Jodena Consulting Blog

When a dental practice is sold, the purchase is almost always financed by a bank. With rare exception, the borrower is able to obtain 100% financing of the purchase price. Accounts receivable associated with that same dental practice are financed very differently.  Banks do not finance at 100%. The typical arrangement is payment of 90% for balances that are under 30 days, 75% for accounts between 30 and 60 days, and only 50% on accounts that are 60 to 90 days old. Banks understand that there is only a 57% chance of collecting in full on an account that is 60 to 90 days past due.

In the ideal world, there would never be a need to send a patient a bill. With a properly executed financial policy, payment should be received at the time of service. I always wonder why is a dental practice the only store in America where you can leave without paying for your purchase? That, of course, is a topic for another day.

For any number of different reasons, dental practices send out a large number of monthly statements. It is a time-consuming and expensive task. Obviously the cost is a great deal more than the 47 cents for postage. And it apparently is not an effective tool for collecting money when you look at a typical aging report. We all know that the older the account gets, the harder it is to collect. But what should you do to shorten the cycle? When do you consider an account to be delinquent? Is it after two or three monthly statements with no response? Is it after a few attempts at making a collection call?

I would like to suggest for your consideration a different approach that involves outsourcing much of the collection process. Transworld Systems Inc (TSI) is a leader in dental collections. They’ve been in the business of helping dentists collect money for 46 years. TSI has partnered with Sikka Software Company to bring dental practices a unique receivables management tool called Dental Collect.  Dental Collect  integrates seamlessly with all of the major dental practice management systems. It helps to increase overall cash flow while saving time and maintaining patient diplomacy.

The Dental Collect platform begins when a practice identifies a non responsive patient payer. In my opinion, that should be 15 days after the second statement was mailed. The data is sent securely to TSI and is totally HIPAA compliant. TSI Technology generates five contacts with the patient over the next 30 to 40 days. They use a combination of written reminders and telephone calls that appear to come from the practice itself. This is a frequency of touches that no practice has the time or technology to do on their own. The systematic approach is designed to help keep the patient in the practice for a lifetime. No practice wants to lose patients. With TSI, all patient payments go directly to the practice. TSI charges a fixed fee per account of about $10.

The take away message here is that to improve collections, patients with overdue balances need to be contacted earlier than later. The results speak for themselves. I recently wrote a blog about leaving your comfort zone. This may be the perfect opportunity. Setup and training with TSI is accomplished remotely in one hour. Their customer support is free and responsive. Give Charlie Colarullo a call at 508-361-2095. He can arrange an online demo to further explain the details of this remarkable technology.

My wife and I recently completed a renovation project of a master bathroom. We shopped online for towels and bath mats, and after visiting many websites we eventually found just what we were searching for. Amazingly enough – for the next 30 to 45 days – there would be an ad for bath towels on the right-hand side of my computer screen. The same thing happened when I was shopping online for a Patriots Super Bowl T shirt. I visited the NFL website, but couldn’t decide on a purchase. Sure enough, I’m still seeing ads for Patriots gear pop up on my computer.

The experience I describe is a form of advertising and marketing called re-targeting. A tracking code is embedded in the footer of a website. The code creates a list of people that visit the site. Re-targeting vendors like AdRoll are able to display ads to your potential customers virtually anywhere that they go online. Studies show that retargeting ads get an average of 10 times the click throughs as other ads.  Plus every time that potential customer sees your ads, your brand gains recognition.

Re-targeting can work beautifully for a dental practice. Imagine someone lands on a page of your website that talks about whitening. They found your site through SEO or Facebook. This person is already interested in what you have to offer. You can now follow them around the web for the next 90 days with ads that talk about the benefits of whiter teeth. Creating these ads takes considerable coordination.  But if done well, it is a terrific opportunity to promote your dental office to people who have already come to your site.

You can run similar campaigns for popular services like implants, adult orthodontics, and same day crowns.  Each campaign needs a series of five different sized ads because the ad space allotted is different depending on which website the ad is showing on. This is very sophisticated advertising, and you need to hire someone with the proper expertise.  If you have any interest in learning more about re-targeting, I would strongly endorse my talented friend Heather LoGrippo of Expose Yourself PR. She charges a one-time fee of $250 to create the five ads and then $500/month to manage and monitor the campaign. Heather has a lot of experience with this technique. You can call her at 617-957-3868.

A common observation over the years in my role as a coach to dentists is that they are very reluctant to change. Change, of course, is always difficult. The status quo is so much more comfortable. But this risk averse, playing it safe mentality, eventually becomes paralyzing. Growth is difficult to impossible to achieve with this mindset. Consider these examples.

• Dentists are reluctant or embarrassed to talk to their patients about money. How can you expect the patient to buy something from you when they don’t know the approximate price? Making the financial arrangements and coordinating insurance benefits is a job for your financial coordinator. But the dentist’s job is to confidently sell the case.

• Dentists are reluctant to leave low-paying PPO networks for fear their patients will leave the practice. This paranoia and lack of confidence and insecurity is often unfounded. A large majority of patients will stay because they love you and your staff and the quality of your work and the excellent customer service experience.

•Dentists are reluctant to fire underperforming employees – those troublemakers who suck the energy out of the rest of the staff. With proper documentation and up-to-date HR protocols, dentists need not be fearful of an improper firing lawsuit.

•Dentists often have difficulty being the leader of their team – knowing how to draw the fine line between being a friend and being the boss. Setting boundaries, setting expectations, and knowing how to consistently communicate the vision for the practice are challenges you should welcome.

I recently read a great book called Reach: A New Strategy to Help You Step Outside Your Comfort Zone, Rise to the Challenge, and Build Confidence. It is authored by Andrew Molinsky, a professor at the Brandeis International Business School. The book lays out a step-by-step process to help you overcome these feelings of inadequacy that so many of us experience. Molinsky recounts with numerous real-world examples the fact that “successful people are not inherently different from anyone else; they’ve just found their own way to rise to the challenge they face.”

This is a quick read with action steps that you can implement immediately. As your New Year resolutions start to fade, reading Reach could be just the jump start you need. Click here to buy your copy.

HR for Health was started in 2010 by a healthcare attorney and a technology guru whose wives are both dentists. HR for Health has now become the leader in providing cloud-based human resources solutions for healthcare professionals. They have created innovative and cost-effective approaches to providing compliance with all HR laws at both the federal and state levels.

I see many dental practices still using paper time sheets or a stand-alone time clock to track time and attendance. Upgrading to a cloud-based platform that is integrated with your human resources management system will provide administrative simplicity, improved accuracy, cost savings, and instant reporting and documentation.

Probably the biggest benefit of hiring a company like HR for Health is the protection and peace of mind you will derive knowing that you are totally compliant with the employee laws in your state. The best way to win a lawsuit is to never have a lawsuit! And lawsuits over wage and hour issues have become all too prevalent. The odds are about one in 10 that you could face an employment charge with the average cost of an employment lawsuit running at about $125,000. EPLI Insurance covers damages for improper firing or discrimination or harassment but does NOT cover wage and hour lawsuits.

For a one time startup fee of $795, and a monthly fee of $225, HR for Health is a genuine bargain for providing required employment documentation, expert guidance with hiring and firing, customized employee handbooks, strategic time and attendance tracking, real-time benefits tracking, and unlimited access to HR specialists and attorneys. Do yourself and your practice a favor by calling David Dee at 401-782-7489. David is knowledgeable and extremely easy to speak with. He would be happy to schedule a free on-line demo so you can see first hand this award winning software.

I don’t usually write updates on companies or vendors so soon after an initial recommendation. I wrote a post about Revenue Well in June 2016. Yet I continue to hear really wonderful feedback on their performance. They deliver their basic product extremely well. That product could be divided into three main areas.

• Appointment confirmation by telephone, text, email, or postcard.

• Reactivation of patients overdue for continuing care.

• Individualized email reminders for diagnosed but un-scheduled dental treatment. Because Revenue Well can read the treatment code in your dental practice management software, these emails can be specifically tailored for the procedure and can also be enhanced by links to videos that describe the treatment. Pretty impressive.

What I also hear about is their ongoing commitment to customer service and customer support. These are the intangibles that in a busy world you might not expect. I have to believe that this commitment is directly tied into their business model. Revenue Well – unlike the majority of their competitors – works on a month to month basis with no guaranteed one or two year contract. If they don’t perform at a high level, they can get fired!

Revenue Well is also very determined to be your marketing partner. They do a great job of creating content that is already in blog and social media format or could easily be converted. So you can incorporate this well-written material directly to your website and/or your Facebook Page in order to help maintain or improve organic search results on Google. Much of the content is seasonal or holiday related and thus can be used appropriately as I am suggesting for proms, graduations, Valentines, Christmas etc. This can all be geared towards engaging a doctor’s patient base in the right way at the right time.

Revenue Well maintains a talented customer support team with answers to questions and solutions to problems. They have accumulated a huge database of analytics so they can advise on what is working and what is not. Please call my friend Kelly Larson at 612-859-3684 to schedule a demo or to get answers to any questions you might have.

I was originally introduced to Six Month Smiles when I attended a two day course in May of 2012. I wrote a blog post about that experience where I compare the benefits of this approach to aligner therapy. Among those benefits would be the ability to fairly easily intrude and extrude and rotate teeth, deliver quicker results, offer a lesser cost option to the patient, and not be so dependent on patient compliance. I then wrote another post in March of 2015 with updates. As we head into 2017, I’d like to keep my readers current with another summary of some exciting new developments that will make Six Month Smiles even easier and more predictable than ever before.

Welcome to Confidex! This new program was launched a few months ago. When you elect this option, for a fee of $110 in addition to your normal lab fee, you will receive a monthly step-by-step written treatment plan guide created by an orthodontic specialist. The plan includes where, when, and how much inter-proximal reduction to perform, where to place the bite guards, and the estimated treatment time to finish the case. This is a terrific life line and a big comfort factor when you are considering starting a case that might be perceived to be more challenging .

Six Month Smiles is now as an option accepting digital impressions that ensure accurate, precise, and quantifiable bracket positioning. With Confidex, you also receive a three-dimensional simulation – similar to the Invisalign ClinCheck – that allows the patient and the dentist to see the case from start to finalization. Although not available now, I have heard that color photography with before and after simulation might be in the works – and that would be an awesome selling tool.

As dental insurance companies continue their efforts to control your fees and the way you deliver dentistry, adding in many cases non covered cosmetic short-term orthodontics to your armamentarium of services seems like a winning strategy. You can contact Umair Ahmed at 408-373-3310 with any questions and certainly visit the website.

There is an old saying that “if you continue to do what you have always done, you will continue to get what you have always got.” I use this maxim as a motivational tool to get clients to open their minds and accept new strategies and adopt new systems that will enable their dental practices to reach new levels of productivity and profitability. Unfortunately for the dentists of Massachusetts, doing what you have always done will no longer get you what you have received in the past – it will get you a lot less!

As of January 2017, Delta Dental of Massachusetts will be forcing in-network providers to accept the Delta PPO fee schedule and not be able to choose to only accept Delta Premier. Premier fees were usually a 10-15% discount from the published fees of a practice. Delta PPO fees are closer to a 25-30% write off from the published fees of the practice. And everyone predicts that this action is the harbinger of the eventual discontinuation of the Delta Premier fee schedule.

This new policy by Delta will have horrific and deleterious implications for patients, dentists, dental staff, and vendors who sell to dentists.  Patient care will be compromised at every level. As a dentist in this environment, are you still going to consider adding expensive state-of-the-art technology? Will your hygiene visits need to be reduced to 35-40 minutes instead of one hour? How can you pay the lab $200 for a quality crown when you are only able to charge a significantly discounted fee? Is it time to buy stock in dental labs in China?

I can envision dental practices now being forced to nickel and dime their patients by charging their insurance for emergency exams and emergency palliative treatment that used to be offered at no charge as a customer service courtesy. The Scheins and the Pattersons and the Bencos of the world were already under challenge from online dental supply stores. Their life just became even harder in this new world of low fee dentistry. And how can we as dentists think about offering even cost-of-living raises to our staff when practice revenue in 2017 will unquestionably be reduced?

The valuation in the sale of a dental practice is directly tied to annual revenue. I see the potential of big turmoil in the marketplace. Dentists will have to work longer before retirement. Dentists who might have been thinking transition might decide they need to stay and work longer. And perhaps some dentists may look at this recent Delta policy change as the final straw and just decide to get out of dentistry altogether.

I have always chosen to look at the glass half full rather than half empty, but I am struggling big time with maintaining optimism for my New England clients. It appears to me that Delta has finally stepped over the line. They are threatening to no longer directly reimburse out of network doctors. They will reimburse the patient directly forcing insured patients and families to pay for dental visits at the time of service and get reimbursed later. The only reason to do that is to punish out-of-network doctors and the patients who choose to see them.

There is no easy answer as to what to do. Staying in the network or leaving the network will be painful – at least in the short term. I think your decision will be based on many factors: your status in the community, how busy you are, your age, the number of years you want to continue practicing, your overall debt,  your financial obligations, and your appetite for risk. When making your decision, for sure you will need to calculate the number of Delta patients in your practice as compared to the total number of patients along with a recognition of the dollars received from Delta as compared to total practice revenue.

And then one very important question: how do you want to practice dentistry going forward, and are you willing to be controlled by dental insurance? I welcome your feedback. I’m certain this will not be my only post on this topic.

Over the years I have often written about the benefits, both to your practice and to your patients, of offering outsourced financial arrangements as a viable payment option for dental treatment.  The practice receives full payment at the start of treatment, and the finance company assumes all of the risk for collecting the borrowed amount.  For this valuable service, the finance company is paid a “merchants fee” by the dental practice. That merchants fee essentially underwrites the loan allowing the practice to offer interest-free promotional packages to patients.

Most of the time these arrangements work out seamlessly. But in a significant number of cases – more than you might expect – a massive PR problem occurs when a patient owes an outstanding balance at the end of the promotional period. Why does this happen? Because some of the major well-known finance companies – instead of sending monthly statements for the agreed-upon payment that will fully amortize the loan – deceptively send monthly statements saying “minimum payment due”. The patient is then billed an egregious interest rate – often in the 25% annual interest range – on the TOTAL amount of the original loan and not just on the outstanding balance.

This is referred to as retroactive interest. As you have probably experienced, patients are really upset when this happens to them. They are angry and even blame your office for offering the plan. That, of course, is not helpful for your reputation.

You might want to check out Lending Club Patient Solutions. The plans they offer are transparent and feature easy to understand terms with monthly payments paced to pay off within the promotional period. And these plans have no retroactive interest. If a patient does not pay off their balance within the promotional period, interest will only accrue on the outstanding balance on the date the payment plan ends and NOT from the date of the initial purchase.  Lending Club also prides themselves on offering exceptional customer service. They answer the phone promptly, and the person who answers will be the one to guide you through the entire process.

Another feature I like is that your practice can tell Lending Club which interest free promotional packages you will offer. That way – if the patient doesn’t make arrangements in your office, but instead prefers to call from home – they can only be offered plans you have agreed to.

You can call Lending Club Patient Solutions at 800-630-1663 for more details. I will be interested in your feedback.

Full disclosure – this blog has absolutely nothing to do with dentistry – but I hope you will read it anyway. My wife and I were recently in New York City for a quick two day whirlwind of business, theatre, and dinner with friends. The unquestioned highlight of our visit was a two hour guided tour of the 9/11 Museum at the lower tip of Manhattan. A year ago, on another trip, we had gone to see the new World Trade Center building and the memorial pools, but didn’t have the time to visit the Museum.

The 9/11 Museum has been constructed within the actual footprint of the North and South towers that were destroyed. This is hallowed ground. At one point, you are seven stories below street level on the bed rock of Manhattan. It is very overwhelming to visit this museum. Bring a handkerchief. The minute by minute account of what happened on that Tuesday morning 15 years ago is dramatically portrayed with video, photography, and the real size artifacts of twisted steel and damaged fire engines. Almost 3000 innocent people lost their lives, and their families were forever impacted.

I can not help but think that as we celebrate Thanksgiving and enter this Holiday season, we should remember the resilience that the citizens of New York and our nation as a whole displayed in dealing with this unspeakable horror. Perhaps that will help us now and give us courage and optimism as we try to understand and cope with the current economic and political issues that are seemingly dividing our country.

Dental Purchasing Group (DPG) is a dental specific group purchasing organization that was started almost 4 years ago. I originally wrote about this company early in 2016. I was impressed with it then, and even more impressed today.

The company has added 300 doctors and over 100 new offices in the past year.

Seth Josephs, the co-founder and CEO, told me that he estimates that based on its negotiated pricing from vendors within the network, DPG member offices will save $1,000,000 in calendar year 2016.

Ten new unique vendors have been added this year including Lighthouse 360 (patient communication software), Prexion (one of the major players in 3-D scanners), and Alpha NetSolutions (a well respected regional IT company).

Prior to this year, DPG members would receive a hard copy vendor book. A big upgrade has been the creation of a new website that makes it easy for members to access valuable information. This is especially helpful now that so many new vendors are being added. New offices can also sign up online and seamlessly have access to all member benefits.

DPG continues to offer the first 12 months free, and then $99 annually for each subsequent year. I asked Seth why more offices haven’t joined. “We all have learned the hard way that if something sounds too good to be true, then it probably isn’t true. Unfortunately we are having a difficult time overcoming this ingrained attitude.”

I encourage all of you who read my blog posts to check this company out. There are no hidden fees. Do the math – if you already buy from these vendors anyway, by being a DPG member,  you get an additional substantial discount. And if you discover a new vendor that you want to buy from, you get the DPG member discount. You can call Seth Josephs directly at 978-609-4281 or visit the website.