Got a great message from someone who sounds really dedicated to her profession and the practice but….feels there is a huge speed bump in her way.  Guess who?  You guessed it, it’s the Doctor!

This reminds me of a series of blog posts that Linda Zdanowicz with a blog (must-read) called Exceptional Dental Practice Management posted some time ago.  It was a series of posts that invited the reader to look at the practice through each person’s eyes.  The best one was the one from the “Doctor’s Chair”.   As someone who has heard practices described by the doctor as well as the administrative team in completely different ways, I see that when there is a definite difference in perceptions and goals, there is dysfunction.   The first sign of dysfunction is blame.  Who is to blame for all of this unscheduled treatment anyway?

That’s such a loaded question, but answering it (honestly) for yourself will identify whether there is dysfunction and possibly, how to turn it around.  The person who messaged me clearly felt she was doing everything she could possibly do to help set the stage for success for her doctor, but management issues were undermining her effort.  So…why should she even try?  If your team feels that moving forward will prompt a banging of their head into a wall, they won’t do it.  Then they won’t move forward even if they normally would have.  The focus will be on what they won’t do, not what they will do.  “Fire them all!” is a common response.  That may in fact be the answer but it rarely is.  If it feels like they’ve dug their heels in, they may have.  If it feels like they’ve got attitude problems, that might be true as well.

If your Treatment Coordinator knows that they are collecting at a high percentage, getting incredible treatment acceptance, and nothing seems to change….why should she even try?  By that I’m not even talking about a pay raise or bonus.  I’m talking about the feeling that she’s always putting out fires.  Lab calling because the bill wasn’t paid!  An unexpected vacation by the doctor during a slow month which closed the practice for a week with little notice.  If she feels that things completely out of her control are undermining her ability to do good work for you, and that even if she does, it doesn’t seem to be making the practice financially sound….why should she even try?

This is where opening up the practice so that everyone has an opportunity to see what’s going on from the other person’s chair is so important.  The most important one, of course, is the doctor’s chair.  They’ve done the training, invested the money and stomach lining, and if the practice goes under, they will as well.  Many have tied their home equity to the credit attached to the practice.  Their practice is personal and sometimes we don’t see what’s right in front of us- they don’t either.  When a team has lost respect for the doctor and talks about them in a tone where it is clear they feel they are the problem…it’s a problem.  It should be the most important problem on the table.  If it’s not addressed, it doesn’t matter what else you do, it will not be sustainable.  Unscheduled treatment can build up for many reasons, but if it’s because of dysfuntion in the Doctor/Team communication it’s alot harder to fix the longer you wait.

I thank one of my readers for bringing up this very important topic.  Since she brought it up, she clearly still cares.  Hang in there and maybe you can get your doctor to see things from your side of the chair.  It might be a surprise for both of you.

“I’m never going back to that place again!”

Wow!  I certainly hadn’t expected that when I called to discuss unscheduled treatment the other day.  I’d say 99% of you would all of a sudden feel like your phone was on fire and have the strong impulse to get off that call just as fast as you could.  I guarantee that your team will have that impulse.  A rapid but polite “I’m sorry to hear that, Mr. Jones…ummm….goodbye.” would probably be a typical response.  Then there’s the predictable search of the record to confirm that Mr. Jones is and always was an ass!  Trouble from the start, right?  Hmm….nothing obvious.  Cancelled appointment history right?  Bad debt patient?  Nope.  Now let’s deactivate his wife quickly (he’s not a patient but was the one who answered the phone), comment to anyone on the team within hearing that Mr. Jones was incredibly rude, and return to trying to fill those huge holes in the schedule.  Here’s the question.  Does anybody in your team ever try to find out what Mr. Jones was so upset about?  Unfortunately the answer is usually “No”.  It can be an uncomfortable question for your team and human nature keeps people from heading into uncomfortable territory.  These kind of calls always seem to happen when you’re sitting at the front desk and there’s a new patient in the reception area listening to every word.  Believe me, your team will want that call to end immediately, rather than have a conversation going that might not reflect well on the practice.   It’s also an easy out when nobody wants to hold onto that hot rock.

With thousands of calls under my belt and blessed/cursed with stubborn curiousity…I will always ask “If you don’t mind Mr. Jones, is there something that we have done or failed to do that has caused you to make this decision?”.  Usually they will tell you.  I will assure them that my interest isn’t in trying to convince them to stay but to find out what we may have failed to do well so that I can properly apologize on behalf of the doctor.  Most of the time the first few minutes of the call are simply listening to them vent.  Close to 100% of the time this type of patient response is tracked to a communication issue.  Fortunately, many of these patients WILL reconsider after having an opportunity to voice their frustration if they feel the listener will look into the issue for them.

In the first quote, the gentleman I’ve dubbed “Mr. Jones” was willing to tell me all about it.  His wife had come in and was treatment planned for a fairly substantial list of procedures.  She had begun the first phase and he paid the estimated copayment.  Some time later they got a big fat statement.  He thought it was an error so just ignored it until the next one came.  They paid the bill and swore never to return.  Did they call?  No.  He was told he would likely have a credit after insurance paid, and he got an enormous bill.  He felt tricked, deceived, taken advantage of…pick one….he used all of them at some point. 

I discussed the hazards of estimating coverage and the curve balls insurance carriers can sometimes throw us.  I told Mr. Jones that I’d really like to call his carrier to find out what hadn’t been covered, and why.  I told him that I wanted him to have this information, regardless of whether he ever came back with his wife for care and I apologized on behalf of the practice for not providing this explanation with the statement.  As Mr. Jones and I talked, he got calmer, more friendly and this older man asked me to call him by his nickname.  He began to understand that this really was a communication issue and wasn’t a relection on his wife’s dentist at all.  He could tell I was concerned on his behalf and believed me when I told him her doc would most certainly want this checked into.  I promised to get an answer to him by the following evening.

Now it’s time to exceed expectations.  After a lousy surprise, you really need to under-promise and over-deliver.  He was only expecting to get an answer of why insurance didn’t pay, and wasn’t expecting any type of reimbursement.  I called the carrier and asked the representative to review the claim and she stated “It was not covered”.  OK……”Why?” was my response.  As your insurance coordinators will confirm the answer is usually some form of “Because I said so”.  My stubborn curiousity rears its ugly head and Maria begins to understand that I probably won’t get off the phone until I have a better answer, so she puts me on hold.  About 10 minutes later Maria returns to the call and states that it was a mistake and they will be reprocessing the claim and paying on it. 

Now I’m able to call Mr. Jones back about 30 minutes after our first call to tell him that his insurance company had made a mistake and were reprocessing that claim.  The moment we get payment we will call him and he will be able to receive a refund check for the money he had to pay us earlier due to his insurance carrier’s mistake.  Mr. Jones is very pleased, and says that when that happens they would like to reschedule and that he also wants to be a patient in the practice.  He will need his first visit with the doctor and knows he needs quite a bit of work done.  He grumbles a bit about how hard it is to work with insurance companies and I agree with him- we’re in this together now.  He promises me, at my request, that if he ever experiences any instance where he feels we have let him down, to get on the phone and be a squeaky wheel.  I assure him that his experience was rare and I thank him for taking the time to tell me what had happened so that I would have an opportunity to try to make things right.

So….first impulse is “Ummmm….I’m sorry to hear that Mr. Jones.  Goodbye.”  Hard as it may be, encourage your team to strap on that stubborn curiousity and ask the most important question.  “Why?”  In this case, the patient will get back his $200.00, his wife will get the treatment she needs, and the practice will get an opportunity to begin again with her husband, who incidentally sounds like a wonderful man and nice addition to the practice. 

ps- Keep in mind also that this couples original decision to leave the practice had absolutely nothing to do with the doctor or the quality of the treatment she received. 

“Hello, this is Sarah from Dr. Wonderful’s Dental Office….”

Sounds like another left message again!  I had a long conversation with some wonderful guys who have made it their business to find ways for doctors to effectively communicate with their patients.  I’m certain they’ll be the subject of a future blog, but for now, I want to focus on one part of our conversation.  Why is it a commonly heard complaint from dentists that their staff either won’t make calls or hate that task with a passion?  I really think it is all found in the purpose of the call itself, as perceived by the person about to make it.

Everyone has heard the old adage of smiling when you pick up the phone because a patient can hear it in your voice.  It’s one of those oldies but goodies because it really is a goodie.  I’d like to take that thought just a bit further.  When someone in your office is picking up the phone, what is their purpose and how do they feel about that purpose in the moment?

If I see a stranger with a clipboard approaching my front door, what is my reaction?  Do I quietly exit to the rear of the house, listen to the door ring, and wait until she gets back in her car?  Well….I have done exactly that in the past.   If it’s two days before my birthday and I see the UPS man backing into my driveway am I standing outside waiting for him to get out of his truck?  Of course I am!  It’s really all about the expectations, isn’t it?  I’m expecting an awkward conversation in the first instance and do what I can to avoid it.  I’m not hostile or fearful, I just want to avoid the possibility of having to reject someone.  In the second instance, it’s a no-brainer.  I know that no matter what, that guy in funny brown shorts is going to be giving me something and not asking for anything in return other than my signature.  Opening my door for him was an easy call.  Picking up the phone sometimes is not that easy a call for many.

This is what I commonly see- If the purpose of a call is to check off a box that contact was made, there will almost certainly be a left message at the home number.  If the home phone doesn’t have an answering machine there will be a call to an alternate phone number.  The first contact is almost always the home number and it is almost always placed during a time that the patient is likely not to be there. 

If the purpose of the call was to actually make voice to voice contact, the first contact would likely be with the cell or work number for most.  Those are the most likely numbers to actually reach your patients during the hours that your office is calling, aren’t they?  Sometimes the thought is that if you actually reach the patient, they now have an opportunity to cancel that appointment.  By leaving a message, you’ve avoided that possibility.  Guess what?  That works both ways, and now your patient calls after you’ve left for the day and leaves a message on your voicemail saying he isn’t able to come in due to a crazy work emergency.  Both of you have avoided direct conversation and you have an empty appointment space at 8:00 AM now.  Yes, the patient could have cancelled, but that would have given your staff the opportunity to actually have that conversation about what a reserved appointment means. 

Unscheduled treatment calls are almost always completely avoided.  Sending letters, postcards, and hot air balloons to remind a patient about their unscheduled treatment are all methods used (well, maybe not the hot air balloons) and can be quite effective.  The most effective method I’ve found is actually more of a domino effect.  Passive contact through written or emailed correspondence followed by a personal call where the purpose is to actually talk to that patient, not to leave a message.  Patients aren’t going to be angry with anybody calling, and aren’t going to feel pressured unless your purpose is to pressure them.  If your purpose is to help make that connection between something that is good for them and something that you have the ability to provide, there should be no pressure.  If your purpose is to fill that 70 minute slot tomorrow, there will be pressure and that time slot will likely go unfilled. 

Shifting the thought process around that 70 minutes as an opportunity for both parties and actually believing this rather than just using those words because they were written in a script someone suggested you use, can turn a chore into something that works for everyone involved.   We’ve got so many additional tools available to us now that are intended to enhance our communication, but sometimes, if the purpose is skewed, they become additional tools to avoid actually making effective communication.  I love text reminders, email reminders and electronic confirmations.  These are patients who have invited you to make it easier to communicate with them!  It’s the patients for whom e-conversations either aren’t appropriate or not possible that I’m talking about.

Today I wanted to talk to a patient who hadn’t been in a practice for 3 1/2 years.  I’d say that’s pretty much a cold call wouldn’t you?  I wanted to talk to her and she knew it.  She was sitting in an airport out of state waiting for a plane and I reached her because my first call was to her cell.  She was bored silly but wanted to talk to someone (anyone) about an important family event and I got to hear all about it.  I also got to talk to her about returning to the practice and trying a brand new doctor.  The entire process took around 10 minutes of my time but will be valuable to both the practice and the patient.  If my purpose had been to make contact I’d have left a message at home and it would have taken 45 seconds, and it is highly unlikely that patient would have appointed to reactivate in the practice upon her return home.

So…examine what the purpose of your call is before making it and step back to think about whether your purpose is more or less likely to result in the best outcome for the patient and the practice.  If emails aren’t being collected or updated, it might be a sign that the purpose of contact might need to be reexamined.  I love talking to patients but I love seeing them in a schedule even more.  You can have your cake and eat it too, but before you have that piece of cake, you’ve got a patient to treat.  The cake can wait 70 minutes because that opening has now been filled.

Call me CRAZY, but it does work!

I posted this on a dental website today and thought it might be something you might want to try as well!  The topic had been about what type of gifts a general dentist likes to receive from their referring specialists.  You might want to give this a try.  Can’t hurt, is inexpensive, and helps you with your own treatment presentation!

I’ve got kind of a reverse gift thing you might want to try.  Doing Lunch & Learns years ago with a Doc I worked for,  I found that the specialist’s teams really never had the connection with the general dentist because they only saw the patient for an isolated appointment and never saw the end results.  When we showed them a book that we had made that included before and after pics of our common patients, you couldn’t get that book out of those ladies hands.

It costs about $40 per book (one for you and one for the referring specialist or general dentist) to get one made at www.kodak.com.  Easy upload and you write your own captions.  Something like “After Dr. _______ beautifully placed a single implant, Dr ______________restored her smile with a natural porcelain crown.”  Benefit of reinforcing to the specialists patients that you do good work….  A treatment coordinator for an oral surgeon who placed implants on a complex case was actually choked up when she saw the before and afters.  She’d only seen that patient with a denture or gauze in her mouth before and had never seen the final results.  Neither had the O.S.  She said she was proud to have participated in it.  Can’t beat an enthusiastic team member reinforcing how good you are, IMO.  The book was used as patient education at the specialists office and any time a patient looked at it they saw the name of my doc.

We did the hard back black cover and it’s pretty darn slick looking.  We also made a CD with the same images and I made a label with our practice logo.  This was used in conference room presentations from what I heard.  The doc could say “This is my patient” when treatment planning.

It Doesn’t have to be Tea Leaves or Ouija Boards!

Insurance letters have likely been sent out by many of you, reminding your patients of their unused dental insurance, HSA, and Flex-Spending allowances. I know I’m getting quite a few patients back in to get that delayed treatment done.  It’s a time that patients and practices are looking at the end of the calendar coming up on the horizon.  Patients are getting booklets from their employers and are making decisions on their benefit packages for 2011.  Practices are wondering about the final year end numbers, and starting the process of comparing those with the previous year.  It’s not just decorations that are getting dragged out, but numbers are being generated and decisions are being made, by you and by your patients.

It is in this dynamic that some of you find yourselves thinking about either becoming a par-provider or dropping participating status.  The pull and tug can be a powerful force and many of you are making decisions in a vacuum.  A practice that is struggling to fill its chairs starts to look at participating simply to generate more new patients and hold onto the ones who are beginning to drift to other offices.  A doctor working to the point of exhaustion  is frustrated with having to add employees with all the management issues that come with them, and is frustrated with the high write-offs made for the privilege.  The decision to participate or not and what to do when you already do participate, sometimes resembles a Ouija Board game…it seems like there is guidance, but there’s always a level of suspicion in the room, and that horrible feeling of not being in control.

Many offices sign up with every plan known to man and would be astonished to find that they actually might be losing money each time some of their patients walk in the door.  If you knew that ahead of time, would it influence your choice?  Many offices decide out of pure frustration to drop all of the plans they participate without thinking through the actual impact of that decision.  Who are these patients?  Who are their employers?  Will these patients leave, and how much might that cost?

I think of dental insurance in the same way as I think of any form of marketing.  If you placed a marketing template over the collection numbers associated with these patients and then made your decision, it might be different.  If you become a par-provider with a plan that many of your FFS patients currently have, you are now paying for the privilege of continuing to treat them.  You need to know the actual numbers in order to make the best decisions for you and your practice.  Participating can be an excellent source of income with a good return on investment.  It can also be a disaster. 

I’ve seen wild ranges of fees nationally as well as within the same geographic region.  The majority of the differences I am finding are in negotiated rates rather than differences between two office’s FFS rates.  Taking into account fees from HMO’s, I’ve seen bicuspid root canals run from $83.00 to $1100.00, and everything in between. This can be alot for any of us to wrap our brains around when trying to make a ROI-based decision.  For my own purposes while I’m working in a practice remotely,  it’s fairly simple.  I triage.  I am not going to commit time to reactivate a patient who has an $83.00 root canal treatment planned, if the same time commitment can bring in a $1100.00 payment for the exact same procedure for that doctor.  This type of triage process is alive and well in most dental offices in some way or another, if one or more of the allowable  fee schedules is significantly lower than the others.

Thank goodness there is a resource available to unravel much of this for you!  Sandi Hudson, with www.droptheppo.com is someone I have previously linked on this site.  I have linked her for a very good reason.  She has a keen mind and cuts through the clutter to get at the bottom line for you and your practice.  The name of her company implies that she leans toward dropping all PPO’s.  Her business was originally formed to help doctors navigate that process, and she does it very well.  She is actually a neutral advisor and will look at your current numbers, your stated goals, and will give you the best advise she has on how participation might help or hurt you.  She will help you request fee increases after studying reports that will help ensure you get the most for your hard work, based on the key procedures in your practice.  She will help you navigate the hazards and give you a roadmap for the way forward. 

Sandi’s focus and style meshes very well with mine, in that she has no intention of positioning herself to be a resource you are dependant on for years.  She will help train your designated person to do the work she does, so that you will be able to confidently move forward on your own after she has put you in your strongest possible position.  We both feel the best thing that we can do for a doctor and practice is to identify the opportunities and challenges, leaving in place a system that is sound and can move forward without us.  She will also hold up that warning sign if she feels that the direction you want to move in may be one you might regret in the future.  The decision is ultimately always yours but she will help unscramble the complexity of dental insurance, allowing you to actually make a decision that is more predictable than a Ouija Board! 

www.droptheppo.com and Sandi Hudson are most definitely worth a call before putting your signature to a contract with a carrier or to a request to drop participation.  We all know that insurance is frequently more complicated than it needs to be in order to discourage patients from even using it.  Why do you think it should be different for providers?  This is not the time to throw your hands in the air and wing it.  Take your time and think about how this will impact your practice globally, before you’re locked into a decision you might regret.  This is marketing, pure and simple and it is either a good ROI or not.  Let the numbers tell the story for you, then make your decision.  There is finally a service out there that allows you to put that Ouija Board back on the shelf!

What a wonderful opportunity to work with an incredible doctor~he shares his results!

“I wanted to publicly state how great Production Finder has been.  I think I was Lisa’s first practice and so it was going to be a big leap of faith to see:

#1), was her ability as good as she had hoped it would be from a telecommuting position and #2) could she understand the policies I had in place and work within those confines.  I guess you could say #3 was since I do not use Dentrix or Eaglesoft, was it going to be harder to extract the information she needed to do her job?

 I think it was a lot of trail and error for Lisa in the beginning to really understand WHAT HER GOALS were in terms of what she wanted to implement and I mean that with the greatest of compliments.  She went so ABOVE AND BEYOND what I expected from our original intention that she turned into a practice consultant without the consultant price.  She cleaned up my database between emergency and existing patients, she contacted the patients that slipped through the cracks to schedule production (her original goal) and even ones where the aging was getting pretty long (with some success) She helped do a phone interview with the FD I did end up hiring, has some great ideas about marketing to patients with families, and even came up with postcards designed for my practice to try and retain some patients who are on the fence with me being OON and brochures for sleep apnea.

 So the final result on an ROI perspective?  4 months on my job was an ROI for me of about 10:1 on a production level.  Even if it was 1:1, she is worth every penny and now a great friend and one that I know I can always bounce a question off and get an honest answer on what to do.  For the price, I don’t think you can get a better bang for your buck than what Lisa can provide for you.  I guess I would sum it up this way:

 If you are on the fence about using a consultant especially because of the high price tag, I would call Lisa first.  I think just a few tweaks from her and a FD that she can work in tandem well with will make big strides in your production moving forward.”

Howard Polansky ~ Go Dental~ Pflugerville, Texas

Dr. Polansky and his Team were incredible to work with and I consider his characterization of me as a great friend as the ultimate compliment, and is  a sentiment I share!  He was indeed my first remote client, doing what I’ve done in offices for years.  Distance really isn’t a barrier any longer to getting the help you need.   

  Lisa Weber

Have you ever heard a patient say “I never knew your did that!”?

Sometimes in all of the understandable focus there is to get new patients, it’s really easy to assume our current patients know alot more about the practice than they do.  I’m sure many of you have dropped into your chair for a recall exam, reclined the patient, popped those loupes on, and….your long time patient has attachments on her lower bicuspids!  After that first jolt you wonder why she went to someone else for her orthodontics.  Some of you get that horrible feeling of betrayal, and then find a way to casually ask them where they went.  That’s when you hear your patient say “I never knew you did that!”. 

How does that happen?  Easy.  Your patient came in for her Comprehensive Evaluation 5 years ago and at that time, had some minor crowding on her lower anterior.  She may have checked the box saying that she was perfectly happy with her smile.  You may not have been doing ortho back then.  For whatever reason, the conversation never happened because she didn’t seem to be an interested candidate.  The brochures in the hygiene room were never noticed since she never wears her reading glasses when she’s getting her cleanings.  Your patient has a friend who raved about Invisalign, whitened her teeth, and it all seemed so easy, so she asked where she got it done, went for a consult, and started treatment.  It never even crossed her mind to contact your office, because you’re not an orthodontist, right?  If she’d known, she would have been more than happy to have you do her treatment.  She just never knew!

We are all hearing alot about people looking more carefully at the value they are getting for their money these days.  I know I’m more aware than I was before, and patients aren’t any different than the rest of us.  We might put fresh flowers out, warm towels, and many other extras to enhance that “value”, all of which are wonderful, and patients do enjoy them.  Now for the “but”….patients see the flowers, they feel the warm towels, but they may not know you place implants, do orthodontic procedures, extract wisdom teeth, do oral cancer examinations, or that their snoring may not just be an irritant to their sleeping partner. 

Selling- so many cringe at the idea of talking about all of these things because it feels like “selling”.  Shhh…..you’re not supposed to talk about these things or patients will feel pressured and think that all you want is their money, right?  Maybe we can just put a few tasteful brochure displays in the reception area and on the checkout counter.  Patients who are interested will see them, take one home, and call for an appointment!  No pressure at all.  Ask your administative staff how often they refill those brochure stands.  I love brochures, don’t get me wrong.  The more information available to a patient, the better.  Brochures may introduce, but ultimately they should actually reinforce information that the patient hears out loud in your office by someone who is connecting that service with a patient who might benefit from it, or know someone else who might. 

I’ve got a challenge for you.  At your next staff meeting, make a list of the services you have to offer.  Stretch the list to include 30, 40, 50 things.  Don’t just go for the easy ones that are obvious to every patient.  WHY are those things valuable services?  WHY should it matter to your patient that you invested in digital radiography?  WHY is early diagnosis of oral cancer so critical, and how is that connected to their visit with a hygienist to clean their teeth?  WHY are sealants important and why are they worth getting even if you don’t have insurance? WHY can’t a dentist just look at teeth without taking impressions for models to tell them what’s wrong? WHY are a few chipped teeth such a big deal?  You know these things, and everyone in your office does as well, but…do your patients?  . 

When my boys were little (all grown now!) I remembered an exercise my mother once made my brother and I do when we fought.  We had to sit down and write down all of the good things about the other.  Of course, it took some time…but, we did it.  First I conceded one, then another, then many more good traits.  Get your staff to focus on what you have to offer, and name it.  Then get them all to talk about these things on a regular basis.  These are the things your patients came to you for, and they are the things that will prompt them to refer their family and friends to you.  If you have a website, go through it page by page and talk about these things in your practice.  A patient searching for a dental practice via Google shouldn’t have access to information that is more comprehensive than the information your current patients have. 

Everything you do is geared toward helping get your patients healthy, and then maintaining that health or to helping them smile with the smile they have always wanted. Sometimes it is to help them do something as basic as eat a meal without pain or difficulty.  There’s no reason to relegate that news to a brochure rack or an e-newsletter.  You are  working in a field of health, artistry, and complex engineering. This is good stuff! Tell your patients about it so you’ll never hear “I didn’t know you did that!” again.

Trying to think of the best image to demonstrate a team I’m getting to know, this one jumped out at me.  The energy associated with moving forward. 

Focus and enthusiasm and a palpable intensity.  Nobody looks like they’re planning on tripping their neighbor (although the one on the far left looks like she’s had some extra caffeine this morning!).  You can almost imagine the “winner” being the first one to high-five the  remaining runners as they make it across the line, can’t you?  I haven’t had the pleasure of meeting this team in person yet, but I’m getting to know them.  I’m getting to know them through the voices on the phone and the clinical notes that allow me to peek through the window into their world, while working with their patients.

If this team’s Treatment Coordinator were told one day that her doctor planned on keeping things exactly the same for 12 months, and there would be no changes at all until then, she would likely not be comforted.  She would probably be concerned that perhaps he was working too hard.  Maybe he’s coming down with something?  In all probability she would really be wondering if he might be losing it.  She would most certainly not be thinking “Whew!  sure will be nice just to do the same thing every day!”  The character of this practice is forward movement.  How can they be better in the delivery of exceptional care, with as much efficiency and profitability as possible is the clear guiding force.  Someone content to do the same thing each and every day would not work in this office.  The old “One of these things is not like the other, one of these things doesn’t belong” would apply and they would run for the  hills. 

How can I tell this about people I have never met?  Detailed clinical notes indicating the level of interaction, the comprehensive nature of each and every visit, and the professionalism of the people involved.  That’s how I can tell.  Talking to their patients with the ability to continue a conversation that was already begun, simply because the notes are so detailed is a beautiful thing. 

Think about when you’ve had a change in your team and everyone has had to reinvent the wheel.  You say “Suzy knew everyone!”  There is no institutional knowledge about your patients when Suzy leaves.  There are probably word documents galore telling how to leave a voice mail, who your suppliers are, and when everyone in the team has a birthday.  If you can’t look in a chart or in the digital record and have a really good idea of what happened at an appointment, what the financial discussions were, and what this patient’s previously stated hopes and fears are…you’re missing a real opportunity to take those patient conversations to another level.

I am fortunate enough to be working with a Treatment Coordinator who probably thought it was absolutely nuts to have someone from a few states away rummaging around in her world, contacting patients she had already developed strong relationships with.  What in the world might I say to them?  What if I say the wrong thing and upset her patients?  Those are absolutely understandable and very reasonable thoughts.  They are also thoughts that, even if felt, were never expressed to me.  You see, she knows her doctor well, and is not being dragged along to the next step.  She’s already gotten there 10 minutes earlier, unlocked the door, and turned on the lights for him!  And…he knows it. 

 There is something wonderful about watching this kind of energy in action.  Albeit remotely.  This team is my “Front Desk Superstar” blog entry for now…I’m saving up an entire post for this one lovely lady- stay tuned.

I’ve enjoyed highlighting many of the success stories at the Front Desk and know I’ll be adding many more.  What I’d like to talk about today is what is more commonly found in a few of the Practices I get a chance to work with.  Why would a Doctor contact me in the first place?  Something is nagging there, usually for some time.  A sense that there may be some missed opportunities.  It may not necessarily be an indication of a lack of faith in the Team but more a lack of faith with the systems within which the Team operates.    This is a post I’ve wanted to write for some time, but haven’t wanted to be seen as hostile to the Front Desk Teams whom I know follow my blog, and whom I consider the glue of any successful dental office.  But….this is what I’m finding, and I’d like to lay it out there warts and all for the doctors out there-some of it may hit close to home. 

I’m an analogy girl so here’s one that I’m reminded of when I’ve been thinking about this subject.  I delayed buying a filter for my A/C unit even when I knew it wasn’t wise.  I always meant to replace it, and kept putting it off.  No particular reason, I just always had something better or more important to do (or more fun). $1500.00 later….I have that maintenance schedule down now. 

Got that nagging feeling there might be cracks in your systems? Guess what?  You’re right!  If you have that feeling, you’re probably right.  The problem may not even be in the area you thought it was.  Most practices have redundancies built in.  Frequently one area can be weak, and the others fill in the gap.  If something is missed at the front, your hygienist might catch it.  If something is missed by the Assistant, you might catch it.  This is how a well-functioning team works.  Because of this, if the ball is dropped by one, you might not ever notice it.  Someone else caught it!  I will say that if the ball is dropped at your Front Desk, for whatever reason, the consequences usually have a broader impact.  If a system breaks down, or there isn’t one in place, problems will grow until they reach a point where they will interfere with your growth.  They may even begin to pull you back. 

Your Administrative Staff may be working like crazy, in early and out late.  Missing lunch on a regular basis.  The idea that they may not be serving you well would be crushing to them, understandably.  If they dropped into a system that was not functioning well, or dropped into an office that didn’t have systems, a huge amount of credit needs to go their way.  If they were new to dentistry, and you were a brand new dentist, a huge amount of credit and a large fruit basket should go their way!  You were both figuring it out as you went along, and she did the best she could do with the limited amount of training most Practice Management Software programs provide.  Believe me- it wasn’t enough time.  They may have tried to make changes and had roadblocks placed in their way.  I don’t know, but you may.

I’m going to list the problems that I see that I feel certain have a direct and serious impact on the ability for a practice to grow.  If I see alot of unscheduled treatment by report, it will be rare that some if not all of these issues are present:

Accounts Receivables- Do you have a high accounts receivables and is a significant portion of it found in the “over 90 day” category.  Is more than 15% of your accounts receivables in the 90+ category?  Before you get real comfortable, now look at your adjustments.  Other than true insurance adjustments due to PPO participation, do you see your adjustments to production and collection by report?  Do you know what you’re writing off?  If it is not a write-off necessary by contract, I believe it is best to consider any additional adjustments in the same manner you would a refund check.  They need to be seen by you on a monthly, if not daily basis.  This is money that someone has determined you will not collect for work you have done.  You need to be assured that this adjustment wasn’t done to avoid an awkward pursuit of a balance.  If your Administrative Team doesn’t end month in a timely fashion, your accounts will not age.  That means the delinquent status of your accounts may appear more healthy than is the case. 

Recall program- It doesn’t even matter as much what type of system you use. Many are much more efficient than others.  What matters is that you have an established recall program, which is followed day in and day out.  Any patient who is due and not scheduled should be in the queu for contact.  A defined sequence of contacts which is trackable to the patient needs to be in place, all the way up to a letter inquiring if they wish to remain active.  One of the biggest cracks in Front Desk systems is found in the recall area.  I’ve seen several different ones that work, but the most critical component is that it must be used.

Insurance- Accurate estimates of insurance benefits, and accurate treatment plan financials.  Inaccurate insurance estimates get you back in the Accounts Receivables Swamp!  It’s a nasty place that neither you or your patients want to be.   Many balances on accounts are due to an insurance carrier not paying on a claim at all.  The easy go-to position for some is to close the claim, and bill the patient.  The extreme of that is to close the claim and either write off the balance, or leave it sitting on the account.  Monitoring your numbers will help prevent this dynamic.   Having filed alot of insurance claims in my past life…I will say that it’s easy to dump on insurance carriers because they give us good reason to!  What I will also say is, if your Insurance Administrator knows it is more likely than not that a root planing and scaling claim will need periocharting, why not send it with the initial claim?  If your patient is under 35, it may be likely that carrier will also want a panorex or FMX.  Plan on it.   If your FD prematurely gives up on a claim, and bills the patient, you might as well say “So long!”  Is it right that the insurance carrier has put you in that position?  Absolutely not!  But, and this is a big “but”, if you are accepting assignment of benefits, you are accepting that layer of effort in order to attract and maintain patients for whom this is important.   Knowing in advance the likely requirements of a carrier, and covering their bases with the initial claim saves so much more time than waiting to do it right the second time.

As I move through a practices unscheduled treatment, it is readily apparant which challenges are present.  I try to identify those challenges without assigning blame, and I hope that my clients do too.  The most important issue is starting the hard work of moving forward, even if the pile sitting in the past may seem overwhelming.  At least, there is no more adding to the problem.  You may have money which can no longer be pursued due to age of a claim, or unwillingness for a patient to pay on an old balance they have just heard about.  You may discover that your write-offs were higher than you’d believed, and your production lower than you’d thought.  You may even have paid out bonuses that in hindsight you might have not given.  It’s likely not productive to go there.  Putting the issues on the table, and making a commitment to move forward is probably the best path.  Unless you find gross misconduct, working hard at putting systems in place with a Team who is already committed to your success, but may not have had the tools to perform well may serve you better.

This is an opportunity to see how a Front Desk Superstar is made.  They’re the ones that do the hardest thing possible.  Having someone (even the doctor) telling them their systems aren’t working may feel like having someone tell them their baby is ugly.  Especially if they created the system.  It’s the one that they know.   It’s important that they know you’re behind them in any changes planned, and equally important for them to know that you will be checking with them on a regular basis. 

My work is focused on the Unscheduled Treatment/Reactivation challenges, and because of that effort, I will find and note areas I believe you will want to address when my active work with a practice is completed.    I will absolutely bring production into your chair, but the cracks that caused the delay in scheduling will then need to be addressed.  I will give your Team suggestions, and then they will do the hard work.  Major practice changes across the board to include the Clinical area may be more appropriately addressed by a Practice Consultant that will spend a year or more with you.   Long-term practice consulting is not something that I do, but I can make recommendations, if asked, for which I receive no financial benefit.  If, during my work, I believe the evaluation of a Dental CPA to audit for possible irregularities might be wise, I will make that referral as well.  The #1 recommendation I am guaranteed to make to anyone I’m fortunate enough to work with is “Check your systems and check them on a regular basis”.  Never allow a situation where your team can say “Dr. ________ doesn’t ever look at ______”.  If you don’t ask, or don’t check, don’t be surprised at what you might find.  It’s scary out there!

If you ask your patients, you may be surprised what they have to share!

“Mrs. Smith is going to go to another office!”  If you hear this from someone in your team, I know you might get that little jolt to the stomach.  “Why?  I thought she was happy here!”  If the answer is, “She’s moving to Botswana”, you let out that sigh, and all is right with the world again.  Mrs. Smith hasn’t rejected you or your office, she just can’t handle that Botswana to Seattle commute every 6 months.  That is an acceptable reason, and you settle back in to do what you always do.  How about if the answer is “She’s going to go to Dr. Perfectpants down the street”?  What happens if that is the answer?  The path you take from this point is what I’m going to talk about today.

You can’t please them all.  That’s certainly true, and some patients are better welcomed to find the practice that will fit their needs better than yours.  Some you might even encourage with a gift basket just to check out the office down the road…. Most patients are ones you’d like to keep and ones you’d like to refer their friends to your office as well.  We’re usually pretty good about asking patients how they heard about us, but we’re not so good at asking them why they are transferring to another office.  Nobody wants to hear bad news, and we all know we’re doing our best to make their experience a positive one.  In fact, we usually get that phone call disposed of just as quickly as possible!  We don’t really want the answer, because we don’t want to know if it was our fault.  We assume this is an aberration.  If they really knew how good we were, they’d never leave, right?  We should want the answer to the exit question just as much as we want the answer to the referral question.  Both give us crucial (and free) data to enhance the quality of our service to each patient we see.

One side benefit to what I do for clients each day is the collection of data on patients who have voted with their feet.  In any reactivation or unscheduled treatment effort you will find out alot about what is happening in the practice, through a patient’s eyes.  If they’re given the chance, many will share at great length what their issues were.  When you hear the same story a few times, a pattern can be clear.  If it is an isolated issue, it can be something to discuss and consider, but not necessarily something you’d want to change your systems to address. 

Commonly heard exit lines

“Dear, my husband and I are on a fixed budget and just can’t afford to go to your office any more.”

“We just didn’t like that new Doctor that someone made us see last time.  He wasn’t as nice as Dr. Brown, so we’re just going to go to our daughter’s dentist now.”

“Dr. Perfectpants has that new _______________ and I won’t have to go to alot of different offices to get my work done.”

“We got this bill from you all about 4 months after I was in there and it was for almost $100.00!”

“We just decided to go to our old dentist.”

“Every time I go there, I see different people!”

“We have to go to someone in our plan, otherwise we’d stay there.”

” That girl was rude to me when I had to cancel my appointment.  Then I got a bill!”

“I was told I would get __________________ and then I got _______________!”

If the goal is finding fault you can’t fix anything!

• Resist the urge to find the culprit, blame them (or the patient) and then move on with things exactly the way they had been.  It is a natural impulse but you lose the benefit of your patient’s free advise if you head down that path.
• Remember that this is not like cross-examination of a witness on the witness stand, where the effort is to undermine the person’s argument to reinforce your own position.  In this case, you really do need to try to disregard all of the side issues and focus intently on what the patient said.  Too many times, we all reach for an argument that will balance or neutralize an opposing view.  I’m guilty of that more times than I’d like to admit. Try to resist this urge, no matter how strong it might be.
• Step back from what you know and try to look at the issue through a patient’s eyes and experience.  They do not know what you do, and may not come to the same conclusions because of that.  Ask if it is reasonable for a patient to know something, just because we think they should.  Have we given them this information, and if so, how effectively did we communicate it?
• Keep in mind that for each dissatisfied patient, you may have others who have quietly walked out the door, or who were not forthcoming when they asked for their records.  For every patient who vocalizes a concern, it is certain there will be others who aren’t comfortable doing so.
• Ask yourself what the “I’m going to go to an office closer to me” might really mean.  If this patient has been driving to your office, what if anything might have caused them to rethink the value of the commute?
• If a patient’s issues are with a particular person, try to have that person present the issue at a Team Meeting, and present it from the patients viewpoint.  That means you too!  No arguments or qualifiers.  Just present what the patient said and lay it on the table for the team to troubleshoot.  It should be a given that all of us are going to blow it on occasion.  None of us wants to upset a patient, and that should be the assumption going into this exercise.  Praise the employee who lays it out there for you, as this is an incredibly difficult thing for any of us to do.
• Send an exit letter to any patient leaving your practice!  You are welcome to download my letter template, and modify it for your practice.  It’s free to you for your use.  Send the letter with a self-addressed stamped envelope, and make sure it is personally signed by you, the doctor.  Then sit down and talk about the patient responses at a meeting.
• Learning what is right about the practice comes from testimonials on websites, surveys, and from referrals you receive.  It is just as important (and may be more) to learn what can be improved.  The toughest advise, as well as the most valuable, can sometimes come from patients who set your teeth on edge!  Don’t dismiss their feedback because they were the source.  Also, don’t make the mistake of carrying over non-related issues of the past to negate a critical evaluation in the present.

Monitor

Keep track of how you handle these issues.  You don’t have to create anything fancy, just keep track so that you can determine trends.  Time has a way of coloring our recollections and you don’t want to miss a developing pattern.  If you get patients who request that a particular provider see them (afters seeing someone else), this should be noted.  If you have more than one doctor or hygienist in your practice, this is crucial.  Your Administrative Team has probably devised a few creative ways to indicate these preferences in a way that will hide them from the person rejected.  Resist this urge, as it creates a system that guarantees your patients feedback cannot possibly be acted on.  Feelings are involved, and those should absolutely be honored, but this is a business and you cannot know what you need to fix unless you know what is perceived as “wrong” by your patients.  We are a people-centered business, and when they tell us something, we all need to be listening! 

Reactivating patients and scheduling unscheduled treatment (which I do each and every day) is exceedingly valuable in and of itself, simply as a means to get production in the chair.  I consider the data I’m able to get from patients who have chosen to leave to be almost as valuable a service to my clients, and that feedback is also a freebie.  Take the time, from this point forward, to ask the “Why?” when your patients choose to leave your practice, or decline the services of one of your providers.  This is good stuff, and it’s absolutely free!