SmileMakers Dental Blog

For many doctors, the ultimate test of self-confidence comes when a patient questions your fees. You may feel that they are questioning your personal and professional integrity, your technical competence, and/or the value of your services.

You have invested years of education and financial sacrifice to master your craft. Yet, invariably, you continue to encounter patients who question your right to be adequately compensated.

In addition, the patient is making you feel that you are overpriced for the marketplace and can’t compete. You worry about losing the time you’ve invested in preparing the treatment plan, if the patient goes to another practice that’s willing to cut fees to compete.

While all of these thoughts and emotions may come to mind, the reality of the situation may be entirely different. In reality, the patient is setting the stage to negotiate. The reality is that the patient hasn’t the slightest clue of what it costs you to provide the treatment. When a patient makes this type of statement, she is really making her opening move to negotiate a lower fee. She is “bottom fishing” for the best deal.

The first thing you must understand is that caving in and cutting your fee is never acceptable. Cutting your fee is cutting your throat. It is tantamount to telling the patient that your craftsmanship is overpriced and your fees are negotiable.

On top of that insult, you are adding injury to the basic economics of managing your practice. It costs money to deliver quality health care. Inadequate compensation can only lead to a reduction in qualified support staff, the use of lesser materials, and reliance on inadequate or obsolete equipment.

Your best choice is to play the game, understanding that you and the patient are really negotiating on the quality of the patient’s health care. You must structure the negotiation so that both you and the patient can win. Remember that in the psychology of negotiating, the person who blinks first often loses. You just have to say that you feel good about your fees and that they are correctly calculated. At this point, eighty percent of the patients will stop negotiating and accept treatment.

It is rare that a patient will persist in questioning your fees. The implication to the patient is that if you want your treatment performed with lesser quality materials or by a less experienced doctor, you are welcome to go elsewhere. In any case, you have made the statement in such a way as to reinforce your personal and professional integrity without embarrassing the patient.

In developing financial strategies for our consulting clients we are often asked, “What should my fees be?”

Our answer is invariably, “Whatever you feel confident in charging.” There is essentially no limit to what you can charge for your services. (Except for insurance fee schedules, of course, but that’s another issue entirely…) The basic premise is that you are confident that your fees are representative of the quality of the materials you use and your experience in performing the treatment. The key word is confident. Any lack of confidence or hesitation will be detected by the patient and exploited in the negotiation.

One of the most successful doctors we know accepts no insurance and requires all fees be paid in full prior to beginning treatment. The cost to a patient for a single gold crown ranges from $950 to $1,250.

He presents his treatment plan by saying, “My fee for performing this treatment is $950. I will attach a copy of the lab bill detailing the materials and their preparation cost to your bill.” Now, in case you missed it, the lab bill was separate and added to his fee for the crown. His case acceptance level is in the 90% range.

Patients immediately perceive that this doctor knows his worth. I must also add that every stage of the patient’s interaction with the doctor’s staff, facility and post-treatment care are of the very highest quality. This high level of quality supports the 90% acceptance level and reinforces the sense of value the patient perceives in the doctor’s capability to deliver the treatment.

The best confidence-builder to help you feel comfortable with your fees is very simple. Just remember that quality treatment must be supported by commensurate fees.

Children Can Come Meet Chomper at the America’s Children’s Holiday Parade. Pre-Parade Kickoff Event at Jack London Square This Friday

OAKLAND, CALIF., December 3rd, 2009- Haydenburri Lane, creators of the Rascals & Routines^TM brand, announced today that Chomper,  the Tooth Brushing Crocodile, will appear in person at the America’s Children’s Holiday Parade pre-parade kickoff event this Friday evening, December 4^th, from 5:30 to 7:30 PM at Jack London Square in Oakland.

Chomper, and Haydenburri Lane President & Founder, Hillary Hayden Burri, will be at the event to meet local children and their families.  Chomper will be passing out free children’s toothbrushes (donated by SmileMakers, www.smilemakers.com) and free music download character cards.

“We are very excited to be introducing Chomper to the Oakland and Bay Area communities at this event.  This is truly a great way to get out there and connect with children and their families.” said Burri.  “Chomper, our goofy, toothy crocodile, loves to brush his teeth!  And we all know that tooth brushing is such an early and important routine to develop in young children and Chomper makes it fun for everyone.”  added Burri.

Developed in Oakland, California, Rascals & Routines^TM is the ”healthy habits” brand designed for preschool children. Rascals & Routines^TM is a learning system of books, music, media, and toys that introduces children to a world of lovable characters who turn daily routines such as bedtime, morning time and mealtime into playful adventures.  Rascals & Routines^TM is excited to be debuting Chomper, the Tooth Brushing Crocodile, from the Go Rascals!^TM animated series, at America’s Children’s Holiday Parade.

On parade day, Saturday, December 5^th, Chomper will be riding with Hillary Hayden Burri in a Jeep Wrangler (provided by Michael Steads Walnut Creek Chrysler, Jeep, Dodge dealership).  Chomper’s ‘Tickle Your Teeth’ theme song will be played from the Jeep throughout the parade route. For those watching the parade on television, Haydenburri Lane will be offering free downloads of our Go Rascals!^TM music at www.gorascals.com.

For more information about Rascals & Routines,^TM please call Hillary Hayden Burri at 510-339-8559 or visit www.haydenburrilane.com.

About Haydenburri Lane

Haydenburri Lane is a creative media company based in Oakland, California. The company develops solution-oriented entertainment that focuses on healthy habits and routines for children. The Rascals & Routines^TM brand is designed for preschool age children. Rascals & Routines^TM is a learning system of books, music, media, and toys that introduce children to a world of lovable characters who turn daily routines such as bedtime, morning time and mealtime into playful adventures. The characters also support self-esteem lessons that enable children to develop the tools needed to establish a healthy self-image.  The integrated system of products becomes fun, instructional tools for parents to use in establishing routines with their children which in turn can become valued family traditions.

About America’s Children’s Holiday Parade

Under the auspices of the Oakland Metropolitan Chamber of Commerce, America’s Children’s Holiday Parade marched down the streets of downtown Oakland ten years ago in front of some 30,000 people. Now the parade is viewed by more than 100,000 in person and can be seen in millions of households nationwide as well as in Puerto Rico, Guam and parts of Canada, thanks to PBS. And, through the generosity of our many sponsors, including Comcast, the title sponsor, America’s Children’s Holiday Parade has become the largest holiday parade in Northern California. The Comcast America’s Children’s Parade is also a holiday championship for the marching band circuit, sanctioned by the Northern California Band Association.

About SmileMakers

Over 30 years ago, SmileMakers was started with one simple idea- to be the absolute best supplier of fun products used to incent, reward, and entertain children - young adults - even adults!  Our quality products bring smiles to both the young and the young at heart.  SmileMakers is a wholly owned subsidiary of Staples, Inc.

Dentists frequently tell me their top New Year’s resolutions for their dental practice is to attract more new patients. Well, January is traditionally one of the best months to acquire new dental patients for your practice! Three completely different types of patients are all coming into the market at the same time.

1. People who have put off their dental treatment plans until after the November-December holidays.

2. New Year’s resolution patients who have decided to clean up their dental act as part of their new physical fitness program.

3. Patients who have put off their dental treatment until their dental insurance benefits are renewed in the New Year.

Group number one, the procrastinators, are already in your practice. All you need to do to get them in the door is to follow through on your normal Chart Audit of patients with uncompleted treatment plans. This means a call from your dental scheduling coordinator to remind these patients that the new year is the right time to complete their treatment.

Patients from group number two are generally not in your practice. These people will be out looking for cosmetic, implant, sedation and orthodontic dentists in droves! Most of these people will look online to find a local dentist who can meet their particular dental needs.

If you don’t already have a comprehensive Internet marketing plan (multiple dental directory listings, email newsletter program, team training on how to convert Internet patients and multiple targeted high-value new patient websites), there’s no time like the new year. Sign up with a dental website provider. and they’ll do the work for you!

Group three, those patients who have been putting off treatment until their dental insurance benefits are renewed, can be quickly converted into active treatment plans with a simple letter that should be sent to ALL your insurance patients. Here is a sample letter:

Re: Dental Insurance Benefits in the New Year

Dear Valued Patient:

I would like to take a moment to discuss your dental insurance benefits.

Almost all insurance companies renew your dental benefits with the New Year. That means that you can take advantage of possibly $1,000 or more of benefits for yourself and your family.

So if you’ve been postponing dental treatment, now is the time!

Many insurance patients neglect to take full advantage of their insurance benefits. These benefits, often part of an employer’s insurance program, are typically lost if not used. What are you waiting for? Call today to ensure your best dental health - particularly if you’re due for your regular check-up and cleaning!

As always, please do not hesitate to call our office or email us should you need anything at all.

Sincerely,
Dr. Dentist

P.S. If you have friends or family who you feel would benefit from our preventive approach to healthy gums and teeth, please send them our way. We’ll take good care of them!

P.P.S. Be sure they mention your name so that we can thank you personally with a token of our appreciation.

To send online newsletters to your entire patient base, and gain access to pre-written dental patient communications letters that can kick-start your dental marketing in the new year, just sign up with a dental email newsletter company.

We all know how many insurance patients wait until the end of the year to use their benefits. All it takes is a simple reminder from you to bring them in earlier!

The Hidden Costs of a $40 Dental Crown

The relationship between dentists and their dental labs is a close one - but is it close enough?

Dental labs have been in the spotlight due to the recent scare over lead apparently finding its way into dental restorations such as crowns and bridges. Dentists are realizing that they are ethically (and possibly legally) responsible for the quality of their dental lab’s work. Doctor, you better have your story straight when you patients start asking you where your lab work in being done.

Start at the beginning

Once upon a time, would-be dentists studied alongside would-be dental technicians. The two professions are inextricably connected, and each would do well to understand the needs of the other. How better to foster this relationship than by educating students together?

Today, however, that is certainly not the case. At most schools, dental students and lab students have little to no exposure to each other. The communication gap that begins in school tends to continue into the working world.

“Most dentists don’t meet a technician until after they graduate and that’s criminal. The pre-clinical students and dental laboratory technology students are able to learn from each other, which helps them hone the skills they have and build new ones.”
- Bob Schneider, DDS, University of Iowa Hospitals and Clinics Professor (Journal of Dental Technology, June/July 2006)

Bridge the communication gap

One of the biggest complaints dental lab technicians have about dentists is that they often don’t give the lab all the information they’re supposed to. A proper prescription for a dental prosthesis includes detailed information about the materials to be used in its construction. When the dentist doesn’t provide all the details, it’s up to the technician to make these important decisions.

“Most dentists rely on the dental technician to choose the materials needed for the fabrication of the prosthesis. With lack of adequate information, all too often the design, fabrication, and completion of the case is left up to the technician. Therefore, our results indicate an apparent trend to which technicians are left to make crucial decisions for dentists.”
- Z. Afsharzand, DMD et al. (from the Journal of Prosthodontics, Vol 15. No 2 March-April 2006 pgs 123-28)

Know your partners

One dentist will have been working with the mom-and-pop dental lab down the street for thirty years. Another will use a major domestic lab after personally visiting the premises. Another will prefer the US-based chain with the lowest prices. Another will go online to find a Chinese lab that offers crowns for $39.95.

The dentist’s relationship with his or her lab isn’t something the patient can see. It’s not even something most patients would think to ask about. But even if it’s invisible to the patient, it’s likely to be the factor that best predicts the quality of the dental work they receive.

Patients deserve disclosure

In the US, dentists are not required to tell patients if their dental prosthetic was manufactured outside of the country. In fact, dental labs are not always required to tell dentists where the device was manufactured. (And since many US labs use partners overseas, a domestic return address is no guarantee.)

However, expect the laws to start changing soon. A number of states are already considering legislation mandating that labs inform dentists and/or dentists inform patients of work fabricated outside of the country. In Canada, for example, patients must sign an informed consent form before receiving any foreign dental work.

Keep on working

It may be a long time before the ADA announces the results of their testing. Perhaps it’s a big fuss over nothing; perhaps we’re all slowly dying of lead poisoning. I can’t predict what the science will say. But I can definitely predict this: you, the dentist, are going to be held responsible for your dental lab work. Here’s hoping you can be proud to stand by your restorations.

The unfortunate truth is that there’s a three in four chance that your practice will be embezzled at some point. If you’re not able to avoid theft, the best thing is to catch it quickly. However, you’re unlikely to discover embezzlement unless you’re checking for it. Blind faith in humanity is not a good business practice!

Are you being embezzled? Here are 20 signs that might indicate the answer is yes.

1.      Unusual Behavior
The perpetrator will often display unusual behavior that when taken as a whole is a strong indicator of fraud. The fraudster may never take a vacation or call in sick for fear of being caught. He or she may not assign out work even when overloaded. The employee may become very defensive, unusually irritable and suspicious.

2.      Complaints
Frequently, tips or complaints will be received which indicate that a fraudulent action is going on. Complaints have been known to be some of the best sources of fraud and should be taken seriously. Although all too often the motives of the complainant may be suspect, the allegations usually have merit that warrant further investigation.

3.      Stale Items in Reconciliations
This is a big indicator in dental practices! In bank reconciliations, deposits or checks not included in the reconciliation could be indicative of theft. Missing deposits could mean the perpetrator absconded with the funds; missing checks could indicate one made out to a bogus payee. Bounced checks could indicate that funds are being siphoned out of your bank account.

4.      Excessive Voids
Voided patient receipts could mean that the patient paid, the payment diverted to the use of the perpetrator, and the internal copies of the receipt subsequently voided to cover the theft.

5.      Missing Documents
Documents that cannot be located can be a red flag of fraud. Although it is expected that some documents will be misplaced, your CPA should look for explanations as to why the documents are missing, and what steps were taken to locate the requested items. All too often, the auditors will select an alternate item or allow the auditee to select an alternate without determining whether or not a problem exists.

6.      Excessive Credit Memos
Similar to excessive voids, this technique can be used to cover the theft of cash. A credit memo to a phony customer is written out, and the cash is taken to make total cash balance.

7.      Common Names and Addresses for Refunds
Insurance refunds are received in error and the perpetrator will make the refund out to a bogus name and the address shown for the refund is then made to the employee’s address, post office box the perpetrator maintains, or to the address of a friend, relative or co-worker.

8.      Increasing Reconciling Items
Stolen deposits, or bogus checks written, are frequently not removed, or covered from the reconciliation. Hence, over a period of time, the reconciling items tend to increase.

9.      General Ledger Out-of-Balance
When funds, inventory, or assets are stolen and not covered by a fictitious entry, the general ledger will be out of balance. An accounting of the inventory or cash is needed to confirm the existence of the missing assets.

10.  Adjustment to Receivables or Payables
In cases where patient payments are misappropriated, adjustments to receivables can be made to cover the shortages. Where payables are adjusted, the perpetrator can use a phony billing scheme to convert cash to his or her own use.

11.  Write-off of Receivables
Comparing the write-off of receivables by patients or insurance companies may lead to information indicating that the employee has absconded with payments. Only the doctor should have the authority to write off an account.

12.  Slow Collections
Pay close attention to your receivables. If a patient or insurance company that has always paid within guidelines has a balance/claim that is starting to age, you should inquire.

13.  Excess Purchases
Excess purchases can be used to cover fraud in two ways: (a) fictitious payees are used to convert funds, and (b) excessive purchases may indicate a possible payoff to the perpetrator.

14.  Phantom Vendors
Perpetrator establishes one or more phantom vendors to pay for goods or services never ordered. The payment goes to an address controlled by the employee.

15.  Ghost Employees
Ghost employee schemes are frequently uncovered when an individual other than the perpetrator distributes the paychecks. Missing or otherwise unaccounted for employees could indicate the existence of a ghost employee scheme.

16.  Duplicate Payments
Duplicate payments are sometimes converted to the use of an employee. The employee may notice the duplicate payment; then he or she may prepare a phony endorsement of the check or turn it into cash at the bank.

17.  Large Payments to Individuals
Excessive large payments to individuals may indicate instances of fraudulent disbursements.

18.  Employee Overtime
Employees being paid for overtime hours not worked by altering time sheets before or after your approval, if required.

19.  Inventory and Supplies Shortages
Normal shrinkage over a period of time can be computed through historical analysis. Excessive shrinkage could explain a host of fraudulent activity, from embezzlement to theft of inventory or phantom inventory.

20.  Charge Accounts and Credit Cards
The perpetrator makes charges for his or her own benefit to charge accounts and credit cards. When the bill comes in, it is paid in the normal course and the merchandise is used by the employee.

Once again re-read the above and check your system. Remember, there’s a 75% chance that your practice will be embezzled during your dental career… chances are it will happen to you!

There is an old saying in business: “It’s not what the cockroach eats that matters… it’s what he spoils for others.” Just imagine you’ve worked closely with a patient to put together a major long-term treatment plan involving a full-mouth reconstruction over an eighteen-month period. Eight months into the plan, both you and the patient are happy with the initial results. So far, so good.

Your patient then visits a local heath fair, stopping at a dental information booth run by a competitor. As she starts to tell him about her treatment plan, he volunteers to do a quick look-see. Of course, he comes up with half a dozen better ways to solve the problem. Your patient comes back to you with Dr. Cockroach’s list of treatment recommendations. This is what we call “Cockroach Competition.”

There is no easy way to defend yourself from this type of competitor. They are just taking pot shots at your treatment plan with little understanding of your history with the patient. Even worse, they may use a self-made diagnostic check-off sheet designed to make their approach look great and anything you might be trying to accomplish look second-rate. Basically, these types of doctors can’t compete on the value of their own services. They need to attack their colleagues’ work to recruit patients.

I recently ran into another version of Cockroach Competition with my Internet dental website business. One of our competitors decided to run an unsolicited automatic analysis of some of our doctors’ websites, claiming that we were doing a poor job because each doctor’s “assigned Google Page Rank was too low to be competitive.” Just for your information, page rank is one of those interesting buzz words that a cockroach can easily fall back on when trying to knock the competition.

Even worse, I recently had several website subscribers attend a seminar held by what I had always thought of as a reputable consulting company. Like the health fair example above, our clients were offered a no-charge analysis of their websites. Lo and behold, they all received a highly critical analysis of their sites, accompanied by a full list of services and how they could do better… another “Cockroach Competitor.”

So what is the solution to these kinds of competitive attacks on your patient base? Patients aren’t stupid, but they can become confused when a cockroach starts throwing a lot of technical jargon at them. Talk with them and, most important, listen to them too. Then bring them back mentally to when they first came to you with their problem. Review how you have worked together to map out just the right treatment plan for them. Remind them of all the things you have accomplished together and, hopefully, how happy they have been with the results.

I’m a fanatic about signage, specifically dental practice signs. I actually carry a digital camera when I travel just so I can snap pictures of a great dental practice sign that I may see in my travels. Why is this so important to me? Signage is the least expensive way to acquire a new dental patient!

Recently I got a question from a doctor asking me if it was worth a 100% premium to add an electronic digital reader board to his new sign. The addition of this feature literally doubled the cost of the sign from $7,500 to over $15,000! He wanted to know if it was worth the extra expense.

For those of you who aren’t familiar with digital reader boards, these are essentially programmable digital displays with changeable moving messages and basic images. They are usually attached just above or below your standard practice sign.

The answer depends on three questions.

1. How much drive-by traffic will your sign have?
2. Are you willing to spend the time changing the programmable message on a daily basis?
3. What is the average value of a new patient in your practice?

First, for any dental practice sign to be successful, it must have great drive-by traffic. If you haven’t got significant drive-by or foot traffic visibility, do not invest heavily in signage.

Second, digital reader boards are involvement tools. Yes, you can program them with the time and temperature and let them run on their own. But for maximum return on your investment, you should change the message daily and turn it into a community bulletin board.

This works especially well if your office is near a high school or college and you program your sign to tie into sporting events, honors programs, community events, plays, etc. People will always look at your sign to see what’s new. If your market is more urban, program your sign with short quotes from famous people.

Third, consider the average net contribution of a new patient to your practice (after the cost of providing the dentistry). For example, if each patient nets you $500, then you only need an additional fifteen new dental patients over the entire life of the sign to pay for the additional cost of the programmable reader board. This falls into the “No-Brainer” category of dental practice marketing decisions.

Click here for more information on dental sign design and positioning

Search Engine Optimization (SEO) is a hot topic online these days - it’s all about making sure that your dental practice website ranks high on search engines. If you’re an orthodontist in Omaha, you want to be at or near the top of the list when people go to Google looking for “Omaha orthodontist.”

If you don’t know much about SEO, there are lots of people willing to take your money in return for (hopefully) improving your page rank with the major search engines. But there’s more to the internet than just your homepage. It doesn’t take a lot of work on your part to get yourself and your practice in the news - and that’s free publicity for you! Consider the power of press releases.

First off, you need to start with a newsworthy item. Some examples:

• You or your practice has received an award or honor.
• You’ve gotten new equipment or introduced a new service.
• You’ve done or are going to do something for the community
• Your practice has moved.
• You’ve hired an associate.

In creating your press release, think locally. Be sure the text includes your city, state, and zip code. Including information about where you’re located makes the local media more likely to notice and pick up on your story. You’ll also want to send copies of your press release to the local media - they are your friends! You’ll pick up more clients from a spot in your local news than from any national media.

Make sure your press release is long enough to look respectable - that means at least 150 words. In fact, your release can be as long as 500-1000 words. Keep in mind, however, that most news outlets won’t reproduce the whole thing. That’s why most press releases are written in the inverted pyramid format, which means that the most important information is at the beginning of the document. That way, it reads smoothly even if paragraphs are lopped off the bottom. Remember the old adage: who, what, where, when and why.

Finally, if it’s an option, consider scheduling your release in advance. This gives the local media time to read your release and research your practice beforehand.

Press releases can seem daunting at first, but they’re pretty simple, and they’re a great avenue for publicity. There are lots of sites for press releases out there - a quick internet search will show you hundreds. And don’t forget to include the local media - not just newspapers, but TV stations, radio stations, and popular local websites.