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Academy of Dental Management Consultants Corner: Seven dental practice killers ... and how to avoid them


Careful attention to many of the commonly overlooked areas of practice health will make a huge impact on 2014. Here are seven chronic practice “illnesses” to look at now before they kill your practice.

Imbalanced Accounts Receivables

Cash is the lifeblood of any practice. When you have it, life is good. When you don't, bad things happen. Every practice owner and office manager needs to pay particular attention to four numbers that reflect the overall success of their accounts receivable system. Current receivables should be between 65 to 75% of the balance, receivables older than 90 days should be 10% or less, insurance claims older than 60 days should be almost 0, and total A/R should be less than one month's production. If your numbers do not reflect these percentages, make a very specific plan that targets collecting at time of check out, using more third-party financing, establishing clear financial agreement protocols, and ensuring your financial coordinator has three to four hours of dedicated time once a week to pursue overdue receivables and claims.

A dysfunctional recare system

Hygiene is the backbone of a general practice. It is where patient oral health and relationships are maintained and the majority of restorative care is found. Effective practices have a ratio of two hygienists to every doctor, have 80 to 90% of their patients actively in recare, have hygiene average 33% of total annual production, regularly have 30 to 40% of hygiene production from periodontal care, and experience less than a 5% hygiene cancellation rate. Practices do not achieve these benchmarks without total doctor commitment to hygiene, total hygienist commitment, passion for periodontal care, very clear hygiene protocols, and a dedicated business team member who owns the hygiene schedule and is an effective hygiene coordinator.

Subconsciously accepting insurance limitations

Treatment planning and presentation that consistently view "what insurance will pay" as the limit of treatment severely impacts both patients and providers. It delivers substandard care to patients while also placing practices on the treadmill that in order to survive it must see 20-30% more patients. Dental benefit plans are a single-tooth solution for restorative care and act in helping patients get into treatment. It is the job of the provider and the dental team to have the patient care mindset and verbal skills to address the patient's insurance questions and concerns while not being limited by it. Effective practices are aware of insurance but not limited by it.

Cancellations and no-shows -- and your team's attitude toward them

Cancellations are one of the leading causes of frustration in the industry. What many teams fail to realize, however, is their attitude toward cancellations and how they respond to them is critical to fighting this issue. Effective practices realize they must be both proactive and reactive with cancellations. Proactive schedulers know that reappointing patients who call to cancel and placing them in the next available appointment time teaches patients not to respect the practice’s schedule. They have the discipline to strive to save the cancellation to begin with and, when all else fails, to place the patient further out in the schedule with permission to call back if there happens to be an opening earlier. Reactively, they also have an active quick fill list they have created to strive to plug these holes when they happen.

Poor treatment acceptance

I was once was visiting with a provider who was very proud of the fact that his treatment acceptance was 33%. I hated to burst his bubble, but that's actually quite subpar (75-85% is actually the target). Providers who verbally, visually, and systematically choreograph effective treatment planning, presentation, and financial option presentation consistently achieve this. Practice production can double, without adding any new patients, by paying laser-like attention to this one dynamic.

Weak verbal skills

My good friend and colleague Larry Wintersteen has said, “Dentistry is first a behavioral art, and then a clinical science." 90% of that behavioral art is learning to communicate effectively with patients and with team members. There are two rules of thumb I have found in regards to patient communication: Always communicate in terms of patient benefit, and set expectations with a smile. This is something every practice can continue to improve upon. Read what industry experts have written on this, role-play together frequently, and work together as a team on raising the bar with this skill. This alone can be a game-changer.

Failing to step up as a leader

Leadership is at the very heart of every practice. Find a successful practice and you will find effective leaders. Conversely, find a struggling practice and you'll almost always find struggling leaders. A paradox for providers is in order to spend more time chairside, there is upfront time needed leading and delegating. Setting clear expectations, defining specific roles and goals for team members, showing appropriate and timely appreciation, learning how to deal with conflict, and knowing how to hire well (and when and how to discipline appropriately) are among the most vital leadership activities. To create an exceptional practice, become an exceptional leader. Study about this and then hire a coach to teach and hold you accountable. It will be one of the greatest returns on investment you have ever made because it will affect everything you do inside and outside your practice.

Action plan

What to do now? Grade your practice in each of these areas and then make a specific plan to turn the two or three of the lowest scores to A’s. Find a consultant/coach to help hold you accountable to these goals, and then work your plan. All of these can be corrected and the results that come from getting these “killers” out of your practice include greater profits, much less stress, happier patients, and a truly effective team. This can be the practice of which you’ve always dreamed.

Editor's Note: For more information on the Academy of Dental Management Consultants, please click here.

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