Dental Industry News

Use this section to keep up with news on topics impacting your profession. Subject areas include practice management, staffing, patient relations and much more. Besides culling these articles from leading news sources nationwide, we update them on a regular basis.

• Driving Medical-Dental Integration with Telehealth Technology
  

  Numerous studies show that having separate health-care systems treating the same patients results in poor health-care outcomes and high health-care costs. Colocation can be a good start, but some big problems still need to be addressed.

  By William Jackson, DDS

  Despite almost a decade of discussionabout medical-dental integration, the delivery of oral health care and systemic health care is still largely done in parallel. Numerous studies show that having separate health-care systems treating the same patients results in poor health-care outcomes and high health-care costs.

  Mountains of evidence and high visibility have done little to bridge the gap. Why? Because it is a complex problem.

  It was initially thought that the solution would be to colocate medical and dental facilities where primary care medical services could be provided during dental appointments, especially for patients with chronic diseases. It would be convenient for a nurse to draw blood for lab tests, review medications, and more while a patient is in the dental chair.

  Colocation can be a good start, but some big problems still need to be addressed.

  What should be addressed

  1. Integrated patient care requires much more than just being next door. Common ways and means of collaboration need to be established; i.e., who does what, when, and how.
  2. Who pays? Financing for integrated service delivery is almost nonexistent, and the third-party reimbursement systems for medical and dental could not be more disparate. Intuitively, the savings realized from the health-care financing system combined with the current spend on dental should suffice, but right now there is very little being done to solve the problem.
  3. Logistically, how will the approximately 100,000 stand-alone dental facilities in the US colocate with medical facilities? It is unreasonable to assume that colocation will move at anything other than a snail’s pace.
  4. Medical and dental records need to be integrated. Even with other barriers removed, the lack of focused collaborative software technology could hinder integrated treatment efforts. In fact, information technology limitations have been shown to be the reason for the exclusion of dental benefits from many accountable care organizations.

  Because of recent collaboration tools developed within telehealth technologies, the solutions to these problems may not be as insurmountable as they seem. Allow me to share an example that is hypothetical as of this writing, but active discussions with accountable care organizations (ACOs) are underway.

  ACOs want to offer limited but very important dental benefits. They recognize the patient health benefits and health-care cost savings of delivering preventive dental care to those with diabetes and periodontal disease. As part of its health-care benefit offering, these patients receive preventive dental services performed at ambulatory health-care clinics at no charge.

  Rather than build and staff a dental facility in the medical clinic, an ACO reaches an agreement with a local dentist to oversee a hygienist who will perform services in the medical facility. The hygienist uses a mobile cart and mobile equipment in any open room at the facility for the day.

  The hygienist screens all patients with diabetes and gathers appropriate diagnostic records (x-rays, images, charting) into the dental electronic health record (EHR), which is a component of the telehealth software. The dentist then reviews the records, typically within 24 hours (asynchronous). If the hygienist decides it’s necessary to do an immediate consultation with the dentist (perhaps to view a lesion via an intraoral camera), a secure videoconference (synchronous) can be done on the spot.

  If after reviewing the records the dentist determines that the patient needs treatment that must be performed in the dental office, an in-office appointment is scheduled. According to Solomon in “The future of dental practice: Demographics,” 77% of all procedures can be performed in the medical clinic without referral to the dental office (see figure 1).1

  Once it is determined that a patient is eligible for the benefit, the hygienist becomes the care coordinator by collaborating with a nurse, physician, etc., before each dental appointment. The result is an integrated delivery model that takes advantage of every single patient touch point. This makes care more convenient for the patient and for training doctors and nurses to work outside of their traditional areas to provide the best care.

  What is telehealth technology?

  Critical to the success of this model is the telehealth technology platform that facilitates easy collaboration and communication among all parties: patients, hygienists, physicians, nurses, and any other health-care workers.

  Telehealth technology is often thought to be simply secure videoconferencing. The platform required to support this model is significantly more sophisticated. Yes, it offers secure videoconferencing, but it takes telecommunications much further. It seamlessly enables 1) functionality for superior patient engagement, or more broadly, patient participation in their health care; 2) easy multidisciplinary collaboration, record sharing, and monitored continuity of care; 3) interchangeable EHRs that vary depending on the primary user’s specialty or subspecialty; and 4) a subset of the shared data into the appropriate applications; e.g., a dentist’s practice management application as shown in Figure 2.

  To summarize, colocation of medical and dental facilities is one approach to facilitate medical-dental integration, but it is not the only one. The value of colocation is that collaboration is seemingly easier, and certainly the ways and means of collaboration are key. Physical proximity is helpful in collaboration, but with it is not neccesary with new telehealth technologies.

  The hypothetical case presented occurs when a dental hygienist performs preventive services and collects diagnostic records in a medical facility. Working with a remote dentist, the hygienist can act as a care coordinator to bring together dentist, physician, and other health-care workers as needed by using sophisticated EHR-enabled telehealth technology.

  Reference

  1. Solomon ES. The future of dental practice: Demographics. Dental Economics. April 10, 2015. https://www.dentaleconomics.com/practice/article/16391631/the-future-of-dental-practice-demographics

  WILLIAM JACKSON, DDS, is the cofounder and COO of Virtual Dental Care Inc., a telehealth technology company founded in 2016. The company’s flagship software, Teledentix, helps clients such as Onsite Dental, Virtudent, and Arch Orthodontics increase patient participation and streamline communications. Online appointment booking, virtual visits, referrals, and networking capabilities are some of the tools offered by Teledentix. For more information about Teledentix or to contact Dr. Jackson, visit get.teledentix.com or email bjackson@virtualdentalcare.com.

  Source: Dentistry Today, January 27,  2021 (https://www.dentistrytoday.com/news/todays-dental-news/item/7714-don-t-lose-your-purpose-in-the-race-for-results)

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• Don’t Lose Your Purpose in the Race for Results
  

  By Bruce V. Freeman, DDS

  I think we’ve lost the plot.

  Yoga philosophy teaches us that we all have a role in life, a dharma. I was lucky enough to be trained as a yoga teacher and introduced to the philosophy of the practice by a wonderful and wise teacher and author, Hali Schwartz.

  In her book One Without a Second, Schwartz writes, “every being on earth has a dharma to fulfill that cannot be avoided; dharma cannot be put off, because dharma is, what is. When one accepts this, then life can truly be lived.” She goes on to explain that “competition in another’s dharma breeds fear and insecurity.”

  We may look at our colleagues and think they have it all figured out. Their life is so amazing. (Thanks again, Instagram.) The results they provide for their patients are beyond belief.

  Yes, it is great to admire others. But what exactly do we find so admirable? Is it the commitment and passion they bring to every aspect of their craft, or just the fruits of their labor? Is our role in life simply to produce results?

  Schwartz reminds us that we must act with patience and awareness and ensure we “choose only those actions which do no harm to yourself or others.” Do no harm. We in healthcare are taught this from our first day in our professional training, but it also applies to how we treat ourselves. Yet here we are tormenting ourselves with our focus on that perfect result, the image of which is engraved in our minds.

  The result is what matters, we are sternly taught. Yet Schwartz again summons the teachings of the great philosophers when she warns that “the ego-driven attachment to the result of action becomes the seed that plants your bondage.” That sounds ominous, now, doesn’t it?

  This does not mean we accept subpar work or throw up our hands and say “well, that’ll do.” That is not what this is about. The issue is that we become so laser-focused on the result that we miss what is necessary to get said result. Our perfectionist tendencies bubble to the surface. We lose sight of our purpose, and ourselves, along the way. Our work and mental wellness suffer as a result.

  Wisdom from the Ancients

  In the Bhagavad Gita, the first complete yoga scripture, Arjun, one of the intrepid heroes of the tale, is told, "The ignorant work for their own profit. The wise work for the welfare of the world, without thought for themselves. Perform all work carefully, guided by compassion." The great philosophers must have come from a trip to the dentist when they wrote this.

  When it comes to the results, Schwartz writes they "actually, truthfully, scientifically" do not belong to us. All we can do is our best work, mindfully, with compassion, care, and awareness, and "the result will be what it is, come what may."

  Here comes the really hard part to wrap our Type-A heads around. We have nothing to do with the results. Wait, what? While we, here in the present, can do our best, the results belong to the future. If we just focus on nothing but the results, well, we have lost the plot.

  How can we learn, grow, and be better when all of our energy is tied up in focusing on the endpoint rather than the steps that led us there? The mind-body disconnection is real as we get so lost in our own heads that we are no longer even aware of our actions. Have you ever driven to work to suddenly realize you have arrived with no recollection of how you got there?

  In his book Letting Go: The Pathway of Surrender, Dr. David R. Hawkins writes, “In all of us, the prideful feeling, ‘I have the answers,’ blocks our growth and development.” Our preoccupation with how others view us and our work creates a vulnerability to the opinions of others and leaves us susceptible, he writes, to one of the basic laws of consciousness: “Defensiveness invites attack.” Ouch.

  Self-esteem, he writes, can only arise when we “relinquish pride.” We do it to ourselves, don’t we? We show our work to colleagues by the tens of thousands when we eagerly post online, looking for validation and, yes, adulation, forgetting that harsh criticisms will flow just as quickly, each barb cutting just a little bit deeper into our psyche, eroding our confidence.

  Our pride insidiously insinuates itself into our work as we obsess about what “they” will say, causing levels of stress and anxiety to slowly build, like a rollercoaster lumbering toward its peak, leaving us screaming in fear on the other side, as we unstoppably speed toward frustration and self-doubt.

  It is, of course, important to evaluate what we do and to seek advice from experienced mentors so that we can do better. But first we must ask ourselves if we did our job with awareness, skill, empathy, and compassion. We can stare at that final photo or x-ray and obsess, lose sleep, question our abilities and career choice, and create more and more anxiety. Or we can take a step back and breathe, asking ourselves how it all happened.

  It is the journey to produce the result, and a positive experience for the patient, that warrants our attention. The final two-dimensional picture of our work does not reveal whether the living and breathing patient felt heard and supported and was treated with respect.

  The effort and study that went into ensuring that at every point, in that present moment, when the steps to yield the final masterpiece were undertaken, should be done so with the care and consideration that the patient deserved.

  We must always remember that there is a patient attached to the result of our efforts. If we want to serve them, and ourselves, we need to let go of our ego-driven focus on the result. We need to liberate ourselves from the bondage to the result and break the procedure down into its components.

  With awareness and objectivity, we can then reflect and assess to understand where we can improve, without allowing pride to paralyze us with anxiety and stress, thinking that, well, if the final result is not ideal, we are hopeless.

  Hawkins reminds us that self-awareness, a “healthy pride,” of our true value, intent, and purpose, our dharma, is characterized by a “lack of defensiveness” and a feeling of freedom that allows us to provide the best care possible.

  Dr. Freeman is the Director of Patient Experience for dentalcorp, helping dentists across Canada achieve clinical success that results in the best experience for their patients. He is an honors graduate of University of Toronto (U of T). He completed the Advanced Education in General Dentistry program at the Eastman Dental Center in Rochester and returned to U of T to complete his Diploma in Orthodontics and his Master’s of Science degree in the field of temporomandibular disorders and orofacial pain. He is also co-director of the Facial Pain Unit at Mount Sinai Hospital and lectures internationally on clinical orthodontics, facial pain, patient experience, and virtual surgical planning. Bruce is a certified yoga instructor with additional training in breathing techniques, meditation, and trauma informed movement. He directs the Wellness Program for Hospital Dental Residents at Mt. Sinai Hospital, emphasizing how self-care leads to the best patient care. He can be reached at bruce@drbvf.com.

  Source: Dentistry Today, January 27,  2021 (https://www.dentistrytoday.com/news/todays-dental-news/item/7714-don-t-lose-your-purpose-in-the-race-for-results)

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• How to Address Unprofitability in Your Dental Practice
  

  Times are tough. Profits are down for many dental practices. Dr. Thomas Cleary has found a solution for revenue loss, and it’s surprisingly easy to get going in your practice.

  By Thomas M. Cleary, Jr., DDS

  The American Dental Association recently reported that 40% of dental offices are not making a profit at this time. This is eight times the number of offices that weren’t profitable prior to COVID-19.

  If you’re among the 40% of dentists struggling to get by right now, it’s reassuring to know that you’re not alone. But just because you’re in good company does not mean you shouldn’t work to become profitable again. There are some simple things you can do now that will help you turn yourself around and increase long-term profitability.

  I have used an in-office membership program to help keep my office profitable, despite changes in the economy and patients’ insurance status, during the downturn that has affected many of my patients. I anticipate the membership program will continue to drive profitability—and remain an attractive option for patients—throughout the downturn and well into the future, even after the economy recovers.

  In their minds, many dentists group membership programs with discount plans and believe that starting a membership program means simply that they must discount their fees and provide the same treatment for less. But rather than offering patients steep discounts, a membership program allows you to create an attractive option for patients while still generating the revenue you need to provide quality care and make a profit.

  A dental coach I spoke with earlier this year summed it up well. As a dentist, your goal should be to find ways to make care more affordable for patients without having to offer steep discounts. A membership program does just that. On top of that, a membership program can do a lot to help you return your practice to profitability and make it more profitable than ever once we emerge from this downturn.

  If you’re like me, you’ve paid a lot of money to consultants who try to teach you ways to boost patient loyalty, fill out your schedule, decrease cancellations, increase case acceptance, and generate stable revenue. A membership program does all of these things. Better yet, it does these things organically. These benefits are baked into a well-run membership program. Just by offering the program you will boost patient loyalty, fill out your schedule, decrease cancellations, increase case acceptance, and diversify your revenue streams.

  A look at each of these benefits individually

  Boost patient loyalty. If you are a member of something, you are likely to be more loyal to it. Just think about your own behavior. I’m a member of Amazon Prime. Next-day shipping is included as part of my membership. If I need to buy something online, Amazon is my first stop. In fact, I’m often frustrated when I need to buy something elsewhere and I’m not able to use the membership benefits that come with Prime. This holds true for dental practices as well. As soon as patients sign up for a membership in your office, they are no longer just patients. They are members. They are less likely to leave the office and they are more likely to recommend you to their friends. Some practices even offer members small perks while they are in the office, such as a bottle of water or cup of tea, to make them feel extra special—and extra loyal.

  Better case acceptance. You know how your patients are now more loyal because they are members of your office? With that loyalty comes increased trust, and with that increased trust comes better case acceptance. Plus, a well-designed membership program can include a way for patients to save money for the treatment you recommend. In my office, many members contribute $30 a month to their “nest egg” savings account, which is part of their membership. Patients who have money available are far more likely to follow through on the treatment you recommend. So, in addition to boosting loyalty, a membership program is a way you can help patients pay for recommended treatment.

  Fewer cancellations. With a membership program, patients have paid for their preventive visits before they even walk in your door. People are far less likely to cancel or forget about something that they’ve already paid for. Fewer cancellations don’t just mean a full appointment book. This also means more opportunities to catch oral issues earlier. This is better for both patients and your revenue stream. Even if someone does cancel, they’re canceling on their dime, not yours. As part of the membership program, they are paying for regular, preventive care. So, if they’ve cancelled, they’re missing out on a benefit they’ve already paid you for.

  Fill out your schedule. This is a bit of a follow-up to the other benefits, but it’s just as important. If you have higher case acceptance and fewer cancellations, it follows that your schedule is fuller. It’s also important how you fill your schedule. Right now, you may be filling your schedule with patients who have PPOs that are reimbursing you at rates below your costs. So, each time you book an appointment, you lose money. With a membership program, you will be booking patients who pay you at a rate that you set. Each time you book an appointment, you make money.

  Stable (and recurring) revenue. This is the golden goose of business. Do you ever wonder why all of those tech companies are valued at billions of dollars when they haven’t made any money? It’s the promise of recurring revenue. To be clear, I’m not saying your practice is going to be valued at billions of dollars just because you start a membership program. But the recurring revenue can benefit you just like it benefits an investor in a big tech company. When patients sign up for your membership program, they are agreeing to pay you $35 (or whatever fee you set) every month. Sign up 100 patients, you’ll get a $3,500 recurring payment every month. With 500 patients, you’ll see $17,500 a month. This is guaranteed every month. It’s kind of like a mortgage payment in reverse. Not only is recurring revenue great because it’s guaranteed month after month, it’s also a great way to stabilize your office revenue. If you’re like me, you have months where you’re going gangbusters, and others where you’ve got nothing but time. Recurring revenue helps a lot here—you get just as much in the slow months as you do in the busy months.

  Even though it has all of these benefits, a membership program can be shockingly simple to set up. I use an automated, user-friendly platform that shifts the work from my busy staff to a software system. Since it is so easy to implement, it’s simple for a dentist to try out with a small group of patients.

  There may not be a magic bullet to deal with the current state of unprofitability in a lot of dental offices. But I’ve found that my membership program comes pretty close. Plus, it’s something that I can continue well past this current rough patch. I know that my membership program will be a big part of running my practice in a smooth and profitable way for years to come.

  Thomas M. Cleary, Jr., DDS, practices in Easthampton, Massachusetts. He is an active participant in organized dentistry. He is also a speaker with dental associations and host of the Toothonomics podcast. Dr. Cleary is continually improving his practice through increased efficiency and by implementing the best techniques and products. He has transformed his practice by successfully changing his relationship with the major dental insurers. Dr. Cleary is the cofounder of Cirrus Dental, which offers the Cirrus membership platform that allows dentists to address some of their biggest economic challenges with an innovative solution. Contact Dr. Cleary at drcleary@mycirrusdental.com.

  Source: DentistryiQ, December 4, 2020 (https://www.dentistryiq.com/practice-management/membership-plans/article/14188469/how-to-address-unprofitability-in-your-dental-practice)

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• The Dental Trifecta
  

  You continually need new patients. You need to have good case acceptance. You must often battle insurance companies. Here was Dr. Michael Tornow has learned about each of these as a private practice dentist.

  By Michael Tornow, DDS

  In 2001, I was a young dentist and captain in the United States Air Force. While I was enjoying my time in the service, I knew my tour of duty would end in 2004. So over the next few years I prepared to begin my private practice career. I learned as much as possible about what to expect in the future. Dental Economics was a trusted source.

  Like so many others, I did not fully understand the roles I would be taking on as a private practice owner: I would be a practitioner. I would be a team coach. I would be the CEO, CFO, CMO, bookkeeper, and HR director. It was not easy at first. At times it was even overwhelming. Eventually I brought on additional team members to perform the different roles in the practice and take duties off my plate.

  Over the years, three important truisms became apparent in my practice. They are still true today:

  • You continually need new patients.
  • You need to have good case acceptance.
  • You oftentimes must battle insurance companies and patients to receive reimbursement for services rendered.

  I would like to share what I have learned about each of these.

  New patients

  The acquisition of new patients has evolved over time. In my experience, a practice needs 20 to 35 new patients per doctor per month. This accounts for patient attrition.

  In 2004, the big push for new patients involved print ads. Dentists such as myself primarily used the yellow pages and local newspaper. The yellow pages involved having a large ad. Dentists would start off with a small ad, then move to a half-page ad, then to a full-page ad, and then a “double-truck” ad. There were also two yellow page companies. It seemed about half of the general public used one book and half the other. Newspaper advertising required a certain number of columns. The decision had to be made about running a black and white ad or color ad. Both forms of media advertisement were expensive.

  Marketing has evolved from print media to digital media. We have Facebook, Google Ads, and web design. These consume the majority of our dollars. There are patient reviews to request and then to contend with should they be negative. It’s not the same advertising game in 2020 as it was 16 years ago. I’m sure it will continue to evolve.

  Dental case acceptance

  Case acceptance is tricky. It is also an underappreciated key performance indicator. We all survive and complete dental school. We learn a new vernacular to help us communicate as professionals. We also make assumptions that patients understand certain dental concepts and verbiage. We erroneously think that all patients understand what a simple cavity is, or an abscess, or pocket depths, or dental implants, or IV sedation, or wisdom teeth removal, or crown preparation . . .

  My experience suggests that a good 90% of patients don’t completely understand what we as dental professionals are communicating. The word “doctor” should really mean “educator.” However, we often lack the time or skill to make education happen. If we recall our dental school experiences, it is probably safe to say that we did not take Patient Psychology 101 or Advanced Patient Education 350. These courses would have been nice.

  What I have learned over the years is that verbiage is important in educating and discussing dental topics with patients. Clear communication can also be learned.

  The concept of “a picture is worth a thousand words” is true. I have taken this concept one step further and say that “a model is worth a thousand words.” I use certain models that I have in a kit in each operatory to show and demonstrate dental procedures and concepts to my patients.

  In September 2015, there was a brilliant Dental Economics article by Jim Philhower, a 28-year veteran of Henry Schein and regular contributor to the magazine.1 In his article, he said that of thousands of dental offices studied, case acceptance rates were 25%–35% for new patients and 50%–60% for patients of record. Yet dentists erroneously thought their case acceptance was much higher.

  Most dentists don’t give much thought to case acceptance. Perhaps they are so busy that it is not an important key performance indicator to them or they inadvertently ignore it.

  During my years in practice, I have become a student of case acceptance and tracked my data. I don’t believe it is ever possible to achieve 100% case acceptance. The biggest obstacle is money. Patients may simply not have money or they lack access to credit to pay for services. My case acceptance has been 80% or greater over the last several years. I have also been able to coach associates to achieve the same.

  Reimbursement for dental services

  It is important for a dental practice to track its reimbursement rates relative to production. You must look at adjusted production versus collections. Here are two illustrative examples.

  Example no. 1

  Let’s assume I’m charging $1,200 for a crown. However, I’m contracted with the insurance company to perform the service for $800. The crown is covered at 50%. The insurance company pays $400 and the patient pays her $400 portion. If you divide $800 by $1,200 you would assume that your collections are only 66.7%. In my office we track adjusted production. In this situation we really billed out $800. We received $800. This is 100% collections versus production.

  Example no. 2

  Let’s take a similar case. $800 is billed out for the crown. The patient pays $400. The insurance company disagrees with the need for the crown, so they deny payment of the claim. $400 divided by $800 is 50% collections versus production.

  In talking with CEO Daniel Ichelson of Dental Accounts at Ease, the dental office may or may not try to seek reimbursement of the rejected claim. The practice may simply be too busy. The insurance biller in the practice could be overwhelmed. Maybe he or she resubmits the claim several times. The claim is rejected a second or third time by the insurance company. The dental practice then decides that it is too time-consuming and not worth more attempts to seek reimbursement for the claim. This can really skew the collections versus production ratios data.

  Ms. Ichelson’s opinion is that a dental practice should be collecting 97% or more of its billable, adjusted production. Her company takes over the insurance billing in a dental practice. It has been financially helpful in my practice to employ her services.

  Summary

  I call the marketing for new patients, the emphasis on case acceptance, and the collection of adjusted production “the dental trifecta.” The mastery of these three aspects of dentistry will allow you to have greater success and fulfillment in this great profession. Remember new patients, case acceptance, and getting paid. Onward and upward!

  MICHAEL TORNOW, DDS, graduated from Oregon Health Sciences University in 2001. He is a practicing dentist and multipractice owner in Utah. He loves to coach dentists and their teams. He can be contacted at mstornow@gmail.com.

  Source: Dental Economics, December 1, 2020 (https://www.dentaleconomics.com/practice/systems/article/14188496/dentists-need-these-three-things-to-succeed)

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• Getting Out of a Shady Vendor Contract
  

  Have you ever gotten caught in a less-than-honest vendor relationship? Dr. Chris Salierno found himself in that situation twice, and he fought back. Here’s what he did and why it worked.

  By Michael Tornow, DDS

  I love working with the various vendors who help support my practice. I consider many groups, such as laboratories and material distributors, to be strategic partners. These relationships are more cooperative than transactional. I enjoy seeing my local sales representative when he or she pays a visit and learning about new opportunities to evolve my practice.

  However, there are some vendors who are definitely in the transactions business. There is a smaller subset of those who, unfortunately, are not very pleasant to deal with and who may engage in unsavory and manipulative sales tactics.

  I found myself in one such relationship several years ago with a major name in the medical waste business. I had noticed my bills fluctuating without explanation and I was not able to set my preferred frequency of waste pickups. When their customer management department was unable to offer the service I was looking for, I requested termination of our business relationship. I was transferred to the business’s cancellation department and was informed about my “liquidation fees” for early termination of a contract. What was odd was that I didn’t recall ever signing a contract. A few days later, the company sent a copy of an email that had been sent by an employee and stated that this qualified as a digital signature and a contractual relationship.

  Have you had a similar experience with a vendor? This kind of bullying makes me furious. Fortunately, there is hope for exiting these abusive relationships without having to pay the termination fees.

  First, develop a firm understanding about how the company is claiming you entered into a contract. Depending on your state laws, the vendor’s tactics may not be legal. If they can produce a document with your actual signature, then you won’t have much ground to stand on. On the other hand, if they simply exchanged emails with an employee who does not have the authority to enter your business into a contract, then you may have some hope. Also, these emails may not make clear that a contract was being created, which further supports your argument.

  Next, with your facts in hand, I recommend writing a letter explaining that you refuse to pay termination fees because you did not willingly or knowingly enter into a contract. State that, in your opinion, no such contract exists. Include a check in the amount of the most recent bill (but not including any termination fees) and write the words “Full and Final Payment” in the memo line. Your letter should also explain that if the check is cashed, the vendor agrees to this settlement and that no further action will be taken by either party. Make a copy of the letter and the check for your records.

  Unfortunately, I have had to take this course of action twice with vendors. In both cases, I received urgent calls from them after they deposited the check and eventually read the letter. They said I was still under contract. I stated I was not and reminded them that since they deposited the check, the matter was now closed.

  They may protest. They may threaten to send you to their collection agency. Let them. You have copies of the letter and the check that was deposited. One of the vendors I dealt with actually did send my business to their collection agency, but when I produced a copy of the letter and check, they immediately ceased pursuing the case.

  In dentistry, we get to work with some wonderful businesses, both large and small. I treasure these relationships. But if you ever find that you’ve been the victim of an improper tactic like the ones I described, consider fighting back.

  Chris Salierno, DDS, is the chief editor of Dental Economics and the editorial director of the Principles of Practice Management and Group Practice and DSO Digest e-newsletters. He is also a contributing author for DentistryIQ and Perio-Implant Advisory. He lectures and writes about practice management and clinical dentistry. Additional content is available on his blog for dentists at thecuriousdentist.com. Dr. Salierno maintains a private general practice in Melville, New York. You may contact him by e-mail at csalierno@endeavorb2b.com.

  Source: Dental iQ, November 23, 2020 (https://www.dentistryiq.com/practice-management/practice-management-tips/article/14187896/getting-out-of-a-shady-vendor-contract)

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• Learning from the Best: Takeaways from dental practices performing in the top 10%
  

  Levin Group studied the top 10% of all dental practices, based on production. Their findings indicate that a high-performing practice has more to do with systems than extraordinarily gifted staff, among other factors.

  By Roger P. Levin, DDS

  This three-part article series will focus on Levin Group’s 30-year ongoing study of the top 10% performing dental practices in production. We felt it was important to understand what makes top practices successful and distill this information into practice management categories that would allow other practices to improve performance. By analyzing the systems, methodologies, and behaviors of top 10% performing practices, we were able to identify commonalities and determine which strategic approaches would help increase production for almost any practice across the board.

  As I have often joked in seminars, 90% of practices will not be in the top 10%. So, teaching practices how to be in the top 10% was never the goal of this study. Our goal was to compare practice management systems, philosophies, and principles against those of the top 10%. In doing so, we were able to identify what the majority of top 10% practices have in common, and then break them down into the practice management operations, systems, training, and other factors that contribute to these practices performing so well.

  What the top 10% are not

  The first and single most important objective of our study was to determine whether or not there was something special about the doctors, location, local economy, insurance profiles, patient base, or other factors that would allow the top 10% practices to reach that level in a way that was not reproducible for other practices. Although many of the doctors studied over the years reported that they felt “fortunate,” “lucky,” or “blessed” to be in the position that they were in, we found that luck had very little to do with their success.

  First and foremost, top 10% doctors aren’t superstars. If we had found early on that only dentists with special talents could move their practices into the top 10%, we would have ended the study. Remember, our goal was to determine what traits and characteristics of top 10% practices could be implemented by other practices to improve their own performance and practice production. Like every finding in the study, there were exceptions. Of course, there were dentists who were driven, charismatic, and had an amazing energy that some might say allowed them to do things that most dentists would not be able to do. Still, they represented the minority.

  What we did find about most of the dentists in the top 10% was that they had a strong desire for practice improvement, a sense of persistence, and a willingness to take the necessary steps to improve. Very few of them had the specific goal of having a top 10% practice. Instead, they just continued to work on their practices, making improvements and designing the practice to reach the desired level of performance; they weren’t focused on being better than any other practice.

  Finding: Top 10% doctors aren’t much different than most other doctors. They don’t tend to have superstar characteristics as much as focus, determination, and a vision.

  You don’t get there quickly

  Once we understood that almost any dentist could take steps to improve their practice on a consistent basis, we began working to understand what contributed to these practices being in the top 10%. Interestingly, the great majority of them did not get there overnight. In fact, the average time frame for a new practice to reach the top 10% was seven years. Some got there sooner, and for many it took longer. There were also numerous scenarios where a practice had been performing at a certain level for 10 or even 15 years, and then the dentists decided to take the practice to the next level. And while there were some practices that quickly rose toward success, for the most part these practices grew steadily, year after year, at reasonable rates of increased production. By simply growing 10% each year, a practice will double in production every seven years. A number of these practices went through the process of doubling production several times before entering the top 10%.

  It was also notable that some of these practices had years where their production dropped. This was especially evident in the Great Recession of 2008–2009 when many of the practices that are now in the top 10% actually dropped by 10% to 15%. These practices took the necessary steps to build back, and as the economy improved, they were able to increase production and reach new levels.

  We did not find that there was a special “light bulb” moment where a dentist suddenly understood exactly what to do to enter the top 10% quickly. For most practices, a slow and steady progress allowed them to continue to grow and compound that growth overtime.

  Finding: Top 10% practices don’t get there overnight or as the result of a single event. Most make steady progress to improve practice performance and production, which allows them to gradually enter the top 10%. It’s interesting to note that our study indicates that many of the top 10% practices have no idea where they rank relative to other top practices.

  Excellent systems

  One commonality among top 10% practices was that they employ excellent business and clinical systems. Gradually we came to realize that top-performing practices were unlikely to grow to that level in chaos. Early on, these practices did not necessarily have excellent or well-designed systems. They were like other offices with moderate systems, staff training, and practice production. The difference was that they continued to work on implementing systems—sometimes on their own, more often with outside expertise—and that led to increases in practice production.

  System implementation and improvement allowed top 10% performing practices to open gaps through efficiency that allowed for growth. We refer to gaps as creating potential that can be accessed to improve practice performance and increase production, moving these practices to the next level and beyond. The excellent implementation of systems such as scheduling, collections, insurance management, and case presentation allows these practices to grow on a steady basis.

  Finding: Top 10% performing practices continue to improve systems on a regular basis, create excellent documentation so that the team can train and refer back to the methodology of the systems, and implement a strict set of measurements to determine if the systems are working.

  Stop managing and start measuring

  Another valuable finding was that top 10% dentists tended to be positive leaders. This resulted in team development where team members were responsible for their jobs, tasks, and results. However, this didn’t mean that the dentists were micromanagers. A dentist who is creating a high level of production does not have time to micromanage a team. We applied the phrase, “Stop managing and start measuring” to this group. They created the opportunity for every team member to know what they’re responsible for and assign a measurement to it. It is easy to measure the front desk staff on things like production, collections, insurance reimbursements, and number of active patients scheduled. When team members know their measurements, especially their top three, they can then be trained and left alone to do their jobs. As one top 10% performing doctor said, “I don’t really care how they do it as long as they get the right results.” While we do not fully endorse not caring how things are done, it did work for this top 10% producing doctor.

  Think of it this way: Rather than continuing to monitor how each staff member does his or her job, look to see if the results are achieved. If results are achieved, you can almost assume that systems were being followed, because without following the systems it would be difficult to produce the right result. If the result was not achieved, this will be determined in some type of regular review. When meeting with team members who did not achieve results, top practices did not perceive it is as a negative unless it was determined that the team member was underperforming by not approaching the task properly. Most of the time it was addressed as an opportunity for discussion and coaching to help guide the team member to better performance. Certainly, there were times that achieving the result was beyond the control of the team member, but in most cases the team member simply needed to follow the systems more closely or make modifications.

  Finding: Top 10% performing practices don’t micromanage. They set expectations based on achieving targeted measurements and results. If a team member falls short on a measurement, they view it as an opportunity for education and mentorship. Team members in top 10% performing practices perform at an extremely high level because of teaching and mentoring, not simply because they are gifted.

  Summary

  Levin Group launched a study of top 10% performing practices to understand some of their principles, habits, systems, and behaviors. This led to a collection of excellent business principles that can be used by any practice to improve performance and move them to the next level.

  Reaching the top 10% of performing practices is not about overnight success, superstar doctors, gifted teams, or micromanagement. It’s about implementing excellent systems for the gradual development of the practice, measuring results, and mentoring.

  In part two of lessons from the top 10%, we will look at other key principles and findings that any practice can use to improve performance.

  ROGER P. LEVIN, DDS, is the CEO and founder of the Levin Group, a practice management consulting firm that has worked with over 30,000 practices to increase production. An expert on dental practice management and marketing, he has written 67 books and over 4,000 articles and regularly presents seminars around the world. To contact Dr. Levin or to sign up to receive his Practice Production Tip of the Day, visit levingroup.com or email rlevin@levingroup.com.

  Source: Dental Economics, December 1, 2020 (https://www.dentaleconomics.com/practice/article/14188807/learning-from-the-best-takeaways-from-dental-practices-performing-in-the-top-10)

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