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Getting Poised for Growth

September 24, 2013 by howardfarran Leave a Comment

Humans are social animals. Social animals exist in tribes, and for the survival of every tribe you need order. For there to be order, there needs to be control. Social animals are hard wired for control, and because of this a lot of businesses become unsuccessful because the owner or CEO abhors delegation and feels the strong need to control everything. How does the CEO of a Fortune 500 company run her operation of 100,000 employees if she doesn’t delegate anything? It would be impossible! The leaders who rise to the top don’t fear risk or delegation – they retain and attract quality key people, give them responsibilities and then get out of their way. Success is counterintuitive to how humans operate.

Another great example is how most dentists imagine the way they are going to retire and sell their practices at age 65. At age 55 they start thinking, “Well, I’m going to retire in 10 years, so the last thing I’m going to do with this practice is invest in any new equipment or new technologies or implement any new techniques into my repertoire.” They’re content with milking the cow dry and refuse to feed it anymore oats, grass, grain or water. But here’s the amusing part: when it comes time for that dentist to sell her practice, she thinks it is going to sell for some huge amount, but it’s not going to happen. Nothing in the practice has been updated, new patients have dwindled to zero and it has become a business that nobody in their right mind would purchase at the price in the dentist’s head.

You have to realize the final 10 years that you are in practice are the most important years to double down on your business bet! In this time you can’t be milking your practice of what it’s currently worth only to sell it for pennies on the dollar. You need to modernize your practice. You need to move it from a lousy 1,000 square foot rental space on the third floor of a medical building to a premium 4,000 square foot building right out on Main Street with a huge sign. This is the time for you to upgrade from 2D X-rays to 3D cone beam computed tomography! This is the time to invest in CAD/CAM! In dentistry the only dogs that can’t learn new tricks are dead dogs!

If your practice is neglected because you milked it for the last 10 years, you will end up with an illiquid asset. You have to get your business poised for growth. You can’t sell a sinking ship. Just like with the sale of a home, when a window breaks, you don’t say, “Let’s just wait until two other windows break and then we’ll fix it.” No way.

Here’s another housing example tied to liquidity: a three bedroom, two bath house in Phoenix, Arizona, can easily sell within 30 days, but a 10 room house with an eight-car garage and a tennis court and Olympic-sized pool can sit there for three years because it is just not a liquid asset. Nobody wants it or can afford it. Along these same lines: the corner commercial lot on the corner of 1st and Main, you can sell in a heartbeat for premium price. But if you go just 300 yards down the street either way, you might be looking at half the price and, worse, you might never be able to sell it. I mean there are intersections in Phoenix that are still vacant from when I moved here 25 years ago because they just weren’t perfect. This is why location is key! So if you’re renting in a medical building or you aren’t set up on a great location, you need to be poised to sell, so get moving!

Here’s something else you need to think about if you’re considering retiring and selling your practice in the next 10 years: interest rates on CDs right now are at two percent, so that means for every million dollars in cash you have in the bank, in government bonds or CDs, you are going to make $20,000. Let’s say the average dentist makes $140,000 dollars a year. That means they would have to have $7 million in cash in a two percent government bond or CD at Bank of America or Chase to maintain their income. That is just not going to happen. I don’t know of too many dentists that can walk away at 65, sell their practice and have $7 million in cash earning two percent.

If you’re a renter and you sell your practice for $400,000, that’s it. That’s all you get. But if you owned your practice and you owned the building, you could sell your practice for $400,000, but keep the building, so you would charge rent to the new dentist who purchased your practice. Every year you can adjust the price of the rent based on the Consumer Price Index, and over the next 10 years, you could earn an additional $400,000. Then, maybe, at the end of the 10- year lease, the new dentist wants to buy the building. Then you finance that to the new dentist and you end up with yet another 10-year income stream. Think about it: the renter made $400,000 and gave half of it to Uncle Sam, so she’s sitting there with $200,000, which at two percent is making $4,000 a year. At that point the renter dentist is going to have to go be an associate somewhere else (at age 65) in order to live the way she did when she was practicing! So instead of continuing to rent the space for your practice, you need to get poised for growth. Buy that premium property on 1st and Main or a 4,000 square foot building right next to a WalMart, then sell your practice and rent out your building to earn revenue the smart way.

But this only applies to dentists who want to retire. Me, personally, I never want to retire. Sure, the first year of retirement is fun – you get to golf all the time and go fishing. It’s like a really long vacation. But by the second or third year of retirement, you start to see some dysfunctional behavior. There’s no passion for life. They let themselves go. They don’t have a reason to shower in the morning, let alone get out of bed. Here’s something you should consider if you’re actually considering retirement: don’t retire! I’m serious! There are 5,000 new dental school graduates entering the dental profession every year and they’re looking for a job. These kids are so desperate for a job, when the government asks them to join the military and sit on an aircraft carrier in the middle of the Pacific Ocean or Afghanistan, it sounds really enticing to them. And I hear the excuse all the time from dentists in rural areas that they can’t find an associate because they practice in Middle of Nowhere, Montana. Really? You can’t convince someone to stay in America where nobody’s shooting at them but the government can convince them to practice in Iraq? Stay in practice and be a mentor for crying out loud! Do you know what your unique selling proposition is to these new grads? Do you know what you have to sell more than anything? You! You get out there, you get poised for growth, you go to the finest finishing schools in America like The Pankey Institute or Spear, you get your practice to the very top of your game, and then you get your pickings from 5,000 graduates, some of which are seriously considering going into the military and practicing dentistry in some third world country. Instead you could just reach out and say, “Hey you, new grad, come work for me. You’ll probably look back on this decision when you are 65 years old and realize it was best decision you’ve ever made, because I’m going to teach you how dentistry gets done. It’s all going to be cool, we are going to have a good time working together and you are going to become a very successful dentist.”

Best Tips for Better Practice in 2013

Dentaltown Magazine wants to know what you’ve done this year to make your practice the best it can be! Visit www.dentaltown.com/BestTips2013 to tell us what you’ve done to improve your practice. Keep your eyes peeled for the December issue of Dentaltown Magazine and your tips could be featured in that issue. One lucky contributor will be drawn to win a copy of Dr. Howard Farran’s One-day Dental MBA DVD.

See more at: http://www.dentaltown.com/Dentaltown/Article.aspx?i=334&aid=4538#sthash.iedaYMzG.dpuf

Filed Under: Dentaltown - Howard Speaks Tagged With: dental, dental office, dental practice, Dentaltown, Dentaltown Magazine, dentist, dentistry, howard farran, howard speaks, meaning of life, practice management, treatment plan

Dentists are Still Doing Way Too Many Three-Unit Bridges

September 24, 2013 by howardfarran Leave a Comment

Dr. Carl Misch, who is regarded by many as the number-one implantologist in the world today, (and who just filmed a series of four awesome online CE courses for Dentaltown.com), wrote in his book Dental Implant Prosthetics that the 15 year survival rate of implant restorations is 95 percent and for a three-unit bridge the survival rate is 74 percent. In this day and age, dentists really have to ask themselves, “If an implant and crown has a 21 percent higher success rate over a three-unit bridge, why are we doing so many three-unit bridges?”

Insurance Coverage?

Is it because insurance still doesn’t cover implants? We all know that’s not true! Twenty-five years ago, when I opened my Phoenix, Arizona, dental practice – Today’s Dental – almost zero insurance companies offered any coverage of dental implants. Today, based on the insurance plans that we have verified and have in our system at my practice, we have come up with the following percent of insurance plans that have implant coverage:

  • Delta of California 86%
  • Metlife 76%
  • Delta of Arizona 74%
  • Aetna 53%
  • Cigna 35%
  • Humana 18%

When I started my practice in 1987, implants were not a covered benefit under most insurance plans, but today, we are seeing an upward trend in insurance companies realizing the benefits of implants; such as, preserving tooth structure and making it virtually impossible for decay to form. With more and more insurance plans covering dental implants, it can’t possibly be a good enough reason to not be placing implants.

Pricing and Presentation?

Here’s another reason why we might be placing way too many three-unit bridges: price breakdown and case presentation. When I graduated from dental school in 1987, I argued with a lot of local Medicaid plans because coverage of an extraction was $2 cheaper than a filling. Moms in lower socioeconomic brackets had the economic incentive to pull their babies’ teeth instead of fixing them, just because it was cheaper. I always thought the extraction should cost $2 more than an amalgam filling, because when it comes to certain procedures for certain patients, affordability was always the key decision maker.

The same thing is happening with bridges vs. implants. Most dentists will offer their patients an exact flat fee for a bridge, and they’ll say they can prep it today and cement it in two weeks. Then when the patient asks about an implant, most dentists break it down to something like, “Well, um, it’s $1,500 for the implant and it’s $1,000 for the crown, but then we might have to do a bone graft, and we might have to do a gum procedure, and I won’t really know what we’re looking at until I pull the tooth to know how long this will take…” It’s a total confusing quagmire! The implant is the better option, but you make it so difficult for the patient to understand. I mean, I’m a dentist with an MBA and an MAGD and because of the way you present a bridge vs. an implant even I would opt for the bridge!

You need to figure out a way to explain that the cost of an implant is the same as the cost of a bridge. If you charge $3,000 for a bridge, then an implant should be $3,000 as well. Now, whether or not you have to do a bone graft or something more, that’s just the cost of doing business. Obviously some cases will be easier than others, but that’s life. It’s also the way everybody else does business. When you take your car in to fix your radiator, they’re going to do it at a flat fee. I guarantee some radiators are easier to fix than others – you’re not going to get nickel and dimed because your radiator was harder to fix than the last one they worked on.

You know what would help you place more implants in your practice? If your implants cost less than a bridge! They have a 21 percent better success rate, after all! You need to take the economic incentive to do the cheaper but less effective option out of the equation. If you tell your patients it’s cheaper to do an implant and a crown than it is to do a bridge, you’re going to be placing a ton more implants, doc!

Specialists?

I recently spoke about this issue with Dr. August de Oliveira, the author of Implants Made Easy, and he brought up a survey conducted by Straumann, which indicated the United States of America currently ranks fifth in total implants placed. More than 85 percent of general dentists in South Korea place implants, more than 50 percent of all general dentists in Europe place implants, and the most implants placed in the world is Israel. When I asked August why he thinks so many dentists still do bridges over implants he said, “It’s a loss in production if general dentists send out the implant case. Rather than learning how to do implants themselves, they do bridges and send out an occasional implant. That is changing as patients are getting educated on the benefits of an implant crown vs. a three-unit bridge.”

In America, culturally, we got into this groove where oral surgeons and periodontists place implants. GPs don’t want to do implants because it’s inconvenient, it’s a loss of revenue to send out, and you have to work with a specialist. If you’re not going to place implants yourself, you need to work with a specialist who will agree with your vision of a flat fee for all implants placed. If you charge $3,000 for a bridge, you’re going to charge $3,000 for an implant whether you place it or the specialist does. You want the safety of being able to tell your patients that they’re going to go to another doctor who will place the implant, it will be the same fee, and there will be no nickel and diming. If your specialist cannot work with the laws of averages like every other service industry does, then find another specialist! Either that or learn how to place implants. Too hard, you say?

Implants Are Hard? Really? In 2013?

I learned how to place implants early on in my dental career. I earned my Diplomat in the International Congress of Oral Implantologists (DICOI) and my fellowship at the Misch Institute. In 1987 placing an implant was hard. You had 2D Xrays, panos and PAs, and you never truly knew what was going on until you laid a flap. Today, with 3D cone beam computed tomography (CBCT), diagnosis is twice as easy – heck, even the software that’s been developed for these systems will tell you how long and wide the implant can be to place in your particular patient. You almost don’t need to think about it. Oh, and anatomical features that scared us to death back in the day, like the inferior alveolar nerve and the sinus, are all spelled out for you in a 3D image. You know exactly what you’re looking at before you even pick up an intrument. This harkens back to my May 2013 column “Is Dentistry Getting Too Easy?” It’s twice as easy to do a root canal today (with high-speed handpiece-driven NiTi files), and it’s just as easy to place an implant with the help of 3D CBCT.

It’s time we all sit back and rethink placing implants. Placing an implant today is so much easier than pulling a wisdom tooth – yet I know more dentists who pull 10 to 30 percent of their wisdom teeth but don’t place a single implant. I think that’s completely backward (and bizarre)! That’s like saying you can repair your car but can’t fix the chain on your bicycle. You need more skill to pull a wisdom tooth than to place an implant. With the technological advancements we have at our fingertips today, it just doesn’t make any sense why dentists don’t place more implants.

Remember the 4,000lb Gorilla in the Room

When it comes to the dentistry we do, nobody likes to talk about the 4,000lb gorilla in the room – mortality. The average man dies at age 74, and the average woman dies at almost 80. When grandma and grandpa go into the nursing home to live out their remaining days, all the dentistry we’ve performed over their lifetime crumbles and rots after 18 months. I’ve been a huge proponent of there being less inert and more bacteriostatic restorative materials in the dental market – and dental implants fit that bill. When I visit nursing homes, it’s sad to say that the lucky ones are the people who have dentures and implant-supported prosthetics. The people who have their mouths full of $20,000 worth of root canals and crowns are the most unlucky, because their teeth turn to mush from root surface decay. These people are too old and brittle to do any extractions or full-mouth restorative, and their home care is essentially nonexistent. You really need to start asking yourselves, especially by the time a patient turns 60 years old, are we really going to do a root canal buildup, a crown and a three-unit bridge instead of titanium implants, which the Streptococcus mutans won’t eat? Think about it.

In Summary

While I was wrapping my head around this issue, I talked to longtime Townie, Dr. Jay B. Reznick, oral surgeon at the Southern California Center for Oral & Facial Surgery, in Tarzana, California, and founder of OnlineOralSurgery.com. He sent me an e-mail that summed up the issue of why dentists don’t place implants more than bridges quite nicely. Jay says:

“A dental implant is designed to be ‘permanent,’ however there are a lot of factors, such as hygiene, patient general health and nutrition, systemic disease, local factors, age, implant positioning, prosthetic stresses and individual variation that will reduce the longevity. I always tell my patients, ‘Dental implants are as permanent as their “permanent” teeth,’ so they understand that even what nature gave them is not always perfect and can fail under the right set of conditions. A three-unit bridge is also meant to last a long time, but dental insurance companies will pay to replace a bridge after five to 10 years (depending on the policy), so that should tell you a lot.

“There are a number of reasons why dentists may choose to do a bridge over an implant. I think the biggest is still the misconception, especially in the older practitioners, that implant dentistry is too complicated. They also feel the bridge will be delivered sooner than in the case of an implant, where the extraction site needs to heal and the implant needs time to integrate. Right behind that is the economic desire to keep all the revenue within their practice, rather than sharing the case with a surgical specialist. Of course, that model is changing rapidly, as more and more general dentists are becoming trained and placing their own implant fixtures and then restoring them.

“We are seeing an increase in the number of dental insurance carriers that are covering implant treatment. They are usually the more expensive plans for the patient or employer, and reimburse at a substantially reduced rate from usual, customary and reasonable (UCR) charges.

“The only advantage a bridge has over an implant is that it is faster. The implant helps preserve bone and soft tissue architecture, is easier for the patient to maintain, and leaves a one-tooth problem as a one-tooth problem, rather than creating a three-tooth problem (which will become a four-tooth problem, and eventually a denture).”

It’s time to change the way we think about implants and the way we present this incredible option to our patients – the future of the dentistry we provide depends on it!

Filed Under: Dentaltown - Howard Speaks Tagged With: bridges, dental, dental office, dental practice, Dentaltown, Dentaltown Magazine, dentist, dentistry, howard farran, howard speaks, meaning of life, practice management, treatment plan

Here’s What Really Happens When You Extend a Deadline

August 20, 2013 by howardfarran Leave a Comment

Here’s a great blog post from the Harvard Business Review on deadline extension… check it out!

 

In June, the Obama administration pushed back the deadline for employers with fifty or more workers to provide health insurance for their employees by a full year — until Jan 1, 2015. Admittedly, the implementation of anything as complex as the Affordable Care Act is going to take time, and those involved have been working furiously to try to meet the government’s deadlines. So, at least with respect to this particular part of the ACA, everyone has an additional year to get everything just right. Sounds like a good thing, doesn’t it?

Only — how furiously do you think everyone with this new, extended deadline is working now? Are they still burning the midnight oil… or are they saying to themselves, Let’s take a breather. We’ve got plenty of time.

Read the rest of the article here: http://blogs.hbr.org/cs/2013/08/heres_what_really_happens_when.html?utm_source=dlvr.it&utm_medium=twitter

Filed Under: Dentaltown - Howard Blogs Tagged With: ACA, dental office, dental practice, Dentaltown, Dentaltown Magazine, dentist, dentistry, Harvard Business, howard farran, Obamacare, practice management

Parents sue Texas City man after boy’s teeth ripped out in dog attack

August 20, 2013 by howardfarran Leave a Comment

A civil lawsuit accuses a Texas City man of failing to control his dog, which attacked a boy so severely in 2011 that it ripped out the child’s teeth. Read the rest of the article here: http://www.chron.com/news/houston-texas/houston/article/Parents-sue-Texas-City-man-after-boy-s-teeth-4744490.php

 

That’s one heckuva dog bite! Comment on this below!

Filed Under: Dentaltown - Howard Blogs Tagged With: attack, dental office, dental practice, Dentaltown, Dentaltown Magazine, dentist, dentistry, dog bite, howard farran, practice management

Burglar Caught on Video Inside South Philly Dentist’s Office

August 20, 2013 by howardfarran Leave a Comment

Hey gang… Check this out… What would YOU do in this situation??

 

Philadelphia police are on the hunt for a man who broke into a dentist’s office in the Pennsport section of the city over the weekend: http://philadelphia.cbslocal.com/2013/08/20/burglar-caught-on-video-inside-south-philly-dentists-office/

 

Comment below!!

Filed Under: Dentaltown - Howard Blogs Tagged With: burglar, dental office, dental practice, Dentaltown, Dentaltown Magazine, dentist, dentistry, howard farran, practice management

Develop Your Front Desk

July 8, 2013 by howardfarran Leave a Comment

Think about how much training goes into running and practicing in a dental office. Dentists go to school and get trained in the art and science of dentistry for eight, 10 or sometimes even 12 years. That’s a long time! Dental hygienists have four years of training in college. My dental assistant Jan went to dental assisting school for a year, like many dental assistants do, to get her degree. But unfortunately the absolute most important position in a dental practice just happens to be the most overlooked when it comes to training – and that’s your front desk!

How your front desk interacts with your patients and what this position does for your practice might not seem like a big deal to you, and if that’s true I’d take great pride in telling you how utterly wrong you are.

For 25 years I’ve said if you’re the owner of a football team, make sure you have a stellar quarterback; if you own a basketball team, get a seven-foottall center; if you have a hockey team, you want the best goalie, and if you own a dental practice, your best employee had better be stationed at your front desk. Your front desk person is always the first staff member to greet your patients as they enter your practice, and they’re typically the last person your patients talk to when they leave. The front desk handles all of the money, scheduling and recall. They are the face of your practice, and without them, you have an empty schedule and you can’t do any dentistry.

The most overly trained person in any dental practice is the dentist. Doc, you can talk the ear off of anyone about gold inlays or your in-office CAD/CAM mill, but if you start talking to a dental practice’s front desk staff, seven times out of 10 they can barely list off two or three procedures that the practice offers. It’s so sad.

In 2008, I was re-evaluating my own practice and, while I had an outstanding front-desk team, I thought there was room for improvement (there’s always room for improvement, right?). While I was deciding what to do, I had lunch with one of my best friends here in Phoenix, Arizona – Dr. Thomas Mattern – and he told me how I really should sign my practice up for training with Jay Geier’s Scheduling Institute as it made a serious impact on his practice. I might as well have been distracted by a purse full of butterflies, because I wasn’t really interested in Tom’s endorsement. I thought, I’ve trained my staff, I’ve got an MBA, I know what’s going on. But as the economy tanked and we started seeing fewer new patients come through our doors, I realized a little outside help might tip the scales more in our favor, so I decided to finally listen to Tom, pick up the phone and call the Scheduling Institute.

In the four years we’ve been working with the Scheduling Institute, we’ve learned so many valuable lessons. Phone book ads are dead and gone in my Phoenix, Arizona, market; most of the searching Mom does for dental practices is done on Google these days (which means you need to have a killer Web site as well… and I’ll get to that in a moment). There are 168 hours in a week and the average dental practice is open only 32 hours a week. Let’s say your dental practice gets 100 calls per week and 50 of them go to an answering machine. Hey guys, guess what, those 50 callers are not going to leave a message – they’re going to hang up! They always will. And they won’t call back. I know for a fact. Why? Because we track all of our incoming calls. They’ll just hang up and call the next number on their Google search and schedule the appointment with the first practice that actually talks to them. Every single one of those calls your front desk is missing could be a new patient! So instead of thinking of your front desk as “mere overhead,” Jay Geier teaches that you ought to beef up your front desk. If you only have one person answering the phones and half of those calls are going to voicemail, you need to hire another person so you can take all of those calls in person! If you have another staff member answering the phones, there’s now time to pull up charts, answer questions about billing, statements and scheduling, and your front desk doesn’t have to worry about leaving someone on hold forever (oh, and on that note I should mention my practice never puts a new patient on hold, only loyal patients should ever get put on hold)!

Let’s say your practice is only open 32 hours a week because you like taking Fridays off. What we learned from Jay Geier is even though your practice isn’t doing dentistry on Friday, you still ought to keep your front desk manned for eight hours on that Friday so they can field otherwise missed calls and keep filling your schedule! Now some front-desk staffers might say, “But, Dr. Farran, that’s not a good idea because some people might call in that Friday and cancel their appointments for next Monday or Tuesday.” I say, great! A cancelled appointment is 100 times better than a no-show! At least everyone on the team would know when they walked in Monday morning that the 8 a.m. appointment cancelled – or better yet, with someone staffed at the front desk that Friday, after they take the cancelled patient off the schedule and a new patient calls 10 minutes later, the front desk now has the opportunity to say, “Mrs. Bussy cancelled her 8 a.m. appointment on Monday, but I was able to re-fill it with Mr. Nanking.” You were put on this earth to do dentistry – not try to figure out how to fill the gaps in your schedule. That’s your front desk’s responsibility.

Something else we learned that every practice should take into consideration: There is software you can install on your phone system (as long as you have a modern voiceover Internet protocol phone system, which, if you don’t have by now, you need to seriously consider it), that can give you the tracking data of everyone who has called your practice. So many dental practices are open from 8 a.m. until 5 p.m., Monday through Thursday, and if you tracked their calls you might notice the calls start rolling in at 6:30 a.m. and don’t stop coming until 6 or 7 p.m. The phones might also ring half as much on Friday and Saturday – but they’re still ringing, nonetheless! So while the dentist would rather golf on Friday afternoon or Saturday afternoon, that’s fine, but he/she really needs to blow open the front office hours. The dentist might only work 32 hours a week, but the practice’s phones ought to be answered by live people from 6:30 a.m. until 6:30 p.m., Monday through Thursday; 8 a.m. to 2 p.m. on Friday; and maybe 10 a.m. until 1 p.m. on Saturday – but only if the data you’re tracking tells you that these are high-call-volume hours. If you double the hours you answer the phone, you will just about double the orders you fill, it is just that simple!

Think about it this way: Heartland Dental, the largest dental office chain in the world, figured out it was a total cash cow to start a call center in Effingham, Illinois, where they set up a gazillion phones and brought in a huge staff to answer after-hours calls. Why did Heartland do this? Because it is the front desk’s job to sell appointments, and the more people you have answering the phone during the day and during off hours, the more appointments you’re going to sell. Whenever I lecture and I ask, “Where are the front desk receptionists in this crowd?” and a few hands go up, and I walk up to them and ask them what their job is, they usually answer, “Well, I answer the phone and take care of billing and I file insurance…”

No!

That’s not the job of the front desk! Your front desk exists to sell appointments! In the back office, it’s the dentist’s, hygienist’s and assistant’s job to sell dentistry and treatment plans. Your front desk exists to sell appointments and make sure the eight to 12 years you spent in dental school wasn’t a total waste of time and money.

Price is always the number-one variable in economics, and the number-one question new patients ask is, “How much do you charge for a crown?” Most front desks will tell that potential patient the price, and usually when they hear the answer they say, “Thanks,” and then hang up. You can’t do this! When they ask how much a crown costs, your front desk should be trained enough to say, “Well, there are many different types of crowns at various price points, why don’t we schedule a time for you to come in and meet our doctor?” When the new patient asks, “Do you take my insurance?” the best response is, “When you come in, while the doctor is examining you, we’ll take a look at your insurance.” Quit being so obsessed about telling your patients exactly what you charge for a crown. Get them on your schedule!

Our latest training day with the Scheduling Institute was a couple months ago. A member of Jay Geier’s team came in with a collection of recorded calls she made to my practice to test my front desk. Even after four years there were still some things my team needed to improve upon. Much like when a doctor is telling his or her patients that they need an MOD or a PFM, patients don’t understand what it means when you ask if it is a PPO, HMO, or indemnity! They don’t teach insurance lingo in American high schools! The goal is to get patients into the office, so that means everything needs to be laid out in plain language they can understand.

Let’s say the person on the other end of the line is hemming and hawing over whether he should come to your practice and he’s about to hang up. Your staff should be trained enough to collect his contact data so you can call him back later in the day when he’s not so hyped up. Maybe he’s tired of the search and really wants to take care of the hot tooth that’s been bothering him for the last week.When your team calls back to find out what the potential patient decided to do, that shows genuine concern and he might actually come to your practice. It shows even greater concern when you can fit him into your schedule at the next possible time he can come in.

And a lot of times, when the new patient actually comes in, meets the staff, shakes the doctor’s hand, realizes how close the practice is to his house or his office, but he finds out that the practice doesn’t take his insurance, a good chunk of those people actually stay. Yeah, I’m not kidding! If he likes you, your team and your office, he’s going to stay and might not even give it a second thought to pay for his treatment out of pocket. Remember, half of all Americans don’t have dental insurance anyway.

At the same time we started working with the Scheduling Institute, we turned our Web site over to Sesame Communications. Sesame built our practice an awesome Web site (check it out: www.todaysdental.com) and did wonders for our search engine optimization (SEO) on search engines like Google. I happen to be in the fifth largest city in America, and Sesame has gotten our practice to show up first, second or third in all local Google searches. It’s changed how people find us. Sesame also beefed up our Facebook page (check that out, too: www.facebook.com/TodaysDental). I invite you to “Like” our page so you can see all of our updates and special offers. In fact, while you’re on Facebook, stop by my page (www.facebook.com/DrHowardFarran) and “Like” that as well so you can glean some more wisdom from my 25 years of personal practice mistakes (and if you’re on Twitter, catch me at “@HowardFarran”)! It’s tools like a killer Web site, a strong social media presence and a highly trained front desk staff filling your schedule that can and will revolutionize the way you practice.

Always make sure you keep up on the new and greatest dentistry equipment, materials and techniques, but remember to reinvest in your front desk as well. When you do and you notice the benefits, you won’t ever think twice about it. – See more at: http://www.dentaltown.com/Dentaltown/Article.aspx?i=308&aid=4183#sthash.OfjtNl9A.dpuf

Filed Under: Dentaltown - Howard Speaks Tagged With: business development, dental, Dentaltown, Dentaltown Magazine, dentist, human relations, humor, inspirational, marketing, motivation, practice management

Response to Frontline: Addressing Symptoms, Not Problems

August 8, 2012 by howardfarran Leave a Comment

In 1997, Reader’s Digest published an article by journalist William Ecenbarger, titled, “How Dentists Rip Us Off.” In the story, Ecenbarger traveled to 50 different dental practices around the U.S. to assess “the consistency and fairness of American dentistry.” He found such a discrepancy between each practice’s treatment plans, it made dentists look like a bunch of clowns. Ecenbarger’s report sent shockwaves throughout our sacred and sovereign profession, appalling just about every dentist I’d ever known up to that point in my professional career. They called the story “shady journalism” and said Reader’s Digest was out to get dentists. My response was, “The author did a respectable job and showcased a weak spot in the art and science of dentistry. This is what he found. It is what it is. Deal with it! Let’s move on together and get better as a profession!”

On the night of June 26, 2012, I prepared for a little déjà vu as I watched Frontline’s Miles O’Brien report on corporate dentistry “filling the gaps in care” in a program called “Dollars and Dentists.” By now I’m sure many of you are familiar with this particular report – a few dental associations have published public responses criticizing it, many have blogged about it and I’d guess many of you watched it, too. Right now, there’s a nice message board thread about this program on Dentaltown.com (you can view the message board here: www.dentaltown.com/frontlineboard. I’ve watched Frontline’s report twice, and while I think some parts of it were fair, I do take issue with the following areas…

The Underserved
O’Brien’s view of our profession zeroes in on an overwhelming crisis in dentistry. There is a grotesque problem with access to care. Affordability of necessary dental care is also troubling; all patient subjects in the program are Medicaid recipients suffering from painful rotting teeth, and there are just too many to count. Frontline shows people waiting in lines for days – all of them in pain – hoping to obtain relief through the efforts of real dental saints like Dr. Terry Dickinson and his crew of volunteer dental professionals. These are the patients – when there isn’t a free clinic to go to and the pain gets to be too much for them – who go to the emergency room to get some relief for a couple days until the tooth starts throbbing again. This is very sad, indeed. It’s the reason why Dentaltown Magazine publishes its “Do Good” issue every May, to highlight the heroes of charitable dentistry and encourage every single one of you to do your part and volunteer what you can – donating time or money – so the underserved in America and abroad have more opportunities to get the treatment they need. When you watch the opening sequence in the Frontline program, you can’t help but feel bad for these people. It truly is desperate.

We meet one of the hopeful patients awaiting complimentary care, who volunteers his eating habits as he explains the right side of his mouth hurts so bad that he can’t eat ice cream or chips or hamburger. Right off the bat, I became concerned about the angle this report was going to take. You see, caries is a disease that is 100 percent preventable, which is not mentioned even once in the program! No wonder that poor young man’s mouth hurts – he’s eating garbage! Only once in the entire program is preventive care discussed, and only as support for why one of the charitable, Medicaid-based practices is successful. I find it unacceptable that Frontline only holds accountable the professionals who went to eight years of higher education, who studied and learned difficult clinical procedures in an academic pressure cooker, and who graduated more than $300,000 in debt because they chose to serve their fellow man. There is zero accountability of the patients who eat high-sugar, high-fat food, and who drink a Dr. Pepper when they wake up first thing in the morning. Frontline addressed the symptom, not the cause of the problem!

New York City Mayor Michael Bloomberg recently made headlines as he introduced legislation banning the sale of sugary drinks larger than 16oz. I completely agree with this move! If the people will not take responsibility for their actions – actions that lead to horrible tooth decay, obesity and diabetes – then the government is going to step in and fix the problem. To take it one step further, perhaps it is even time for a sugar tax. Maybe dentistry and diabetes should be paid for by a tax per pound of high fructose corn syrups.

On the other hand, perhaps I shouldn’t be too surprised about prevention not being the focus or even mentioned on Frontline, considering the American Dental Hygienists’ Association (ADHA) – the association in America that is supposed to be the one true champion of oral health prevention – took the opportunity to tout its controversial “mid-level dental provider” campaign instead of prevention in its public response to Frontline’s report. Speaking of mid-level providers…

Mid-level Providers and Dental Therapists
I don’t know why anyone would want to oppose a very well-trained professional, treating someone who otherwise would not get treatment.” – Christy Jo Fogarty, RDH, MSOHP, quote from “Dollars and Dentists.”

To be perfectly honest, I have to agree with Ms. Fogarty who was featured in the Frontline report. The reason why comes down to the very simple concept of price segmentation. China is the classic example of price segmentation. China has 1.3 billion people. You have two-year dental schools for the 49 percent of their country that is rural and poor, and they have four-, five- and six-year programs for the 51 percent of China that lives in the big urban areas and can afford a higher quality of care. There is not a one-size-fits-all model of dental care in China, and there shouldn’t be one in America.

One-size-fits-all is also the reason communism doesn’t work. Karl Marx thought everyone should have integrity, purpose and meaning to get up every day to earn an equal share, but it was flawed. You can’t have one guy work 80 hours a week and another guy show up to work every day two hours late and drunk on vodka and expect everyone to be happy to earn the same. There’s no incentive for the first guy to work as hard as he does, and there’s no incentive for the lazy drunk to actually pull his own weight if he knows someone else is going to pick up the slack. To have a one-size- fits-all, dentists-only model for 313,000,000 Americans is ridiculous. Just because something looks good on paper doesn’t mean it works.

There are areas in Alaska the size of Rhode Island that don’t have a single dentist. And when someone asks if we can send in some dental therapists because there’s nobody up there, dentists go ballistic. We dentists think our system is superior, and I agree! It is! But what we all need to finally comprehend is some form of dental care is far better than no form at all. I think Frontline is spot on here; mid-level providers do have a place in this system.

Profitability and Bonus Systems
The Frontline program was critical of management of the corporate dental practices that had insisted on the billing of $15,000 per day. Nowhere in Medicaid’s billing charts is a charge for a dentist to sit down with the patient’s parents and explain what’s going on in the mouth of their child. That cost has to be rolled into something. We all can’t be charitable doctors all the time. We’re sitting on a mountain of debt just to be able to provide patients with our services. We need to recoup our costs and we need to make a profit in order to keep our doors open. This goes for any dental practice. O’Brien’s report goes on to demonize bonus systems of these corporate dental entities. This is sad for health care because a bonus system is standard in sales for every single business in America. If you paid salesman on a car lot an hourly wage, they’d all be sitting in the back playing cards. But when you pay them a percentage of sales, they’ll stand out in 115-degree heat and pouring rain to entice you to buy a car. People always chase incentives, but whenever you introduce an incentive in health care, people question your motives. We all have bills to pay. I can see how the incentive can get out of hand, however, when dentists only see the bottom line instead of the patient sitting in front of them, that is wrong. You need a bustling practice, but you also need to keep your patients in mind. It’s also why, as a non-Medicaid-only practice, you need to present treatment plan options with the pros and cons of each option. It’s why you need to say, “OK, you can get a denture at this price today, but here are the limitations and problems you might face down the road. Or, you can finance implants, and this is what your quality of life will be in five, 10 and 20 years down the road.”

All in all, Frontline’s report didn’t open my eyes to any specific atrocity other than this country needs an oral health public awareness campaign, and it needs it yesterday! So, because your associations and leaders are busy not representing you and squabbling over things that don’t matter, what are you going to do to help improve the overall dental health of America? I’ve got an idea! How about you grow your dental practice so you can treat more people, because we are doing a terrible job explaining that the number-one disease in children – caries – is totally, without a doubt, preventable! There is also a lot of good, charitable work being done all over this country and abroad. I urge you all to get involved. Take a weekend each quarter at the very least and volunteer for people like Drs. Terry Dickinson and Jerome Smith. Get out of your comfort zone and change the life of someone who can’t afford it. If you want big change, you need to start changing small things. Get Started.

Read Townies’ discussion on the PBS Frontline “Dentists and Dollar” programs here.

Filed Under: Dentaltown - Howard Speaks Tagged With: business development, dental, Dentaltown, dentist, human relations, humor, inspirational, marketing, motivation, PBS, PBS Frontline, practice management

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