Sunday, May 24, 2015
The practice of dentistry has evolved well past the old description, “Drill, fill, and bill.” As a result, managing an office has become much more complicated and burdensome. Multi-doctor practices with more staff members are now the norm rather than solo practices with two or three team members. Government-imposed regulations such as HIPAA and OSHA demand much time and attention. Electronics, including website management, social media postings, electronic charting, filing of claims, patient privacy regulations, marketing and so on demand expertise of a knowledgeable manager. In short, the dentist often cannot juggle all the balls necessary for managing today’s dental practice while continuing to care for patients with the latest and best treatment.
Many dentists are finding the answer to the additional stress of managing today’s uber-busy dental office by hiring a Practice Administrator. That poses the question to many dentists, “Where can I find someone to fill the role?” Look for likely candidates among your own team members. A bright, experienced, dependable staff member with a sense of the business aspects of the practice can evolve into an excellent Practice Administrator. You may find the right person by recruiting business or management graduates at local colleges or community colleges. Additionally, place ads with employment agencies, particularly those specializing in management level positions or healthcare practice administrators.
While you are weighing the possibilities of adding a Practice Administrator to your staff roster, the questions may arise: “Do I really need a Practice Administrator?” “What will the position cost?” “Can my practice afford it?” I’ll post some thoughts about Administrator responsibilities and compensation in my next blog. Watch for it.
Monday, May 18, 2015
As every practicing dentist knows, certain practice statistics are measuring sticks, measuring success or problems in the management and profitability of a dental office. The menu of must-know practice stats is variable, depending on how much or how little detail a particular dentist wants to know about the business aspects of his/her practice.
The following list is, in my opinion based on a 30-plus year career as a practice management consultant, the minimum amount of information needed to guide/manage a practice to sound profitability. The final set of four bulleted points are items the dentist needs to see daily to keep an on-going check on the pulse of the practice, to assure proper record-keeping, and to avoid embezzlement.
ANNUALLY, you must know:
· Break Even Point (BEP) – collections needed to pay total costs of operating the practice. Remember, ONLY collected dollars can be spent. (Read Practicon’s blogs during May; one of them will contain the formula for calculating the BEP for your practice.)
· Dr.’s (Drs.’) compensation including wages (draw), taxes, and benefits
· Net profit goal
· Budget – based on projected collections for the year less write offs and refunds (net collections) and projected expenses (How to Write a Budget is the title of the article for June 2015---watch for it.)
ANNUALLY and MONTHLY, you must know:
· Production annually, monthly, daily, hourly, year-to-date (YTD), and last-year-to-date (LYTD)
· Collections annually, monthly, daily, hourly, YTD, and LYTD
· Collection % YTD (collections
production) – 97% minimum goal
· Number days worked; number hours worked
· Expenses in dollars and as % of collections
· New patients, not including single visit emergencies who never return for a comprehensive examination
· Number of inactivated patients; most frequently given reasons for leaving
· Recare system effectiveness – goal - 70% to 80% of active patients returning regularly for Recare (# of Recares seen in past 12 months
of active patients)
· Treatment acceptance ratio when compared to case presentation (treatment delivered
treatment recommended) – goal - 85% to 90%
· Show rate - % of kept appointments (appts. kept as made
appts. scheduled) Average is 80% - 85%; goal is 90% to 95% in
General, Orthodontic and other specialties practice. Average is 75% - 80%; Goal is 85% - 90% in
Pediatric Dental practice.
· Aged accounts receivable – maximum total is 1 to 1½ months’ gross production
· Accuracy of budgeted projections for production, collections, and expenses; analysis and justification for over-spending and under-spending
DAILY, you must know:
· Collections – over-the-counter plus mail – goal 35% to 50% of that day’s charges
· Bank deposit
· Adjustments and write offs
· Total number of patients scheduled
· Total number of patients seen
· % of patients seen (show rate)
· Referrals made or received
· Total number of broken or cancelled-not-rescheduled appointments (BAs and CAs)
· Total number of BAs and CAs rescheduled
Items on Dr.’s desk daily:
· That day’s schedule with all broken and cancelled appointments, emergencies, and walk-ins noted with copy of sign-in sheet attached if one is used. Tomorrow’s schedule.
· Day sheet with production, collections, including electronic or mail receipts, and patient account balances noted
· Daily Activities Form with number patients scheduled for treatment and for hygiene, show rate for treatment and for hygiene, % of production attributed to treatment and to hygiene, number of BAs and CAs rescheduled
· Bank deposit
Friday, May 15, 2015
Every business owner, and that includes dentists, must know the break-even point for his/ her business. The break-even point is the minimum amount of money needed to pay overhead, compensate the dentist, service debt, and allow a profit (a return on the owner’s investment – ROI). Production/collection goals and the annual budget can be calculated once the BEP is determined. Remember that if a BEP is based on production rather than collections, it must be adjusted if the collection rate for the practice is less than 100%.
Formula: BEP = Total fixed costs
1.0 minus % variable costs are of gross collections
Fixed costs include office overhead (staff wages and benefits, occupancy and administrative costs, taxes, insurance, etc.), the dentist’s compensation, and debt service.
Variable costs are considered to be laboratory fees and clinical supplies (those costs which vary according to patient load) and are, typically 8% to 12% of collections in pediatric and orthodontic practices; 15% to 20% in general and prosthodontic practices.
Example: If total fixed costs are $625,000 and variable costs are 10%:
BEP = $625,000 = $625,000 = $694,500 BEP (collection goal)
1.0 - .1 .9
1.0 - .1 .9
Tuesday, May 5, 2015
June 1, 2015 is the deadline for dentists to opt-in or opt-out of being a Medicare provider. Most dentists are well aware that Medicare does not cover standard dental services; and, therefore, question the necessity of signing up. However, some dental services, surgeries for example, may be covered under Medicare or Medicare Advantage plans and some medicaments prescribed by a dentist, for example antibiotics for prophylactic coverage of patients with joint replacements or heart issues, may be covered as well. Your Medicare-age patients will expect you to help them take advantage of any available benefits, and your office can do so only if you opt-in to be a provider.
Though it seems odd, knowledgeable advisers declare that healthcare providers must make a choice between being a Medicare provider or not, and file paperwork either way. Opting-out of being a Medicare provider requires compliance with specific regulations, including maintenance of proper documentation and meeting deadlines. The healthcare provider who chooses to opt-out will be locked out for two years, at which time he/she will again have to go through the opt-out or opt-in decision making process and all necessary paperwork.
Opting-in also requires proper completion of applications, documentation, and specific compliance requirements. The dentist who opts-in agrees to submit patients’ eligible claims to Medicare and to accept Medicare limits on payment of fees.
The decision of whether or not to become a Medicare provider and the process of meeting compliance requirements is a tedious and time-consuming chore. With the June 1 deadline looming, dentists should seek counsel from their own practice management consultant, their billing service, their state dental society, or the American Dental Association at www.ada.org.
Thursday, April 30, 2015
The majority of children who receive regular dental care are seen in general practice offices. The general practitioner and the pediatric dentist, therefore, occasionally share a common problem: several adults plus the patient’s siblings show up at the appointed time, all expecting to accompany the young patient to the operatory. The dentist and staff know it is counter-productive to the young patient’s behavior, safety, and other patients’ privacy to allow several individuals in the operatory while care is being delivered. How can this problem be handled tactfully and effectively? Answer: Inform before you perform. In other words, inform the parent/guardian prior to the initial appointment that only one or two parents/guardians may accompany the child to the treatment area. Business staff can alert parents to this restriction when the initial appointment is made. Additionally, a note similar to the following example which also forewarns against cell phone use in the operatory may be emailed or USPS-mailed as part of a New Patient Welcome Packet prior to the child’s first visit.
We are looking forward to your child’s initial appointment in our office on ____(date)_____. We will make you and your child feel welcome and comfortable as we begin the journey to keep him/her dentally healthy.
During your child’s appointment, one or both parents/guardians are welcome to accompany your child to the treatment area. We ask that other adults and children who are not scheduled at this appointment remain in the reception room. It is for your child’s benefit and for the safety and privacy of all patients, Young children left in the reception room will need a supervisory adult with them.
Additionally, the use of cell phones is prohibited in the treatment area. Phone conversations can be most distracting to children, your child and others as well, preventing us from close careful communication with each young patient.
Thank you for your understanding and cooperation in these matters. Following these guidelines will allow us to better serve your child.
Dr. Mary Doe and Staff