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Dental Business Blog -  Advice By Kat

Dental Practice Transitions - What are my first orders of business?

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Check List for New Dental Practice Owners
Buying a Dental Practice is exciting, and setting yourself up for success is important in the first month. Here is a list that will be helpful in organizing business to-do items that will smooth out the transition from old doctor to new doctor. 
  1. Secure Financing for the purchase.
  2. Attorney to review final agreement, and make adjustments. 
  3. Set up Business Checking Account with a Line of Credit attached. 
  4. Lease - Must be moved over to the new doctor. I recommend consulting an attorney or The Business Advocate (See listing under Professional Services) to negotiate terms.
  5. NDAS Fee List - This is a list of UCR (Usual & Customary Fees) for your zipcode. Your Practice Transition Broker will have access to this. Request a copy for your zipcode. The fees are listed by %, and you want to compare your fees to at least the 70% column, if not more. 
  6. Identify what PPOs the practice currently participates in, and order ALL insurance PPO applications. Fill them out ASAP for credentialing, review (compare to NDAS) and file fees. This is very important, and must be done as quickly as possible. Insurance companies credential you by location, so if you were credentialed some where else this does NOT transfer to your new location. The Insurance companies take 4-6 weeks to process applications, even if you were credentialed some where else. The longer this takes the more write offs you will have to take, to keep your new patients happy. 
  7. Hire a CPA & Book keeper - Request them to set up your Quickbooks (List of Expenses). Dental Practices are usually set up on a Cash Basis format. This is important so you are able to look at your P&L (Profit and Loss) statement, and see where your business is month to month. 
  8. Set up a vendor for Visa, MC, AMEX, Discover... whichever ones you will accept. Make sure that ALL credit card terminals are switched over to you, so payments are not deposited into the previous owners account. 
  9. Hire a Payroll service. ie. Paychex, ADP
  10. Create a letter to ALL of the Patients introducing yourself. These letters commonly consist of a half page from the previous dentist endorsing you, and handing the practice over to you. The other half a page is a paragraph introducing yourself to the patients. Your photo should be included on this page next to your paragraph.  
  11. Update computer system with all of your current information, Name, Lic.#, Tax ID, DEA#, NPI#, etc... Print out an insurance claim to confirm all information is properly listed. 
  12. Change over all services to you. ie. phone, cable, internet, electronic insurance claims clearing house, register with dental software & support...
  13. Website - Contact the developer and update the website.
  14. Sign up for outside Patient Financing Sources; Care Credit, Chase, Spring Stone...
  15. Give your new team a phone script on how you would like them to answer the phones, and field questions about the practice transition. **The team must sound like your biggest fans to instill confidence in the patients!
  16. W-9, fill this out and give it to your Admin team. They will need to fax/file this with EVERY insurance company. They will also need to enclose a copy in all paper claims for at least a month. **If this is not done then insurance companies will pay under the old doctor, and they will request ALL payments back, and then they will reprocess all the claims under you. A minor accounting, and cash flow nightmare. 
  17. Order new; Letterhead, envelopes, business cards, postcards, appointment cards, and recare cards.
  18. Review; Welcome letter, Recare cards, treatment consent forms, tx refusal form, records release form, financial policy and forms, dismissal letter, collection letter, office policy manual, OSHA/WISHA manual is current and updated to you (Harris Bio Medical), current CDT code book.   
  19. Create a Marketing Plan; Val Pak, Direct mail post cards, radio advertising, SEO (search engine optimization) of your website & paid Google advertising, buses, sandwich board on the sidewalk, local newspaper, ask current patients for referrals, etc...
  20. Chart Audit A-Z- Admin team to review every active chart for over due hygiene, and uncompleted treatment. Admin teams calls each patient to schedule these appointments. ex.. Doctor is concerned that you are 1,2,6 months over due for your cleaning appointment... when would be a good time to get you in? Doctor asked me to give you a call. He is concerned that your fillings, crown.. were diagnosed 6 months ago. What days and times work best for your schedule?
  21. 60-120 days pull the Insurance Pending report to make sure insurance companies are not holding payments due to lack of information. Your Admin team should be on top of this, but it's best for you to review it with them so they know they are accountable. Cash flow is very important for you to sustain and meet your monthly obligations. **Patient portion must be collected at time of scheduling or time of treatment, unless a payment plan or outside financing source has been previously arranged. 

When purchasing a practice it's best for the transition to be clean. The old doctor leaves, and you come in and take over the team & patients. This is best because the team will emanate what culture you set, and the patients will connect and create relationships with you. 
If this is NOT clean, your new team will have a hard time respecting you as the new owner/boss. The other problem that frequently arises... is that patients generally want all of the major restorative to be completed by the old/original DDS. YOU, the new DDS must be the producer for this restorative production to pay for your new practice and financial obligations. 

Written By: Kat Johnson-Britsch

Bought A Dental Practice - What Do I Do Now?  

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Doctor's give your self a pat on the back for getting this far! Great job!! You've survived school and your ready to take all of that knowledge and apply it to a successful life plan, which includes running your own business. What you might be realizing is that Dental School did not give you the skills to run a successful business, and your trying to figure out HR, payroll, accounting, dental software, successful treatment planning and acceptance, effective communication with your patients, how to manage your new team, and make sure all the systems are in place for your new business to run smoothly and efficiently. Just know that it's ALL possible!
How does my Dental Practice function?
Begin with setting up separate weekly meetings with your dental assistant(s), admin(s), and hygienist(s). Also, set up Team Meeting every 2 weeks for 1 hour with an agenda for each meeting. These topics can be gathered from the individual meetings. Make it clear that these meetings are to create a better culture for them, and your patients. Let me be CLEAR, this is NOT a personal attack session. Think brainstorming, and implementation by your highly skilled team. Did you hear that... NOT implementation by YOU, but by your team. Give them ownership of tasks, asking them questions along the way to keep them accountable. They will report to you and the team at the Team meetings.

What if my team is in upset and not functioning?
Identify the negative person on your team, that causes others to be upset... this person is a CANCER and must be removed, immediately. I do not care how key you THINK they are to your practice. Get rid of them. You say, oh that is so harsh. No, it's not and you are the manager & owner who should set the tone and culture of YOUR practice. It's not fair for the rest of your team to be emotionally abused on a daily basis, and it will infect your culture and eventually you will loose your prized team members, and the patients who drive your practice. Getting off my soap box...
Moving forward with a positive, engaging team that knows you have their back, will make your life so much easier as the business owner. Your team will be happy and productive, this will translate into your team's exceptional patient care.

What is the MOST important daily task you perform to increase production? 
What is the 1 thing you should LOVE to do in your dental practice everyday? EXAMS!! When your assistant comes up to you or your hygienist, and asks for you to come and do an EXAM... from now on... you will jump up with a smile on your face and say YES! I will be right there. Now, your thinking... I hate exams, they interrupt me, they are inconvenient, and I just do not have time. REMOVE this quickly or you will not succeed. EXAMS are the key to filling your restorative, and hygiene schedules, and thus creating a successful dental business. 

How To Fill Your Restorative and Hygiene Schedules?
  • Exams - New Patient, Hygiene, and Emergency exams
  • Your Team - Discuss optional services you provide for your patients. Brag about how amazing your services are... Bleaching, Invisalign, Veneers, Nightguards. 
  • Dental Software - Pull the Unscheduled Treatment Report & Unscheduled Hygiene Report.  These reports tell you which patients must be scheduled for their appointments. Pull it for the last 2 years, and have your Admin team CALL patients. Some practices also print out the treatment plans, highlight "Patient Portion", and mail them with a letter from the doctor. Dr. ______________ is concerned that he has not seen you.... Please see the treatment plan that is attached for treatment that must be completed to keep you healthy....
  • Build a Short Notice List - Create a "VIP" list. Ask every patient who schedules an appointment if they would like to be on your "VIP" list. If Dr. ___________ has a change in his schedule would you like to be on our "VIP" list to  be seen sooner? If they say, yes, then ask days and times that are best for them.  

Written By: Kat Johnson-Britsch

Production - How To Fill Your Restorative Schedule

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What drives or creates production in your dental practice? 
Hygiene Program & Quality Exams - Your hygiene program will drive the most production in your dental practice, and quality/comprehensive exams will fill your restorative schedule.  

Make sure that you have a very thorough Hygiene Recall/Recare System in place. 
  • Every patient should leave with their 6 month appointment scheduled. If not, then a tickler or note in your dental system should be placed to keep track of this patient. 
  • Every  patient fills out a recare card to send out in the mail, 1 month prior to their appointments. This gives your patients plenty of time to reschedule, and saves last minute cancellations and no shows. Some offices automate this with some success through Demand Force, or Smile Reminder.  
  • Recall/Recare "Confirmation" calls. 1 week prior to their appointments give them a "Confirmation call". Gives your Admin time to fill the hygiene schedule if their are changes.   
  • Recall/Recare "Reminder" call. 1 day prior to their appointments. This is a reminder and can be done by call, text or email. 
  • Your dental software will also give you a report listing patients who are not scheduled for their recare appointments, and who is past due. Check in with your admin weekly to make sure they are servicing this list. 
How many Hygiene days do I need? 
250-300 patients are equal to 1 day of hygiene in your Hygiene Schedule. So if you have 1500 patients, then you will need 5-6 days of hygiene. I tend to lean towards the 250 patients to 1 day of Hygiene, so that there will be room for New Patients, and Periodontal root planing and scaling appointments in the hygiene schedule.

How long should a Hygiene appointment be in length?
I suggest keeping Hygiene appointments to 1 hour in length. This gives the Hygienist time to give your restorative anesthetic (restorative assistant to take the hygiene x-rays, and doctor to do the exam), patient doesn't feel rushed, perio charting, intra oral photos of areas in question, and this time gives your hygienist the opportunity to discuss the treatment plan after your exam. Your Hygienist is then able to answer the patient's questions, thus over coming their resistance to scheduling restorative procedures. Do your best to do the recall/recare exam within the first 10 minutes of the Hygiene appointment. 

What if I don't have enough patients to have a Hygienist?
OK, now if you are building your dental practice from scratch or have less than 500 patients, you will be doing all of your own hygiene appointments. The tipping point is when your schedule is too full for restorative appointments, and your patients are getting scheduled out 2+ weeks for their major restorative work. At this point, hopefully you are up to 800 or 900 patients in your patient base.  Then gradually, add hygiene days 1, then 2, then 3, then 4 days, and so on as your Admin team are able to fill them. 


Written By: Kat Johnson-Britsch

Hiring New Team Members In Your Dental Practice

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As doctors and business owners this has to be one of the most difficult and important decisions you have to make. Hiring new team members effects your current team, office culture, and your ease of conducting business on a daily basis.  

Personality traits you want to look for in an Exceptional team member:
  • Outgoing/Engaing, able to communicate procedures to patients
  • Eternal learner, this type of personality will grow with you
  • Looks at the Big Picture, and is able to detail the process
  • Loves projects, and is focused on the completion of projects
  • Takes ownership, creates solutions - Glass half full...

Let your current team help you hire! Say what...? YES, involve them, let them help you get down to 2 candidates. Why...? When you involve your team in making this decision they are able to ask questions you are not allowed, and they will have ownership in the new team members success! The team will automatically take responsibility for their decision, and create a structure for success. When the 2 candidates are chosen that you and your team would be happy hiring. Then YOU make the final choice. 
  • Schedule 2 lunches, let your Team (your not allowed to go) take each candidate to lunch. You pay for lunch.
  • Meet with the Team, and let them give you their feedback on both candidates. 
  • Thank your Team for their feedback. 

Set up your new team member for SUCCESS!! Meet with them at the end of each day, for 2 weeks to see how their day went, and how you can help them succeed? Let them know that you are there to help them succeed, and are very happy to have them on your team! Emphasize that there is NEVER any dumb questions, and you are here to help them learn how your team culture succeeds, and integrate them as quick as possible. 
  • Ask: What questions do you have for me? 
  • Ask: Is there anything you see that could be improved?
  • Thank them for their feedback. This does not mean you have to implement their suggestions. They have been in a lot more offices, and seen different routines or products help with other successful practices. Good feedback.

Verbal Recognition and Praise! "Praise Them & Raise Them", and FYI... this is not a religious statement.
Very important! Everyday, make sure you compliment each of your team members on something they did that day! I call this "Praise them & Raise them"! Make this your mantra! As a result your team will go the extra mile for you, and your patients! You will create a positive culture, and your team will be loyal to you! 

Written By: Kat Johnson-Britsch

***This is advice, and solely my opinion, and we are not responsible or liable for any adverse outcomes due to taking or implementing this advice. 

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