Jodena Consulting Blog

Hopefully you have been fortunate over the years to surround yourself with trusted advisors or mentors who have been influential in your growth and development–both personally and professionally. Often the advice they give comes in the form of words or phrases that stick in your head and resonate. One of my favorites is “the harder I work the luckier I seem to get.” I so totally believe that!

Consider the doctor who attracts 40 new patients a month. Did these patients just fall out of the sky? I don’t believe so. That doctor has spent money and time to develop a great website. He also employs an energetic and social media savvy staff member who has been given the opportunity to spend one hour a day maintaining an active Facebook Page, publishing posts and engaging and responding to followers. That is work–not luck!

Consider the doctor who started two large veneer cases this month. Does that happen by chance? I don’t think so. That doctor has spent countless hours on continuing education courses with the best of the best. That doctor spends the time and money to fly to Scottsdale a few times every year to improve clinical skills hanging out with the likes of Dr. Frank Spears. That takes effort and dedication and commitment and work.

Consider the doctor who actually loves going to work every day because she has made the effort to surround herself with a fabulous staff. She has built and maintained a great team of talented customer service oriented people. She has created a wonderful atmosphere where staff truly want to work, and patients love to visit and refer others.  Can this all happen because she is lucky? This is the result of a lot of hard work.

It is my opinion, after interacting with 600+ practices over the past 19 years, that probably 85% of dentists significantly under-achieve their true potential. They don’t do this intentionally. They may often feel successful on some fronts. But they simply are just not aware of the upside.

On a personal level and as a way of illustrating my point, I want to tell you that for years I have been consistently going to the gym and putting in the time. This past January, I decided to hire a trainer. I have lost 14 pounds and am in the best shape of my life. I now realize that what I thought was a workout at the gym was the equivalent to a walk in the park!

So the sooner you stop waiting to hit the lottery with your dental practice, the better off you will be. Lady luck is unlikely to pay you a visit. There is no substitute for setting goals and then working really hard – harder than you ever thought possible – in order to achieve them. Then – and only then – will you feel lucky.

In February 2012, I was excited to publish a blog post announcing a new look to my website. That post discussed a re-design or re-skin of my original website that had been created in 2008. You can read that post to learn the benefits of such a project. Ten months later–in December of 2012–I was still trying to stay ahead of the curve, and I asked TNT (my long time website developer) to reformat the site with a new technology called responsive design.

Responsive design was important then, and it is particularly important today, considering the continuing trend of expanding screens (Galaxy Note, Kindle Fire, iPhones, iPads, etc.). An issue that serves as an immediate turnoff for nearly half the population is a website’s failure to display correctly on a mobile device. As far as these visitors are concerned, if it doesn’t fit or load correctly on the screen of your phone or tablet, it may as well not even exist. A mobile responsive site, on the other hand, automatically adjusts to the size of the screen on which it is being viewed.

Time goes by quickly when you are having a good time! So just a few weeks ago, I had TNT to do another re-skin for me. Here’s what my site used to look like. Here is the newer version. And here they are side by side. I decided to go with a brighter and cleaner look–a bit more open space to make things look less cluttered and easier to navigate–more youthful colors, and a slightly larger and more modern font. I also made the page somewhat wider and increased the  space between the lines of content for ease in reading.

What you don’t see is the underlying code structure behind the site. The re-skin alters this code in order to improve the way that SEO spiders crawl the site and index it, promoting better search results. A re-skin is substantially more cost-effective than building a new site from scratch, thus it offers a relatively inexpensive and time efficient opportunity for your web developer to review and improve the functionality of the site’s backend.

Here is how I look at external marketing. When you use direct mail or radio spots or TV ads, or subliminal Facebook ads to attract new patients, you are essentially hoping to get your message noticed by someone who wasn’t really thinking about going to the dentist. You have to bombard this potential audience over and over – spending LOTS of money – hoping someone will eventually respond. On the other hand, when someone goes to Google and does a search for a dentist or a dental procedure, they have taken the initiative and are truly motivated to find what they are searching for. Totally different!!

The Internet is HOT.  Studies show that people read and believe Google reviews. If people are searching for neurosurgeons on the web, they certainly are searching for dentists. Conclusion – it is absolutely imperative that your website be easily found on a search from any device.

A few weeks ago, my wife and I went on a “bucket list” trip to Berlin and Normandy. We traveled to Berlin to view the transformation of the city from the horrific times of Hitler and Natzi Germany to the welcoming and passionately transparent atmosphere that exists today. Beautifully designed memorials to the Holocaust, built in the most prominent areas of the city, insure that the sins of the past will never be forgotten. We traveled to Normandy to see the D-Day beaches and the American cemetery. When you actually view the 80 foot cliffs above the beaches that were heavily fortified by the entrenched German soldiers,  it is hard to believe how these brave Americans – part of the “greatest generation” as described by Tom Brokaw – were able to advance.

What we didn’t know about were the hedgerows. A hedgerow is a fence or barrier formed by a row of closely planted shrubs or bushes. In Normandy, these hedgerows separated one small farm from another. Many of these shrubs were very think and dense and often 20 to 30 feet in height. The American war machine was ill-suited to this maze of tiny enclosed fields and sunken lanes. The Germans turned the hedgerow complexes into deathtraps by covering every road and trail with machine gun, mortar, and anti-tank artillery fire. Eventually the allied forces prevailed, but the hedgerows were a major impediment to the eventual success of the invasion.

For some reason, as I was viewing all of this, it occurred to me that,metaphorically speaking, we as dentists create our own hedgerows, our own obstacles,  that prevent or certainly interfere with our ability to grow and prosper. Five examples immediately come to mind.

1. Patient unfriendly hours of operation – 8:30 to 5 Monday through Thursday is what I see more often than not. You will exponentially increase your income by offering some early and some late options for appointments. The needs of the patients need to be balanced with your own personal life. It is not a one way street.

2. Limited payment options – people love and understand budgets. That is how they live their lives. The need is more necessary than ever to employ a dedicated, talented, and compassionate staff member who can sit down with a patient and navigate the intricacies of out-sourced financing while coordinating payments with sequenced treatment plans.

3. Failure to delegate – doctors are always complaining to me that they “don’t have enough time”. I realize that there are only so many hours in a day. In my experience, the most successful doctors are the ones who have figured out how to absolutely delegate EVERYTHING possible in order to have the time to pursue what only they can do. You may have to leave your comfort zone on this.

4. Consistently running behind schedule – a favorite topic of mine. You have to figure this out. There is no compromise position. It is not an acceptable level of customer service to keep patients waiting.

5. Weak or zero Internet presence – In this day and age, successful practices attract 30-35% of new patients from Google or Facebook. It must be a top priority to create or upgrade your website so that it positions prominently in your geographic area, is current, informative, and conveys the distinctive personality of the practice.

As you can see, none of these five suggestions requires changing or enhancing your clinical expertise. There is no need in this case for expensive continuing education courses. These are basic principles that apply to any business. So cut down your hedgerows! Eliminate these easy- to -overcome obstacles that are unwittingly preventing your practice from  reaching the next level of productivity and profitability.

A significant part of my work week is spent assisting and advising dentists who are buying or selling a dental practice. I would like to share my current observations.

• By and large, it remains a seller’s market. There are definitely more dentists looking to purchase a practice than dentists wishing to sell a practice.
• Because of that supply/demand ratio, I see practice valuations continuing to increase.
• Financing for practice transitions has never been easier. 100% financing of documented practice valuation is the norm. Banks have realized that very few dental practices ever fail, and so they are lining up to compete aggressively for your business. And we all know that when banks compete–you win.
• The Federal Reserve has been your friend. Monetary policy that has kept interest rates at historically low levels has stimulated acquisition activity by making borrowing costs so cheap.
• Prior to this low interest rate environment, it was often difficult for a buyer to be able to afford and take on the debt of both the dental practice AND an office condo or stand-alone office building. Sellers would usually be required to offer a lease to the buyer, and become the landlord. Now, it is almost cheaper to buy than to rent, so buyers actually want to own the physical location and build their own equity.
• There is still a premium to a seller if he or she has stayed current with new technology. Upgraded practice management software and advanced computer networking also guarantee a practice valuation at the higher range of the spectrum.
• There are numerous interesting and innovative ways to enable a win/win transition.

My message to buyers is that you should be prepared to pay a little more than you thought in order to buy a quality practice. That increased cost is easily offset by the availability of ten to fifteen year amortization schedules with low fixed rate financing that still allows a great return on your investment. My message to sellers is to get your house in order if you want to receive top dollar for your practice.

As always, I welcome your comments and thoughts.

In a post written on July 8, 2014, I referenced two companies that could assist your dental practice with the daunting and time consuming process of becoming HIPAA compliant. Today, I would like to add another recommendation for your consideration.

MedSafe has been providing compliance solutions for health professionals for over twenty years. What I find attractive about their model is that they offer their services on site. A MedSafe compliance consultant will come to your office and work face to face with your team. That could allow you to have your security risk analysis done with your IT person right there with you. They would also offer on site representation if and when you were ever audited by regulatory agencies or private payers.

As a MedSafe client you have easy on-line access to their website where you can download various essential forms such as business associate agreements, vendor confidentiality agreements, staff confidentiality agreements, and breach notification letters. These documents are automatically updated as regulations and policies change. MedSafe also serves a dual function of providing OSHA training and annual updates and certification. This service, of course, is totally separate from the HIPAA compliance program, but it is nice to have that opportunity for one stop shopping.

To find out more information about MedSafe and their pricing, you can contact Julie Sementa at 781-237-9700  Ext 124.

The overriding message I am trying to convey to all of my readers is to take this mandate to become HIPAA compliant seriously. So please make the calls – get the information – and then make the decision to commit to a program that will keep your practice safe and let you sleep nights!

My last two posts explained and justified my recommendation for considering the introduction into your practice of a formal structured plan that will benefit patients who do not have dental insurance. If you agree with my analysis and decide to implement such a plan, here are my suggestions for getting the word out.

• You need to tell EVERY patient every day that your office is now offering this new exciting opportunity–and that includes patients who have dental insurance. Patients with dental insurance have friends, acquaintances, and relatives who do not have insurance. These patients with insurance will spread the word. They become your emissaries and ambassadors. The message and information you are delivering to your patient base has to be concise and clear and obviously all staff members need to be trained on the specifics. There has to be a definite plan as to which staff member delivers the information and when. This has to be carefully orchestrated.

• I recommend a very large sign to be hung on a prominent wall in the reception area. This sign should be professionally designed by a graphic artist. It is an announcement of the plan, but no details. ” No dental insurance–no problem. Ask us about our very own in-house membership plan.”

• I suggest reserving a prominent space on the Home Page of your website to announce the plan. Again–no specific details. “Call us to learn how you can take advantage of our members-only dental plan.” Tracking the calls should be easy because prospective patients are clearly interested  and calling because of their curiosity about your plan.

• Create an e-mail blast to your patient base announcing the new plan. Again–no real details should be provided. You are hoping that your patients will call the practice for information. Most every practice these days uses some kind of program like Patient Activator, Demand Force, Lighthouse, or Smile Reminder that allows you to easily e-mail your patient base. You should also in time consider sending out an electronic newsletter with a greater description and many more details of your in- house dental benefits plan.

• I am more and more impressed with the power of Facebook. But before I would recommend a post on Facebook announcing your plan, I would hope to see you accumulate a minimum of 500 Likes. Ask every patient over the next six months to Like your page from their phone while they are in your office. This is so easy. Once you have reached this “critical mass”, then you should put a few posts on Facebook talking about the benefits of your members only plan.

I have always been a strong advocate for internal marketing= marketing to your existing patient base. There is very little expense to any of these five strategies. The key is to be consistent with the internal promotion and the clarity of the message. As always, I welcome your comments, ideas, and feedback.

In my last blog post, I offered my observations on the disparity between insurance patients and fee-for-service patients regarding their commitment to undertaking comprehensive restorative treatment. I concluded that offering an in-house dental membership plan for your patients without dental insurance would stimulate existing fee-for-service patients to initiate treatment while also attracting new fee for service patients to your practice. Here are the basic parameters of such a plan.

• Patients pay in advance–in full–for a one year membership that includes two prophys, two exams, and a set of BW X-rays. The total cost of those basic services is discounted by about 20% from your published fees. So for example if the normal fee for those services would be $325, these same services are offered at $260.

• While enrolled in the plan, the patient can purchase any dental service that you provide for a discount from your published fees–usually in the range of 15-20%.

The calculation is that even though you are receiving less money from your fee for service patients for these procedures, they will be agreeing to do more of the procedures. In other words, isn’t it better for you to do ten crowns at a fee of $1050/crown rather than two crowns at $1300/crown?  Adopting such a plan does not need to alter your current business relationship with the dental insurance companies you work with. There is nothing “illegal” about offering your own membership plan. However, there are many extremely important details that need to be addressed during set-up to keep it from appearing like insurance and/or a dental discount plan which are regulated by state governments. And as long as the fee that you charge is more than the fee that you receive from Delta Dental, Delta should have no issue with you.

I realize that while it would be possible to do this “on your own”, I am strongly recommending a company called Quality Dental Plan to help you be successful right from the start. Quality Dental Plan was started by Dr. Dan Marut in 2009. The company currently works with over 400 dental practices nationwide. QDP Is more than just an in-house dental plan or dental membership. It’s a complete system for getting patients into your office, accepting treatment, and referring many others. Essentially what QDP does is give you a systematic approach to creating, implementing, and maintaining an in-office patient benefits system. QDP gives you an easy-to-follow recipe and from there, unlimited support along the way from the QDP administrative team.

QDP has been developed and refined since its inception by conducting market research, hiring PR experts, copywriters and designers as well as soliciting feedback from patients, dentists and staff. The best part is that you remain in complete control of all fees and services. There is no third party involved. Once people pay your office for their QDP membership, they will want to use the benefits they paid for, so treatment plan acceptance goes up.

I feel comfortable suggesting that you call Dan and his team at 888-960-1221 or email them at info@QualityDentalPlan.com and get the details yourself. Their fees are extremely modest. The training they offer on how to sell the plan, how to track it with your management software, how to handle renewals, what to say and what not to say, makes the price worth it. Why reinvent the wheel when the wheel already exists?

Next time–in my concluding blog on this topic–I will offer my own ideas on how to successfully market a membership plan.

A few months ago, I started polling my clients about the number of patients in their practice who had dental insurance. Typically that answer was 75-80%. A recent article estimates that only 62% of Americans have some kind of dental insurance benefit. Based on that information, why is it that more patients in your practice are not fee for service?  Very simply–the perception on Main Street  is that you can’t afford to go to the dentist unless you have dental insurance.

I further requested clients to total the number of “big ticket” items (crowns, root canals, implants, etc.) performed in their practice for the last 18 months. I then asked to know how many of those procedures were performed on patients with insurance–and how did that number compare to the overall percentage of patients in the practice who have dental insurance.

Without exception–in every practice–the number of big ticket items done on insurance patients was way out of proportion. In other words, if a typical ratio would be that 75% of the patients had insurance, almost 90% of these major procedures were done on insurance patients. So although dentists are always bemoaning the “write-offs” between their published fee and the fee they receive as an in-network provider, the results clearly show that it is a lot easier to “sell” a Delta crown than a fee-for-service crown.

I have come to the following conclusions:

1. You would do more big-ticket items and more comprehensive restorative treatment for your current fee-for-service patients if they perceived that they had a better deal–a little help with the cost.

2. You would – with a consistent marketing effort – attract more fee-for-service patients from the general population if they knew that your practice had a better plan for them.

3. You should seriously consider an in-house dental membership plan.

In my next post, I will discuss the logistics of how to introduce such a plan into your practice.

My most recent blog post referenced privacy and security actions that are necessary for a dental practice to implement in order to be compliant with the 2013 Omnibus Final Rule. That rule is scalable and flexible based on the size of the business. But knowing exactly what is necessary for your dental practice has created tremendous angst,  uncertainty and confusion in the profession.

I feel that the biggest liability for a dental practice is cyber theft. If someone breaks into your office and steals a laptop or a cell phone, under the Omnibus Rule, this will trigger a series of events. If over 500 names are in the computer, you are required by law to notify the local media and have your practice listed on the Health and Human Services website. You also have to notify every patient in your practice in writing about the possible loss of Social Security numbers and credit card numbers and other protected health information. This undoubtedly leads to many unhappy and angry patients and damage to your reputation. The economic fallout to your practice is potentially catastrophic. That is the bad news.

The good news is that if your data is encrypted, and that same breaking and entry and theft occurred, you are now exempt from the Breach Notification Rules. So to protect yourself, you must have sophisticated and coordinated systems in place including but not limited to the following.

• Encrypted practice management software.

•Encrypted email. Even if your computer is secure, your e-mail message passes through dozens of unknown servers en route to its destination.

• Staff training on the proper methods of data disposal and data protection.

• Understanding special rules for fax machines.

• Secure credit card systems. Credit card terminals must be PCIDSS (payment card industry data security standard). In order to meet those standards, you must have both a software and hardware firewall that needs to be configured properly to prevent data from being compromised.

• Business associate agreements. You need agreements in place with any vendors with whom you do business that have access to your protected health information. This is  essentially an agreement with any third-party service provider that will indemnify you – the covered entity – from liability based on their negligence. That agreement might also require the third party to have a certain level of cyber liability insurance.

• IT support. You will need significant support from your information technology team to assist in all of these technical requirements for compliance.

For most of us, trying to do all of the above is just  not possible. I would like to recommend two companies that have the expertise and the experience and the programs in place to guide you on a journey to becoming HIPAA compliant.  Both of these companies work remotely and have costs that are quite reasonable. Eric Simmons is a HIPAA Security Analyst at SecurityMetrics located in Orem, Utah. His direct telephone number is 801-995-6366. Dr. Lorne Lavine is the founder of The Digital Dentist located in Burbank, California, and is a Certified HIPAA Security Professional. Lorne can be reached at 866-204-3398 X 200.

Please open the links that I have included for both companies and read the material. I suggest that you then call each of these companies and listen to their approach. Then  make the decision on how to proceed. You absolutely can’t afford to drag your heels and put your head in the sand on an issue of such great importance.