Monday, July 24, 2017

One of the most important numbers in the management of a dental practice is the number of active patients. Question: if you were asked how many active patients you see in your practice, could you answer correctly, or within 100 patients, or even within 300? Just think—an accurate active patient count is the basis for calculation of the effectiveness of the Recare System and the Recare System is the life blood, the very heart, of a viable practice. In fact, typically 50% to 85% of the treatment delivered and 30% to 35% of office production in a general or pediatric practice comes via the Recare System.
Active patients are NOT simply the number of charts in the file cabinets or the number of names in the computer. An active patient in a general practice is one who has been seen for recare or treatment within the past 18 to 24 months, not counting single visit emergencies who never enroll in the practice. An active patient in a pediatric dental practice has been seen for recare or treatment within the past 12 to 18 months, again, not counting emergency patients who never return for other care.
The process of counting the number of active patients in your practice must start with a chart purge, either manually or electronically. Each patient record must be reviewed for:
  1. (Overdue recare visit
  2. Undelivered or incomplete diagnosed treatment
  3. Delivered but unchecked dental appliances, or
  4. Post-ops on emergency or surgical cases
Patients in these categories should be contacted for re-scheduling. A telephone call provides an opportunity for a staff-to-patient personal conversation, producing the best results for reappointment. A text message is next most effective, followed by email contact.
Once an accurate patient count is completed, the effectiveness of the Recare System can be determined following the model below. Be sure to note the Effects on Production figures at the end of the model—SURPRISE!
Given, for example, 2,000 active patients on a six-month recare schedule:
  • The Goal for Monthly Recare Patients in a 100% effective system would be about 333 appointments per month.
If your actual average is only 120 appointments per month, then:
  • Your Recare System is only 36% effective.
BUT, if you set your minimum goal to be 80% of your active patients instead (1,600 patients out of 2,000):
  • The number of recare appointments increases to 267 per month.
AND, if the average fee charged for each recare appointment is $150:
  • The Effects on Production of adding 147 monthly appointments would be an additional $22,050 per monthwhich equates to a $264,600 annual increase in production!
WOW! The potential increase in production plus more frequent and consistent care for patients proves the value of maintaining an active patient count. A dentist must know just how many active patients are enrolled in his or her practice. The decision to determine how many active patients you have in your practice may necessitate a chart purge, and, if necessary, hiring another hygienist and adding another hygiene chair, but are well worth the time, effort, and investment!

Monday, July 17, 2017

A Dental Service Organization (DSO) is a group practice working under contract with a Dental Management Organization (DMO) that manages all business and personnel activities and decisions of the practice. DSOs and DMOs are making serious inroads into the profession.
A bit of history: As recently as 2011, one well respected dental practice management advisory company* reported 72% of the dentists in their significant client base were in solo practice. In a May 2017 survey conducted by this same company, only 56% of their client base remained solo, demonstrating a startling move to group practice. This survey supports other evidence that the dental practice model we’ve known for generations in the U.S. is changing from solo to groups of two, three, or four or more dentists.
Group practice offers advantages such as increased hours of operation, economies of scale, expanded use of the office and staff work hours, and a wider scope of procedures available in-office. Management of group practice is, however, more difficult and time consuming. Obviously, more personalities are involved among a group of dentists and among the increased number of staff, often bringing  a propensity for increased interpersonal conflicts. Individual dentist’s preferences for certain instruments, equipment, medicaments and such complicate inventory control and ordering. On and on—practice management typically becomes more laborious in group settings. That truism is a major factor in many dentists’ willingness to sign contracts with DSOs and, subsequently, DMOs. When an outside company is running the practice, it would seem to some dentists, particularly the younger doctors, that the burden of management is lifted and they are, therefore, free to concentrate only on patient care. Unfortunately, that is not true; but that’s a topic for another discussion.
Just how widespread is the DSO/DMO onrush? The American Dental Association Health Policy Institute (HPI) released a survey of new data in March 2017 via webinar. An excellent infographic summarizing data from the webinar is available at The data is broken down by gender, age, specialty, and state.
Interesting highlights from the survey: By gender, 10.2% of female dentists and 6.1% of male dentists are in group practice contracted to a DSO. By age, DSOs have enrolled 16.3% of 21-34 year old dentists, 9.8% of 35-49 year olds, 3.4% of 50-64 year olds, and 2.5% of practicing dentists 65 years and older. Specialties are listed on the infographic in descending order with pediatric dentists in first place with 8.1% practicing within a DSO. Prosthodontists are fewest in number with 3.6% involved in a DSO. 7.7% of general practitioners have opted for a DSO contract. Six states report no DSOs operating within their borders: AK, DE, MT, ND, SD, and WV. Arizona and Texas report the highest concentration of DSOs and DMOs at 17.5% and 15% respectively.
For additional information, including the infographic and an opportunity to view the entire webinar, go to Suggestion: see where your state falls in the ratio of concentration of these for-profit organizations that are changing the landscape of private practice. Begin now to evaluate the positives and negatives of DSOs and DMOs so that if the time comes to choose whether you will retain ownership and control of your practice or to sell to a management organization, you can make an informed decision.

*The management advisory company mentioned above is The McGill and Hill Group, LLC. Go to for more information on their services. 

Monday, July 10, 2017

New research shows that even one fluoride varnish treatment per year can reduce cavity rates by 50% for children in the 6 month to 3½ year age range. Additionally, more dentists are now using fluoride varnish on adult patients who are at high risk for developing caries. In addition to helping combat a rising caries rate in adults, the preventive varnish treatment can increase hygiene production in the dental practice.
Latex gloves were first used by health care providers in 1883 at Johns Hopkins Hospital in Baltimore, Maryland. A surgical nurse, Caroline Hampton, developed a rash from chemicals she handled while assisting with surgeries. Dr. William S. Halstead, the surgeon with whom she worked, contacted Goodyear Rubber Company to manufacture gloves. Nurse Hampton demonstrated great dexterity while wearing the gloves, demonstrating their value to others. By 1884, the gloves were in regular use by medical personnel at Johns Hopkins Hospital, spreading from there to become standard use in surgical procedures across the country.

By 3000 BC, Egyptian embalmers practiced disinfection procedures using a mixture of resins (organic plant and tree secretions), naphtha (a flammable liquid hydrocarbon mixture used as a solvent or diluter), liquid pitch (the residue of a variety of organic materials including tar, resins from conifer trees, etc.), vegetable oils, and spices. Aren’t you glad you can purchase disinfecting agents rather than alchemically concocting your own? J

Monday, July 3, 2017

Pretend it is late afternoon of a very busy, somewhat frustrating day. Five o’clock is approaching. The last patient of the day is checking out. You, doctor, are bone-tired and eager to go home. So is your staff. Question: what is the minimal amount of information you need to know to understand how things went today? Was production on track to meet the monthly goal? Collections too? Are patients keeping appointments as scheduled? Is the hygiene department fully busy? Do you need to be aware of any problems with patients today?
Four items should be on the dentist’s desk at the end of each day: three are daily reports; the fourth is the actual bank deposit or the deposit receipt if a trusted staff member made the deposit earlier. Careful attention should be paid to all four, noting questions to ask staff the next day.
The four items are:
·      Daily Activities Report that includes production and collection totals with comparison to the daily goals, the show rate for appointments kept as made, adjustments to production and write-offs from collections, and other pertinent data necessary to provide a snapshot of the day. (An example of the Daily Activities Report can be found on Practicon’s website at in the Practice Management; Knowing the Numbers section of Free Resources for Your Practice.
·      Day’s schedule—a hard copy noting the name of each patient seen and the treatment delivered. Include the name and phone number of patients receiving extensive treatment that day so the dentist can call them at home that evening.
·      A brief narrative/explanation of any noteworthy problems with patients seen that day. With this explanation, the dentist can decide if follow-up is necessary.
·      Bank deposit or the bank receipt for the deposit.         

These four items represent the minimum information a dentist/owner should review daily in order to keep a finger on the pulse of his/her practice. Daily review allows problems or discrepancies to be caught early and potential blockbuster issues rectified before they become a major crisis.

Monday, June 26, 2017

All dental offices lose patients occasionally. Patients move. Patients pass away. Patients enroll in managed care plans and must seek an office where their plan is accepted. Some who leave may not like a particular aspect of the office ambiance—I once knew a patient who left an excellent office because she did not like the type of music played. Some are lost due to no follow-up when a patient leaves without scheduling the next appointment. Others are lost through holes in the hygiene program, never being enrolled in the regular recare routine. Still others leave due to a disagreement with the payment policies or the treatment modalities. For a wide variety of reasons, patients come and patients go.
Problems arise when multiple patients leave an office so that production declines and profit suffers. The difficulties are exacerbated when there are too few new patients to replace the ones who leave.
Look at the following chart; substitute your own fees for, perhaps, a hygiene visit, a single restoration, and a more extensive procedure. Multiply the fee charged for a particular type of procedure by the average number of patients lost per day (1, 2, or 5 in the example). Multiply that number by the number of days worked annually to calculate an annual loss of production. The total annual loss for even one lost patient per day for 190 work days in a year is staggering.
If you work 190 days/year and lose:
Spending $150/year
Spending $400/year
Spending $700/year
1 patient/day
2 patients/day
5 patients/day

Suggestion: Share this information with staff to drive home the importance of enumerating and analyzing the reasons patients leave the practice. Comprehension of what causes patients to leave should lead to diligent work to correct problems and retain patients.