Monday, February 1, 2016

FEES---TO RAISE OR NOT TO RAISE IN 2016?

Practice management surveys report that approximately 74% of dentists raised fees in 2015.  Those of us involved in the management side of dental practice would prefer that 74% were closer to 100%.  I agree with many other management consultants who recommend an annual fee increase, every year.

Why an annual increase?


  • An annual fee increase allows a practice to better control overhead (as a percent of collections), and, thereby, steadily increase profit.
  • Fee increases each year raise the fee profile in a dentist’s zip code area, thereby applying some pressure on managed care companies, including Medicaid, to increase reimbursements.  The greater the number of dentists who increase fees annually in any given area, the greater the chance of increased reimbursements under managed care contracts.
  • Without a regular annual increase, a dentist has no hope of staying ahead of inflation.  A dentist who skips an annual increase can never sufficiently raise fees some year in the future to make up for lost revenue.  Additionally, managed care plans that require providers to submit an annual fee schedule will not allow an inordinately large fee increase in a single year to compensate for previous years in which a dentist did not increase fees.  

If you’re unsure of the percentile into which your fees fall compared to other practices within your zip code (first three digits), do some homework.  Remember, you want to know where your fees rank in the overall scope of fees within your zip code; you cannot collude with other dentists to set your fees.  An excellent source of information for making this comparison is Dr. Charles Blair’s comprehensive Revenue Enhancement Program which provides analysis of fees for every ADA procedure code listed by specific zip codes.  For more information about Dr. Blair’s Revenue Enhancement Program, call 866-858-7596 or go online to www.practicebooster.com.  If you find your fees are well below others in your area, use 2016 to adjust them to a percentile that reflects the quality and scope of your practice.


The Consumer Price Index predicts inflation to be 2% - 3% in 2016; therefore, I recommend a fee increase of 2.5% to 3% in 2016 once your fees are within an acceptable range commensurate with others in your area.  If you have let your fees lag well behind averages for your area, it may take several years of fee increases greater than the inflation rate to bring your fee schedule in line.  Begin to do so in 2016. 

Monday, January 25, 2016

SMORGASBORD OF CLINICAL NEWS

Pick up almost any dental publication, and facts based on new research and technology development seem to jump off the pages.  Dentists are life-long learners and, now more than ever, they must stay abreast of the latest factors affecting the profession.  Such factors may concern clinical research, business management, or overall changes in the profession itself.  Let’s look at a few clinical research facts in the news now.  Incidentally, I learned of these and many other clinical studies in just one hour of perusing dental magazines, journals, and newsletters.

·    Tetracyclines have been linked for years with staining and enamel hypoplasia of developing teeth in young children.  In a recent study, No Visible Staining in Children Treated with Doxycycline for Rocky Mountain Spotted Fever, researchers observed no staining of children’s teeth in the group receiving doxycycline which is a newer medication in the tetracycline class.  58 children who received doxycycline for RMSF were compared to 213 children who had never received the antibiotic.  There was no significant difference between the two groups in either staining or tooth shade. 

     For more details, visit jpeds.com to read the article that was published online earlier in 2015 in the Journal of Pediatrics.

·    Dentists and other health care professionals are being reminded to take a thorough health history before prescribing prescription pain medications or even over-the-counter (OTC) medicines to women of childbearing age.  The U.S. Centers for Disease Control (CDC) has stated that prescribing opioid pain medications is a “significant public health concern.”  Further, the CDC states that taking opioids early in pregnancy can cause birth defects and other serious problems.  According to the most recent figures for one year, approximately one-fourth of privately insured women and one-third of women covered by Medicaid between the ages of 15 - 44 year filled a prescription for an opioid. The most commonly prescribed opioids for pain are codeine, hydrocodone, and oxycodone.

      For more information on this topic, visit cdc.gov.

·    In a new study researchers at Case Western Reserve University (CWRU) School of Dental Medicine and Case/Cleveland Clinic Postmenopausal Health Collaboration found link between postmenopausal women who are susceptible to bone fractures and symptoms of severe gum disease.  While the study states that more research is needed, the link may prove a useful tool in predicting severe gum disease in post-menopausal women.  In short, bone-loss scores (determined by physical examinations to assess Fracture Assessment Risk) may provide a reliable indicator for the propensity of gum disease in post-menopausal women. The reasoning follows a trail that begins with the fact that women may have a significant amount of bone loss in the first ten years of menopause as estrogen levels drop.  Lower estrogen levels affect the mouth, causing inflammatory changes that can lead to gingivitis and more severe gum diseases which, if left untreated, may result in tooth loss.

     Visit the CWRU School of Dental Medicine website for more information on this and other studies.


Monday, January 11, 2016

A PERSONAL STORY…

First, you need to know that I consider the greatest benefit of my 35 years of working with the dental profession to be the close relationships I’ve developed with many dentists, some of their family members, and many of their team members.  I am beyond grateful for the close friends I count among you.  You are a true blessing in my life.

Second part of this story---in February 2015, I wrote an article for Practicon’s Premier Rewards Program members entitled The Magic Bank Account.  The article quoted a written piece that was found among Coach Paul “Bear” Bryant’s papers after he died.  Of all the articles and blogs we’ve posted on Practicon’s website, this one has brought the most comments and the most requests for permission to duplicate.

And the third chapter of my story---imagine my surprise and delight when a long-term friend, dentist extraordinaire, emailed me a copy of my article that he had adapted to read at his daughter’s wedding in October.  Wow!  Talk about making my heart happy?! He did just that!

The original Bear Bryant piece quoted in my article:

“Imagine that you won the following prize in a contest---each morning you are to receive $86,400 deposited into your private bank account for your use.  However, the prize has rules:  (1) You and you alone may spend the money.  (2) The money may not be transferred into any other account, and all that you do not spend that day will be taken away from you.  (3) The bank opens your account with another $86,400 each morning, but at any time, without warning, the bank can say, “Game over.”; close your account; and you will not receive a new one.

What would you do?  You would buy anything and everything you wanted, right?  You would spend it on those you love and care for, and, perhaps, you also would buy things for some people you don’t know.  You couldn’t possibly spend all that money on yourself every day, right?  You would try to spend every penny each day---use it all because otherwise it would be taken away.  And, besides, it will be replenished in the morning, right?

ACTUALLY, THIS GAME IS REAL!  SHOCKED? YES!!  Each of us is already a winner of this PRIZE.  We just don’t realize it.  THE PRIZE IS TIME.

Each morning we awaken to receive 86,400 seconds as a gift of life.  And when we go to sleep that night, any wasted time is not credited to us.  What we haven’t used wisely that day is forever lost.  Yesterday is gone.  Each morning the account is refilled, but the “bank” can dissolve our account at any time with no warning.

So…what will you do with your 86,400 seconds?  Those seconds are worth so much more than the same amount of dollars.  Think about it, and remember to enjoy every second of your life because time races by so much quicker than we realize.  Take care of yourself, those you love, and other people as well.  Be happy, love deeply; express appreciation and cherish life.  Enjoy!  Here’s wishing you a wonderful, beautiful day.  Start spending.  Spend wisely.  And don’t complain about growing old---some people don’t get the privilege.”

My friend added words of wisdom for his daughter and new son-in-law as only a loving father could.  He reminded the couple to enjoy ALL of their life’s seconds and named special ways to add to that enjoyment.  On and on…he shared beautiful thoughts and poignant phrases that honored the young couple and reminded them to “be grateful for the blessing and privilege of growing old together.”
I must admit my eyes were overflowing with happy tears by the time I finished reading my friend’s masterpiece.  I can only imagine wedding attendees and the happy young couple needing hankies and tissues also.


Thank you, my dear friend, for sharing with us your heartfelt wisdom in the words spoken to your daughter and her groom on the day of their wedding.  

Monday, January 4, 2016

HELP! WHAT DO I NEED TO KNOW DAILY TO MANAGE MY PRACTICE?

Do you sometimes feel you are running with your hair on fire, trying mightily to control all the details of managing your practice?  If you don’t occasionally experience such frustrations, you are, indeed, the rare practitioner who is a natural at juggling all the details of business management.  However, if you are among the vast majority of your peers who experience stress as you try to weave all the threads of your practice together, let’s start by discussing what you should know on a day-to-day basis.  We’ll begin with a list of specifics you need to know each day and conclude with a Daily Activities Report which your staff can complete for you at the end of every day.  With such information, you will be able to analyze the business aspects of your practice and, if necessary, seek advice from your accountant or practice management consultant.
Daily, you must know:
            Production – total and in comparison to goal
            Collections – over-the-counter plus mail and electronic payments – total and in                           comparison to goal
            Bank deposit
            Adjustments and write-offs, including managed care, welfare, and professional                           courtesy
            Total number of patients scheduled
            Total number of patients seen
            % of patients seen = Show rate (number of patients seen ÷ number scheduled)
            Referrals made or received
            Total number of broken or cancelled appointments (BAs and CAs)
            Total number of BAs and CAs rescheduled



Daily Activities Report
Date:____________________

Restorative
# Patients scheduled                                                                                __________
# Patients seen                                                                                         __________
% Show rate, not including emergencies                                                __________
            (Divide # seen as appointed by # scheduled)  
Broken/Cancelled appointments                                                             __________
# Rescheduled appointments                                                                   __________

Hygiene
# Patients scheduled                                                                                __________
# Patients seen                                                                                         __________
% Show rate                                                                                            __________
#Broken/Cancelled appointments                                                           __________
# Rescheduled appointments                                                                  __________

Total production                                                                                   $_________ 
            (% Restorative _______     % Hygiene_______
Total Collections                                                                                   $_________
Collection % rate                                                                                    _________%
            (Goal = 97% or more; collections  production)
Over/Under Production goal                                                               $_________
Over/Under Collection goal                                                      $_________              

Monday, December 28, 2015

Ann answers your questions - How can I bill insurances for apnea device for my patients?

Dear Dr. Cole,

Thank you for your question concerning billing for sleep apnea devices.  That is a growing concern among dentists who fabricate these appliances.

You are correct---obstructive sleep apnea appliances are not typically a covered dental benefit and should, therefore, be billed to the patient’s medical insurance plan.  If, however,  you choose to file with a patient’s dental insurance, use code D5999, Unspecified Maxillofacial Prosthesis, by Report, and include your diagnosis and treatment plan with the claim. 

You mention you have been trying to bill medical plans for these devices, but are having difficulty doing so which must mean you are not receiving payment.  Most medical plans will not reimburse a dentist for these devices unless the claim is accompanied by a medical diagnosis including a sleep study for that particular patient.

Due to these cumbersome restrictions, many dentists choose to bill the patient for sleep apnea devices.  I suggest you calculate a fair fee for the device and present it to the patient as just that---a fair fee for a device that will greatly enhance their sleep patterns and, therefore, their overall health.  Inform them about the need for a medical diagnosis and sleep study if the claim is to be filed with their medical insurance.  Make it clear to each patient needing a sleep appliance that you try to help patients by billing both their dental insurance and medical insurance plans; but so far, you have not received payment from either type of plan.

Most CDT 2016 advisory guidebooks state that snoring is generally considered neither a dental nor a medical problem and, therefore, cannot be billed to either type of plan.  One guidebook even states that snoring is a social issue.  Interesting!  Therefore, I think you should bill patients for whom you fabricate snore guards with no mention of filing insurance unless the patient requests you do so.  Then you can explain that the fee for anti-snoring appliances are not reimbursed by either dental or medical insurance.

In researching new information to help answer your question, I came across a website that you may want to visit---www.sleepcomplete.com which has a byline, Sleep Complete, Dental Sleep Medicine Program.  Additionally, I suggest you contact the American Dental Association to ask if the Code Maintenance Committee which takes suggestions for code changes and additions until November 1 of each year has sleep apnea appliances on its list of suggested changes for 2017 codes.  If a sufficient number of you practicing dentists ask the ADA Code Maintenance Committee to propose an additional code for 2017, perhaps dental insurance carriers can be pressured into covering this service.  The ADA has the collective clout of all you practitioners and may well be the only organization powerful enough to demand an answer to this problem.

Thank you for your question and your interest.  We appreciate your considering Practicon among your favorite dental suppliers as evidenced by your orders, and we look forward to providing world-class products and service to you and your staff for many years to come.


Ann Page Griffin