Jared Kaltwasser

	Establish the protocols and work the systems and the results will improve.

When business consultant and speaker Roy Shelburne, DDS, meets with fellow dentists, he urges them to go beyond their initial appraisals of their practice, and dig into their practice’s actual data.

“I’ve had many dentists and office managers who feel they have everything under control, but when reviewing hard data, the real information, they are shocked to see that everything is NOT under control,” he told 

As an example, Shelburne said many dentists and office managers assume their treatment plan acceptance rates are solid. However, once given a definition of what treatment plan acceptance actually means, many practice leaders re-examine the data to find they’re missing the mark.

That might be disappointing, but it’s also the first step toward improvement.

“With this ‘true’ information, the practice can establish protocols, expectations and controls that will help to improve that area of the practice,” he said.

Shelburne, a Virginia dentist, travels the country helping dentists implement quality improvement principles in their practices. He will discuss the topic next month at the 

One area of focus for Shelburne is defensive record-keeping. He spent two years in prison from 2008—2010 on charges of healthcare fraud, an experience that caused him to realize that his own records, billing, and coding systems were flawed. He now uses that experience to help teach other dentists to do a better job of keeping careful records to back up their charges and treatment decisions.

Much of what Shelburne teaches is about leveraging data to identify shortcomings in a practice and then create a customized plan to boost quality and efficiency. The techniques he teaches work in an office of any size, from a solo practice to a large group practice.

“Once the area targeted for improvement is pinpointed, the plan for improvement is established and the investment needed determined,” he said. “That investment could be in software, hardware, training, or in some other adjunct to help improve the area of need.”

A careful evaluation and action plan can spark significant results, Shelburne said. He noted one medium-sized practice with which he worked. The practice had invested significant capital in search engine optimization (SEO) in an effort to win more new patients. In theory, they were following the latest advice in practice marketing. Unfortunately, the campaign was falling short of expectations.

So, the practice decided to generate data by polling its patients. What the office staff found was that a majority of patients were frustrated by the inability to get a live person on the phone when they called the office.

“In today's world, even if the practice is No. 1 on Google's list, if the caller cannot get through to No. 1, they call No. 2 on the list,” Shelburne said. “Because of the findings from the patient interviews, another team member was added to help handle the calls.”

That extra staff member required additional spending, but it was worth the expense. After expanding the office staff to better handle incoming calls, the practice saw its new patient numbers triple.

Results like that are impressive, but they’re not unique.

Shelburne said if he had just one piece of advice for dentists, he would start by asking about the dentist’s pet peeve, the thing that frustrates the dentist the most. He said that frustration can turn into an opportunity.

“Quality assessment/quality improvement principles can be applied to improve the outcome regardless of that frustration,” he said. “Establish the protocols and work the systems and the results will improve!”

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A dentist and consultant says many dental practices are missing opportunities to improve revenue. The first step toward fixing the problem is analyzing meaningful data.


To Boost Quality, Take a Hard Look at Hard Data

	Mass-market sites like Google and Facebook tend to be the easiest to use when it comes to leaving online reviews.

This past spring, Leonard F. Tau, DMD, was traveling in Canada when he ate at a restaurant that blew him away.

“I had the best dining experience of my life at a restaurant in Toronto, from the food to the service,” he said, in a recent phone interview. “And I told the owner I would go online and write a review.”

More than six months later, he still hasn’t done so. It’s not that he’s changed his mind about the restaurant. Rather, Tau is like the majority of Americans who, for reasons not fully known, is much more motivated by negative experiences than positive experiences when it comes to posting online reviews. 

“We’re a complainer society,” Tau said. “It’s hard for us to say a compliment, but when we have a complaint it’s easier for us to say we have a complaint.”

For dentists in an industry increasingly dependent on online referrals, that tendency can be a big problem. In short, it means that dentists need to take an active role in optimizing their online reputations.

In addition to his successful Philadelphia dental practice, Tau helps dentists get a leg up in online marketing in his role as general manager of the dentistry practice at 

, a business reputation management company.

He’ll be speaking Nov. 30 at the American Academy of Oral and Maxillofacial Surgeons’ 2017 Dental Implant Conference, in Chicago. His topic: “5 Star Strategies for Dental Practice Growth.” In advance of that talk, he spoke with 

 to offer some tips on how dentists can get their online houses in order.

Tau said good online reviews aren’t optional. They’re critical. That’s because most people start their buyer’s journey online, regardless of the industry.

“You want to put your best foot forward, and now, when people search they look at your reviews before they even go to your website,” he said.

Specifically, the first thing most potential customers will see are your Google reviews. That’s because the vast majority of web searches — at least 70% — are done on Google. And for most businesses, Google’s search results include a business listing with basic information and a summary of user reviews.

If Google is king, the other important sites are Facebook, Yelp, and the healthcare-focused site Healthgrades. Healthgrades is about as niche as it gets when it comes to mass-market, customer-trusted review sites, Tau said. There aren’t really any major dental-focused sites.

“[Customers] don’t trust the very specific niche sites as much, so you want to go where there’s a lot more trust out there, and that’s the sites all the people are on,” he said.

Tau said mass-market sites like Google and Facebook also tend to be the easiest to use when it comes to leaving online reviews, which increases the likelihood a patient will write a review.

Still, reviews can’t be left up to the patient. The dentist and thier staff need to take initiative and actively solicit reviews from online patients.

“I always think the best way to do it is ask, but asking doesn’t always get it,” he said.

You can send an email asking them to leave a review, but research shows most people don’t even open most of the emails they receive. Tau says the best strategy is to reach them on their phones.

“I think you have to send an automated text message and there are a number of systems that do that as well,” he said. “So few patients have unread text messages. I read every text I ever get.”

Tau said most dentists already have the habit of texting patients, in order to confirm appointments. He said it’s not necessary to get patients’ permission before-hand, since the texting systems come with an opt-out link.

Texts make it simple for the patient — they can just click a link and go directly to a review interface. The more that happens, the better the dentist’s online reviews will be.

However, Tau said dentists can’t stop with good reviews. They also need to make sure those positive results show up high in the search results. For that to happen, it’s essential that a practice’s online citations are “clean.” That means ensuring your practice’s information — phone number, practice name, spelling of your name, and address — are consistent across the web. Doing so will earn the “trust” of Google’s algorithm, and help your practice stay near the top of Google’s search results.

“Google doesn’t like you if they don’t trust the business,” he said. “If they trust the biz they’ll rank you high. If they rank you high.”

As more and more patients look at online reviews when making healthcare decisions, dentists must take an active role in ensuring their online presences are strong and accurate.

In a World of Online Referrals, Reputation Management Is Key

	Branching into sleep medicine doesn’t require a major financial investment, though it does take an investment of training time.

When the field of sleep medicine began, pulmonologists were at the forefront, studying how some people’s breathing changed at night and coming up with a pressure mask — the continuous positive airway pressure (CPAP) device — to help patients with sleep apnea.

Thus, almost from the start, the people diagnosing the condition also had a tool available to fix it. Back then, dentists weren’t part of the equation.

“Early sleep medicine professionals weren’t aware of how dentists can help,” said Steve Carstensen (pictured), DDS, co-founder of Premier Sleep Associates, Seattle.

What many people don’t know is that soon after the CPAP was developed, another approach came on the market.

“Oral appliances came about within 5 years of CPAPs being available in the marketplace,” Carstensen said. “Oral appliances were developed by physicians and dentists working together.”

Though it’s taken time, more and more physicians, and patients, dentists have begun using oral appliances to treat sleep apnea, and the result has been a new business opportunity for many dentists, including Carstensen. He’s been in practice for 32 years, and has incorporated sleep medicine into his practice for the past 2 decades.

Carstensen said branching into sleep medicine doesn’t require a major financial investment, though it does take an investment of training time, since most dental schools don’t cover sleep medicine in depth. He said there are a number of sleep medicine training programs, including some at dental schools, and the American Academy of Dental Sleep Medicine that offers a “Qualified Dentist” designation, which dentists can obtain to demonstrate their expertise.

Other than that, there’s no expensive equipment that needs to be purchased, though there is 1 piece of equipment dentists don’t usually need.

“To do this is we have to have a scale in our office,” he said. That’s because weight can have an impact on sleep apnea.

Carstensen, who is also editor in chief of 

 magazine, said dentists who add sleep medicine to their services will need some understanding of the available oral appliances. Around 100 are on the market, but he said dentists need only become familiar with a handful in order to serve a broad range of clients.

Once a dentist is trained and has the minimal equipment needed, 1 of the first steps is to add questions to patient intake procedures to screen for sleep problems. Doing so will help identify patients who may benefit from an oral appliance or other device.

One question that often comes up when Carstensen speaks, is insurance. Sleep therapy is a medical procedure, so it must be billed to a patient’s health insurance, rather than dental insurance. Carstensen said that can cause headaches for a billing department, though he said there are plenty of vendors available that can help a dentist adapt to the billing requirements for the devices.

The good news, Carstensen said, is that insurers generally cover oral appliances, with occasional restrictions. What they don’t cover is all of the administrative time it takes to bill, get medical records, and outfit patients with the device. That’s why Carstensen said it’s critically important that for a dentist to accurately understand the administrative demands of sleep medicine, and then factor that time into the fee for the service. Dentists who fail to account for the extra time in their fee, “will be on the wrong side of the money equation.”

For dentists who calculate their time correctly, the money equation can be quite good, though Carstensen said dental sleep medicine isn’t a “magic fountain of cash.” Rather, it’s a solid income stream, a chance to branch out, and an opportunity to identify and help out patients who could benefit from sleep therapy or who don’t do well with a CPAP mask.

Still, Carstensen doesn’t think every dentist needs to become a sleep medicine specialist. Ideally, he said each area would have some dentists who practice sleep medicine, to whom other dentists could make referrals. Some dentists could specialize exclusively in sleep medicine, though he said a given area doesn’t need more than a few people with that exclusive niche.

Even if a dentist decides not to go into sleep medicine, that doesn’t mean it should be ignored.

“I think that every dentist should be looking for patients in their practice at risk for airway problems,” he said. “And it’s very easy to implement screening questionnaires in their practice.”

More and more dentists are starting to practice sleep medicine. An expert says it's relatively easy to branch into, though it's not for everyone.

Dentists Play Important Role in Sleep Medicine

The recent series of disasters in the U.S. and abroad have many dentists wondering how they can help.

The final month of summer brought no shortage of major natural disasters to America’s southern shores and its southern neighbors. Those disasters, in turn, brought out thousands of volunteers, all asking one question: “What can I do to help?”

For dentists, it turns out there are many different ways to participate. Unfortunately, many dental professionals don’t realize the role they can play, according to Anthony Cardoza, DDS.

Cardoza is a practicing dentist in California and the forensic dentist for the County of San Diego. He says dentists can use their skill sets in many ways following a disaster.

Cardoza will discuss the dentist’s role in disaster response 

 at next month’s American Dental Association meeting in Atlanta, GA.

Cardoza told Dentist’s Money Digest he believes every dental health care professional (DCHP) should have an understanding of their community’s needs in the event of an emergency.

“As trained health care professionals, we have skills that can be utilized to assist the Office of Emergency Services (OES) and/or Department of Public Health (DPH),” he said. “This assistance would involve minimal training.”

For one, dentists can assist trained forensic dentists in the task of post-mortem and antemortem victim identification.

“Training would be moderate for the typical DHCP who has no experience in forensics,” he said.

Dentists can also help out by leveraging more basic medical skills.

For example, in the event of a bioterrorism event, many localities have plans to set up mass inoculation centers. Those centers need to be staffed by trained health care professionals, and Cardoza said dentists would be able to perform the work with minimal additional training.

Dentists could also assist with health history screenings, patient education and triage.

Cardoza’s knowledge of disaster response comes largely from his work as a forensic dentist, but he also has experience on the other side of a disaster. 

“The Southern California wildfires I experienced in both 2003 (Cedar Fire) and 2007 (Witch Creek Fire) were disasters at my doorstep,” he said. “In the 2003 event, I was forced to evacuate on the second day of that event. Fortunately, my home was spared. On the third night of that event, I was identifying the burned remains of recovered victims of that event.”

Cardoza noted that disasters can come in many shapes and sizes, and he said the need for assistance from dentists will vary based on the population of a given area and the size of a particular jurisdiction.

When he gives talks on disaster response, he urges dentists to look for ways to help out. That message seems to resonate. The number one question he gets after he speaks is, “How do I get involved?”

“My answer is always to contact the regional DPH or OES to inquire about participation in an emergency response team,” he said. “Some states, like Illinois for instance, have a dental emergency response team. If your interest is forensics, contact the local medical examiner or coroner’s office to put you in contact with their forensic odonatologist.”

Cardoza said it’s important for dentists to be proactive and find out what role they can play before disaster strikes.

“The bottom line is we all need to prepare in advance so that if that day ever occurs, we as a group are prepared to assist,” he said.

A California forensic dentist says there are a variety of roles dentists can play in the event of a major disaster. He's urging dentists to contact local authorities to volunteer.


When Disaster Strikes, Dentists Can Be a Valuable Resource

A timekeeping system will protect you and save time when it comes to running payroll.

Running a dental practice can sometimes feel like an obstacle course, full of unexpected challenges, both clinical and financial. So perhaps it’s no surprise that regulatory matters like employment law sometimes fall through the cracks.

Though it may seem like a minor issue, attorney Ali Oromchian says employment law is a minefield that dentists need to navigate carefully. Failure to do so can result in costly fines, lawsuits, and other legal headaches.

, a web-based human resources solutions provider. He will discuss the “employment law minefield” during 

a session at the 2017 Dentsply Sirona World meeting

, which takes place Sept. 14 to 16 in Las Vegas. Ahead of his talk, Oromchian shared some of his key insights with Dentist’s Money Digest

DMD: What are some of the most common mistakes dentists make when it comes to navigating employment law?

Inactivity. To be successful in navigating through the complex world of labor law, one must be proactive. Without this mindset, one can easily be inadvertently breaking labor laws. Keep in mind, there are also associated penalties for noncompliance, typically per occurrence. Consider you have been unknowingly breaking a labor law daily, and over many years, and with multiple employees. Now a somewhat small violation (and penalty) has manifested into a serious problem — and that’s only from the financial side. This is not considering that these violations could result in lawsuits and time spent dealing with past violations, as well as the effort it will now take to make retribution for all other staff affected. You can never forget, it is the responsibility of the employer to maintain compliance and stay on top of legal updates. If you are not proactive, you could end up paying for it.

Attitude. As a business owner, it is imperative that you maintain a level of professionalism and compassion. Even in the face of an employee for whom you may have personal contempt, you must never let your emotions play into your professional actions. When practice owners act with emotion, they tend to make critical missteps, neglecting much needed documentation and often times speaking with a tone of resentment. You would be surprised to know that many arbitrators evaluate situations not based on what was said, but on the attitudes and tone of how things were said. That is why it is important to always begin tough conversations with positive openers, to emphasize your efforts at working in good faith towards an employee’s success. I cannot tell you how many times an arbitration case is lost because a doctor or owner could not tone down their ego by simply speaking in a respectful and compassionate manner. Even when you may feel wronged, you must be the bigger the person and go about every situation in a calculated manner. A good rule of thumb, is to speak and document situations like the whole world is watching.

DMD: What employment law errors are dentists particularly prone to?

Not having an up-to-date employee handbook! The employee handbook is the foundation for your company as it is a vital communication tool and an important piece of protection. Without the handbook, you aren’t protected if you were subject to claims and lawsuits. If the information is not valid, up-to-date, custom to the practice, or signed by employees, then the rules and policies essentially do not apply. Employees win every time whether it is right or wrong. An employee handbook is easy to update and customize, but be sure it’s done in a timely manner so that you are protected before a potential claim occurs. 

The other common error is trusting too much or not checking on details. For example, not using a time clock because you trust your employees or because it is easier to process payroll can be devastating to a practice. Rules and laws apply for breaks, lunches, and overtime, and if there is not a clock to verify when employees work, then there is no way to prove their actual hours worked. Protect yourself and save time when it comes to running payroll by using a timekeeping system.

DMD: What new regulations, if any, do dentists need to be aware of?

Many city and states have implemented sick leave as a required benefit for all employees both part-time and full-time. Many doctors are unaware of legal changes, which leads to them misinterpreting details of minimum requirements and who is eligible. Most importantly, they are unaware of how to manage a team and what limitations they have if they deny sick leave or pay to an employee. There are penalties and other repercussions that can happen if not managed correctly. A professional who understands how to navigate these regulations is crucial to your practice staying compliant.

Hygiene pay is also another growing issue. Many practices have hygienists set up as independent contractors, and in most states, this is a misclassification of an employee. Misclassifying staff is another error dentists often make, because they get stuck in the “that’s what everyone else does” realm. Consequently, you have tax issues and usually owe employees back pay for unpaid overtime and penalties. Most employees in practices are nonexempt employees, meaning they are eligible to earn overtime and other benefits such as meal and rest breaks in certain states. The statute of limitations for incorrect pay and penalties can go back three or four years. Let's just say you go back three years, your employee worked four days a week and you owed them $100 per day for missed break and unpaid overtime violations. This would add up to $60,000 just in back pay, not to mention penalties, legal fees, or anything else thrown into the claim. 

DMD: Are we mostly talking about federal regulations, or do state and local regulations tend to vary significantly?

Federal law is important and is part of the foundation, but it's just the start. State, city, and county laws have changed across the country, and there is no end in sight for future changes. Small practices with two employees and large multiple locations with 50+ employees are all seeing changes. Every type of practice has their own hurdles to jump and when not setup correctly, it leads to future problems that are expensive and can be detrimental to the practice. 

DMD: What advice can you give to a dentist or practice manager who wants to keep better tabs on employment law issues, but doesn't know where to start?

The first step is asking for help. Figuring it out on your own is the most common error, which consequently can lead to more legal issues. There are companies that are available and specialize in helping dentists be proactive rather than reactive with employment laws. HR for Health is at Dentsply Sirona World, and they focus specifically on helping doctors and managers not only become compliant, but stay ahead of the ever-changing legal regulations. They also focus on improving employee performance and using technology to help streamline all of your team management and compliance needs. Be sure to stop by the HR for Health booth at booth #831 so our team can help you take the complexity out of compliance!

HR for Health will be at booth #831 at Dentsply Sirona World. 

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With everything loaded onto a dentist's plate, it's easy to neglect your regulatory responsibilities. While you may not face any immediate consequences, financial and legal consequences could be right around the corner. Continue below to see what attorney Ali Oromchian advises regarding employment law. 

Employment Law: Dentists Can't Afford to Ignore It

Insurance premium hikes could hurt both dentists and their employees. 

When Craig Start thinks back to the 2010 debates over health care reform, the outcome of the overhaul has been pretty much what he expected. But that doesn’t mean he has any clear answers as to where things go from here.

Start is the longtime president of MDA Insurance, a wholly owned subsidiary of the Michigan Dental Association. The company provides a suite of insurance products to the state’s dental community, including group health insurance. MDA Insurance also provides advice and counsel to dentists who don’t offer health insurance, but instead have their employees buy their own coverage on the individual market.

Start isn’t surprised that health insurance premiums have shot up on the Affordable Care Act’s insurance marketplace.

“Four years ago, I would have definitely said, ‘Don’t do it — here’s what’s going to happen,’” he said. “And I predicted these high premium increases, and they’re absolutely coming true.”

But now that the ACA is law, Start is watching the will-they-won’t-they repeal debate with mixed feelings. He would have preferred if the law had never been enacted, but he’s also aware that millions of Americans now rely on it to be able to access health insurance. As lawmakers in Washington have learned, the healthcare overhaul is difficult to undo.

“Now it’s kind of like the cat is out of the bag,” he said.

Start will do his best to help MDA members navigate their next health insurance steps during a 

A lot has changed in Michigan in the years since the ACA was first passed in 2010. Initially, a significant number of members decided it was a good opportunity to get out of the health insurance business and let their employees buy their own coverage.

Those who did ended up subjecting employees to double-digit premium increases. In Michigan, the main ACA marketplace insurer is proposing a rate increase of about 27 percent next year, a number that could be slightly higher if the federal government decides not to fund insurance subsidies.

President Donald Trump has yet to say whether he will continue the subsidies.

Start said that kind of cost hike could hurt dentists who don’t offer their employees insurance, since it might make them less attractive to potential employees.

Meanwhile, dentists who stayed with MDA Insurance and its group plan saw much smaller increases in the low single-digits the past two years.

Altogether, about 4,000 people are on the MDA Insurance plan. At the beginning of the ACA era, Start said about 2,000 people in the MDA community chose to go to the individual market, but he said that number has dropped by a few hundred as people have fled rising premiums.

Start noted, however, that some of those people don’t have the option of group insurance — they either don’t work enough hours to qualify, or they don’t qualify because they are contract workers and not staff members.

As 2018 open enrollment rolls around, what’s a dentist to do?

Start said those in the MDA group plan already know what to expect for 2018 — an increase in the range of 3 to 5 percent on premiums. That number shouldn’t change, regardless of what Washington does regarding health reform.

“[Current MDA Insurance customers] can safely elect their renewal and make that decision early in our open enrollment process. They don’t have to wait til the end,” he said.

Those in the individual market might do well to wait, he said.

“For those folks still stuck in individual market, I think it’s at least worth waiting until word comes out on the subsidies,” he said.

It’s unclear when that decision will come. Even after the subsidy decision is made, it’s unlikely that employers will be able to enjoy long-term clarity when it comes to federal health policy anytime soon.

“The million-dollar question is, ‘What’s going to happen?’” he said. “Of course, I thought I knew about four months ago, but I sure don’t think I know now. We’re all caught in this crossfire of uncertainty going into 2018.”

The leader of the Michigan Dental Association's insurance program says employers are facing a tough time in the era of the Affordable Care Act. This is especially the case if they told their employees to buy insurance on the open market. Continue below to find out more. 


For Dentists Picking Health Benefits, Uncertainty Looms

	Shelly Ryan, RDA, has spent more than three decades working in the dental industry, both in a dental practice and as a trainer and consultant. She says dental practices need to ensure that their entire team — from the receptionist to the dentist to the billing department — needs to understand the roles of each team member in order to ensure the patient has a successful and satisfactory experience, start to finish.

, will lead a course next month on “The Team Approach to Dentistry” for the 

. She recently shared some of her tips for building a strong dental practice team with Dentist’s Money Digest.

DMD: What do you mean when you refer to the “team approach” to dentistry, and how does it differ from a non-team approach?

I started out as an assistant, and at one of my first offices, the administrative person had some health issues, and I covered her position. It was during that time I realized how little the clinical team understood what happens at the front desk, and the administrative team didn't have an understanding of what was going on in the clinical area. This caused confusion for patients. The team approach is simply developing systems, protocols and verbiage with the entire team regardless of their position. In short, the entire team understands how and why a system should work, as well as what each individual’s role is. When the right hand understands what the left hand is doing, the outcome for the patient and the team is more positive.

DMD: You say patients base their perceptions of a practice on how they feel as opposed to basing perceptions solely on their clinical experience. Why is that, and how should it affect the way a dentist or practice manager approaches her or his job?

Patients don't generally understand dentistry or the language we use, similar to an auto mechanic explaining an engine to the average lay person. What they do understand is trust, compassion, pain, embarrassment and other emotions. The average patient couldn't tell their friend how good the dentist’s margins are, but they can tell them the dentist made them feel comfortable, explained things in a way they could understand, didn't pressure or lecture them, etc. The entire team will build better relationships, and patients will accept dentistry when the focus is on their concerns instead of the clinical reasons the patient should proceed. In many cases, patients don't want to understand how an implant is placed, they simply want to know why it is the best course of treatment for them and how it will positively impact their lives.  Recognizing what the patient is experiencing emotionally, and where they are at in regards to accepting their situation, allows the team to converse with the patient in a more caring and individually focused manner. Patients are not just a number or a name.

DMD: How can a dentist tell if their practice is operating well as a team? 

I think mainly through growth. When there is a systematic approach to the protocols in the offices, there is less patient and team confusion. A happy team means happy patients. Happy patients refer other patients. I also think scheduled team meetings can help, as they allow interaction between team members the doctor can observe herself.

DMD: How does the team approach make a difference when staff must confront patients with news they might not want to hear (bad clinical news, late bill payments, etc.)?

Every team member plays a role in helping a patient move forward with treatment. The administrators assure they have the insurance information and breakdown of benefits to help clarify financials. They are also in charge of greeting the patient in a manner that helps put the patient at ease: warm and welcoming. Hygienists and assistants help prepare the patient for the likelihood of the doctor’s recommendations through photos, radiographs and verbal discussion. This is the first time the patient hears of the bad news

 They are in charge of helping the patient see their situation and prepare for a solution. When the doctor enters for the evaluation, it is the role of the hygienist or assistant to fill in the doctor on exactly what was discussed, in front of the patient. This is the second time the patient hears it.

The doctor then completes the diagnosis. This is the third time the patient hears it. Either the doctor or a clinical team member then commits the patient to care with phrases such as, "You have heard my recommendations, what are your thoughts?"

 or "Is there anything standing in your way of moving forward?  

Any thoughts, questions, or concerns I can help with before we get you scheduled?" 

The clinical team then assures all treatment and notes regarding why the treatment is necessary, where we recommend the patient begin and how much time will be needed is entered in the chart notes. They then hand off the patient to the administrator with a transition statement: "I'm going to have you stop and talk with Judy about the treatment doctor recommended. She's going to help make sure the finances are comfortable and get you scheduled." The administrator now has all of the information to once again verify and validate the treatment with the patient (this is the fourth time they hear it) and discuss payment options and schedule.

Everyone is on the same page, and this is reassuring to patients and gives each team member confidence when approaching patients with bad news.

DMD: What are some examples of low-hanging fruit — team mistakes that practices can quickly correct?

Be sure you are having team meetings monthly. 

Doctors, talk with your team! Tell them what you want and ask them what stands in the way of getting there.

Administrative team, avoid making outgoing calls from 10 minutes to the hour through 10 minutes after the hour. This is the busy time and you want to be available for patient hand-offs.

Verbal skills: Avoid phrases such as " Do you want?" or "Would you like?” Instead try "Let’s" or "The doctor asked that I." Instead, say, "Let's get you scheduled" and, "The doctor asked that I take the necessary X-rays. Let’s get started."

Just calling to confirm/schedule." It minimizes the importance.

As a dentist, you may have a great team of people working around you. But are those great people working together as a team? The answer to that question can make all the difference when it comes to building and maintaining a loyal client base. Continue below for a Q&A with consultant Shelly Ryan. 


To Maximize Patient Satisfaction, Take a Team Approach

Ask candidates what they did in past scenarios to gauge their personalities. 

Hiring a new employee — whether it’s an office assistant or a new dentist — is about more than just acquiring a set of skills. It also impacts the internal dynamics of the office, customer relations and ultimately the practice’s bottom line.

For dental practices, the hiring process is a high-stakes game that can consume a lot of time and energy. With so much at stake, how do you make sure you get it right the first time?

Tim Twigg, MS, will be tackling that question when he speaks at the 

, Aug. 17 to 19, in Las Vegas. Twigg is president of Bent Ericksen & Associates, where he leverages three decades of practice management consulting experience to help dentists optimize their businesses. He spoke with Dentists’ Money Digest to offer some do’s and don’ts for hiring a new staff member.

“Probably the number one mistake is that they focus on skills and experience as opposed to focusing on attitude and fit,” Twigg said. “The analogy with that is that you should hire for the things you cannot train.”

Clearly it’s important to make sure your new hires are qualified to hold their position, Twigg said. But if the person meets that bar, don’t get too hung up on how many years of experience they have or whether they know how to take an X-ray. Someone can easily be taught how to use certain equipment or interpret dental terminology. What’s harder to teach is having a positive attitude or understanding the ethos of a particular dental practice.

2. Ask not what they would do, but what they did do.

One way to gauge whether a person is a good fit is to find out how they performed in real-world scenarios. Twigg advises that interviews be weighted more toward these types of behavioral questions.

“You want to make sure that the questions look specifically to how someone has handled or behaved in the situation in the past,” Twigg said. “It’s not them talking theoretically about what they would do, but truly how they did this.”

For example, if interviewing a dental hygienist, a dentist or office manager could ask how they handled a scenario in which a patient refused to have X-rays taken. They can also ask the prospective employee for the name of someone who could verify their handling of the situation.

Twigg said these types of questions say much more about the interviewee, and whether she would fit in the practice, than simply asking if she knows how to perform X-rays.

Twigg outlines seven steps in the hiring process, from defining the job to checking references. One oft-overlooked step is performing a personality assessment.

“Outside of dentistry, it is very, very common,” he said. “Even companies like Home Depot do this as an absolute aspect of hiring, and it’s just not a technology that’s been routinely employed in dentistry.”

However, Twigg said a personality test can tell an employer a lot about whether the person has traits and characteristics that make them likely to succeed in the specific position. The test his firm uses has profiles of high-performing people in a variety of dental office positions. By comparing prospective employees to high-performing employees, a dentist can get a sense of that person’s likelihood of success.

“It gives a whole bunch of information that is pretty much impossible to get by just talking,” he said.

Twigg said using personality tests in the hiring process can increase the chances of a successful hire by 75 percent.

It can cost about $100 to $150 for an assessment, but Twigg noted that such a test should be a later stage, so those costs would only apply to your top three to five candidates.

He also cautioned that it’s important to make sure any personality test you administer meets validation criteria. Validated tests have undergone a series of analyses to ensure they’re effective and don’t profile or discriminate. Using a validated test ensures that the test will be worthwhile, and it also protects a practice against allegations of discrimination in the hiring process. Twigg noted that the vast majority of commercially available tests aren’t validated, so practices need to be diligent.

4. When seeking candidates, try your waiting room.

Many dentists use newspaper ads, job-listing websites, and employment agencies to find employees. But Twigg said there’s another place people should look: their patient rolls.

If he asked a practice to make a list of five patients they love, Twigg said, every practice would not have any trouble doing that.

“Why wouldn’t we ask this patient if this patient knows of anyone who might be looking for a job?” he asked.

Mentioning the opening to favorite patients can succeed in a couple of different ways: they might know someone who would be a perfect fit, or they might be looking for work themselves.

Hiring a new employee is a costly experience, and the costs extend beyond buying ads, paying for personality tests, or hiring an employment agency.

“The statistics are that when you have turnover it’s going to cost you however much you pay for that position for the year,” Twigg said.

If that sounds high, consider the fact that you or your staff will need to spend hours poring over applications and interviewing candidates. That’s time that could otherwise be spent on practice business. Between that extra work and the loss of manpower due to the vacancy, your practice will likely be less productive, translating into lost revenue over time. Twigg said it’s hidden, insidious costs like these that can prove most expensive, so it’s important for practices to plan out a careful hiring process that will lead to a successful long-term hire.

It can be tempting to “trust your gut” when filling a position, but Twigg said the data simply doesn’t support impulse hiring.

“Virtually every study out there shows that the gut is not very reliable,” he said. “It’s not a very good source for truly making a good decision about whether this person will be the ideal or even a good employee.”

Instead, Twigg advises hirers to base their decisions on “preponderance of evidence.” If you go through all of the steps of the hiring process, you’ll have data that can tell you whether the person has the skills, personality, and instincts to be a good fit in your practice. A gut feeling might play into that mix, but Twigg said the best hiring decisions are ultimately based on evidence, not intuition.

Hiring a new employee can be a costly and stressful experience. For dental practices, finding an applicant with the right balance of hard skills and customer service savvy is crucial. These tips from practice management expert Tim Twigg can make the process run smoothly.


6 Tips to Keep in Mind When Hiring a New Employee

Pride Institute CEO Amy Morgan will lecture at the 

So you’ve just completed a complicated procedure with unimpeachable clinical accuracy. Surely you’ve just won the patient’s loyalty for life, right?

Entrepreneurship is an essential element of running a successful practice, and with the rise of corporate dentistry, it is more important to distinguish yourself now than ever. Expert Amy Morgan sat down with DMD to talk about how to catch a patients' eye and keep them coming back, and being a good dentist isn't enough. Continue below to find out more. 