How Often Should You Raise Your Fees?

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.

What’s Your Dental Office Collection Percentage?

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Creative Commons License 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.

Dentistry’s Business Secrets is Going Global

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Dentistry’s Business Secrets: Proven Growth Strategies for Your New or Existing Practice continues to sell copies to dentists all over the United States.  We have been pleased as well to see how popular the book is becoming in other countries, including South Africa, Denmark, Australia, Singapore, Italy, the United Kingdom and Canada.  Dentistry’s Business Secrets contains 420 pages of valuable dental practice management and marketing content for dentists in all stages of their career, in the United States and abroad.

 

Why I Wrote Dentistry’s Business Secrets

I decided to write Dentistry’s Business Secrets: Proven Growth Strategies for Your New or Existing Practice as an attempt to help dentists avoid the many mistakes I have made while developing three practices from scratch over a nearly 20 year career. I was also of the opinion that I could probably write an entire book about the principles relating to the business aspect of dentistry that I never learned in dental school. These are things we all need to know in order to be optimally profitable in our practices, but that most dental schools were not able to find time in their busy curriculum to adequately accommodate. If we are fortunate enough to employ a business manager with a developed sense of business acumen, we are truly blessed. Nonetheless, we as practice owners need to have a firm grasp of these business principles as well, even if it is merely to keep one’s staff in check.

Recently I was pouring over the list of dental product and service categories that were available to exhibitors at the Chicago Midwinter Dental Meeting. It struck me as interesting that of the more than 200 separate categories for dental goods and services, there were only a handful of items relating to the dissemination of business knowledge. Clearly, most of us as dentists are far from MBA’s, but I was overwhelmed at the diversity of disciplines in which we are expected to become experts. With respect to clinical dentistry, the population at large demands that we be a Jack of All Trades, but it is up to us to become a Master of Business.

I was hoping in writing this book that I would be able to provide a detailed and comprehensive guide to starting, growing and successfully managing profitable dental practices, while giving dentists a road map to avoid the expensive pitfalls and headaches associated with taking wrong turns along the way. It was also my desire to provide this dense 439 page manual as an affordable alternative to the multi-thousand dollar practice consultant approach. I am excited to share with you my book, Dentistry’s Business Secrets, and my sincere goal is that you will find it as valuable as I have striven to make it!

Treatment Planning for Dental Nightguards

I Don’t Need a Nightguard!

This scenario presented itself in my office just yesterday.  I had a patient who admittedly grinds her teeth and shows moderate to advanced wear on all her teeth.  I have recently lowered my dental nightguard fee in an effort to get more of the patient population in need to schedule this treatment.  Her excuse was that if she had the money sitting around somewhere, she would do it.  I shot a quick glance at her Louis Vuitton handbag resting in the chair and the BlackBerry smartphone she couldn’t resist but to answer and had to wonder.  When she finally revealed that she would be taking a two week vacation to Florida next week, my suspicions were confirmed.  It wasn’t that she did not have the money.  It was that I apparently did not do a sufficient job in convincing her of the value of the nightguard and of her real need for it.
So this begs the question: What do you do in your practice to gain treatment acceptance for occlusal guards?

When Should I Begin Year-End Evaluation of My Dental Practice

There are many good questions to ask yourself before you begin floating down the same path in your dental practice as that which you took this year. Did you reach all your goals? Did you establish clear cut goals to reach in the first place? Are there other goals you should be aspiring to reach? Are you happy with the way your practice life is translating over into your personal life? Could both of these lives be better? What marketing strategies are working? Do you need to increase your dental office’s online presence? If so, what concrete steps will you take to do this? Are there office duties that are taking up too much of your time that could be accomplished with delegation to another staff member or outside company? Are there items that need to be addressed with employees at a year-end evaluation? These are good questions to ponder before the end of the year, every year. Starting now gives you a head start on the competition.

Lance Armstrong began his focused Tour de France training November 1, while others waited until New Year’s Day to start aggressively training. Seven Tour victories later, we know how well this approach worked out for him. Take time now to evaluate your books and your existing practice protocol. If you feel there is room for improvement, by all means, implement the changes necessary to take your practice to the next level.

What Should a Dentist Tweet About?

My dental office has been participating on Twitter for a few months now.  It has become easier to think of tweet ideas, but we are always working to keep a good mix of dental health tips, local events, office news, helpful resources and personal highlights.  I just came across a great article on Rizzo Tee’s blog entitled “The Top 50 Tweets That Businesses Should Be Doing.”  It was a good reminder that people soon tire of hearing about your dental office or their teeth.  While tweets about these subjects must be included, it’s important to engage with your followers. The entire experience will be more enjoyable for you and for those following you.

How to Hire the Right Employee the First Time

In attempt to avoid the need to fire an employee and begin the hiring process all over again, one must make every effort to hire “right” the first time.  With the “two weeks’ notice” standard, we are often left with too little time to hire a new employee.  Rushed interviews and reference checks can lead to poor decision making and settling for an employee candidate who is less than ideal.  Nonetheless, striving to hire right the first time can eliminate headaches down the road. Business coach Eric Herrenkohl speaks to this in his book “How To Hire A-Players.”

Recently, I was given two weeks to hire a new dental assistant when my current dental assistant changed careers unexpectedly.  With the economy and unemployment being what it is currently, I was afforded the opportunity to consider more candidates for this new hire.  Within the first 24 hours of posting a free Craigslist job ad, I had received multiple resumes from qualified individuals.  In order to avoid having to sift through countless resumes from unqualified applicants or applicants who would not be able to satisfy the timing requirements that I needed, I drafted a detailed ad.

In the midst of a busy day of dentistry and practice management, it is tempting to settle for the first warm body to present herself somewhat positively in an interview.  Having read Eric Herrenkohl’s book and knowing from past experience where “settling” had gotten me, I decided to interview several additional candidates even after meeting one that might have been adequate.  In this employment market, we do not have to settle for adequate.

Implementing the right interview protocol and background checks on potential staff members is imperative in the hiring process.  Coming soon to our website is a Resource CD which contains 17 Questions to Ask in an Interview as well as a dozen questions to ask references when a potential hire shows promise.  Please check back to www.dentistrysbusinesssecrets.com for the impending release of this Resource CD and my new book, ”Dentistry’s Business Secrets: Proven Growth Strategies for Your New or Existing Practice.

How Do We Treatment Plan the “Baby Boomer”?

The “longevity” factor of our patients cannot be overemphasized when it comes to our treatment planning.  We would be remiss in our examination process if we were determined to diagnose the pocketbook and not what the patient (read, Baby Boomer) might want.  Calculations for retirement plans are now being performed based upon the expectation that the retiree will live to be 100 years old!  Baby Boomers know this and are trying to plan for the welcomed eventuality that this occurs.  Therefore, they are valuing their teeth for a lifetime and not opting for the extraction as often as I have witnessed in my practice life.  I am reminded of a quote from history,

“Every tooth in a man’s head is more valuable than a diamond.”

Miguel deCervantes, Don Quixote, 1605

Getting to “Yes” for Esthetic Dentistry Treatment

Even though we may want to drive the sale of cosmetic dentistry to our patients, it is generally more profitable to allow the patient to take the wheel in this process.  The idea is to balance the notion of investigating what the patient really wants without “selling” the patient something she does not want. Fleshing out true desires is an art.  I have been disappointed at times when the desire for esthetic improvement was primarily my own and not the patient’s.  When this is the case, the patient tends to be even more critical of the work and more difficult to please.  Tread lightly with the patient who was actually “sold” cosmetic dentistry, I would caution.  Be sure to present all available cosmetic improvement options you can provide and then let the patient “buy” the treatment from you.