bing also have their own version of local business listings and a maps function.  The maps listings of all three of the major search engines typically appear after sponsored listings, but before natural (or organic) search result listings in major cities.

Creative overhead control can yield return on investment exceeding that of most high-cost marketing campaigns.  The following cost cutting strategies can be employed to save thousands of dollars over the course of a year. 

Programmable Thermostat

Investing in a programmable thermostat takes the guess work out of whether someone remembered to turn the heat down over the weekend when the office is not in use.  Setting the thermostat prior to the initial daily appointment ensures patient comfort.  Many programmable thermostats allow for different settings for each day of the week. 

Payroll

Payroll company fees vary widely as do their services.  I have had the unfortunate experience of sifting through multiple payroll companies in order to uncover the one making the least number of errors.  After leaving a small local payroll company which continually failed my expectations, I tried one of the largest payroll companies assuming there would fewer mistakes.  While the payroll giant charged fees three times as high, there was no reduction in errors as compared to the smaller company.  It became routine for me to learn of costly tax errors having been made, requiring multiple staff hours on the phone to resolve.   I now utilize a smaller company that allows my business manager to input the payroll information electronically and check for errors prior to processing the payroll.  It is also possible to handle payroll in house through the use of payroll software, thus reducing the cost even more.   Switching payroll companies allowed me to save over $750/year.

Internet Marketing

My dental offices have employed many marketing techniques over the years, including new mover direct mailers, advertising in the phone book and local publications, radio ads and network marketing.  In recent years, I have discovered that a well-optimized website can provide the greatest return on investment.  Without investing a fortune in search engine optimization, I have been able to position my dental practice website quite highly in online searches for a local dentist.  Maintaining and optimizing my website has yielded the best return on investment of any marketing practice I have attempted.  I have also saved money by eliminating many other routine marketing strategies.

Website Hosting and Additions

Recently, I switched my dental practice websites, as well as this site, over to a new web host.   After thorough research, my office decided to go with InMotion Hosting.  InMotion’s low price and great customer service won my business, but I have found the most savings through the use of the easy to navigate control panel.   My business manager is able to make changes and updates to my websites, including adding a blog, through the control panel.  This saves considerably over the high hourly cost of a web designer.

Selecting Repair Companies Before You Need Them

The worst possible time to be looking for a repair company is in your moment of need.  The old adage, “Never be a hungry shopper,” comes to mind.  Turning on the office lights at the beginning of a fully scheduled day only to discover that a pipe has burst or a computer server has crashed can cause us to question our choice of profession.  Unfortunately, I have experienced both of these scenarios.  A dentist can save money and time by maintaining a list of possible repair companies prior to requiring their services.  This list can be established by requesting recommendations from business associates, patients and friends.

Forwarding Incoming Calls to a Cell Phone

When our office is closed, our phone lines roll over to a cell phone carried by one of my staff members.  This allows us to answer the calls of potential new patients while not requiring the office to be staffed at all times.  This staff member is paid a monthly on call rate to answer the phones during regular business hours when we are not in the office.

Telephone Company Bundles

Recently my business manager called the telephone company to investigate a billing error.  At the conclusion of the call, a customer service representative informed her of a new offer that bundled several services for a savings of $50/month.  We, of course, took advantage of the new offer.  When I called back several months later to inquire about any potential new offers, we were able to reduce our monthly bill even more.  Be mindful that these companies are typically in fierce competition with their rivals, and are thus willing to negotiate their rates.  Do not miss the opportunity to take free money off the table.

Negotiating Insurance Company Reimbursement

Some dental insurance companies allow negotiation of the fee schedule they pay to participating providers.  When my dental offices were participating providers for various insurance companies, I spent time negotiating my fees prior to signing participation agreements.  One major insurer allows negotiation twice per year, resulting in slight increases in certain fees each time.  Our calendar contained reminders to re-negotiate fees at least once every year.

As it relates to the profitability of our practices, we as dental health professionals commonly undervalue the importance of reducing and controlling our overhead.  Routinely, the focus is on increasing our production, and for the truly savvy, improving collection percentage.  While these factors are clearly imperative to maximizing that which we take home, lowering overhead can also serve to moderate the stress involved with running a dental practice.

One efficient way to achieve overhead control is to hire a staff which is completely part-time.  Operating in an economy in which the stated unemployment rate is approaching 10%, while the true rate may be closer to 17%, workers are happy to secure a position of nearly any type.   This is particularly true of job opportunities for those lacking advanced or specialized degrees.  Retaining staff on a part-time basis allows doctors to avoid high-cost benefit programs, overtime pay and dollars lost to the inefficiency of salaried positions.  Stress reduction occurs by eliminating the headaches related to staff discord and discontent.   Additionally, the doctor is not forced to work hours beyond that which are desired simply to conform to the longings of the staff.  Running a profitable dental practice does not require us to out-produce our peers, yet only to more efficiently manage our businesses.