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Everything Dental Blog – June 2014

Late May/Early June are Trigger Months

Put your resources where they will do the most good during trigger months. Your administrative team should be focused on appointing/reactivating and confirming all appointments now. Many patients with dental benefits have a use it or lose it (calendar year) annual benefit. The ramifications of not having a patient seen for their re-care appointment by June 30th results in more than one lost preventive appointment later in the year.

Run a continuing care report in Dentrix (your practice management software). It will identify patients that have not been seen this year for a re-care appointment. You will see an enormous opportunity for your practice when you analyze this report. Remember – one hundred newly appointed preventive patients can yield between $120K – $200K or more in gross production (not including the treatment done or identified during these visits) for this quarter and again in the fourth quarter!

One missed hygiene opportunity influences oral care, patient education/relations, operational performance and revenue. Many offices do not monitor things like missed appointments, perio penetration and closure rates. I recommend that you monitor key performance indicators like; cancellations, accounts receivables, % of patients in perio and radiography utilization. The groups and corporate dentistry facilities that are popping up around town are progressive, by the numbers operations. They monitor performance and improve their weaknesses over time. They have goals and strategies to infiltrate and become relevant in their space.

Focus on providing comprehensive care with a strong emphasis on prevention. Compound that with the opportunities around elective cosmetic and implant dentistry and you have a solid business strategy. Remember – September is a trigger month also. Begin your yearend push in mid/late September. Get all presented and approved dentistry appointed and have all returning re-care patients scheduled.

Over the last few months I have interviewed several key opinion leaders and have asked them to answer the questions that are on everyone’s mind. The interviews have run the gamut but most agree that PPO dentistry and the groups (corporate dentistry) represent a definitive shift in dentistry.

Below is an interview with Dr. Steven Katz and Kelly Fox Galvagni, CDA. I have known of Dr. Katz and Kelly for over a decade but have become friends over the last few years. Dr. Katz and Kelly are successful wet handed dental professionals who have built an incredible reputation and following with their hands-on style of management and care giving. Steve and Kelly do not work in the same office and that is what makes them unique. They share many views and have their own personal perspective on where dentistry has gone and how dentistry is done.


Interview with Dr. Steve Katz and Kelly Fox Galvagni, CDA

EDB: What is the greatest challenge you see facing privately owned dental facilities today?

Smile Potential: Jack, thank you for this opportunity to connect with your network and all of the clients you serve so well. I see the greatest challenge is the lack of belief that our role is to make a difference in people’s lives. Too many dentists have been influenced by the commoditization that our profession is experiencing. In spite of the pressures from insurance companies and corporate entities we must remain dedicated to understanding how dental conditions affect people’s lives in many ways and our responsibility is to address these effects of the presenting conditions or complaints.

EDB: Which attribute is more likely to yield a good practice – great clinical skills, charisma or systems?

Smile Potential: Nothing exceeds the importance of dedication to the highest quality control in delivering care and service. The first responsibility of dentists and their teams is to insure that they are providing care to the highest standard of care. The next most important attribute would be systems. Systems insure that results are reproducible. It is important to remember that systems should run dental practices and team members run the systems. When practices falter it is usually due to an absence or inadequacy of systems. The third attribute out of these three would be charisma. A dentist with charisma has a big advantage in developing believability, likability and trust. However, if the personality type of a dentist is more introverted or task oriented, it is possible to have strategically selected team members fulfill the need to establish a quality relationship with the patients.

EDB: How does a consulting firm create leaders and managers from dentists with little or no business training?

Smile Potential: I have spent the last three years writing my recently released book, “They Didn’t Teach Us THAT In Dental School” which deals with this topic in detail. The challenge of leadership is to develop the vision for the practice, inspire and create motivation in the members of the team and then to show generous appreciation for their efforts. Robert Gates, the former Secretary of State and CIA director was once asked what it takes to be a great leader. His response was, “Take care of the people below you.” The challenge to dentists is to spend as much time honing their leadership skills as their clinical skills. Coaches are instrumental in helping them develop these abilities.

EDB: Do you both consider dentistry to still be a very rewarding and profitable profession?

Smile Potential: I am unique in that while I am a Dental Practice Coach, I am still a full-time, wet-fingered dentist. I wouldn’t have it any other way. I still love going to my office every single day. I get to work for an amazing group of women and together we are able to provide needed and wanted care to appreciative patients. Even during the economic challenges of the last few years, dentistry is financially rewarding and can be quite lucrative when business management practices are followed.

EDB: Kelly – what are the three biggest challenges/opportunities do most office managers have?

Smile Potential: Unfortunately, most office managers lack the empowerment to do their job unencumbered by micromanagement and a lack of systems. If dentists feel that their “office managers” are unable to do the tasks necessary to relieve their administrative role, then they really need to reevaluate their selection process. Once selection is complete, then provide the office manager with as much training as necessary and afford them the resources to do their jobs properly. When the office manager is allowed to truly manage a practice, it allows the dentist to do the task that they are best able to contribute to the practice, clinical productivity.

EDB: If you were to build a dental practice for one of your children, would you shoot for a Fee for Service practice, a PPO practice or a Hybrid model?

Smile Potential: Moving forward I believe that the ideal practice will be a PPO practice with the ability to maximize insurance benefits and when the benefits are exhausted, to inspire patients to want elective and comprehensive care independent of insurance coverage. I attend many continuing education lectures where the presenters show amazing, heroic and complicated cases. Those in the audience have undoubtedly attended numerous similar lectures. The unfortunate situation is that most of the dentists attending the presentation will never get to do cases like they are seeing projected on the screen. This is not because they don’t know how to do them, but rather because they are unable to inspire patients to want that level of care. Doctors must attend more programs like our “Team Approach to Successful Treatment Acceptance” to develop these skills.

EDB: Is there one piece of advice that you would give to a young associate who plans on owning their own practice one day?

Smile Potential: The best advice that I can give a young dentist, and I delivered this message to a New Dentist Symposium in April, is to spend as much time visiting offices and observing doctors in practice. Watch the dentists, naturally, but pay as much attention to skillful hygienists, administrative team members and clinical assistants. Take note of the things that seem to make them successful and take note of the things that seem to create barriers to success. The second suggestion that I have is to develop mentorships. There are many practitioners who are successfully accomplishing what the newest members of our profession strive for. Those that are accomplishing great things are usually eager to share their secrets for success. Develop relationships with these doctors and the path to success will be more direct and free of as many detours.

EDB: How do you see the Fee for Service business model in 2015 and beyond?

Smile Potential: I agree that the quest to remain fee for service is more difficult than it once was, but it is also the most fulfilling way to practice. It takes a much greater dedication to the interpersonal skills and an unwavering commitment to raising the perceived value of care.

EDB: Are Fee for Service practices extinct?

Smile Potential: The true fee-for service practice, as we have known it, is going through a transformation. As I mentioned previously, the obsession to raising the perceived level of care ultimately lowers the perceived cost of care. The success of fee-for-service care is dependent on constantly staying ahead of current trends. Understanding the need to create an incredibly caring culture, incorporating amazing latest technology, understanding the needs of our patients has evolved to necessitate same-day dentistry, and embracing the digital age in communication are all strategies necessary to insure success with the fee-for service model.

EDB: Can you share your thoughts about these four emerging dental offerings: Facial fillers/ facial cosmetic procedures?

Smile Potential: I am not a big advocate of embracing this modality of treatment. Maybe I’m a purist, but I view this procedure as a gray area in the scope of dental treatment. If you are adequately trained and are truly able to employ this scope of care to enhance your cosmetic dentistry, then I am able to validate it. I firmly believe that it is not a procedure to incorporate in order to merely increase the production of an underperforming practice.

EDB: Sleep Dentistry/Medicine?

Smile Potential: I believe that Sleep Dentistry and treating patients with snoring or Obstructive Sleep Apnea is an area that dentists can help to improve the lives of their patients when properly trained and performed in conjunction with Sleep Medicine Physicians.

EDB: Comprehensive oral cancer exams with a device that can identify abnormalities in the oral mucosa?

Smile Potential: I do not view oral cancer identification as an optional offering. I view it as our obligation to our patients. It can be the single most important procedure we perform when you consider what the effect of failure to diagnose may be. The latest devices such as Identify and Velscope are incredible adjuncts to conscientious white light evaluations of every patient. I am often asked how to respond to a patient who may have difficulty affording or who might not want to pay for these exams. Without hesitation I emphatically insist that it be done anyway. That is how important this responsibility is.

EDB: Cad Cam dentistry and digital impression scanning?

Smile Potential: I was one of the first doctors in the country to use the Itero Digital Impression system. The main result of having this technology for many years has been a better result in care. There is no dispute that the crowns fabricated with this technology fit better. I have a hard time understanding how more offices have not incorporated this technology. The cost of the technology is offset by the savings from lessening the need for conventional dental supplies such as impression material. More recently, I have incorporated the E4D into my practice. It combines the technology of digital impressions with the additional savings of producing indirect restorations in-house. I have found an incredible level of appreciation from patients when we are able to complete this treatment in a single appointment. Our patients’ schedules are so much more complex now and this seems to make it easier for them to receive care.

EDB: What role will hygienists play in the future?

Smile Potential: In most offices hygienists are underutilized. In the current model they should be empowered to be true periodontal therapists. Probing must be done on every patient and patients have to be led to own their periodontal disease. When perio is detected at the very earliest stage it must be treated and not swept under the rug by doing “just” a prophy. Treatment for periodontal disease should be compensated appropriately. Use of lasers, subgingival antimicrobials and salivary diagnostics should be incorporated in the procedures that our hygienists are empowered to do. In addition, the most important responsibility of the hygienist is to raise the patients’ perceived value of care. The hygienists must be able to recognize clinical needs and patient desires for possible elective treatment and they must be taught how to skillfully communicate these to the doctor so that treatment acceptance can be maximized.

EDB: Do you believe in expanded duties and mid-level care givers?

Smile Potential: If auxiliaries are trained to do tasks beyond the normal and certified to do so, they can be a competitive advantage for a practice. I won’t go as far as to say that certification should be required, but it should be encouraged and compensated appropriately.

EDB: How important are job descriptions and operational systems to the over-all health of a dental practice?

Smile Potential: Written job descriptions and operating systems are essential for the functioning of a successful practice. A simple way to develop this documentation is to have each team member make a list of the 50 or so tasks that they perform during a typical day, week and month. Once these tasks have been identified, then each task should receive a detailed, specific and thorough written description. If each of these tasks is defined one week at a time, it will take approximately one year to develop a complete practice manual. If anyone would like more information about this project, please reach out to me using the contact information at the end of this interview.

EDB: What do you think about the growth of corporate dentistry?

Smile Potential: Corporate dentistry is inevitable at this time. We are seeing it in medicine and we are seeing it in dentistry. The reason is that these companies have identified that when practices are managed effectively with a lower margin from the leverage of scale they can be profitable ventures for investors. It becomes necessary for all practitioners to adopt some of the lessons to be learned from these extremely well managed corporate practices.

EDB: What do you think will happen to specialists as more offices are engaged in multispecialty services? Are there any specialists that you think will thrive in the future?

Smile Potential: The trend seems to be towards full-service practices that can provide all specialty services under one roof. There is a lot to be said for efficiency with this model. When this occurs, fees can be retained and continuity of care can be more efficiently managed. If properly equipped, there is no reason why the full scope of specialty practice cannot be accomplished in this model. The alternative for specialists will be multi-doctor practices. The future for single practitioner specialty practices seems challenged at this time.

EDB: Dr. Katz, what are the top 3 leadership mistakes that Drs. make?

Smile Potential: The first major error that dentists seem to make is failing to keep up with technology. The patients we serve are savvier than ever before and fully understand that doctors who do not keep up with technology are not able to deliver the same quality of care. The second major error is failing to understand that patients are inspired by an emotional connection to what we can do for them and not by our educating them about all of the technical aspects of care that mean more to us. The third error is not placing a priority on the aspects of care that allow us to meet the challenges of a faster and more complicated general lifestyle. It is essential that we be punctual, that we exhibit flexibility in our schedules because our patients may not have that flexibility and that we try to make it possible to accomplish treatment in as few appointments as possible.

EDB: Please tell me the process you take when consulting with a dental office?

Smile Potential: Kelly and I have been providing Coaching Services to dental practices for 5 years. The average practice we work with will show a 20-25% increase in the first 3-4 months. When committed for a longer period of time, we have seen numerous practices double their production with less effort in 12-18 months. This benefits young dentists starting out, doctors in the midst of their most productive years and those looking to increase the value of their practices prior to a transition. All of our work with practices is highly customized to the practice. We have never followed the same course with any practice, thus far. Each practice is different and we recognize that. Our greatest advantage is in our follow through. We are incredibly hands on and actively hold the doctor and team accountable to committing to the changes we have agreed on.

EDB: Your contact information?

Smile Potential: The best ways to contact me are by email at SmilePotential@aol.com or by phone. Smile Potential’s phone number is 516-599-0214. 

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