Jodena Consulting Blog

No one involved with Internet Marketing can question the importance of having the name of your practice and its website prominently displayed when a prospective patient does a Google search for a dentist in your town. My definition of prominent has been to be one of the seven spots on the local Google business map. On August 6th, Google instituted a major change. The Google 7-Pack became the Google 3-Pack. As mobile usage continues to grow, Google has changed the desktop search to appear more like mobile search results. So now only the top 3 positions on the Map are shown. Positions 4-7 in the old map pack are still there if you click the “More Dentist” icon – now jokingly called the “hamburger”. So those practices that worked so hard to gain that visibility have been definitely penalized.

Another change is that you can no longer get to the Google Place Page of a dentist from the Map. When you click the results on the map, you get a hybrid Google Plus Page or “card”. The only way to get to the Plus Page and see all of the reviews is from the practice website.

A third change is that when you do a search from a mobile device, the paid ads (Google AdWords) for a dentist show up prominently and you need to scroll down to see other results. A fourth change that is really irritating is that Google no longer is including the full address of the practice on the Map.

I believe that Google – with these new changes – is doing everything they can to leverage their vast power and force more dentists to buy AdWords to guarantee a top position. If you don’t choose to pay for a top position, your SEO strategies have to be exquisitely executed. The challenge for organic optimization is greater than ever. Your next generation marketing platform for your website must focus on the following.

• Creating continuous additional content. The easiest way is with blog posts. These posts should contain key words and mention your geography. Google rewards relevance and proximity as contributing factors for ranking in the Pack.

• Listing your town and surrounding towns in the first paragraph of your Home Page.

• Using a call tracking telephone number for your website. Let’s see how people are getting to your site.

• Adding Google patient reviews on a consistent basis. Have your Google Plus Page linked from your website to make it easy for patients to leave a review. And be sure to change the ugly orange, blue and green generic Google banner with the banner of your website.

• Better consistency with directories (citations). This is often called NAP verification (name, address, telephone number). Making sure that the name of the practice, the name of the doctor, address, telephone number, dental degree, etc. are all exactly correct on the major directory sites like Angie’s List, Bing, Yahoo, and Yelp.

The challenge for effective Internet Marketing has become even more difficult. A dental practice needs professional technical advice. I highly recommend TNT Dental. I have been using them for many years. Call Tim Healy at 214-680-1270 and see how he can help.

I have long been an advocate for staff to wear name tags with a title. There are many benefits to this. There is a comfort factor for the patient to know your name, and a respect factor for the staff member to be recognized for her skill. Susan – Patient Treatment Coordinator. Laura – Clinical Assistant. Joyce – Dental Hygienist.  People always relate better to you when they know your name. It stimulates conversation, and conversation builds relationships. And we all know how easy it is to forget a name, even if we were introduced a mere five minutes ago!

I’d like to bring to your attention a quality resource called Badge America. As with many topics that I blog about, I found out about this company at one of my client visits. Badge America is a small business owned by Rose Marie Branconnier.

The product that I am recommending is a two-sided card that contains the first name, title, AND a picture. The card is very sturdy–not flimsy at all. The card clips to scrubs or a jacket, rather than being pinned to the garment and making a hole. Using two sides makes a lot of sense so that the card is always visible,  even if it gets twisted or caught in the folds of a uniform. The cost is only $15  per card. All you need to do to place an order is e-mail a digital photo along with the pertinent information for each employee to badger1@cox.net. If you have any questions, you can speak to Rose at 401-766-1816. The delivery is quick–usually within three to five business days.

Just another simple way to distinguish your practice from the competition.

Dental partnerships, where two or more doctors own equal or minority/majority interests, are very complicated entities.  The legal documentation for a dental partnership routinely runs over 100 pages, and unfortunately the value of these partnerships is often only as secure as the legal language describing them. Over the years, I have witnessed a lot of unhappy professional partnerships. My observations have reinforced the dictum that “one marriage is difficult enough!” There are, of course, exceptions to every rule, and I have many clients who are successful with this model . But in general, I am not a big fan of dental partnerships and I believe there are better options.

One of the biggest challenges is how to fairly compensate a partner who becomes disabled and can no longer perform clinical procedures. Death, as they say, is easy. Life insurance policies will pay out the appropriate valuation to the estate of the deceased partner. The surviving partner does not take one dime out of his/her pocket. In the case of disability, however, usually there is the requirement for the healthy partner to buy out the interest of the disabled partner and become the 100% owner of the practice. In order to do this, the healthy doctor does in fact now have to go to the bank and get a loan to cover the buyout. This new debt service will put major stress on a business that is already revenue compromised.

I recently became aware of a great insurance product called Disability Buyout Insurance (DBO). A DBO policy is designed to fund a disability buy/sell agreement. It helps ensure that a professional practice can continue after the total disability of one of the owners or partners. It does this by requiring the disabled partner to sell his or her interest to the remaining owner for an agreed upon price and according to terms defined in the agreement.

I believe that the cost to purchase this type of insurance policy is relatively low considering the massive benefit. A $500,000 DBA policy for a healthy 45 year old costs about $4100/year.  Considering that one out of three dentists will be disabled at some point in their career, it provides great peace of mind.

There are many guidelines and specifics for this type of policy, and not all situations will apply.

• The two doctors cannot be more than 15 years apart in age.

• The older partner cannot be more than age 51.

• The partners cannot be husband and wife or father/mother/child.

• The policy will cover siblings.

• The maximum limit of the policy is $2,000,000 with a valuation of no more than 1 X  gross collections.

For obvious reasons, this very valuable insurance product does not apply to everyone. But if you think that you might fit into this narrow niche, you should call Tyler DeStefano at 978-907-6002 and get some advice from a real expert.

First impressions dominate. And by definition, you never get a second chance to make a great first impression. So I am flabbergasted and certainly underwhelmed by what I often experience when I call a dental office.  Here are my suggestions for proper telephone technique that are designed to impress.

1. A real live person should answer the telephone. I hate phone trees! A phone tree is an automated telephone information system that speaks to the caller with a combination of fixed voice menus in real time. The caller can respond by pressing phone keys or speaking words or short phrases. “Please listen closely because our menu options have changed: Press one for the doctor, press two for the hygienist, press three if you are in pain, press four if you are a new patient etc. Many times, after pressing all these buttons, you end up in voicemail anyway. I don’t care about listening to menu options that might have changed. I just want to speak to a real person who can take care of my request right away. When you call Lands’ End or LL Bean, the phone is always answered on the second ring and you speak to a friendly person who is ready to take your order. Why can’t this happen in your practice?

2. When someone answers your phone, please have her announce her name. “Dr. Jones’ office” is not an acceptable greeting. Patients really appreciate knowing to whom they are speaking. I like “Thanks for calling Dr. Jones’ office – this is Melissa”. And “this is Melissa” is said with an intonation that implies “how may I help you?”

3. Answer the telephone over lunch. For many people, the only time that they can call is during lunch. Arrange coverage utilizing all staff members. Pay them their normal hourly rate.  But please–teach assistants and hygienists who normally do not answer the telephone the proper way to answer. You don’t want it to sound like the cleaning service is answering your phone.

4. Answer your phone on the weekends. You don’t want to miss these calls. It is very easy to arrange call forwarding to staff cell phones. Staff members should be required to take weekend coverage on a rotating basis and are compensated for their efforts.

5. If you must default to a message machine during normal business hours, please do not say “we will get back to you as soon as possible”. It is much friendlier to say “we promise to return your call within 15 minutes.” And then make sure you do!

6. Never place a person on hold without asking their permission. “Dr. Jones’ office – hold please” is simply not acceptable. If you are on another call, or assisting someone at the desk, simply excuse yourself from the primary conversation. Then answer your telephone with the normal telephone greeting – find out who is calling – tell them you are on another call – and then ask them if they would like to hold or be called back in a few minutes. That entire process will not take longer than 20 seconds. Time it if you don’t believe me.

7. Consider answering services as a possible alternative to an end of the day message machine. There are some good companiesout there that are cost effective. But be sure to do your due diligence and check references.

The telephone is the entryway to your dental practice, and the person answering your phone just might be the most important person in your employ. Exquisite telephone technique is part and parcel of exquisite customer service. You shouldn’t accept anything else.

I recently did a survey of current clients asking them what percentage of gross receipts were attributed to credit cards. 35-40% seemed to be the number. Very few patients pay by cash anymore–it’s either a check or credit card. So on a million-dollar practice–certainly a nice practice but nothing unusual these days–that would represent $400,000. The average published processing fee of a credit card company is 3% of the sale. That is the amount the practice pays to the merchant service provider.  In this example, that would be $12,000.

But when I examined expense reports to analyze the total amount of processing fees charged to the practice, it was often more than 3% – sometimes between 4 and 4 and 1/2%. Why should that be? There are a number of potential reasons:

• The true costs associated with processing are not disclosed.

• The electronic processing and merchant service industry is mostly unregulated when it comes to     billing and sales practices.

• There is an extremely complex and cloudy system by which processing costs are determined.

If your analysis shows similar results, I would strongly suggest that you contact Schooley Mitchell. It is the largest independent payment processing consulting organization in North America. Here is how they work. They monitor your credit card statements on a quarterly basis to identify all of the bogus or seemingly incidental fees that creep in. Fees like interchange rates, dues and assessments, monthly access fees, front end authorization fees and back end capture fees.  The cost for the analysis they provide is on a 50% contingency basis: their fees are self funded out of the savings generated from reduced processing expenses. They claim to consistently save their clients 40% if they switch to a new credit card provider or 30% if the client chooses to stay with their existing credit card provider.

Schooley Mitchell has a strong incentive to do a good job. The more they save you, the more money they make. You take no risk. They will either save you money and self fund their fees, or give you a no-cost validation that you are receiving the best overall value for your existing services.

There is another very important reason to revisit your electronic payment processing protocol. In the United States, the migration from magnetic stripe cards to embedded chip cards is underway. The liability for fraudulent transactions is changing along with the switch to chip payment technology. Currently, banks absorb the majority of fraudulent credit card costs. But as of October 2015, if a customer pays for services with a fraudulent chip embedded card–and your practice processes that transaction without a chip embedded terminal–you will be liable for that transaction.

It is a different world out there my friends! Forewarned is forearmed.

I was in a client’s office a few weeks ago and I overheard one end of a conversation where someone at the front desk was trying to explain to a patient why there was a $35 charge for a broken appointment. As you can imagine, the conversation did not end well. This relatively inexperienced staff member broke two cardinal rules: never disrespect or disappoint a patient and never use the word “policy” as the explanation or answer to a question. Dentistry could easily qualify as a business where the average lifetime value of a patient is $15,000. How insane is it to lose that patient over a $35 charge for a broken appointment?

The above situation doesn’t happen when the doctor has created an exceptional workplace culture. That means an environment where employees love their work and are empowered to do whatever it takes to please a patient and make them happy. That means an office where the doctor has built a team and not just a group of people that work together.

I recently wrote about how difficult it has become to assemble that team. The value of building that team was reinforced in a recent article in Dentaltown authored by Howard Farran.  “When we plot highest net income with all the variables that can be associated with it, we don’t find it related to where you went to school or what institute you did some training at; we find it linked to longevity of the average staff member”. Interesting.

I don’t want to sound like a broken record. You need to do whatever possible to build that team. One of my mentors – the incomparable Seth Godin – says this so eloquently. “Building an extraordinary organization takes guts. The guts to trust the team, to treat them with respect and to go to ridiculous lengths to find, keep, and nurture people who care enough to make a difference”. Amen.

Discussions about staff continue to be an ongoing part of practically every monthly meeting or telephone call with my clients. This is not something new, but it seems to be on the rise. Staff performance, staff incentives, bonus plans, job descriptions, complaints, HR issues–the list is endless. Our conversations are happening because of the critical nature of these issues. Building and maintaining a quality, customer-service oriented, loyal, and talented team continues to be the biggest challenge–and a key ingredient–for the establishment and growth of the superb dental practice.

In preparation for this blog post, I re-read an article about staffing that I published in the Spring of 1997 in the Journal of the Massachusetts Dental Society. I had just started my consulting business, and my thoughts for that article were solely based on my 29 years of experience running my own dental practice. To my surprise, there was not much of anything that I would change. But 18 years later–and over 650 dental client relationships later–I realize how much more difficult it is today to mold that perfect staff.

1. Our society has become extremely mobile and transient. In the world of today, both spouses working is the norm and not the exception. If one spouse gets a promotion, it may involve relocation of the entire family unit. So you can lose a great staff member through no fault of your own and you are suddenly back to square one.

2. A competitive benefits package has become quite costly. Healthcare costs have skyrocketed and bear no relationship to inflation. So offering employees a good medical insurance plan is absolutely essential if you hope to attract quality people. Combine that with the costs of pension, vacation pay, holiday pay and sick time/personal days (now often mandated by State employment laws), and you realize that the dollars start to add up.

3. Terminating an under performing employee has become much more complicated. Over the past five to ten years, there has been an exponential increase in the number of lawsuits accusing dentists of harassment, discrimination, and improper firing. This fear of litigation may paralyze the doctor and prevent decisive and necessary actions. There has never been more of a need for an exquisite and well-written office policy manual. There also needs to be a sophisticated understanding of HR issues, especially the necessity for meticulous documentation.

Fortunately, there are some positive to offset these negatives.

1. The power of the Internet is amazing! Google, Facebook and Twitter have made it infinitely easier and quicker to find qualified staff. Our world has become incredibly connected.

2. Doctors can now purchase EPLI insurance and greatly reduce or eliminate the fear of financial ramifications from frivolous employee lawsuits.

Over the years, my favorite ad for finding great employees is what I call an “in your face” ad. It used to be placed in the Classified Ads section of your local newspaper. Now it gets posted to craigslist and you get replies instantly. It is designed to attract the very best people. These people are most likely working in another dental practice in your general area where they no longer feel challenged or appreciated.

” Busy general practice seeking the absolute best dental assistant in the Metrowest area. If your clinical skills, team building skills, and communication skills are not excellent, please do not respond to this ad. This is a full-time position with benefits. Money is no object. Compensation will be commensurate with ability and experience. All resumes will be kept in strictest confidence. E-mail your resume to______________.”

In spite of how difficult team building may seem, please don’t settle for average. Strive to build an exceptional workplace culture in order to attract, motivate, and retain top talent. Culture attracts, culture retains, and culture drives performance.

Acquiring a consistent stream of quality new patients is an absolute necessity–and a key ingredient–for the continued growth and success of a dental practice. My hope would be that at least half of your new patients come from referrals from within your existing patient base. There is no greater validation of your entire customer service experience than when a satisfied patient recommends a friend, business associate, or family member to your office. And, of course, we know exactly how that new patient found your practice. There is no mystery.

The rest of your new patients find you from offline or online marketing campaigns. Offline marketing refers to TV commercials, radio ads, billboards, and mailers. Online marketing refers to organic search on Google/Yahoo/Bing, paid advertising on Google (Adwords), and of course all forms of social media like Facebook or YouTube. In contrast to internal marketing initiatives that produce referrals from your existing patient base, these external marketing programs can cost significant amounts of money. The challenge as marketers is to be able to measure the effectiveness of any of these programs in order to see where you get the best bang for the buck.

I have a strong bias for online initiatives. Online search is very specific. Someone has decided to look for a dentist or a dental procedure. Your goal is to be there and show up so they can find you easily. Offline programs require you to constantly put a message out there– 24/7 – spending lots of money and hoping and praying that someone will be motivated to call because you have stimulated their interest. Very different.

Call tracking has been around for many years. A unique telephone number is attached to the marketing or advertising message. When someone calls that number, it is call forwarded to your office telephone number. You can track the volume of calls to measure the effectiveness of the program. The calls can also be recorded to analyze your staff’s ability to convert the calls to actual patient visits.

I like the concept of using call tracking for online marketing. The call tracking platform works by inserting a small piece of code into the backend of your website. The code recognizes where the call is coming from–from anywhere online. In other words, the telephone number that shows up on your website is dynamic,  and it changes to reflect the referral source. You can have as many unique telephone numbers as you wish – each assigned to a particular online marketing program – and the number on the website changes based on where the call is initiated. The recorded calls will then provide you with useful marketing intelligence:

• What search terms did they type in to reach your website?

• How did they find your site? Was it an organic search, or from another marketing campaign like    Adwords or a Facebook ad or even  a Facebook post?

• What page of your site were they on when they made the call?

Basic Google analytics can measure how many visits occur on your website. But adding call tracking greatly enhances your ability to refine this data, and measure how successful you are in converting visits into an actual telephone call. That then leads to the ultimate analysis of how many calls are converted into an actual new patient appointment.

Call tracking is relatively inexpensive. Your webmaster can add this for about $100 a month. I think you should give it a try.

Remote deposit capture is a technology that was first introduced about 10 years ago, but only in the last few years has become much more available to dental offices. RDC is a service which allows users to scan checks and transmit the scanned images to a bank for posting and clearing. Requirements for users are a PC, an Internet connection, and a check scanner provided by your bank. Practically all banks now offer this service.

The bank’s software is downloaded into the office computer. Training is quick and easy. Basically, if you can read, you can do this! The checks that you receive at the practice are scanned and a digital deposit is created. The digital deposit is then transmitted over an encrypted Internet connection to your bank. The bank accepts the deposit, posts the deposit to your account, with next day availability of the funds. Four advantages come to mind.

1. Efficiency–it takes less than 5 seconds to scan a check, and when you have finished scanning all of the checks, a virtual deposit slip has been instantly created. Without this technology, someone has to manually record the dollar amount of each check on a deposit slip. This process typically includes counting the number of checks and adding the value of the checks–at least twice–to be sure that the deposit is accurate and balanced.

2. Convenience–the doctor or a staff member is no longer required to physically leave the office and go to the bank branch to make the deposit.

3. Reliability– RDC stores up to 60 days worth of check images. This will usually eliminate having to pay your bank “research fees” for problems associated with the deposit of any check.

4. Functionality – The RDC software interacts seamlessly with all of the major accounting software programs.

In my opinion, however, one of the biggest advantages of this technology is that it gives a dentist multiple options for finding better or more competitive banking relationships. Without this technology, you are pretty much limited to using a bank with a branch office in your neighborhood so that you don’t have to travel very far in order to make a deposit. Now you can potentially use any bank.

Let’s say that you want to take advantage of current low interest rates and refinance an existing loan. Maybe you need a new loan for expansion of your facility, or for the purchase of major technology, or to acquire another dental practice. XYZ Bank–located two states away–may have a fantastic low interest rate and generous amortization terms. That bank, however, will only offer that great rate to you if you give them your depository relationship. That’s how banks make money. With remote deposit capture, you are now able to expand your options and most likely save significant amounts of money. Go for it!

Whenever a bank considers the merits of a commercial real estate property–whether an apartment building or a mall with stores–they make their financing decision and loan allocation based on expected revenue. That revenue is always reduced by some kind of historical metric that accounts for shrinkage, because there will always be periods of time when an apartment is not rented or some store suddenly goes out of business.

Dentists tend to go ballistic when a gap opens up in their schedule affecting their expected revenue. Especially when it is because of a last-minute cancellation for a large block of time reserved for some profitable comprehensive dental treatment. Unfortunately, these kinds of situations go with the territory. People will always disappoint you, and there is no way to totally eliminate this behavior. The trick is how to reduce it. I have been around long enough to realize that success is how you deal with plan B.

I have never been a fan of charging for broken appointments. People always rationalize their actions and will not accept responsibility. The negative ramifications and publicity from someone bad mouthing your office for the charge is simply not worth it. And the amount of money you charge can never come close to replacing the revenue that was lost. Another strategy that doesn’t work is having people leave a significant nonrefundable deposit on a credit card to guarantee the appointment. This, in my opinion, seems unusually harsh and severe.

I have found success in reducing last minute cancellations by using a concept I call “the power of the doctor”. When the diagnosis is made and the patient agrees to treatment, the doctor–looking the patient directly in the eye–says the following to prepare the patient for any crown and bridge appointment:

“Mrs. Jones–I’m excited to be able to perform this treatment for you. But I want to let you know that we only schedule these appointments on certain days and at certain times of the day. You probably are not aware that there are many people involved in this appointment: I have a lab technician on call, I have a delivery person standing by to be sure the impression gets to the lab on time, and I have a ceramist all set to make sure that the color is perfect. So since so many other people are involved with this procedure, when you schedule this appointment with Jane, please be sure to do so at a time when you will absolutely have no conflicts in your personal schedule. Is that okay?”

When the patient answers in the affirmative, the patient has in fact made a promise to their doctor. This is very different from giving the impression that you are going to lose a lot of money if the person doesn’t show up. I have found this technique to be extremely successful in reducing last-minute cancellations and no-shows in the doctor schedule. But it has to be the doctor -not anyone else–delivering this message.