Monday, May 2, 2016

THE MAYONNAISE JAR

For 10 years I have saved an email post, one of those read-quickly-and-delete items.  This one, however, stuck in my mind, and I have found the concepts it poses useful many times in the ensuing years.  I’d like to share this bit of philosophy with you in hopes it will be helpful to you too when life crowds in and days do not have enough hours to accomplish all you must.

A professor walked into his classroom and wordlessly began to use several small items on his desk.  He picked up a large empty mayonnaise jar and filled it to the brim with golf balls.  He asked his students, “Is the jar full?”  “Yes.” came the response. 

Then the professor opened a bag of small pebbles, poured them over the golf balls so they filtered around the balls.  “Is the jar full now?”  A more emphatic “Yes.” rose from the group.

Next the professor shook the jar slightly and picked up a small box of sand, easily adding its contents to the jar.  “Full now?”  “Absolutely.”  After a pause, the professor took a cup of coffee from his desktop and poured it into the jar.  Students laughed as they puzzled over the meaning of this exercise.

Now, explained the professor, the jar represents your life.  The golf balls are the important things---your God, your family, friends, health, your passions that are so meaningful that if everything else were lost and only they remained, your life would still be full and rich.

The pebbles represent the other things that matter---you career, your home, car, hobbies, work with worthwhile organizations and so on.  The sand is everything else that occupies your time and energy, the small stuff. 

If you put the small stuff, the sand, in the jar first, it would be so packed that no pebble- things or golf-ball-things could be added.  The same principle applies to your life.  If you spend all your time and energy on the small stuff, you’ll never have time for the things, the golf-ball-things or the pebble-things, that are supremely important to you.  Play with your children, regularly attend your house of faith, take time to get medical checkups, schedule regular dinner dates with your partner, play another 18 holes, go hunting or fishing before raking leaves.  There will always be time for cleaning the house or fixing the disposal after the things that really matter are done.  Pay attention first to those priorities that are necessary for your happiness and well being, and let the minor things fit between or disappear entirely.


One of the students raised her hand to inquire what the coffee represented.  The professor smiled.  “I’m glad you asked.  It just goes to show that no matter how full your life may seem, there’s always room for a cup of coffee with a friend.”

Monday, April 25, 2016

“FREE STUFF” CAN BE VERY VALUABLE!

Most of us have learned from experience that “free stuff” is seldom worth much.  “You get what you pay for.” is an oft-quoted axiom---but I want to negate that idea by focusing your attention on free resources for your practice that will, I believe, prove most valuable to you and your practice.  These free resources are offered as a way for me to say “Thank you!” to the hundreds of dentists with whom I have worked personally and the thousands of dentists and staff members who have attended my seminars, read my articles and blogs, used my dental text book chapters, and continue to be loyal Practicon customers.  You have allowed me to work with this profession that I love and respect for over 30 years, and I appreciate you!

We have created a section on Practicon’s website, entitled FREE Resources for Your Practice.  The Resources include practice management numbers, averages, and statistics, forms, letters, surveys, marketing specifics, guidelines, and articles---practice management data that has been time-tested in busy practices and proven invaluable in growing and managing any dental practice.  And they are all FREE!

Search by topics for ideas and advice:

·         Associateships, Partnerships, and Start Ups
·         Interviewing, Hiring, and Training
·         Personnel Administration
·         Scheduling and Recare System
·         Practice Management; Knowing the Numbers
·         Marketing                     

YOU need to gear your practice to new levels of service, profitability, and just plain enjoyment.

Monday, April 18, 2016

FLASHING NEON HEADLINE: JUNE 1, 2016 IS THE DEADLINE…

By June 1, 2016, dentists must register as a Medicare ordering/prescribing provider of Part D prescription drugs for your Medicare-eligible patients or opt out of the program.  Just what does that mean for your practice?  There is much more at stake here than whether or not prescription drugs you prescribe for your Medicare-enrolled patients will be covered.

If you do not register with CMS (Centers for Medicare and Medicaid Services) or formally opt out of the program, your patients, your practice, the pharmacy filling prescriptions for your Medicare patients, the labs and specialists to whom you refer Medicare patients, durable medical equipment suppliers who might supply a sleep apnea device you order for a Medicare patient, etc., will not be paid by Medicare.  Incidentally, OPTING OUT as a Medicare provider requires action by the dentist---it is not the same as doing nothing.

In summary:

  •  If you do not register with CMS or formally opt out, drugs you prescribe for your patients enrolled in Medicare normally covered under Part D or Medicare Advantage plans will not be covered.
  • If you do not register with CMS or opt out, you will be unable to submit claims to Medicare Advantage plans, some of which do cover dental services.  Further, your Medicare patients cannot receive payment from their Medicare Advantage plan either.  And if you choose to opt out, neither you nor your patients can submit claims to their Medicare Advantage plans.
  • If a dentist takes no action by June 1, specialists and oral pathology laboratories to which you refer Medicare patients will not be paid by Medicare.  Ditto for imaging services and durable medical equipment suppliers.
  • If a dentist chooses to opt out, he/she must complete an affidavit to be sent to all Medicare contractors with whom he/she works.  If a dentist complies with opting-out procedures, specialists, laboratories, service and supply providers to whom Medicare patients are referred will receive payment from Medicare.  Additionally, Medicare patients can get their Part D prescription drugs covered by Medicare.

The easiest way to register with CMS is to complete CMS Form 8550 to become an “ordering/referring provider.”  The alternatives are:  (1) to register as a “Medicare Provider” using CMS Form 8551 or (2) to formally opt out of the program.  (Note the method and consequences of opting out listed above.)

These regulations, part of the Affordable Care Act (Obamacare is the commonly used name.), squeeze dentists between a rock and a hard place---either enroll as Medicare prescribers or providers which means they agree with rules, regulations, and guidelines of Medicare and can, therefore, be audited at any time by Medicare agents or forfeit the use of Medicare Advantage plans for their patients dental care, prescriptions, referrals, oral pathology work, etc.

Currently there is a bill active in Congress, H.R. 4062, that would exempt dentists from having to enroll in the Medicare program in order for prescriptions for Part D covered drugs to be paid under Medicare.  Suggestion: contact your U.S. Congress member to urge passage of the bill.

For additional information about enrollment/registration procedures or opting out of the program, go to Success.ADA.org/en/practice/medicare.  Move on this before the June 1 deadline!

Monday, April 11, 2016

CORPORATE DENTISTRY---LOOK BEFORE YOU LEAP!

“Corporate Dentistry” is the term used to describe the second wave of effort by industrial corporations to operate dental offices.  In the late 1980s – early 1990s the phenomenon was called “Dental Practice Management Companies” (DPMC).  At that time few practitioners were willing to sell their practice to a DPMC, but quite a number were willing to sign a contract with a DPMC, allowing the management company to take over the administration of their practice, making all business decisions and the majority of clinical decisions as well.  It was the interference with clinical decisions, specifying the type of equipment, instruments, materials, and medicaments to be used, the lab of choice, the referral pattern, etc., that finally called a halt to large growth of the corporate effort.  The DPMC concept faded but did not disappear entirely.

In the last few years, the corporate world has again mounted an effort to turn the practice of dentistry into a corporate profit center, this time as “Corporate Dentistry” seeks to buy practices and then hire dentists to provide services, much as any business would hire employees.  Active since the early 2000s, the corporate takeover of entrepreneurial-based dental practices is now a reality.  “Corporate Dentistry” is attracting many new-to-practice, deep-in-student-loan-debt dentists as well as seasoned practitioners nearing retirement, eager to sell their practices.

The success of “Corporate Dentistry” is supported by facts---the four largest dental corporations grew by 85% between 2011 – 2015:  Aspen Dental grew from 240 offices in 2011 to 497 in 2015; Heartland Dental grew from 300 offices to 670 during those years; Pacific Dental increased from 200 offices to 400; and SmileBrands, from 325 to 400.⃰  
Several reasons for such explosive growth: 
  • A steady supply of venture capital from investors interested in the health care arena.
  • A growing number of newly-minted dentists eager for immediate employment so they can begin repaying student loans.  Signing bonuses and re-settlement allowances sweeten the corporate offers.
  • Corporations have inflated the value of existing practices to encourage practice sales by dentists approaching retirement or those practitioners who simply want to be free of the rigors of practice management. 


Mistakenly, many of the dentists who decide to sell are convinced it will be a benefit to sell to a dental corporation and remain in the office as an employee without the stresses of practice management.  Little does the dentist realize he/she will just exchange one set of stresses for another; i.e., meeting the production/collection goals set by the new owner/corporation, delivering care under regulations set by the new owner; using materials and supplies that are chosen and purchased by the new owner, working days and hours set by the new owner, and so on.  

Any dentist considering going to work with a dental corporation or selling his/her practice to a corporate buyer should consider the following list of questions and concerns and obtain answers before signing on the dotted line.  If you consider sale of your practice to a dental corporation, I urge you to use this list of questions as the starting point for any number of additional questions that may occur to you.  Make a written list of all questions.  Get answers in writing or in a recorded conversation.  For you seasoned dentists, seek full counsel from the professionals who have advised you through years in practice.  For those of you considering beginning practice as a corporate employee, do your homework.  Calculate your prospective long-term compensation in private practice VS the more limited compensation you will receive long-term in a corporate setting, and seek professional advice from advisors fully knowledgeable about the business aspects dental practice, associateships, employee status, contract negotiation, and so on.

Key Questions to Ask About Corporate Dentistry

How long has the dental corporation been in business?  Is it offered for public sale?  On which stock exchange?  What is the performance history of the stock?  How was the corporation funded initially?  Who was involved and are they still associated with the corporation?

Who are the corporate officers?  Managers?  What is their background, experience, fiscal responsibility, location?  How is their remuneration calculated?

How is this dental corporation different from other similar companies that purchase dental practices?

May I have the names of several other dentists who have sold to this corporation or are employed by this corporation?  May I discuss their experience with them?

Will a neutral professional do the evaluation of my practice?  Who?

Which practice management responsibilities are retained by the dentist who remains as an employee?  How is practice management advice given to the dentist?  By whom?  What experience, expertise, and credentials does the manager/administrator of the practice have?

May I see an employment contract at the same time I receive a purchase-offer contract?
If I am to remain as an employee, will there be a confidentiality agreement?  Will it apply to the corporation as well as to me?  Describe the restrictive covenant.

What will be the duration of my employment?  What happens if I do not wish to leave when my employment contract ends?

When I am ready to retire from practice, how will my replacement be recruited?  If employment of my replacement is delayed, will that affect my departure date or process?

How am I to be compensated as an employee?  Once the sale is completed, will my compensation remain the same?  For how long?  Which benefits may I continue to run through the practice?  Which benefits will I receive as an employee?

Will I receive all fees generated and due prior to the date of closing?  Will this be in the sales contract?

If one or more additional dentists or more auxiliaries are hired, will that affect my compensation?

Will I receive full purchase price at closing?  If not, why not?  If full payment of the practice evaluation depends on my meeting certain production goals, what happens if I do not meet those goals for some period of time?

Will my current staff remain employed when the sale is finalized?  Will current computer, telephone, dental equipment, etc., remain in place?  For how long?

Does the purchasing corporation operate dental practices on cash or accrual accounting systems?  (If an accrual system is used, charges are counted as income when made/produced rather than when collected.  This could affect a computation of compensation based on a percent of production/collection.)

If one of the advantages of a practice owned by a dental corporation is volume buying of supplies, what happens if I prefer different brands or different materials than on the contracted product list?

If I, the practicing dentist, disagree with some decision or requirement of the owner or administrator, how is the disagreement mediated?  Settled?

Sale of your practice to a dental corporation and/ or employment by a dental corporation is an important, potentially life-altering choice.  I urge you to seek answers to these and other questions that may occur to you.  This is not a decision to be made hurriedly or unadvisedly.  Get counsel from a professional familiar with all aspects of your practice and/or the corporate dental world before you leap into the arena of dentistry as a public profit center.  It will be well worth the time and any fees involved. 

⃰  The McGill Advisory, The Hidden Threat of Student Loan Debt, Volume 30, Issue 7, July 2015

Monday, April 4, 2016

TELEDENTISTRY

Ever think dentists might deliver care outside the confines of a physical operatory?  The time for doing so has arrived.  In 2012, the ADA House of Delegates first issued policy guidelines on Teledentistry, primarily addressing technical aspects of virtual dental services.  In November 2015, the ADA House passed Resolution 45H-2015, Comprehensive ADA Policy Statement on Teledentistry.  This resolution outlines patients’ expectations and rights, workforce licensure, and payment concerns.

Providing services via Teledentistry tickles one’s imagination, considering the provider may be across town or even hundreds of miles away, on a computer screen instead of chairside.  The number of ways for dentists, allied dental personnel, and patients to interact is growing quickly. 
Currently Teledentistry includes:  

·         Live video exchanges between a dentist and a patient or between providers using audiovisuals such as Skype or FaceTime.
·         Secure electronic transmission of patient records---health history, photos, x-rays, digital impressions, etc.---allows an off-site dentist to evaluate a patient’s condition and recommend treatment; i.e., remote diagnosis and case presentation followed by services delivered during a hands-on appointment.
·         Public Health practice and education can be delivered via mobile communication devices that include apps that teach and monitor homecare regimens.
·         Residents in nursing homes or other residential care facilities, people in rural areas with no access to dental care, community dental events---people in these and similar circumstances will benefit enormously from remote patient monitoring possible with Teledentistry.  Their cleanings, fluoride application, sealants and so on can be delivered by a virtually-supervised dental auxiliary with services from a dentist provided in person as needed.    

The ADA House Resolution further stipulates that auxiliaries participating in Teledentistry must be licensed and supervised in accordance with the state practice act of the state in which the patient receives services and the supervising dentist is licensed.  Additionally, the Resolution states that third party payers and dental benefit plans should reimburse Teledentistry services at the same rate as in-person services.   Earlier the state of California moved a step ahead in mandating similar payments when the legislature passed laws directing the state’s Medicaid program to reimburse providers for Teledentistry services on the same scale as in-person delivered services.