Jodena Consulting Blog

HIPAA is a federal mandate first introduced in 1996 that requires a health care organization to keep patient data secure. As a dental office that stores, processes, transmits and receives, and maintains protected health information, you must be compliant with the mandate. Over the past 17 years, there have been many iterations and modifications to the original mandate. The culmination of these changes is called The 2013 HIPPA Omnibus Final Rule and was enacted in January 2013. This rule enhances a patient’s privacy protections, provides individuals new rights to their health information, strengthens the government’s ability to enforce the law, and increases penalties for security violations. The deadline to comply was September 2013.

Compliance requires a number of privacy and security actions including, but not limited to, completing what is called a risk analysis, creating a risk management plan, continuous employee training, and the implementation of updated policies and procedures. It is all pretty daunting for the typical small business. You can get dizzy and overwhelmed just trying to follow all the rules and understand what is required -never mind implementing solutions and systems.

What has prompted me to write about this topic is that I am finding in my conversations and meetings with clients that not one single office has taken ALL of the major required steps to be in compliance. The Department of Health and Human  Services (HHS) Office for Civil Rights (OCR) is the federal agency responsible for enforcing HIPAA compliance. These people take their job very seriously. If you are found in violation of HIPAA, you could be assessed large fees. I am reading about fines of $25,000 to $50,000 per day!! That can put you out of business! And if your lack of compliance leads to a security breach, the fines will be even larger.

The bottom line here is that you can’t afford to be complacent about the potential economic disaster that would result from an audit or a breach. Under the Final Rule, the general presumption is that any improper use or disclosure of protected health information (PHI) is a breach UNLESS the covered entity (your dental practice) can show that there is a low probability that the PHI has been compromised. In other words, your are essentially guilty until proven innocent.

The word is that the OCR is performing 1200 random audits a year. Computers can get stolen from your office. Back up discs or tapes somehow disappear or get lost. A disgruntled employee or patient can become a whistle blower.  Your financial exposure as a dentist could be enormous.

In my next post, based on my research, I will offer advice on where you can find reliable and professional help at a modest cost.

We have all experienced this. “Doctor – could I speak with you for a few minutes at the end of the day?” A valuable and talented team member wants to tell you something in private. Nothing good can happen from this! And sure enough, you find out that because a husband got a promotion, or a new grandchild is being born to a single mom four states away, or an elderly parent needs a caregiver, this great employee – one of the cornerstones of your dental practice – is leaving town.

As I have written many times before, in my experience, the most difficult challenge in dentistry – or any business for that matter – is to keep intact a quality, loyal, caring, and customer service oriented team. All these moving parts running seamlessly and effectively is the engine that powers a successful organization. So even though this soon to be departing staff member has graciously agreed to stay on for three weeks before leaving, it is very possible that her replacement will not have been identified and hired. Thus all of her knowledge and experience and special systems will not be able to be transferred.

Over the years, I have found that an effective solution to this situation is to create a video training manual for every position in the practice. I think it is most beneficial for the front desk. Doctors are able to train dental assistants and hygienists fairly easily because they work closely together in the back/clinical side of the office. But doctors are often quite uninformed about the intricacies of what is supposed to happen on the administrative end.

So let’s make a video in front of the computer showing how to begin the day, how to close the day, how to interact with a Patient Activator or Demand Force dashboard, how to post payments from a big insurance check, how to calculate insurance write offs, how to make adjustments, how to back up data, how to make financial arrangements on treatment plans, how to follow up on overdue insurance payments, how to print out daily/weekly/ monthly reports, etc, etc. The list is extensive to say the least. When that next front desk person is hired, I think that you can see how much easier it will be to get her up to speed on how all of  these various functions are performed in your office. No guess work – just watch to learn exactly how to perform each and every task. The same principles can be utilized for clinical jobs as well.

I also strongly suggest that when you have to contract and absorb the expense for a full day of training for new updates and improvements for your Eaglesoft or Dentrix or Practiceworks management software, that you videotape the entire presentation.

This process of video taping should not be misconstrued as a threat to anyone’s job. We hope that our great staff members will stay on forever. But life is complicated – we live in an increasing mobile society – so it is a wise and prudent business strategy to be prepared for the worst.

In this day and age of interconnectivity and on-line search, we all know and recognize the importance of your practice website. Whether for marketing or patient verification, your website has replaced the Yellow Pages to let the world know how to find you, who you are, and what you stand for.

Two recent problems reported to me by clients have prompted me to write this post. Without going into the gory details, each client, when trying to upgrade or re-skin an existing website – using a different website developer – found out that they did not have control of their domain name.

A fresh look to your website is an absolute must these days. New artwork and different graphics can make a big difference. I am currently in plans to do this to my own website even though I did a makeover only four years ago. The one thing that absolutely can’t change – for numerous SEO reasons – is your domain name. So here are some basics that you need to know.

1. Ownership. When you own your business’s domain, you possess a superior level of control over your web presence, your practice’s branding, and the portability of your website, should you ever experience the need to move it from one host to another.

2. Expiration and Renewal. The majority of domains must be renewed once every year. A domain name that is allowed to expire can rapidly be picked up by a third party – either for their personal use or for the sole purpose of reselling it later – maybe even back to you at an exorbitant price! Develop a way of reminding yourself when your domain comes due for renewal or, better yet, consider renewing for an extended period of time rather than the typical span of 12 months. Domains that have been renewed consistently and for longer stretches of time tend to be favored by search engines like Google.

3. Trust – Entrusting an individual entity or company with the possession of your domain means knowing that the entity has your best interests in mind. Never hesitate to ask questions: Am I listed as the owner / registrant of the domain name? If important changes are required, how do I ensure that they are made? Can I be sure that everything will be set up properly and, if not, do I have the ability to have these issues rectified? A trusted partner will help you navigate the more complex aspects of domain name ownership and maintenance.

4. Contact Information. Often, a domain will be purchased and associated with a specific set of contact details, including an email address that is used for confirmations, expiration reminders, and notifications of impending changes. If your contact information with your registrar or host is out of date, you may miss vital correspondence pertaining to your domain and, therefore, your practice’s website. Perhaps you ordered the domain name from an old aol or hotmail account that you don’t use any more. All pertinent information regarding any domain name currently registered can be found using the helpful search tool at whois.sc. You can quickly view your domain’s expiration date and the name to which it is registered. Being an informed consumer, particularly when it comes to your domain, ensures a more successful web presence overall.

I have had a trusted relationship for nine years with TNT Dental. Full disclosure – I receive no compensation from this company. If you need help or advice about any of the issues I have discussed above, you won’t find nicer or smarter people.

How I wish I could be as eloquent as Seth Godin. Godin is a marketer, an extraordinary successful entrepreneur, the author of 17 best-selling books, a world class public speaker, and a committed  philanthropist. He writes a daily blog that is read by millions of people around the globe. I am a big fan, and normally start my day by reading his posts. I am continually amazed at how relevant his advice is and how sage his observations are regarding what is important to be successful in business.

The over-riding message that I hear and take away from Seth – and one which I totally embrace and share with my clients – is the need to think long term. How you must resist the temptation of taking short term profits at the expense of long term relationships.

As a dentist, if you agree with the statement that the lifetime value of a patient is significant – and if you agree that in our crowded and competitive marketplace that value is only increasing – then it behooves you and your team to think long term. Godin commented on this very topic in a wonderful post called “Thinking Lifetime – Don‘t Break the Chain” where he remarked that “a customer is never out of warranty even if his product is.”

Always ask yourself how you – if you were a patient in your dental practice – would feel by the solution offered to “fix” your problem. Whether it was a scheduling conflict, or a financial misunderstanding, or a dental insurance issue. Was it done quickly and expeditiously?  Was it fair?  Was it convenient? Was it generous? Would it have exceeded your expectations?

Empower your staff to offer solutions that are more than fair. Ritz Carlton has pioneered this philosophy and is considered the gold standard of exquisite customer service. The customer is always right. You never want to say “no”.  Be very careful about taking a “line in the sand” mentality. You never want to give a patient a reason to leave your practice.

And above all else, never abuse a patient’s trust. It takes time and effort to earn that trust. And as Seth says “while trust is expensive – trust is worth it.”

As I conclude this series on how to achieve success in the practice of dentistry, I have one more observation for you to consider. I consistently find that successful doctors have figured out a way to take a little bit more time away from their practice. That may seem counter intuitive – how can working less equal greater success? We all know that we are in what I like to call the “widget” business. You do one crown, you get paid for one crown. You do two crowns, you get paid for two crowns. You do no crowns, you don’t get paid anything.

But dentistry is not an easy profession. There is a lot of stress. We are working in a very small confined area. Our patients many times don’t really want to be there, and that can really get to you. So as a way to become rejuvenated  and combat burnout, I am suggesting to everybody that they try to take more time out of the practice. Studies show that time away from the practice will rekindle energy, and the business will actually become more productive because the doctor is in a better frame of mind. We also have to remember that we only go this way once–that our kids are only going to be young once, and that it is important to spend time with family.

So here is an amazing statistic: the worst two weeks in a dental practice for production and collection are the first two weeks of September. I see this year in and year out. More dentists want to jump off bridges in September than any other month of the year! I think it is a combination of the summer doldrums and kids getting back into the school year with their schedules not being set. So these two weeks of September routinely and consistently have the highest number of last-minute cancellations and no-shows. Don’t try and fight it. If it’s  at all possible, those two weeks might be a great time for you to take a vacation, and the practice will suffer the least.

Over the past three months, I have shared my thoughts in a series of nine posts – garnered from seventeen plus years of full time coaching – as to what I see as the commonalities of successful dental practices. Now it is time to sum things up, to  put everything in proper perspective, and to tie the loose ends together. At the risk of sounding pretentious, I would encourage you to print out the posts and read them again. See what you agree with, and what you may not agree with. See what you have already instituted in your practice, and what you haven’t. Take a look at what could be improved – or added – and then decide on a detailed plan of action.

Achieving success is not easy. If it were, we would all be there. You have to take it one day at a time. It is a marathon and not a sprint. Slow and steady wins most races. A recent Chinese fortune cookie message just might say it all: things turn out best for the people who make the best of the way things turn out.

I wish you all good luck in your pursuit of success.

After writing eight posts in this series on my observations over the years of why certain doctors achieve success in the practice of dentistry – none of which relate to clinical expertise – it is finally time to discuss something related to teeth and the oral cavity! In truth, there really is no substitute for great hands and great confidence and great diagnostic ability. Some of that is God given, and those people are very lucky. But I see so many doctors who really grow into  becoming excellent clinicians with some serious commitment to continuing education that can increase their productivity. All states, of course, have minimum requirements for continuing education. I am talking about going way beyond that.

• Spending time with world class clinicians and educators like Frank Spears and Ross Nash or David Hornbrook gives a doctor  confidence and the ability to visualize cases. I hear only good things about these guys, and I see wonderful results from my clients. A major additional benefit to the learning process in formalized lectures is the socialization and rubbing elbows with other doctor attendees who are as serious as you are about improving. Often the idea sharing among the participants at the conference is just as beneficial as what is presented on stage.

• Participating in study clubs. In just about every successful practice I have been involved with, the doctor is an active participant in a well organized study club. Again, you learn not only from the lectures but from the involvement with other doctors in the club who are serious about upgrading their skills and knowledge.

• Learning new procedures like short-term orthodontics with Six Month Smiles enables a doctor to create opportunities for much more restorative dentistry. In the past two years, I have had fifteen different clients attend the Six Month Smiles  course – and they are all happy. I actually attended the course two years ago just to see what this was all about, and I can honestly tell you it was the first time in all these years that I wished I was back doing clinical dentistry. It is really pretty amazing. The room was filled with frustrated Invisalign providers!

• Promoting aesthetics. I see a lot of good results from practices that continually talk about whiter teeth. I think people in general want to look better. I think they feel it will help their life both personally and professionally. But if a doctor wants to be successful promoting aesthetics to the patient base, he or she better be very sure that their own smile looks great as well as the smiles of their staff members.

So challenge yourself to be the best clinician you can be. It is a privilege to be a “doctor” and to be held in high esteem by your patients and your community. You have earned this by hard work and perseverance over many years – but the quest for excellence is never ending. So continue on this path, and success is almost guaranteed.

Successful doctors, as I’ve said in an earlier post, do a great job of offering treatment choices and have a high level of case acceptance with a focus on quadrant and arch dentistry. These successful doctors then know how to schedule treatment in a way that maximizes productivity and profitability.

Productive doctor scheduling is actually a topic where I feel that I have more expertise  than just about any other area in dentistry. I started consulting full-time 18 years ago, but prior to that–for the last seven or eight years that I was in clinical practice–I was doing some part-time consulting in a very niche area -showing  busy dental practices how they could be more productive and more profitable through scheduling techniques developed in my own practice. This would involve an analysis of current production per hour in a practice that was pretty busy, followed by a six hour seminar with their entire  team, teaching them how to increase their production. There is, you know, a big difference between being busy and being profitable. Obviously it would be beyond the scope of a blog post to give all the specifics of how to do this. But here are some basic principles of scheduling that I frequently see in a successful dental practice:

• Realize – as simple as it seems – that there are only so many available hours in the day, and so many days in a week. Once the time goes by, you never get it back. So you have to try to maximize every hour of every day.

• Have a consistent 12 to 15 minute morning huddle at the beginning of the day. I really do believe that practices that have a morning huddle do 15% better than those that don’t.

• Do not save designated time blocks for emergencies. Emergency time can be determined at the morning huddle every day. At the huddle, identify the three best times based on the doctor’s schedule that day as to where an emergency could be seen. Those are the times that are offered to an emergency patient who calls. That emergency is always side booked.

• Do not do definitive therapy for emergency patients.  That is the surest way to get behind.  Palliative treatment is what is indicated.

• Do not place a procedure in the primary schedule unless it has been diagnosed by a doctor exam  and financial arrangements have been made with the patient.

• Seat every patient requiring local anesthesia  in a room 20 minutes before the doctor  will be starting that actual procedure. The doctor leaves the patient he or she was treating,  takes a quick few minutes to deliver the anesthesia to the patient who was just seated, and  then returns  to the original treatment room to finish the dental procedure.

• Stop scheduling defensively. I see a lot of sloppy scheduling where much too much time is allocated to a procedure. This of course may be a defense mechanism by the front desk if the doctor is always running late.

• Delegate delegate delegate–where ever possible to highly  trained dental assistants.

• Stay on time–the best schedule in the world can be blown up by the doctor. The doctor absolutely has to know  when to “punt”.  In a football game, if it’s the first quarter and you have 4^th down on your own 30 yard line and three yards to go, the obvious move is to punt the ball away. There is plenty of time left in the game to score. With that same yardage situation and only a few minutes left in the game, you don’t punt. You go for the first down or else the game is over. Metaphorically, when there is a pulp exposure in the middle of a prep temp impression visit for a crown, or when your impression fails because of gingival bleeding – this is the time to punt. Finish up what you can in the allotted time period, and re-schedule the patient for another day to finish the procedure. Cut your losses. Don’t be tempted to extend that appointment and get 30 to 45 minutes behind for every other scheduled appointment and keep those patients waiting.

Running  late and behind schedule on a consistent basis is just not acceptable. Working into the lunch hour and past the normal end of the day gets pretty old. Clearly the doctor must be aware of the time. Productive doctor scheduling is an absolute must to insure a successful dental practice.

I routinely see the correlation between state-of-the-art technology and successful dental practices. There is no question in my mind that the latest in technology is hugely influential for promoting practice growth. Two true stories.  I am playing golf in Florida with a friend of mine from the Boston area. He tells me that he has found this wonderful dentist in Naples, and is leaving his dentist up North. When I asked him why, he said ” this guy in Florida took an x-ray that immediately showed up on a computer in his treatment room, and he was able to make a crown for me in one visit.  My dentist in Boston is a nice guy, but he is clearly behind the times.” A few months later I was at a cocktail party and I hear someone whom I didn’t know describing how amazing her dentist was (actually one of my former clients), and talking about how this dentist used “a laser to check for cavities”. Someone in the group listening to this conversation then asked ” do you know if she is accepting new patients?”

The overall message to take away is that there is a wow factor and a marketing factor to technology that definitely needs to be understood and evaluated when decisions are being made from an investment point of view regarding the affordability of the technology itself. The old adage of having to spend money to make money is so true. And there is so much great technology out there – digital impression systems like iTero that completely eliminate goop and gagging, cone beam three dimensional diagnostic imaging for implant placement, CAD/CAM systems such as Cerec and E4D that create all ceramic restorations in a single appointment, digital radiography that allows instant viewing and manipulation of images, various hard and soft tissue lasers, iPads where you can download intra-oral high resolution photographs for intimate case presentations–the list goes on and on.

I believe that the idea here is to promote new technology to your patient base not only for being cool, but also as something that is going to be beneficial to their health. I feel strongly that you want to cultivate an image of being state-of-the-art and certainly the most up-to-date practitioner in your area. I also feel another important benefit is that new technology keeps the doctor challenged–keeps the doctor from getting burned out–same old same old can get pretty tired.

Since any dentist can avail themselves of this opportunity, what on earth is holding you back?

Successful dental practices make marketing a top priority. In this day and age, you certainly need to spend money to make money. I am advocating to my clients that they spend up to 3 to 4% of annual collections on marketing strategies to attract new patients. I also don’t believe that there is one magic bullet that will apply to every practice and every situation. And beware of people selling you on that concept. You need trackable data to justify every marketing plan, and you can’t be married to a plan forever. You have to be flexible –sometimes have the courage to abandon something that you thought was a good idea–and possibly invest more in strategies that seem to be working. Here are some possibilities to consider.

Internal Marketing – I have always been a huge fan of internal marketing because it is very inexpensive, but it can be very effective as long as it is done consistently. Internal marketing is defined as marketing to your existing patient base. I am big on rewarding patients in all kinds of ways for their referrals. Have fun with this–leave your comfort zone and do something different or unexpected. A key component of an effective internal marketing program is hand written notes from the doctor. I suggest there is the opportunity for at least two or three of these to be written everyday. Patients feel so very important when they receive a note from the doctor.

Internet Marketing – I have seen enormous benefits from Internet marketing that begins with the development of a great website,  that through various and clever SEO techniques, positions well on the local Google business map. It is hard for me to believe that something like 40% of all dentists still do not even have a website. They must be living under a rock! You simply have to play in the Internet world. Everyone these days searches for everything on Google–I mean why would you go anywhere else?

Google Adwords – Targeted campaigns are effective for specific services like same day crowns, implants, invisible braces, etc. These are the kind of popular services that are often searched. When people click on these campaigns, they can be directed to a very nicely designed landing page within your website. You can start to get into spending some serious money here, but you will definitely drive traffic. Again–in  competitive metropolitan areas where it is more difficult to get organic rankings of your website on the Google map–Adwords campaigns can level the playing field.

Facebook Advertising – I am starting to see more successful practices getting involved with Facebook advertising. It is much less expensive than Google Adwords. But in order to be successful with Facebook, you have to make a commitment to be responsive and reactive with posts on your Page. Successful practices have one or two staff members who  take this on as a project spending dedicated time every day creating new content and responding to comments. Most doctors do not have the time for this, or even more to the point, don’t understand it.

Direct mail–I recently wrote a post about this. I am feeling more positive about this marketing medium, and it is definitely something to consider.

Marketing and advertising is a business apart from dentistry, and there are experts out there that you can hire to help you. It really helps to have an objective advisor in this area.

In conclusion, I would like to make one very important point regarding patient retention. It is futile to try to attract a continual source of new patients–and absorb all of that cost–if you don’t continue to take good care of these people forever. It is critically important that you retain and please these patients on an ongoing basis. Having an inviting front door that is wide open will not help if the back door is open as well.