According to the American Dental Association,  two or more applications of fluoride varnish per year are effective in preventing caries in patients identified as high or moderate risk. Why is it then that so few practices are aggressively promoting adult fluoride treatments? There seems to be a major misconception by your patients–and unfortunately by many dentists–that fluoride is only beneficial when the teeth are developing, that there is no sustained benefit from fluoride, and that fluoride treatments are just for kids. I recently attended a fabulous three-hour seminar presented by 3M ESPE on CAMBRA. That is the acronym for caries management by risk assessment. Here is what I learned.

1. An actively promoted program is of great benefit to your patients, and it represents a really, really significant revenue stream to the practice through the dispensing of fluoride toothpaste and fluoride varnish treatments.

2. The hygiene department must be supported by the doctor and all staff regarding the importance of risk prevention. Every team member needs to be on board and committed to the program.

3. Patients need to be educated to understand that just treating cavities will NOT prevent future disease.

4. A well-designed, simple, one page caries risk assessment form is essential to success. It is metaphorically similar to a blood pressure cuff at a medical exam. Every time you see your physician, you have your blood pressure taken as part of an assessment of your overall health. So the risk assessment form for caries should be used for every patient visit in hygiene.

I have created a form for your use. You can download the form and personalize it with your practice name. I am also suggesting that you watch this brief video that 3M provides on the application of fluoride varnish. I am also including another brief video that discusses the dispensing of fluoride toothpaste in your office.

This seminar, attended by dentists and hygienists, was a wake-up call for me. As part of the program, we all had to do a self-assessment of our risk for caries. In my case, I am 72 years old, I have significant recession with exposed root surfaces, my mouth is heavily restored with fillings and crowns, and I wear a night guard which causes dry mouth. I am at high risk! I should be receiving fluoride varnish at least twice a year, and the risk assessment form graphically illustrates this fact!

The national average fee for fluoride varnish is about $35. More and more insurance companies are covering this procedure because they recognize the value of prevention. You should be aware that as of January 2013, ADA codes 1203 (child) and 1204 (adult) topical application of fluoride (not varnish) will be combined to code 1208. Code 1206 is now and will continue to be application of fluoride varnish for moderate or high risk patients.  Insurance or no insurance – if patients understand the value, they will buy – it’s that simple.

Establishing an aggressive evidence-based carries prevention program should not be that difficult. Please make it one of your resolutions for 2013.

In my role as a management consultant and advisor to the dental profession,  one of my core principles is that if at all possible, a doctor should own the dental practice location and not rent. Over the years, I have probably helped more than 75 doctors acquire a building or a condo space, and I cannot remember even one situation where the results were not beneficial. In this current low interest rate environment, owning makes even more sense. Commercial real estate prices are still depressed, construction per square foot is as low as I have ever seen, in most situations there is rarely more than a 10% down payment required, and fixed mortgage programs for 15 to 20 years are amazingly attractive.

The major reason to own is the opportunity to build equity. The monthly payment goes to you–not the landlord. At the end of 20 years, you own your condo or your building free and clear. When you rent, that money has bought you nothing. Even if there was no appreciation in value over the length of the mortgage–highly unlikely–you now own an asset that you can sell or rent. Investing in real estate that you occupy is a major advantage because renovation costs for a dental practice are expensive, and are special-purpose for that business only. If you own the building, then all that investment remains with you the owner rather than being forfeited at the end of a leasing relationship.

The clinical path that I observe for the large majority of dentists is an associateship leading to an eventual outright purchase of that practice or another dental practice. For financial considerations of debt, the dental office space is often not included in the purchase. Usually a lease is secured with an option to buy in the future if in fact the selling dentist is the owner of the facility. It is at this critical juncture – when the lease is expiring – that a decision must be made to buy – or to extend the lease – or perhaps to move.

I realize, that as with most things in life, timing is everything. If you decide to purchase your office space, it will be one of the major investment decisions of your career. In my experience, the biggest obstacle to continued growth of a dental practice is the lack of an adequate facility. So perhaps it is time for a serious gut check on your future. These current low interest rates won’t last forever. Money currently is so cheap that the cost of acquiring property is not much more than renting. If you currently rent–and you are getting close to renewal time under the terms of your lease–I encourage you to reassess your opportunities.

Every year during the month of November, I set aside time to meet with my clients to help them formulate a budget for the following calendar year. We actually create two budgets. The first is what I call a “break-even” budget. This assumes that revenue–in the worst-case scenario–will be equal to the previous year. Our challenge for budgeting purposes is to identify and control anticipated expenses so that the doctor in this scenario at least “breaks even” and draws the same W-2 wages as the previous year.

The second budget is the “growth” budget, euphemistically called the dream sheet. This is what we hope will happen if the sun and the moon and the stars are all in perfect alignment. But hope is not a strategy. For growth to actually happen, a great deal of hard work and teamwork must take place. Here are my four suggestions that are paramount for any growth plan to succeed.

1. Share the vision–In my experience, many dentists are poor communicators. Yet good communication with your staff is one of the most important ingredients for success. The doctor cannot exist in a vacuum, and your staff are not mind readers. So meet with your team and go over in exquisite detail what you expect to accomplish–and how they will be involved. I definitely believe that incentives get results, so show staff how your growth plan will be good for them.

2. Attracting new patients is an essential component to growth – Re-visit your internal marketing plan where you hopefully are now rewarding  your existing patient base for referrals – and see how that plan can be improved.

3. Maximize your online presence– it is definitely a brave new world out there! Word of “mouse” has become just as important as word of mouth. You need to take advantage of every opportunity to not only participate but to shine in the Internet arena.

4. Commit to improve customer service–I don’t care how good you are–you can get better. Make a full-blown, no holds barred commitment to creating an unbelievable customer service experience.  This experience must be consistent and not schizophrenic. Friendliness and respect for your patient should become the DNA of your practice. This demands an unwavering commitment by the doctor and every staff member at every interaction and at every level. The goal is to make each patient feel so special that they feel compelled to share their experience with others.

I know this is possible. I hope you will give it a try.

Those of you who read my blog posts on Internet marketing and strategy know that I have been a huge fan of Google. Simply stated, Google is by far the most dominant and popular search engine. Since 90% of buying decisions these days are influenced by people searching on the Internet for products or services, I have taken the position that it is extremely important that your dental practice website position well on the local Google business Map.

One of the best ways to optimize the position of your site is by accumulating reviews from satisfied and happy patients. There is a direct correlation between the quality and volume of patient reviews and how you rank on the map. Not surprisingly, studies show that people choose from the top two or three sites.

It used to be relatively easy for someone to leave a review on Google. But about three months ago, Google Pages morphed into something called Google+Local. Google changed its rating system (stars to Zagat) and required anyone trying to write a review to join Google+Local. This required you to leave your full name and a bunch of information about your friends and your interests. The theory was that Google was trying to become the next Facebook. Google claimed it instituted these changes in order to try to prevent false or spam reviews detrimental to legitimate businesses.

Well whatever they did has been an unmitigated disaster because it is now almost impossible to post a review. The person writing the review from his/her computer sees the review published on his/her computer screen, but the review does not transfer to the Google Page of the business. I’m not certain if dentists are aware of this, but go ahead and try to write a review and you’ll see exactly what I am speaking about. Check your own Google+Local page and most likely you will not see a new review posted in over three months.

I took some flak recently when not because of this problem with Google –but because of the Apple Maps connection to Yelp on the new iPhone 5 – I started recommending that dentists spread their reviews around and to try to solicit reviews from their patients on Yelp. Well guess what–even though Yelp aggressively filters reviews–at least they get posted!

I am distressed and disappointed with what Google has done. They are without a doubt harming their own brand. How can a company so smart be acting in this manner? Google of course doesn’t even answer the phone–all complaints have to be done by e-mail, and they rarely if ever respond. I have enlisted the help of a number of tech savvy people, but to date nobody has been able to figure this out. I can say that over the past two weeks, a very small number of reviews are starting to get through. But it is very spotty. So when a patient wants to write a review for you, don’t waste the opportunity. Have them use Yelp until further notice.

The good news is that Google references reviews from all other rating sites. So your Yelp reviews will help your position on the Google Map. Go figure!!

A new client recently asked me a question about disability insurance. I referred her to a that I had written a few years ago. But her question prompted me to revisit the inner workings of disability insurance, so I would like to share with you my latest thoughts and recommendations.

1. Purchase a policy that is non-cancelable/ guaranteed renewable. This type of policy cannot be changed by the insurance company. Policies that are not guaranteed are typically group policies.

2. Only consider purchasing what is called “own occupation”. In the event that you are disabled and cannot work as a dentist, with this type of policy you can earn income from other sources yet still be able to collect your full disability benefits. This is a more expensive policy, but if you don’t buy this type of coverage, income earned from other sources will be deducted from your benefits.

3. With “own occupation” coverage, you are basically insuring your career–all the money, hard work, and years of education that it took for you to become a dentist. Why wouldn’t you want to insure that to the fullest extent possible? In fact, with “own occupation” coverage, if you become disabled,  you still retain the option of ownership of your dental practice

4.  You want your policy to pay residual or partial benefits if you are still able to perform some duties as a dentist, but not all duties.

5. Be sure that mental/nervous disorders are covered. Most policies don’t cover this for dentists.

6. Keep coverage relevant to your current income–not what you were earning 5, 10, or 15 years ago

7. You absolutely must have an office overhead expense policy in addition to your disability coverage. Disability coverage is designed to cover your fixed personal expenses–mortgage, college tuitions, student and/or business loans, etc.

8. Avoid shopping for price. When you buy disability insurance, you are buying a promise. If it is cheap coverage, it is probably a bad promise.

According to everything that I read, it is not only possible–but probable–that a dentist will become disabled before the age of 65. That being said, it is so important to have the proper coverage. I strongly advise having a disability insurance expert review the contract language in the policy. These contracts can either be written in your favor, or in favor of the insurance company. Your choice!

In the past six months, two of my clients have been sued by staff members whose employment was terminated. One doctor is being accused of age discrimination,  and the other doctor is charged with harassment. Fortunately for my clients, they each have an insurance product called Employment Practices Liability (EPLI).  This insurance plan covers the cost of defending yourself against the charges and the settlement costs of a claim if the judgment goes against you.

I believe, in both of these cases involving my clients, that the accusations were frivolous and unfounded. But we live in a very litigious society. And it is only getting worse! Gender discrimination, age discrimination, and retaliation claims are all on the rise. In America, anybody can sue anybody for whatever reason. And because we are one of the only countries that allows an attorney to take a case on contingency, there is no economic deterrent  to the plaintiff for bringing the suit. The fact that the loser usually does not have to pay the winner’s legal costs only contributes to more litigation.

No business owner would consider going without general liability and property insurance, yet employers are more likely to have an employment practices liability claim than a general liability or property claim. And the legal costs just to defend such a claim could easily be 25-30K.

EPLI  is not expensive. The  annual premium is probably under $1000 for 250K coverage, usually with a deductible of 5K. Employment practices liability insurance covers not only actual but also alleged acts of discrimination, harassment, retaliation, and wrongful termination. You should know that these are not situations that would be covered by your malpractice insurance.

The Hartford, Chubb, and United States Liability Insurance are three companies that I know provide this coverage for dentists. Some of these companies also provide online related resources such as training, forms, and model employment policies. So please check with your insurance agent today and inquire about how to purchase this valuable and necessary protection. The potential financial hit to an uninsured  doctor would be devastating.

When I call a business, I like hearing the telephone answered by a super friendly person who can help me. So much better than layered options that require you to navigate and select multiple buttons – and maybe you still get to a recorded message. What is even worse, and one of my pet peeves, is calling a dental practice during normal business hours and having to listen to the end of the day after office hours message. How stupid–and what an embarrassment–to hear “you have called the dental office of Dr. No Clue. Our hours are 8 AM to 5 PM Monday through Thursday, etc.” and it is 11 AM on a Tuesday morning! Why does this happen?

This dental practice has either an antiquated telephone system (hardware), or they buy their telephone service from a company like AT&T or Verizon that only allows one recorded message. When someone sitting at the front desk gets overwhelmed with answering calls and making appointments, the only relief is to grab a life raft and put the machine on. What a person calling the office in that situation should hear is a separately recorded message–an inter-day message–that says “Thanks for calling the office of Dr. Has A. Clue. We are in the office but busy assisting other patients. Your call is very important to us. Please leave your name and telephone number and we promise to call you back within 30 minutes.”  Giving a defined time period for the callback is much more user-friendly and customer service oriented than saying “we will get back to you as soon as possible.”

Not having the option of storing multiple messages is unacceptable.  The solution is to buy a new or updated telephone system that will allow multiple messages, or a better option is probably to sign up for a VoIP plan.

VoIP (voice-over internet protocol) phone service is phone service that runs over your existing high-speed internet connection instead of traditional land lines from the local provider.  This is a hosted (Cloud-based) phone system that requires a high-speed Internet connection (DSL, T1, Cable, or Fiber).   The office of course must be hardwired for internet – meaning that a data port (rj45jack) is available at each deskstation where there will be a phone. There is no PBX (phone system) equipment on-site, and all you need in terms of hardware is the phones themselves. So  you do not need a closet full of hardware at your dental office that you have to lease and pay a fee for maintenance.

I have been impressed with a company called Vocalocity. I have seen savings of up to 50% on an apples to apples comparison of services, number of phone lines, and cost of minutes used especially when compared to a local provider handling all local and long distance calls. You can have multiple messages, your choice of music on hold, and there is no contract!

A nice combination is to buy one line from your internet provider so you can get a reduced bundled rate, and use that line for fax and credit card. Use VoIP for everything else. An updated traditional phone system will cost in the vicinity of $3500 to $4000. Hard to justify when compared to just buying the phones ($100 each) and using VoIP.

Four to five years ago, I became very actively involved with my clients in helping them to develop and design websites. It was at that time that I began to recognize the power of the Internet and the magic of search engine optimization to direct potential patients to a dental practice. It was about two years later that I began recommending Demand Force to my clients as an alternative to telephone confirmation of scheduled appointments, because e-mail confirmation or texting to a cell phone seemed like such an innovative idea, and a great time saver for front desk staff.

I am writing today, however,  to report on a benefit that I never originally thought about or realized – and that is the amazing power of Demand Force patient reviews to improve Google rankings. I have referred over 40 clients to Demand Force, and without exception, every single one of them – after having Demand Force in operation for six months –  is in the top three positions on the local Google business map for their geographical area. This has happened in small towns and large cities.

I believe these exceptional results happen because of the special relationship that Demand Force has forged with Google. Google has always been synonymous with relevance, and what could be more relevant than patient reviews that come from actual customers. It is probably not coincidental that both companies are located in Silicon Valley. I also think that Demand Force does an impressive job of  syndicating these patient reviews to about 145 popular and visited sites on the Internet that are also referenced by Google.

Demand Force patient reviews can be continuously streamed to your website and to your Facebook page. Your webmaster can easily set this up for you.

In this “wild wild west” of the Internet–where your online reputation is always potentially fragile and at risk–it is something of a comfort that Demand Force gives business owners the ability to read and respond to all customer reviews from one dashboard before they are published.

There are many companies that can do automated confirmation emails and texting. They can also help with re-activation and do email blasts and customized newsletters. But none of them, in my opinion, can hold a candle to Demand Force when it comes to utilizing positive patient reviews to create high positioning on local search engines. Do yourself a favor and discover this fabulous resource.

After spending countless hours over the past six weeks speaking with dentists around the country, it is quite apparent to me that dental practices–based on their experiences–either love or hate Yelp. But since Yelp–as this Forbes article points out–is going to be the preferred provider for Apple Maps and the website to power Siri’s search results, you can no longer ignore it.

Yelp started in San Francisco in 2004 as a local search business. This is probably why dentists perceive it as a “West Coast thing”. But since going public in 2005, it has grown incrementally city by city and in the second Quarter of 2012 reported an average of 78 million monthly unique visitors, and 6.3 million of those visitors use a Yelp mobile app. Two of my three kids live in the Boston area and they tell me they search on Yelp all the time. The demographics of Yelp are hard to ignore. According to Quantcast, 64% of Yelp  users are relatively affluent, educated adults with an annual income of 100K or higher.

Dentists report frustration with Yelp because the review process is more difficult than with Google. With Google, the reviews that are posted stay visible and are rarely filtered. There also seems to be a direct positive SEO factor: the more quality reviews posted facilitates higher positioning on their map. With Yelp and their aggressive filtering mechanism, a lot of legitimate positive patient reviews are going to disappear because they are perceived as “one time” reviews. They are not in the spirit of the Yelp mentality which is to try to get reviewers to weigh in and review lots of local businesses. Yelp admits their system is not perfect, but they feel it has proven to be the most effective way to provide useful content for consumers–and to have those consumers continue to use Yelp in very very large numbers.

So unquestionably, because of the filter, you’re going to have to work harder in order to keep your reviews appearing on Yelp. Don’t get frustrated. Your practice must strive to provide exquisite customer service and quality dentistry each and every day. Anything less is unacceptable in today’s competitive market place. Yelpers seem to be more discerning, so if you and your practice are not first rate, you run the risk of a negative consumer review. My good friend Bill Rossi from Advanced Practice Management recently published a great article about what drives patients to write a negative review.  The article is called Unhappy Patients Point of View: Consumer Research.

I would encourage you to view the Yelp site for Dr. Robert Fields in Van Nuys, California. This practice seems to have figured out how Yelp works to its advantage. They consistently come up in first or second position. They do NOT advertise, but because they have what is called an Enhanced Profile (need to average 100 user visits per month), they can pay $75 per month to have Yelp put up a video that shows on their review page. At the bottom of their reviews, please note the number of filtered reviews that Yelp has taken off their page. You can see that most of those reviews are by one time reviewers. For the most part, the ones that stay on their page are done by patients who have written multiple Yelp reviews. But no worries–they continue to work hard to get more reviews and they keep replenishing their page.

It is so important–whether it is with Google or Yelp–to strive to get positive reviews from your patients. The volume and quality of reviews are a major ranking factor in search engine ranking criteria. A recent study showed that 34-46% of online traffic was drawn to the first listing on the page, and 12-29% was drawn to the second result. So being in first or second position is HUGE!

The web world is a tough one. Consumer reviews sites are here to stay. Managing them to your advantage is one of the biggest challenges facing your dental practice.