Linda and Rhonda were regular contributors here at DentalBlogs.com in 2009. Their column, Two Sides of the Management Coin, provides practical tips and information on issues you face every day in your dental practice. The goal? To help you increase production and collections for a bright, solid future.

Dental insurance can be a frustrating topic for dentists and dental team members. In this article, we’ll review common concerns from both sides, then present an end-of-the-year insurance benefits template that you can use for your insurance patients.

Staff’s Viewpoint

“There are just too many insurance plans to keep track of. Why don’t the patients understand their dental benefits?”

“I get so weary trying to explain these benefits.”

“It is so time-consuming to do pre-authorizations, and 80% of the patients still say ‘no’ to treatment after we wait for weeks to get the responses back. What a waste of time!”

“Doctor wants to become a provider of a few PPOs. We have always been fee for service. Why the change now?”

“We (the team members) will never get a raise if the practice writes off so much of our regular fees.”

Doctor’s Viewpoint

“The hardest part of practicing dentistry is the constant change in the patients’ benefit plans. How can one local business/company have so many different plans? No wonder the patients are confused. We need to hire a full-time dental benefits expert to keep our heads above water and our patients informed.”

“Why is it that so many patients must have in writing just exactly what their plan will cover? Most of their treatment plans exceed their annual maximum benefit. And it seems that the pre-determination is nothing but a delay tactic dreamed up by the insurance company knowing that 75% or more of the patients say no to their treatment plan by waiting to hear back in a few weeks.”

“In the past 20 years, I have remained fee for service, but it has become increasingly difficult to attract and keep patients in the slower economy as patients feel their ONLY OPTION is to go to a dentist on their plan. With so many dentists around me accepting XYZ plan, and as low as my new patient number is per month, I have two choices: either spend $6,000 per month on an expensive marketing plan to attract FFS patients or go on a plan or two to compete. I will have a busier schedule and write off about $4000 per month. At this point, I must reevaluate my pride, philosophy, and my marketing budget/versus write offs to measure the differences.”
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In this slower economy the past year, team members are spending an inordinate amount of time on insurance verifications, requested pre-authorizations, insurance follow up, billing and explanations of benefits. They are also handling more patient complaints regarding their dental benefit plans and out of pocket differences.

For the first time in 20 to 30 years, the die-hard, fee-for-service dentists are finding emptier chairs and less case acceptance than ever before. In order for practices to survive versus just get by month to month…right now is the time to send out the END OF THE YEAR INSURANCE LETTER to help patients maximize their benefits for the calendar year (if the benefit renews in January). Here is a sample that can help make October, November, December and January your four biggest months of all (December/January with split year cases to take advantage of benefits in both calendar years).

PATIENT LETTER OR CARD:

Just a friendly reminder….

Most insurance plans have a calendar year maximum and deductible period, and insurance maximums do not roll over from year to year. This means that if you have unused benefits at the end of the year, you lose them.

Each year, our schedule is very full in November and December as patients have dentistry completed to take advantage of their dental benefits. If you wish to have treatment completed before the end of the year, please call to schedule your appointment soon.

If you have questions about your benefits, or about recommended treatment, please don’t hesitate to call!
Remember, you earn your benefits, so make the most of them!

Patients build trust based on how they perceive the dentist. Does he or she treat their employees well? Is the doctor warm, caring and empathetic? Do you have your patient’s best interests at heart? In addition, many dentists have employees who are empathetic and care about their patients, but they have trouble expressing warmth.
How many of you have known someone who knows dentistry perfectly but doesn’t understand the human side of case acceptance?

Doctor’s Viewpoint: (Rhonda Savage)

You may have spent years focusing on the technical side of dentistry and are very knowledgeable about it, yet its warmth and a relationship that our patients need and want. It’s warmth that is a “hard to measure” invisible quotient of the highly successful businesses. Pressures of running a successful business can weigh heavily on many offices. It’s a tough job we face. How can we exude warmth and win the trust of the patient when our minds are scattered with the pressures of a business, being a boss and solving complex problems.

Staff’s Viewpoint (Linda Miles)

Dental team members face the same pressure. How can an employee show warmth, empathy and concern if they have other patients waiting, haven’t had a restroom break and perhaps little time to eat? Think about your own emotional needs and those of your team: are you hungry, tired, sad, angry, and frustrated? It’s difficult to project warmth if we don’t feel well.
We do have an opportunity to work on our ability to project warmth and communication skills, beginning with listening skills. The answer to the complex questions raised above is that being a good-to-great, successful business requires a range of “soft” skills, like listening skills and rapport building.

• Listening skills for the doctor and team:
  1. Listen by leaning forward; don’t say a word.
  2. Pause before replying; when you pause, it raises the self-esteem of the other person.
  3. Question for clarification: “what do you mean?”
  4. Feed it back; paraphrase in your own words; show you’ve really been listening.

When we first meet a new patient, talk to your patient about their problems before offering solutions. This all takes time and cannot be accomplished in 5 minutes during the hygiene appointment. Separate your new patient exam from the hygiene time. The doctor should spend between 10-15 minutes personally with the new patient to establish rapport, be empathetic, talk about patient’s issues and problems and then offer treatment. Unless the patient really understands their needs, they won’t buy into treatment. Your patient must know that you have their very best interest at heart. The best way to do this is to talk to the patient about their needs as if you needed them yourself.

Do this by holding off in offering the solution until the patient understands what’s needed. As practitioners, we often get started talking in depth, clinically, about the fracture, impacted food, bacteria, infection…without defining the problem in lay person’s terms and outlining the consequences if they don’t have treatment done. To improve case acceptance, work on warmth, empathy, have time for the patient, and define the problem so the patient understands; then offer treatment options.

• Verbal skills: Doctors, train your team to speak for you. Practice and then delegate the ability for your team to communicate with the patient. Patients ask common questions. For the next week, put a notepad by every chair and phone. Ask the team to write down every question the patients ask. At the end of the week, tally the questions. The doctor’s homework is to then, over the weekend, write out a 2-3 line answer, briefly and concisely. The questions can be placed on one side of a 5 by 7 card, the answer on the other. Then, the team practices. The essence or meaning of the answer is internalized. The team member learns what the doctor wants him or her to say, but uses their own words. Be careful to not script word for word. Patients know when they’ve been “scripted” and do not like feeling like they’re being “sold”.

• Make certain that you have the time to take a break! If you are constantly running over on your schedule and the team members do not have time for lunch or breaks, or you’re working after hours, you have a scheduling problem! Morale will drop and it’s hard to project warmth when you’re tired, hungry and running behind.

• Learn the answer to common questions/concerns:
  1. My insurance won’t cover it!
  2. I’ve been going to another dentist for years! He never told me I needed all of this treatment.
  3. I’m terrified of having any dental treatment done!
  4. I’m too old for this type of treatment!
  5. My insurance company says your fees are above average!

• Final “To-Do” list: communication and listening skills require continual training. The book, Dynamic Dentistry, and our DVD’s go in depth into verbal skills. To see the range of products that can be used for team training and your staff meetings, go to DentalManagementU.com and look under Products. We also have a two day workshop, the Dental Team Conference, which is excellent for motivating and training the entire team. We look forward to helping your practice grow!

Visit LLM&A Consulting online!

During the life of a practice (30-40 years), keeping up to date with new equipment, technology and facility updates are all necessary investments that take time and money. In the past few years having a tax credit for equipment purchases has made it easier for dentists to make the decision that now is the time to make some of those purchases they have put off for a long time.

Being technologically savvy is actually a marketing tool to patients who are also big on technology. One of the biggest mistakes dentists make is investing in computer software and hardware along with other pieces of equipment is NOT investing in the training for the entire team for maximum and accurate usage. It’s like buying a new expensive automobile but not investing in driver’s education or buying gasoline for the vehicle. Reading the manual that comes with this technology does not create the necessary skills to get the maximum usage out of it….Having one person learn the ropes and pass it along to the others doesn’t work well either. That is often called “the blind leading the blind.”

Doctor Viewpoint by Dr. Rhonda Savage
Investing in new equipment is quite expensive and is only beneficial if the equipment or technology is used consistently. Most dentists don’t want to be the first in line for the newest toys or updates, but they also don’t want to be the last. Moving to a larger and newer office is a necessary part of doing business if the current space hampers growth or begins to look worn and tired. (Patients judge the dentistry by what they see…so having an up to date and modern look in this arena is critical to success and the resale value of the practice one day.)

Dentists expect the dental team to be excited about the new equipment, technology or facility updates and can’t understand WHY they aren’t. As many dentists have stated, “they never use the intra oral cameras like they should…and they don’t tell patients about our new technology and what it can do for them….it’s up to me and I don’t always have time.” Or, “I have no idea why the team members are not happy about our move to the new office in a few months. We will have twice the space; everything will be brand new so they should be happy about that.”

Staff Viewpoint by Linda Miles
I’ve interviewed thousands of team members over the past three decades and I can tell you the many reasons they are not on the same page with their doctors in most practices when it comes to making major purchases in equipment, technology or facility updates.

If the purchase has not been explained as to the return on investment (benefit to the patients, benefit to the practice as a healthy business and benefit to the doctor and team that use it) they will NOT be happy. Some of their comments include: “Our doctor has constantly said over the past two years that there is no money for raises yet we see him spending money on things we could do without.” Or, all we hear is the overhead is out of control…if it is, why does our doctor think she can afford a new office…we are barely making ends meet now”. The staff sees that new equipment or updated facility as the raise they did not get and the raise they deserve. Without realizing it, they can sabotage the usage of new equipment or technology as in a sense they blame the purchase on the financial decline of the practice. They have no clue that investing in this might make the difference in growth or further decline.

If I were a dentist and decided to invest in anything of major significance I would make the team feel part of the decision. (We all know that it is the doctor’s practice but a participative approach works well.) I would mention the buying decision I’ve made, outline the benefits to the patients, benefits to the practice as a healthy business and the benefit of that growth to the doctor and total team. I would then say “we are now producing X per month without this investment. When we hit out new target of Y per month, there will be a one-time bonus of Z in appreciation for doing all you can personally to use and promote this.” “And when we average y for three months, I will evaluate and provide increases in staff salaries to reflect this nice increase in our practice.

The staff members need to view this from the “owner’s eyes” and not from the “I can’t believe he is spending more money” talk over lunch in absence of the doctor. Getting the team on board with major purchase decisions is the difference in night and day as to how they will utilize that new equipment and how excited they will be in front of the patients and the community about their doctor, his or her practice and him or her as a positive leader.

Visit LLM&A Consulting online!

Life would be great, at times, if it weren’t for other people! Yet it is through relationships with others that you’ll often obtain the greatest rewards! Your dental office is where you spend many hours of your life. Getting along and working productively is so important, yet many offices experience stress because team members argue, give each other the silent treatment or allow someone else to do all the work.
How well does your team work together? Can you depend on each other? Trust and respect one another?
Trust and respect are two essential key elements for a dental office.

Staff Viewpoint by Linda Miles:

Why do I have to work with her? She’s on the cell phone, taking personal calls and texting! I have to do her work, plus mine. Or… he’s not a team player. He’s surfing the internet instead of focusing on past due accounts. I’m afraid to talk to the doctor about this, but the job’s not getting done!

Or: I just don’t like her. We don’t think alike.
Or: Does your office seem divided, with the front against the back and vice versa?

Doctor’s Viewpoint by Dr. Rhonda Savage:

Why can’t they just all get along? The bickering and infighting are driving me crazy. I just want to go to work and go home. My job is to treat patients, not act as a referee! Every time I get the staff squared away, another problem erupts. I’m ready to fire the whole bunch!

Steps to Follow:

As a team member: You do not always have to be a close personal friend with everyone in your office, but you do always need to show respect and professionalism. Your role as a team member is to first approach the other person and try to work out difficulties. This is not an easy thing to do, but is very important. Use the “feel, felt, found” method to diffuse the defensiveness of the other person. As an example: “Marci, could I talk with you? Is this a good time? I’d like to let you know that I feel tension between us. I’ve felt this especially today when you were silent all day long. What I’ve found is if we can talk this through, that we can work together better and really help the patients.” If you’re not able to resolve the situation, approach your doctor and ask for a 3-way discussion to resolve the problem.

As a doctor: Many dental offices have conflict arising when weaker members do not follow thru on commitments, which creates a lack of trust. Here are some guidelines to facilitate accountability for your team members:

1. Write down and detail the steps/duties in the responsibility. Defined duties are a must in a dental practice. Eighty percent of your time at work should be defined by your job description and responsibilities. Remember that when everyone does everything, no one is accountable for anything! 20% of your time is spent bending over backwards helping others however you can. The words a successful, trusted, well respected team member uses when asked for help are: Absolutely! Or… Certainly!
2. Outline the time commitment and set aside adequate time. It is not fair to assign or accept a responsibility and then have no time to accomplish the task.
3. Be careful to not overload the staff person with too many commitments or too many interruptions. They will get discouraged and burn out.
4. Follow thru by putting a note on your calendar to check on progress. If you don’t check on progress, the task may not be accomplished. Find out how the project is progressing and show interest! It is discouraging for a team member to work hard and not received recognition for a job well done!

To build trust and accountability, dental offices need consistent leadership and effective team meetings. With team meetings, staff have the opportunity to volunteer for projects. Create a strong team by not showing favoritism to certain team members. It is impossible to build trust if one person is favored over others.
Ask yourself these questions: Does your staff believe that they are being treated fairly, without prejudice? Do some feel excluded from the decision making process? Does one person “do it all?” When there is not accountability, often times another more detailed oriented person will pick up the slack and take the job on, over and over again, until he or she becomes upset with the situation.

For everyone: Designated duties and holding ourselves accountable creates trust and respect in the dental office. Your sense of teamwork will grow and stress will decrease!

Visit LLM&A Consulting online!

Staff Viewpoint by Linda Miles – Doctor’s Viewpoint by Dr. Rhonda Savage

STAFF VIEWPOINT (Linda Miles)
The Dental team members in some practices have no idea that their compensation is very closely associated with effective use of the dental chair time during the workday. It is no mystery to me why some practices have 10 wasted chair hours per day (doctors and hygiene), while others have only 2 hours throughout the day, which, in most cases, is normal. In some practices, the staff feels so overwhelmed with busyness that they find themselves secretly hoping for a no-show or failed appointment, which is the ONLY way they can possibly catch up. Some team members remain neutral and are not stressed about it, but often think, “There is nothing I can do about it.” Smart team members are VERY aware of the fact that wasted chair time is income their doctor can never recoup and adversely affects their ability to make higher wages or to have improved benefits. These smart team members go out of their way to reduce open chair time.

DOCTOR’S VIEWPOINT (Rhonda Savage, DDS)
Dentists feel totally helpless and frustrated with open chair time. They KNOW this is income that can never be recouped, and they also know that two broken appointments per day in each hygiene schedule (with two hygienists), does not mean a $600 plus loss that day, but in reality with the four opportunities lost in future operative, (hygiene is a third of total gross production), this is actually a $1800-plus loss each day! If this figure is multiplied times 200 work days in the year, the loss is HUGE ($360,000). If staff salaries are 22% of collections and collections are 100%, this is $79,200 that could have been paid in additional staff wages or benefits…With 6 team members, and this is a loss of more than $1000 per month per staff member. This is why our firm, Linda Miles and Associates hopes for as close as possible ZERO DEFECTS in the schedule day to day.

Broken appointments are caused by several problems with number one being a lack of communication from the dentist and the team about the importance of the NEXT VISIT. The last conversation a patient should hear before getting out of the dental chair each day is a 30-second eye to eye, heart to heart message stressing the value of the next appointment and the importance of not postponing or missing it.
Another major factor is an unmotivated team or one that has no planned “downtime” to finish all their behind-the-scenes duties ,so when patient hours are scheduled, zero defects becomes the norm. This is why we recommend team incentive bonus plans and planned organizational time to work on other projects throughout the month. Planned downtime for doctor/team meetings, behind the scenes duties, and in-house training (your people training your people) is FOCUSED down time which creates a huge increase in hour to hour efficiency during patient hours.
Another cause of broken appointments and no-shows is leaving messages on home phones for courtesy confirmation calls. Very few people listen to their home VM as anyone they wish to speak with has their cell phone number. If your practice has not collected the patient email addresses and cell numbers, I would venture to say that your no-show rate is much higher than it should be….
Untrained in verbal skills at the desk is another huge problem. Sounding neutral or happy when a patient calls to cancel is NOT the way to handle these type calls. FRIENDLY DISAPPOINTMENT is key. “An appointment will never become more important to the patient than it appears to be to your team and you.”

Moving already schedule patients to fill openings is “the kiss of death” for patients moving themselves on the schedule! Using an up to date pending appointment list is better than moving patients forward. “You move them, they will move themselves.”
STEPS TO FOLLOW:
1) Remind the team how costly broken appointments are to the overall health of the practice. Remind them that it directly affects their paychecks.
2) Schedule non-patient time to do all the duties that can’t be done during patient hours.
3) Stop leaving messages on home VM. Companies like Sesame and Smile Reminders can be a huge help in making confirmations by cell VM, emails and text messages.
4) Start stressing the importance of the next visit while the patient is in the chair.
5) Invest in DVDs or in person courses such as the Dental Team Conferences by LLM&A that changes the way the team talks with patients (www.DentalMangementU.com) or 800-922-0866.
6) Have an incentive bonus plan for your practice that WORKS for patients, doctors and the entire team. For a complimentary copy, email lindamiles@cox.net.

Visit LLM&A Consulting online here.

Staff Viewpoint by Linda Miles – Doctor’s Viewpoint by Dr. Rhonda Savage

Knowing the numbers and overhead control in a dental office is important for both the staff and dentist. To control overhead, the staff must be aware of the numbers. Oftentimes dentists hesitate to share financial information with the team because of confidentiality concerns. However, if your team is capable of patient privacy, they are likewise capable of keeping the business information about your practice under wraps. You will be amazed how sharing the information can empower your team to work together for the greater benefit of the dental practice.

STAFF VIEWPOINT (Linda Miles)
We’ve all heard the phrase, “what gets measured improves.”

“Why then does our doctor not want to share practice numbers with us as my last employer did?”

The team needs to know certain practice numbers in order to help control overhead, set goals, see those goals reached and share in the rewards if they improve. It is amazing to me how many dentists still keep the staff in the dark about numbers that they and the team need to be aware of each month. Numbers should be reported at the health of the practice team meeting week one of every month. Each member of the team (including the dentist) should take turns facilitating the team meeting. They should also give a three-minute personal progress report on certain areas of the practice that they personally monitor.

Scheduling Coordinator-
1) Number of new patients last month and where those new patients came from (patient referral, marketing project, doctor or team referral etc.) It is also good to do a comparison study of how the NP number compares with the same month a year ago.

2) Number of failed or last minute changed appointments in the doctor’s schedule.

3) Number of emergency patients worked into the schedule last month. How many were patients of record versus new patient emergencies. If a NP emergency, how many rescheduled for a complete oral health exam and radiographs? How does this compare with the same month a year ago?

Financial Coordinator-
1) Number of past due collection calls to patients and overdue insurance.

2) Number of dollars collected last month through patient financing. How does that compare with the same month a year ago?

3) Total A/R balance and the percentage of dollars past 60 and 90 days old. Comparison of same month a year ago.

Assistants-
1) Number of unit of crowns/veneers/implants etc. and a comparison of the same month a year ago.

2) Number of dollars spent last month on dental supplies, the % of last month’s collections and how close it is to my budget of 6%.

3) Number of infection control violations given last month and number of dollars collected. (We recommend that one assistant be the “infection control cop” giving $5 tickets to those who they see breaking the rules of good infection control. The money is used to take the office team to lunch.)

Hygienists-
1) Number of daily dollars produced in their treatment room last month with a comparison study of the same month a year ago (Total $ divided by # of days.)

2) Number of procedures in the 4000 code (initial perio procedures) and how this compares to the same month a year ago.

3) Number of units of open chair time in their schedule last month and how that compares with the same month a year ago. (Goal is zero defects in hygiene schedule.)

Doctor or Practice Administrator-
1) Last month’s gross and adjusted (net) production. How that compares with the same month a year ago.

2) Last month’s collected amount with a comparison of same month a year ago.

3) Was the practice bonus goal reached and if so, it is a time for celebration and bonus checks to be distributed.

DOCTORS VIEWPOINT (Rhonda Savage, DDS)Almost from the very beginning (1994), I worked with a LLM&A consultant who encouraged me to share practice numbers with the team. It was most empowering to have the staff “own” certain areas of the practice by keeping me in the know about how things were going in their departments. One point that dentists must make very clear when sharing the figures: All team members know that confidentiality about practice business, patients, and each other stays within the walls of the office and is not shared with others. Being a confidant is part of being a professional. Reminding the team of this at the beginning of each team meeting is important.

The point of having health of the practice team meetings is threefold:
1) To create “owner attitude” versus “unionized thinking,” which is, “Give me my paycheck and let me out of here.” The team loves to have good reports!

2) To create accountability within each position of the practice.

3) To promote teamwork. When they hear each other’s reports they know they
are not the only dedicated, hard-working team member and that each of them are important to the success of the practice.

And as a final benefit, they all work harder as they love seeing the dentist pleased with reports that focus on their contributions each month. They also love knowing they reached their bonus goals and are now rewarded for their extra effort. This equals happy dentist and happy team. Patients notice!

Visit LLM&A Consulting online here.

Staff Viewpoint by Linda Miles – Doctor’s Viewpoint by Dr. Rhonda Savage

Favoritism is common in many dental offices and can cause a serious rift in your practice. Favoritism is a complicated subject, but what it really amounts to is a boss or office manager favoring a particular employee, which puts the other employees at a disadvantage. The unfair disadvantage leads to resentment, lower moral and decreased productivity in your dental practice. The worst part of favoritism is that it can destroy relationships, initiative, and trust!

STAFF VIEWPOINT (Linda Miles)
“Did you hear what she said? She’s such a “brown-noser!”

“Why does she always get to leave early? I would get into so much trouble if I asked to go early like she does!”

“Doc listens to her more than to me and I work harder. I know what’s going on, but she never asks my opinion!”

“I don’t know why I even try. I won’t ever have a chance to get ahead in this office because he lets her do it all!”

“I know she makes more an hour than I do and she never follows through with her work! I have to pick up the slack for her all the time, but my doctor won’t do anything about it!”

(From one staff to the new hire): “Don’t bother talking to the doctor about her….she won’t do anything about it. They’re friends! They do a lot together outside the office. She’ll never believe anything bad about her!”

Consider the pain of being in a job where you think the boss doesn’t like you. What can you do as a staff person? Sometimes the staff can feel trapped. They can’t talk to others about their feelings and know the job is a dead end for them because the other person gets all the attention, perks, and freedom to do whatever she wants. In an office where favoritism exists, enthusiasm and spirit can die along with trust and candor.

DOCTOR’S VIEWPOINT (Rhonda Savage, DDS)
I was guilty of favoritism once. I became good friends with my office manager when I was a young dentist. Over time, she began doing things on office time: paying her bills, making personal calls, and planning her daughter’s birthday party. She came and went as she pleased. There were worse things also: she began speaking badly about me behind my back…. Gossiping about me! She also gossiped about others in the office, creating rifts and tension. The team was unwilling to tell me about the issues because they felt I wouldn’t believe them. When I did find out that she was behaving so inappropriately, we had a talk. She was appalled that I would talk to her about her behavior and left in a huff.
As leaders in our practice, we may be encouraging favoritism without realizing it. Do you send out signals that encourage your team member to mute their criticisms and exaggerate their praise of you? Do you give more praise and appreciation to certain team members and not others? Do certain employees do it all and get all the recognition and rewards? You may inadvertently be creating favorites if this is the case in your office.

If you have trouble keeping a second dental assistant or a second front office person, have you’ve allowed one person to “do it all?”
Your team needs four things to feel they are a valued part of your team, with their top priority listed as number one:

1. Appreciation and recognition
2. Feeling like they belong to a close-knit team
3. Responsibility and feeling like they have a say in the practice
4. Money and rewards

If one team member gets all the responsibilities and rewards, you’ll find you have turn over in the second position.
When a staff person waves the white flag of surrender, ask them to share with you how they feel in an exit interview. If they tell you they’re leaving for a job closer to home or for more money, they’re being polite!

STEPS TO FOLLOW:

• First, be friendly with all your team, but not friends with any one particular staff member.
• Second, work hard to share appreciation and recognition as best you can. At Linda Miles and Associates, we have a motto: “Hire, train, trust and praise!” Do this relatively equally with all your team members. Recognize that we all have a tendency to favor those who favor us, even if we don’t mean to.

• Third, we like to see that benefits and bonuses are equal among all staff. Pay is personal.

• Fourth, be in close contact with your team. Create an atmosphere where your team can feel comfortable coming to you about things… not just what’s right! Create an atmosphere where it’s okay to talk about what’s wrong in the practice.

• Fifth, facilitate open communication through team meetings, meetings by department, and daily coaching. If you have a team member that is causing a problem, deal with it. If you bury your head in the sand, the problem will get worse. By being in close contact with your team, you can deal with an issue early on and prevent a “molehill from turning into a mountain.”

• Finally, train all of your team and encourage them to be the best they can be! Look at job descriptions within the practice and delegate appropriately. Your team members need to be challenged and excited about coming to work. You can facilitate this by continually asking your team to stretch, be slightly uncomfortable as they’re learning, and then reward them when the tasks are accomplished. Remember to: “Hire, train, trust and praise!”

DB: What has your history been in dentistry?
I started working in the front office of a dental practice while in high school. Then, in 1976, I became a dental assistant and continued that for four years. I earned my DDS from University of Washington School of Dentistry in 1989. I was a Navy dentist during Desert Shield/Desert Storm. For 16 years, I owned a private general dentistry practice, but sold it in 2003 and opened new practice, which I ran for four years. Because I had used Linda Miles’ systems in my first solo practice, it took only took two or three months to boost production at the new practice to levels that rivaled the former one. I used Linda’s systems my entire time in dentistry. The staff training and management systems made me very successful very quickly.

DB: What did you do before consulting?
In 2007, I sold my private practice and went to work with Linda. A shoulder injury simply wouldn’t allow me to practice chairside any longer, but dentistry was my passion and livelihood. Having used Linda’s systems for so many years, I thought it natural to take over LLM&A when she was ready to sell. She still works with me, though. We make a great team.

DB: What made you decide to become a speaker?
I actually grew up as a very shy girl. Speaking in front of large groups didn’t come naturally for me. When I became the first female president of my local dental association, which had 400 members, I joined Toastmaster’s International. I highly recommend it! Learning how to effectively and confidently speak in front of groups led me to become the second female president of the Washington Dental Association. Because of the leadership skills I gained from holding these offices, as well as being in the Navy, speaking became a natural progression for me. I have since presented across the US and in Canada. I never would have imagined this career choice as a 17-year-old dental assistant!

DB: What made you decide to purchase LLM&A?
Disability insurance is very important, as is protecting your body as a dentist. I had three surgeries on my shoulder (rotator cuff problems) and was told that I could no longer practice. My family has a history of bad joints, which isn’t good for a dentist. I also had several falls when I jumped horses. All of these issues caused my problem. I had to get out of chairside dentistry.

DB: LLM&A was established and run by Linda Miles for three decades, and Linda is a former dental office administrator. Now you, a dentist, own the company. What do you bring to your clients that was not previously offered?
Linda has always been strong in leadership. My many years of leadership in different arenas bring LLM&A strong leadership, as well. My ability to connect with the doctors is a bit different than Linda’s because I can speak clinically and provide individual coaching for case acceptance, dealing with labs, communicating with specialists, comprehensive care, and interdisciplinary dentistry. I can tailor our practice management philosophy to all aspects of the dental practice. Our other consultants can also rely on me as a resource on topics such as treatment planning, working with staff from a dentist’s perspective, difficult patients, etc. I have a knack for this. Sometimes the root of a problem lies with the doctor. I can address this by having experience in the dentist’s role. I can address these issues effectively and respectfully. Our success at LLM&A is based on the concept that the dental team drives everything forward. Our role is team development and making the team part of the practice. We have doctors who are tired, frustrated, burned out, and I can re-motivate, re-energize, and refresh them with goal setting, mission statements, vision, etc.

DB: Dr. Savage, why would a dentist hire a consulting firm like LLM&A?
I hired LLM&A in 1992. The productive practice I purchased was chaotic without complete systems. The team worked hard, but I knew we could work smarter for better production and less stress. I brought Char Sweeney on in 1993, and she helped make our office a fine-tuned machine with systems. I also didn’t want to drive the staff crazy with too much change at one time. I needed my staff on board with my vision and what I wanted the practice to be. The LLM&A company had similar philosophical beliefs as I, so we got the staff on board effectively. As part of LLM&A, I now do this with startups or existing practices. Small groups, solo practitioners, large offices – we work with them all. We help facilitate change.

We oftentimes see issues with collections and accounts receivable. To help with this problem, we organize front-desk and recall procedures: how to handle follow up calls, past due insurance, division of duties….staff development with teamwork and communication. We create great team meetings that help everyone get on the same page. Everything runs more smoothly as a result. Every team and every doctor is different. Onsite consulting REALLY helps. We analyze a practice from top to bottom and then facilitate change over a year or longer. We find that even in recessions, the clients that follow our recommendations improve 20%, and then increase 10-15% more if they bring us back to fine tune the practice. Some dentists are uncomfortable with investment and change, but our clients generally recoup their investment in first two or three months. The doctors do not have to facilitate change alone!

A current client I’m working with was producing about $30-40K per month when LLM&A stepped in. After a month, he did $91K; the next month $118 K; and the next month $97K. Not all of our clients see this kind of dramatic growth, but some do. Our average is 20-30% growth in the first year. All practices should increase profits every year, even in the current recession. We may have to work harder to fill the schedule, improve diagnostic skills, and connect better with patients. Our systems help this happen. They also help create the time for it to happen.

DB: In your months as owner, what trends have you noticed as a result of the economic downturn that (they say) began in December 2007?
Over the last several years, we’ve seen problems with broken appointments, last minute cancellations, and filling the schedule. Patients are more cautious with discretionary dollars these days – even those who aren’t affected job wise. Some areas in the US are hit much more, like in the Midwest. The areas that depend on boat and RV sales, the tire industry, and the travel industry are more depressed. Dental practices also sometimes create broken appointments by our own actions. If we move appointments and keep patients waiting, they will think that’s okay, and they’ll do the same. Patients only respect the appointment as much as we do! Linda says, “People count the faults of those who keep them waiting.” That’s true. It’s really important that we need keep patients on time. We must also always inform them of fees and not do work without informing them. It can cause embarrassment, which leads to anger, and we lose patients that way. Our goal is to attract new patients and retain the ones you have.

DB: Tell us about your seminars…
We have two, two-day seminars. One is Practice Administrators’ Workshop. It’s unique in that it’s a training program for an office manager, but it also focuses on the owner-doctor and spouse who may be in charge of the business side of practice. We focus on the skills that a manager needs to manage people. Most office managers are former dental assistants who also did scheduling and insurance, and then graduated to office manager. Managing people is a different skill set. There’s just not enough training on practice management out there and very little on leadership skills.

At LLM&A, we focus on practice management from a numbers standpoint and key in on leadership skills to effectively manage people. The program is two full days, very intense, and undeniably fun! We always hear attendees say, “It’s the BEST course we’ve ever taken!” I also want to say that humor is important. It makes the work environment a better place to be! Work can be draining at times. A good sense of humor tends to make things better.

Our second is the Dental Team Conference for doctors and staff. Sometimes dentists send their staff, but for best results, it’s important for the dentist to experience the program with the team. If the staff is excited, but the dentist isn’t, the program’s not as effective as it could be – and vice versa. We focus on the need for effective, productive team meetings. Fun is also priority! Many docs avoid team meetings because they can be a gripe session or non -productive. The theme of this workshop is communication from front to back, back to front – doctor to patients to staff, etc. This is the foundation for success. We also address numbers in regards to where the practice needs to be; things to say and not to say; how to have good verbal skills and speak for the doctor. A heavy focus is placed on insurance and scheduling at the front desk. We focus on reasons for broken appointments and cancellations. Marketing, keeping pts happy, and attracting new patients are also topics of concern. We discuss how to deal with difficult people. We focus in on the office policy manual. What does the front desk do when a patient arrives late? How do we deal with the patient who doesn’t bring money to the appointment? What if a patient will only do procedures that insurance covers? It’s important to work out an office policy on how to deal with these issues… It’s all about COMMUNICATION! Policies are communication. Team meetings are communication. Marketing is communication.

DB: What does LLM&A have in store for 2009?
I would like to expand into other healthcare industries in time – vet, chiropractic, ophthalmic. All of these fields have accounts receivable, procedure, team, and communication issues. That’s a long-term goal. We plan to expand nationally and internationally first with dentistry. Our goal has always been to focus on quality service to our clients. This is and will remain our highest priority.

We have many speaking engagements across the nation and four major meetings, as well as many smaller meetings. We’re all over the US! I have two new DVDs this month on teamwork and communication – the joys and challenges of clinical assisting, both in business and at the chair. We’re excited about our new DentalBlogs column, Two Sides of the Management Coin, in which Linda tells about the team’s view and I touch on the doctor’s view of an issue. We have a number of articles being published this year, and I am working on a book, as is Linda. We just built a new office in Gig Harbor, WA, which is in the Seattle area. There we will host workshops; the one in April is our Practice Success Series on Teamwork and Communication. Then we’re off to the ADA meeting in October 2009 to present Two Sides of the Marketing Coin in person.

DB: Since you’re a Great Mind that dentists and dental professionals respect, give us an inside peek at your nightstand… What books are you reading?
I have a list of books I’m constantly working on, and articles. I do a lot of research. I am affiliate faculty member of Washington School of Dentistry, as well. I read leadership and communication books. A powerful tool I’ve found features the five of best authors in leadership and communication whose books are summarized at Lessons for Leadership by The Business Source (includes John Maxwell). You get five DVDs and a transcript, plus Internet access, and for $400, and you can share it with four people. It’s really the meat and potatoes of communication and leadership. Best I’ve ever read! You can check it out online at http://www.thebusinesssource.com/lilrs.htm.

In Isn’t It Wonderful When Patients Say Yes by Paul Homily, I like much of what he says about case presentation. How much is it going to cost is the emotional side of our patient’s concerns. Is it going to hurt is the other important point. As dentists, we usually talk clinical and overlook these questions. One of the greatest success factors we see is being warm and connecting with patients or surrounding yourself with staff members who accomplish this.

I See Your Name Everywhere is all about marketing. I read a lot about marketing for successful dental practices. This book talks about the power of press. As a volunteer Zoo dentist, I worked on polar bears, monkeys, walrus, lemurs, and even a snow leopard. Because I volunteered, it was a great human interest, and I got publicity for it in the newspaper and on TV. One paper featured a full-page picture of me cleaning monkey’s teeth with the caption “Someone hasn’t been flossing!” I got calls from this. One new female patient said, “If she can work on monkeys she can work on my husband!”

Everything we do in the community brings in patients. I focus on marketing for my clients, as well. ~

Review Dr. Rhonda Savage’s biography on our About Us page, and stay tuned to DentalBlogs for her monthly column, “Two Sides of the Management Coin” with Linda Miles. Together, Dr. Savage and Linda will address big issues in dentistry from both the doctor’s and team’s perspective.

STAFF VIEWPOINT (LINDA MILES)

During these difficult economic times, the dental team doesn’t understand WHY raises and improved benefits don’t automatically happen. This is especially true if they are having a more difficult time with their personal finances. There needs to be open and concise communication from the doctor as to how times like these are handled so that when times are better, their personal compensation can be better as well. Not discussing this issue with the team crates low morale, inner-office gossip, and total dissatisfaction of employees.

The staff members think and in most cases say to each other: “We have worked harder this past year than any other, yet there was no end-of-the year bonus, as in the past (or it was much lower)…AND, have you heard anything about our annual raises?” Or, “We did not replace _____ when she left in September, so now WE are doing her work too… The doctor(s) should have divided her salary with us!” The “working harder with little recognition” is commonplace in the dental office, yet the dentist owner has, in most cases, taken a huge HIT with out-of-control overhead, lower profit margins, and a frighteningly slower schedule the last quarter of 2008.

The team needs to realize that if the money isn’t coming in the front door, the business owner can’t send it out the back door in the form of raises. “Raises must be earned, not EXPECTED.” If, however, there is open communication with the entire team, this can relieve much of the stress related to this often taboo topic. Not discussing it is the REAL issue.

DOCTOR’S VIEWPOINT (RHONDA SAVAGE, DDS)

Dentists, for the most part, dislike confrontations and will oftentimes ignore a situation or issue thinking if they ignore it, it might go away. Discussing the team’s performance (if it is anything but stellar), is often difficult and viewed as a confrontation. Then knowing that after a performance review, thirty days later, there should be a 15-minute merit review to discuss salary and benefits, which is even more difficult knowing the staff member wants a raise and thinks he/she deserves one. Avoiding these issues or delegating them to an office manager is most likely how many dentists deal with it.     

STEPS TO FOLLOW:

• 1) Remind the team that there will be annual performance reviews in their anniversary months with a 30-days later review of their personal compensation (which does not always mean a raise).
• 2) Let the performance evaluation be in three parts: 1) Doctor(s) Review, 2) Self Review, 3) Anonymous Peer Review. (For a comp copy of the LLM&A Performance Evaluation Form email rsavage@harbornet.com).

Open communication should go like this:

“We have all worked very hard this year. As you know, the US economy is down, but we can’t let it get us down. If we have a great year net profit wise, we can offer increases in pay and benefits. When there is a flat year, we must, for the sake of our future business, put a freeze on all salaries until things improve. If there has been a “down year,” as 2008 was (our first in the history of the practice), we as a business took a decline. Just as families pull together when things get tough, we consider you our work family and we, together, will weather this storm. We will do our very best to keep all employees employed but will evaluate this every 90 days. We may have to ask employees to have a higher cost share on their health benefit plan, but the alternative is to cancel the insurance, which we hope not to do. Please also know that in business, when we keep a positive attitude and pull together as a work family, things will get better, and when they do, we will resume sharing the growth with you; the team that makes it happen.”

Final To-Do:

• 3) Make a list of all the areas of the practice you can work on as a team during slower times, such as reactivation calls to all patients not seen in the past seven months or more and clearing up insurance past-dues and patient accounts; perhaps transfer those patient accounts to a patient finance plan to avoid interest for the patients. Pull a copy of your incomplete dentistry and revisit patients by letting them know that postponing dental care can cost more in the long run, not to mention creating pain and dental emergencies.

If your practice has an issue that you wish to have our LLM&A team discuss in future DentalBlogs, please send them to media@dentalblogs.com with the subject “Marketing Coin.” Last but not least, remember those practices that keep a positive attitude during tough times are those that have a positive outcome in the years to come. Call Rhonda at 800-922-0866, or Linda at 800-922-0882 if we can be of service to you and your team.

DB: Tell us about LLM&A and how you got started.

LM: LLM&A is a practice management and team development company that has evolved over the past three decades into one of the most respected names in dentistry. While working as a practice administrator for a start up practice in Richmond, VA from 1976 to 1980, I realized practice and business team development are not taught in dental schools, thus leaving young dentists to seek this help after they graduate. I developed a collection, inventory, and pending appointment system to more effectively manage the practice for which I worked. Several friends of my doctor (also recent grads) asked me to come to their practices to teach these systems, along with telephone techniques, scheduling, A/R management, insurance follow-up, and marketing. One doctor suggested I sponsor a one-day seminar and invite many to attend and share the ideas that had helped his practice so much. My first consultations were in 1978 and my first lecture in 1979. After moving to Virginia Beach in 1980, I stopped working in a practice and devoted all of my time to consulting, writing, and speaking.          

DB: Now tell us about how SCN originated.

LM: After mentoring many consultants and speakers individually (for 18 hours one month), I decided to manage my time better. In 1996, I set aside three to four days per year for mentoring others who wish to enhance their own speaking, consulting, writing, and product development. The first year of SCN (1997), we had 11 attendees and two of our staff people in Orlando. From there, in 13 years, SCN has grown to between 100 and 150 people, including VIP meeting planners, editors from leading dental journals, and exhibitors from top dental companies.

DB: Who is the ideal member for SCN?

LM: We deliberately set tuition for year one that is rather steep to attract only serious minded speakers who wish to book more engagements and improve their materials/skills. Our members, staff, and I enjoy sharing consulting ideas and “tools” that will make all of us better by tweaking each other’s ideas to apply to our own firms. The best benefit is the tremendous networking with other dental professionals who offer products and services to help dental practices more effectively serve their patients and in the process become more profitable.  

DB: Tell us about the success of some of your SCN members.

LM: It truly makes my heart sing when I open a dental journal and see that anywhere from 4 to 8 authors in each issue belong to SCN. Oh, the thrill I have sitting in their seminar audiences at major meetings! And having them email me their year-end success stories makes me very proud! They and I know that through networking at SCN, they continue to thrive as speakers, consultants, and authors. Does this mean that everyone who has attended becomes an overnight success? Absolutely not! SCN, like anything else, is not going to do the work for the members. It is up to each one who attends to go back and work VERY hard individually, year after year. In this business, there is no magic pill or Fairy Godmother who is going to do it for them. Like anything else, you get out of SCN what you put into it… Those who thought speaking and consulting was fun and a little-work business came once or twice and realized this business is a lot harder than they ever imagined!    

DB: What events and networking opportunities does SCN offer?

LM: SCN has a major conference on uneven years (2009, 2011), with a Members Only Meeting (MOM) on even years (2010, 2012). The major conference allows new members to experience a full day with the Executive Board Members who act as personal coaches for that first day of the major conference every other year. MOM is a more intimate group with no new members, no exhibitors, no VIP meeting planners, nor editors. It is a roll-up-your-sleeves meeting to share ideas and materials while taking in more great ideas than you could possibly implement in a year’s time.

DB: What’s on the schedule for this year’s Sun Fun Seminar?

LM: We will have our “Newbie Day” exclusively for new members and the Executive Board all day on Tuesday, February 17^th in Ft. Lauderdale at the Embassy suites Hotel. At 5:30 PM that day, we will host a Welcome Reception for new members to meet those returning for the land portion on the 18^th and half-day the 19^th. At noon on February 19^th, we will take a bus to the Navigator of the Seas (Royal Caribbean Cruise Lines) for a 4- day Cruise with close to 500 dental participants. We’ll enjoy our two half-day SOS (Spotlight on Speaking) Seminars while at sea. Fourteen SCN members will each give a 20-minute talk on their best material, followed by a short Parade of Products with our exhibitors. Afternoons will be free to explore the ship or for the dentists to network with consultants who are available for complimentary 25-minute Mini-Consults. We will have a full day of Fun in the Sun in Cozumel, with excursions or an all-day beach party for those who choose to just relax.        

DB: How can someone become a member or attend the seminar and cruise?

LM: They can call Lee Tarvin at 800-922-0882 to register for either the cruise only (dental practices) or SCN (land, sea, or both) at the same number. They may also email inquiries to Lee at leetarvin@cox.net or to me personally, LindaMiles@cox.net. Cabin space is limited, and we need to have everyone registered ASAP so that we can order workbooks by early February.     

DB: Now that you’ve retired (partly) from LLM&A, what are you doing with your time?

LM: Rhonda Savage, DDS is doing a great job her first 18 months as new owner and CEO. She is very busy speaking and consulting and has just built a new office with a conference space to house LLM&A West Coast Two-Day workshops and practice retreats in the WA area. I call myself Rhonda’s East Coast Marketing Director. My favorite job is telling long-term, established clients about Rhonda and her other consultants/speakers. I still lecture about 30 dates each year – and love it. Traveling less is wonderful for more family time. I am owner, and Lee Tarvin is the director, of the Speaking Consulting Network. This takes about 10 to 15 hours per week of our time to coordinate the annual conference and create new projects that will keep our members growing.

DB: Do you have anything exciting in the works – books, videos, audios, speaking engagements – that our readers should consider?

LM: Our seminar schedule for 2009 is listed at www.DentalManagementU.com under Seminars. I plan to start writing a new outlined book soon entitled Unhappy Employees (An International Epidemic). It’s about the lack of customer service and how frontline employees treat customers exactly the way upper management treats them! This is my first non-dental book, but it can certainly be used by dental practices or any business that has employees. For the most part, I feel dentists are good employers, yet in some practices that we consult, we realize leadership is often a weak part of the practice. Rhonda, while practicing clinical dentistry, was one of the strongest and fairest dental bosses I’ve ever met. She is an expert with helping dentists in that arena. Rhonda and I are both speaking at the Hawaii ADA meeting in early October 2009 with a new and exciting program called “Two Sides of the Management Coin.” We will discuss day-to-day issues that occur in a dental practice. Dr. Rhonda will give the dentist’s view, and I’ll chime in with “and here is how your dental team sees this.” We each have about 20 to 30 speaking engagements from CA to MI and in between this year. 

More About Linda Miles

You can review Linda’s biography on our contributors page where all of our Great Minds are featured. Linda will begin to share her expertise with us in conjunction with Dr. Rhonda Savage. Their new Dental Blogs column, “Two Sides of the Management Coin” will tackle some of the big issues in dental practice management from both the doctor’s and team’s perspective. Stay tuned for great things from Linda Miles this year!