As I have stated previously, it is imperative to strive for the collection of accurate co-payments on the date of service.  Many dental offices choose to bill after receiving insurance payment.  Some make an attempt at co-pay collection simply by calculating a percentage of the total fee assessed.  Most patients believe that the estimate they have been given and the co-pay they initially submitted reflect the actual balance that they will owe.  I know how I feel when the auto mechanic provides me an estimate prior to dismantling my vehicle and then surprises me with a much larger bill after the work is completed.  I understood at the time that I was being given only an estimate, but my frustration at receiving such a high bill quickly overwhelmed that understanding.  In order to get my vehicle back, I will need to pay this higher than expected bill.

Patients react in a similar manner when opening the bill from your office reflecting what their insurance did not pay.  They generally believe they have already paid what they owe and that you are now overcharging them.  This belief is further compounded when they receive the estimation of benefits from their insurance company explaining how your fees are remarkably higher than UCR.

Dental insurance benefits are confusing and disappointing to many patients who are accustomed to the more extensive and often clear cut benefits provided by their health insurance company.  The common insurance company practice of downgrading treatment and the incredibly low yearly benefit maximum are two factors that really surprise patients.  In order to lessen the shock our patients might feel from the disparity between the perception of their insurance and the reality of what it does not cover, we designed a dental insurance explanation brochure from questions that we frequently heard our patients ask.  This brochure, entitled Understanding Your Dental Insurance Benefits, has been extremely helpful in conveying some of the limitations of dental insurance plans to our patients.

 The patient dental insurance explanation brochure clarifies in laymen’s terms some of the most misunderstood features of a dental plan.  The veil is lifted from the infamous UCR, or Usual, Customary and Reasonable, which dental insurance companies often employ to depict to patients why a doctor’s fees may be higher than those of the insurance company.   PPOs and in-network versus out-of-network benefits are described. Pre-existing conditions such as the missing tooth clause are discussed.  Frequency limitations, deductibles, percentages covered, yearly maximums, treatment exclusion, wait periods and alternative treatment covered are all addressed as well.  We conclude the brochure with wording indicating how we can help the patient utilize the particular coverage to get the most from the plan, and that the co-payments will be calculated with the greatest degree of certainty that the insurance plan’s available information will allow.  We also invite the patient to feel free to ask us any questions regarding concerns about insurance benefits.  The Understanding Your Dental Insurance Benefits brochure can be found in its entirety on our dental Practice Management CD.

You can purchase this valuable CD buy clicking “Add to Cart” below.

Over time, you may find that you need to modify your fees based upon patient feedback, equipment and supply prices or overhead costs. Routinely raising fees by 3-5% every 10 months has many advantages. When implementing this adjustment, raising every fee by the same percentage across the board is beneficial. I would suggest not wasting time and energy attempting to adjust each fee separately, perceiving possible negative reactions from patients and insurance companies. These perceptions are usually much worse than reality. The adjustments typically go unnoticed by patients, but serve to add significantly to your bottom line.
 
Raising your fees every 10 months gives you an additional fee increase every five years above what a typical yearly increase would provide. Set a reminder on your scheduling software when your next fee increase should occur. Since it is very difficult to institute large fee increases to make up for lost time, doctors who do not raise their fees annually commit themselves to greater overhead percentage and lower profits for the remainder of their careers.
 
It is commonly recommended to raise your fees 5% across the board in order to keep pace with inflation. This fee increase helps defray the costs of investing in new technology for your office and rising payroll expenses. On average, operating costs for the typical practice are advancing at a rate of 3-4% annually. In order to maintain or improve profitability, practice fees must be raised above that level.
 
Being mindful of the economy at large, go easy on fee increases in times of economic downturn. A 3% increase will normally keep pace with inflation during these periods, as overall growth and spending will wane. Though some practitioners will continue to operate with apparent immunity to any recession, most will find practice volume to slow in accordance. The goal is to take the patients along for the long haul, so absorb some of the recessionary pain with them while striving to keep them in your operatories.
 
If you practice in a state which allows resubmission of your fee schedule to Delta on a yearly basis, by all means take advantage of this. I have my office manager keep a note in the software alerting her to the day in which we are able to do this each year. Therefore, every twelve months to the day we submit our fee schedule to Delta reflecting the new, higher fees for the codes we use in our practice. Although Delta does not regularly grant us the full value of the increases we appeal, Delta is required to enter our new fees into its database as those of a provider in our zip code. This ultimately raises the level of approved fees in our area, as Delta bases its fee schedule on a percentile of the overall fees submitted for each zip code.
 
In determining your fees, do not underestimate the value of the efforts you have made to create a unique dental environment for your patients. They value that, and therefore, so should you. You are taking pains to provide high quality care and a comfortable encounter. It takes time to provide exceptional clinical care and service. Low fees and high volume encroach upon that time. Being rewarded for your efforts will allow you and your business to continue to satisfy your patients’ desires and expectations for the best dental experience available.

Treatment plan presentation will vary in methodology from clinician to clinician. Conversion success rates are not always consistent with the type of methodology implemented. One thing being clear, however, is that it is imperative that the clinician effectively communicates how having the outlined treatment completed will benefit the patient.

Experience has taught me that most new patients are skeptical that the dentist is there to take my money, and are leery of aggressive treatment planning on the first visit. I do not refrain from comprehensive treatment planning and I always make sure to completely inform the patients of their needs. I just do not feel the need to sell them the entirety of an overwhelming treatment plan on their first visit. I educate them and encourage them to select the treatment that I know is best for them. They need to trust me before they will buy what I am selling.

Because we are obligated to inform our patients of all oral health concerns we diagnose, we must at the very least disclose the defects we see clinically. This can be done quite appropriately in about 90 seconds, even when considering extensive treatment plans. This does not mean that you are required to provide a financial arrangement to the new patient on the first visit which dictates all the money owed for the entirety of the treatment outlined.

Logically, we are not going to do all the treatment at once anyway, so suffice it for us to disclose the fees associated with the initial phase of treatment. This commonly means the treatment that gets the patient out of pain or that which is in greatest need of immediate attention. Sometimes it is the treatment that the patient desires most, or the patient’s chief complaint.

This approach serves to gently escort your patients into the comfortable environment you have established for them without requiring them to push a wheel barrow full of cash to the doorstep before being allowed entry. You goal is to eventually care for all of your patients’ treatment needs. You will stand a better chance of doing so if you simply do not give them the whole enchilada on the first visit.

Another seemingly controversial way our practice may stand out from others is that we require a credit card number on file in order for a new patient to book an initial appointment. This may seem to fly in the face of the traditional philosophy of treating the new patient like royalty in your practice, which I happen to agree with by the way. The problem comes when you leave yourself exposed to the whims of someone whom you have never met and with whom you have yet to establish a relationship of trust. Every provider has been burned by this individual far too many times. Even when good intentions are in mind, it is unfortunately too easy for a well-meaning new client to fail an appointment when no inherent consequences are in place.

In our practice, it works as follows when a new patient calls to schedule the initial visit. The receptionist warmly greets the caller and answers all questions, including those regarding insurance benefit information. The central imperative here is to establish a welcoming relationship up front. When this has been achieved optimally, the new patient typically has no problem answering a couple of questions from us before the call ends. We politely explain to the patient that all new patient appointments need to be secured with a credit card number, which we will never charge unless the patient fails the appointment altogether. Though many of my friends and colleagues fear that by adopting this strategy they may chase away potential customers, we have found that this is simply not the case. Less than half of one percent of patients ever balks at this approach, and those that do are likely cognizant that they cannot trust themselves to show up at the appointment as scheduled. Personally, I do not want those risk laden clients in my practice anyway. They are simply weeding themselves out of the patient population.

Another benefit to securing credit card information prior to the initial appointment is that it tends to instill a sense of value in the time set aside for the client. We let our patients know that we do not double block their time slot and that this appointment period is being specifically allotted to them. In dentistry, time is more valuable than material costs or any other, because staff costs and other fixed overhead is wrapped up in it. When patients do not receive any goods or services, they may surmise that no real cost is assumed by the proprietor. By requesting credit card information on file, patients are alerted to the fact that in the business of dentistry, time is money. Be sure to check into the laws in your area regarding the storage of credit card information when implementing this practice protocol and take steps to ensure credit card information is stored securely.

photo credit: thebarrowboy

All dentists should be acutely aware of the collection percentage in their dental practice and review it on a monthly basis.  The collection percentage in my dental office in an average month will hover around 99%.  We very rarely send patients to collections because we work hard to calculate accurate co-pays and collect payments at the time of service.  I would estimate that less than .01% of my patients ultimately require collection proceedings.  This ratio stands in stark contrast to a practice in which I once associated.  In this practice, it seemed that nearly every other account went to collections.  It was so common that the office manager once informed me that many of their patients simply pay the collection agency and then schedule another appointment.  My experience with these types of accounts, however, has been that once a patient goes to collections, the patient chooses another dentist to dole services.

Interested to learn what the specific collection percentage in this practice was, I inquired this data of the office manager.  She seemed knocked off balance initially, though my intent was merely one of curiosity and not one of judgment.  She quickly filled the void in the air with the response, “Around 93%.”  I thought she may not have been certain about that number, but that it had sounded good to her and a collection percentage about which a dental practice should be proud.  I would caution you not to be so pleased with a collection percentage of that order in your practice.  It would behoove us all as business owners to have the number that accurately reflects our true collection percentage at the ready in our minds as well.

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Let’s look at an example of what not collecting that 7% of produced income would do to our bottom lines if our collection percentage was at that seemingly respectable level of 93%. As the math will bear out, a 7% neglect in collections will in reality amount to a 17.5% reduction in your take home pay.  Now let me ask you, would any of your employees come to work for nearly 18% less money per year?  If so, they are likely being paid way too much.

In this hypothetical example, let’s set our yearly production at $500,000.  We’ll assume a reputable overhead percentage of 60%, though I am convinced that you can have an outstanding practice with an overhead closer to 50% without too many changes.  Dentistry’s Business Secrets outlines in greater detail the various means by which to achieve The Low Overhead Practice.  In our example, your take home pay after overhead of 60% will be $200,000 per year.  This, of course, is assuming you collect 100% of that which you produce.  When collections are off by the purported 7%, the bottom line take home pay is automatically reduced by $35,000, or, 7% of the $500,000 you produced.  Therefore, your salary is no longer $200,000 but $165,000.  That $35,000 you left on the table is equal to 17.5% of your original salary after overhead.

This brings me to the topic of free money.  I look at that $35,000 of failed collections as free money.  Since we all realize how hard the job of dentistry is, we know that this money does not truly come for free.  The fact is you have earned it.  I want to see you keep it!  This was a big reason for why I wrote Dentistry’s Business Secrets in the first place; to help you collect and keep your hard-earned money.

Another way to view the money we lose when we fail to collect what we produce is in the amount of labor necessary to regain this lost income.  If we collect the extra 7% we discussed, we get to keep 100% of that $35,000.  This money is not subject to overhead expenses, because overhead is calculated as the ratio of expenses/production.  Lost collections is not an overhead expense per se, it is in addition to overhead.  In order to receive that full $35,000 in our paychecks, we would need to produce $87,500 more than if we simply collected it from our patients and the insurance companies who owe it to us.   This is simply because whatever we produce is subjected to overhead expenses and what we collect is not.

Obviously, the greater the production value in your practice, the more negatively failing to collect will affect your bottom line.  In turn, the harder you will need to work in order to produce the money lost to insufficient collection techniques.  Take heart though, there are tried and true methods that can be easily implemented into one’s practice to ensure collection numbers closely approximating 100%.  You have earned it, so it stands to reason that you should be able to receive it and then do with it as you so choose.

This is a special guest post from Patrick Toms, DMD, a Gainesville, Georgia dentist.

Nearly everyone these days is on Facebook and currently businesses are utilizing the ubiquitous social network site as a marketing tool. And as a business, a dentist’s office also has the potential to exploit the free advertising opportunities available through Facebook. By utilizing social marketing, you can effectively drive business to your office, increase your return on investment, and expand your brand awareness. Here are some tips on using Facebook in your dental practice.

1. Include the Facebook URL on business cards – When leaving the dentist, most people receive a reminder card for their next appointment. A good way to get the word out about your Facebook page is to place the Facebook URL on the card so patients will be reminded of your social site whenever they look at the card. Similarly, place the URL on standard business cards. Facebook URLs are becoming just as, if not more, important than phone numbers, and a well-placed URL on a card will work wonders for expanding your awareness. You can even customize these URLs to contain your practice name.

2. Promote new blog articles on Facebook – Have you ever considered hiring a communications employee who is primarily responsible for blogging, updating the Facebook page and contributing content? Social media technology moves quickly, so expanding the staff to include a ‘professional Facebooker’ is an effective way to stay ahead of the curve and promote your brand exclusively and consistently.

3. Introduce current and prospective clients to the team – When people move to a new city, they need a dentist. A great way to introduce your staff is through pictures, profiles, and short biographies on Facebook. You can even upload video tours of the facility or of the staff, and customer testimonials to increase your practice’s awareness in the community.

4. Use Facebook as a promotional tool – After you begin to acquire followers on your Facebook page, consider doing something promotional. Have a contest highlighting great smiles and give away things like toothbrushes and floss. One office that currently uses Facebook has previously held a drawing for an iPad. When patients donated winter coats for the homeless, they were entered into the drawing and a winner was chosen. Also, Facebook is a great tool for advertising specials. Consider offering deals like 15% off teeth whitening or other cosmetic procedures.
Communication is the key to solid marketing and currently Facebook is the premier way to communicate. It makes sense that any business, even a dentist’s office, would benefit from using Facebook as a marketing tool. Above I have outlined a few simple ways in which to get the ball rolling on promoting your brand via Facebook.

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Patrick Toms DMD is a dentist in Gainesville, Georgia, who offers a wide range of services within North Georgia. Dr. Toms is proud to be a leading sedation dentist in Georgia who also offers routine services like teeth whitening and dental checkups in Gainesville.

Recently I fielded a question from a concerned client regarding the way in which an associate dentist was treatment planning his patients. The question and answer are presented below:

Dear Dr Logan,
Kudos on a great book. My question to you is, how do you
motivate a clinically great dentist with no business sense? Two and half years into private practicing he is still treatment planning based on what he ‘thinks’ patients can afford. Can you direct me to a resource to help me help him? Thanks for
your help.

Thank you for your inquiry. The best resource I can give you is an answer from personal experience. I have had associates in the past who maintained this style and the best way to redirect their thinking was to have a dedicated sit down with them and spell out the reasons why this thinking is not good for the patients and not the way people who are seeking treatment in your private practice would like to be treated.

For example, treating problems with patchwork dentistry almost always requires further, more extensive and more expensive treatment down the road. This happens sooner than five years in most cases. Therefore, when we fail to provide optimum care up front, the patient will be saddled with redoing inadequate restorations (such as large fillings when crowns were the ideal long-term solution) or even losing teeth that could have been saved. No patient wants this, and no one wants to pay for things twice. These things happen in patchwork practices all the time.

You should point out your degree of experience, which is bound to be greater than your associate’s, which reveals the failure with these restorations. People are coming to you for the best you can give them, so the associate needs to understand that not providing this is failing the patient. Presenting your case in this manner will enlighten your associate doctor as the benefits to the patients of treating with optimal dentistry and relieve you of the impression that you are merely out to increase your profit.

I hope you have found this information helpful. Best of luck with this and please follow up to apprise me of the results you will obtain from this.

Kind regards,

Ed
 
One thing to always impart to your patients when discussing treatment needs is that there will never be a time again that will allow you to treat more conservatively and more affordably than optimally treating the condition right now.

Online reviews can serve as a wonderful resource for attracting new dental patients. When considering which patients to ask to write an online review, we choose patients who have been coming to our office for an extended period of time and who are complimentary. Before sending an email requesting a review, our front office manager personally asks the patient while they are in the office if they would be willing to write a review so that this email is not unsolicited.

My dental office uses the following email script when asking patients to write an online review.

We have found online reviews to be a wonderful way of setting new patients at ease before they come into our office. Many people fear the dentist and are comforted by reading positive experiences from other patients. Since you are a valued, loyal patient, we thought you might be the perfect person to ask to help us in this way. Would you be willing to contribute a positive online review of our office?

This initial paragraph is followed with a link to the web page where a patient can write a review. The link takes them directly to our dental practice’s listing on whichever review site we are sending them to so that they don’t have to take any time to search around for our office. We also include simple directions as to how to fill out the review.

My dental office sends patient reviewers to a variety of review sites, but only one site per patient. If the patient has a Yahoo! or SBCGlobal email address, we ask them to write a Yahoo! review since they already have an account with Yahoo! If the patient has a Gmail account, we ask them to write a Google review on our Google Places listing. For all other patients, we divide the review requests between InsiderPages, CitySearch, MerchantCircle and Yelp. Our goal is to make the process of writing a review as simple as possible. 

My dental office is looking into the possibility of using a dental patient reminder and recall system. I designed the following comparison chart of LightHouse 360, Patient Activator and Smile Reminders while researching their information online. If you have experience with any of these companies or more information that is not provided in the chart below, please comment and let us know your experience.

Dentistry’s Business Secrets: Proven Growth Strategies for Your New or Existing Practice is now available on Amazon.

A Kindle version is available on Amazon as well.