to Dental Practice Solutions

Welcome to dentistry’s largest dental hygiene practice management resource center! We are the leading dental hygiene consultant/coaching business.

We will increase your TOTAL dental practice profitability without working more hours or days each year.

- Debbie Seidel-Bittke, RDH, BS, Speaker, Author. Dental Hygiene Coach & Consultant

Dental Practice Solutions - Debbie Bittke

Mid- Year Financial Report. Where Do You Stand Today?

By: Debbie Seidel-Bittke, RDH, BS

July 27, 2012

We are half way through 2012! Hard to believe I know! Are you on track with your financial goals for this year?

Maybe you are questioning, what financial goals?! And maybe you answered “Yes, I have already reviewed my numbers and I know exactly how I compare to last year!” Or maybe you answered, “How can I be expected to review financial goals when I am at the office all day and working on patients?!”

No matter how you responded to this question, you will appreciate the sensible steps about how to improve your financials and proven steps to success.

No matter which of the above listed groups you fall into, I have outlined a few steps for you to hit your financial goals this year. In fact why not plan to add an increase to your numbers without adding more stress or time to your day?!

  1. First step  is to run your YTD  income and expense statements
  2. Run your software reports; year to date (Dentrix has the ability to run previous year so you can compare)
  3. Compare your current performance YTD report  to your previous YTD report
  4. Identify opportunities and challenges to achieve End of Year goals
    a. Develop processes to achieve Year End goals
  5. Schedule team meeting to promote collaboration
    a. Ask your team to problem solve and assist in development of solutions
  6. During last quarter schedule team meeting and repeat above steps

There are many ways to increase your income. Some dentists will increase fees although during this economic climate this can create more challenges and you may lose many patients. Other dentists will choose to lower employee salaries or cut back hygiene hours and days.

If you want your revenue to improve you need to look at all the details of your profit and loss statement. It is not as easy as increasing fees nor cutting salaries and days of hygiene. Many dental practices have numerous cancellations but are making more money seeing fewer patients and working less days. One way to identify increased production is to provide more preventive services. Many of the clients of Dental Practice Solutions have implemented the preventive services through valuable communication skills. This has benefited the patients overall health and the financial health of the practice’s although an economic decline occurs in our world today.

Here are the steps to take:

  1. Run Your Profit and Loss Statement

Run your profit and loss report which will provide an overview of your current financial picture. This is where you can compare employee salaries, leases, equipment, etc., etc. This provides a black and white report providing a true financial picture YTD. Run this statement From Jan 1, 2011 – June 30, 2011 and compare to Jan 1, 2012 – June 30, 2012. When you look at these two years and compare, now you have a better idea of where your last half of year goals truly need to be to accomplish your Year End goals.

  1. Run Your Half Year Software Reports

Many of Dental Practice Solutions clients use DENTRIX software. If you use Dentrix you will go to Office Manager and select Practice Analysis. Now you can run a detailed production report for each provider in your practice. This will allow you to analyze the procedures, who has provided the various procedures, how many and the amount of production from these procedures they have provided for the practice. Once you have this information you can analyze the trends and discuss with the team at the team meeting you have scheduled at half year meeting and again at the end of year team meeting. This is a great time to discover how many of the procedures you most desire providing patients, have been completed. If you enjoy providing veneers or implants, now is a great time to assess how many you have provided and what you may need to change (Are you communication skills effective?  Or do you need to review other third party payer information for patients to use and easily pay for treatment?)

  1.  Compare your Current Performance YTD Report  to Your Previous YTD Report

Be sure to use these benchmarks: Collections should be at 98% or >, Employee expenses 22-33%, Lab expenses 8-12%, Marketing 1-3%, Facility expenses 4-8%, Minor expenses 6-10%, General expenses 6-10%. The total expenses should be no higher than 75%.

Once you have a spreadsheet (Excel) designed with these expenses listed out, total the amounts spent and compare to your total collections. This is how you will calculate the % you have spent for each of these areas to run your dental practice. Now you can use your P&L to discover if you are on track to accomplish your financial goals. Which areas do you need to adjust and prepare a system to improve these areas that need adjustment?

  1. Identify Opportunities and Challenges to Achieve End of Year Goals

In reviewing one of our clients (Became our clients Jan 2012) financials mid-year we discovered that her employee salaries are 50% higher than one year ago. It is now time to sit down to discuss why this happened and how to get on track to accomplish the year end goals. Possibly, you have moved to a new location or you have taken out a loan in the past year. If you lease expense (Facility expense) is now 10% instead of 8%, you will need to adjust your goals for the year end and discuss a way to close the gap for the year end goal to be met. Maybe your collections are down this year. It is time to create a new system to increase collections. If insurance payments are behind you may want to discuss using the collection services of Trojan Professional Dental Services.

We teach our clients how to implement preventive and same day services. These have proven to be great ways to improve patients’ health, add value to your services, WOW patients and improve the financial health of your practice.

Our offices have also implemented team bonuses based upon the bonus system. This provides improved team collaboration and definitely improved team spirit!

  1. Schedule team meeting to promote collaboration

As a team these changes will be much easier to implement. Plan a half day or even full day, off-site and have everyone on the team come with ideas to create change. Have a time for them to express their challenges and concerns. Ask everyone to provide ideas for success.

At the end of year, it is a great time to not only have a Holiday Party but a time to go outside of the office for a Success Celebration and also a time to plan out the next year’s success. Each year plan to have 2 major team meetings. These need to be at least 4 hours in length and it can be a great idea to add some fun to a meeting which can be thought of as boring or monotonous

  1. Schedule Your End of Year Team Meeting and Repeat All of the Above

Plan a time in November and December to sit down as a team and plan for a great year in 2013. What do you need to change or continue for added success in 2013? This is a great time to CELEBRATE your success in 2012!

At the end of year in 2012 and every year to come, run these reports and repeat the steps outlined above. This is how you will run a financially success dental practice. Two times each year you will follow these steps and sit down as a team to collaborate your plan for success. If you do not take time to plan than you have planned to fail. There is no other way to put it so plan now for your future success!

A Profit Center Within Your Dental Business:10 Facts of the Matter

By: Debbie Seidel-Bittke, RDH, BS

July 3, 2012

For many years the dental hygiene department has been thought of as a loss-leader in the dental practice. In the world of today’s preventive patient-centered dental practice, the dental hygiene department needs to be a very big profit center. The patients gain optimal overall health and the dental practice has healthy profits when you follow these guidelines.

When you see the words “the business of dentistry” what do you imagine? Perhaps you see a treadmill where high volume and financial reward are the main focus of the dental hygiene department. Or do you see a hygiene department where quality patient care and profitability are congruent, operating with systems and protocols that would not allow one to compromise the other?

A Paradigm Shift

Years ago when I decided to become a dental hygienist a dentist –friend of the family–said to my father, “All my hygienist does is cost my dental office a lot of money! Your daughter should not think about becoming a dental hygienist. Hygienists really don’t add much value to a dental office and I wish I didn’t have a hygienist.” Good thing I didn’t listen to what that man said!!

During the past ten+ years the goal of helping dental patients has now progressed from cleaning teeth into supporting good overall health and preventing disease. One thing that hasn’t changed is the cost of running a dental practice. It is important that the team understand the cost of running a business and also a hygiene department. It is when the team understands these financial aspects of the business that the members of the dental team will be committed to excellence. It is important to have team meetings that educate every team member of the cost associated with the daily operations of running the business of dentistry. Share the vision for your practice and with the team and let everyone, know your mission: The “WHY” you do what you do.

The Facts

The fact is, the hygiene department is the second largest profit center in the dental practice, and provides support for the practice as a whole. Within the hygiene department are several other areas of profitability for the dental practice.

Most of your patients spend one hour–two to four times a year with the dental hygienist(s) and because of this ongoing relationship patients are more likely to remain in your practice, accept treatment recommendations and refer patients to the dental office. This makes your hygiene department a business within a business. It makes the executive(s) in this department held accountable for his/her success. When the dental hygienist is held accountable for the department success, when he/she understands the vision, and the principles of the dental practice, success will follow. You will find the team working in harmony when they all understand the vision for the practice, share the same code of patient ethics, and take ownership for the way patients are treated.

When every team member takes ownership of their role, the patients are sure to experience a caring attitude, an ultimate dental experience, the highest level of care, and the profits are sure to follow. This provides a win-win situation.

One of the most important aspects of the dental hygiene treatment that is often overlooked, is this list of assessments. (see below) Dental hygienists feel as if they are on a treadmill but when the team effectively plans their day, these assessments can really make the day run smoothly, this will make patients feel they received the highest level of care, and it now allows provides a higher level of comprehensive care. The treatment plan now moves to a higher level of care.

New Treatment Heights

There is a list of 10 assessments and patient procedures that stimulate profitability in the dental hygiene department. (keep reading below) These ten are all important aspects of the patients’ oral and total health. Not all offices participate in this list of 10 and this is what sets your office apart when you offer a menu of these services to your patients.

If you take a look at the list below and notice a missing piece in your dental practice, choose to just implement 1 or 2 of these within the next month. Make an appointment this month to discuss with your team how to implement these ten successfully into the hygiene patient appointment. Be patient with yourself when making these changes. Take time to discuss at a team meeting how to effectively implement these with full participation from the entire team.

The most overlooked assessments are the annual full-mouth periodontal screening exam. Still in the 21st century many hygienists who see a patient every six months, they neglect to pick up a periodontal probe prior to picking up a curette.  Most dental offices have approximately 15% of their adult patients with untreated and even undiagnosed periodontal disease. If each of these patients continues down this path we know that the research states — “this disease process will continue and the patient will at some point experience tooth mobility and possible tooth loss.”

What will this cost your dental business? Take into account that most non-surgical periodontal treatment plans are approximately $1,000.00 (USD) for 4 quadrants of scaling and root planing, not taking into account the use of antimicrobials and/or laser therapy. Now take into account the frequency of the periodontal maintenance. (Add in another $100.00 USD maybe 4 times a year.)

Once a periodontal patient, always a periodontal patient. It is the same as a patient with diabetes or high blood pressure. These patients are seen frequently and always at risk for future disease even after the disease has been halted. These patients are asked to schedule a preventive care appointment with their physician to be sure their disease is now “status-quo.” This is no different when our patient is diagnosed with periodontal disease.

Take into account that if you have 100 patients with 6 areas of 5mm pockets and they now receive Phase-1 non-surgical periodontal treatment. And then after the Phase-1 non-surgical treatment is completed the patient returns 4-6 weeks later for the re-evaluation, (Similar to a post-op appointment) which is now considered the 1st periodontal maintenance appointment. If the disease goes untreated we know what the cost to the patient may be tooth loss and poor systemic health. If you neglect this treatment for 100 patients what is the financial loss to your dental business?

Another new area of treatment that is overlooked at this time is the pediatric patient – first visit. CAMBRA (Caries Management by Risk Assessment) is a new evidence-based protocol for assessing caries. It is now the standard of care for the pediatric patient to have their first visit when the first primary tooth erupts. This appointment can be done in a consult room with the child seated on the mothers lap. This is an appointment to assess the tooth structure, biofilm and any suspicious areas of the child’s oral cavity. If you are concerned about receiving payment the CDT codes in the United States have you covered. There are two specific codes to bill for a child to have this exam and bill for the procedure in a consult room, if an operatory is not available. A biofilm assessment, oral hygiene instruction and a fluoride varnish can now be completed in a consultation room and billed accordingly, according to the CAMBRA protocol.

CAMBRA recommends that a patient who is at moderate to extremely high-risk for caries see a dental professional for preventive measures every 90-120 days for biofilm assessment, oral hygiene recommendations, a fluoride varnish and home care instructions; not just at the six month continuing care visit. This adds another area of profit to your dental hygiene department. The Insurance book of CDT codes outlines specific codes to bill various procedures including CAMBRA patients.

How many patients qualify for this preventive measure? How will this benefit your patients and your bottom line? It is all up to you. How will you decide to answer these questions?

When the hygienist and team all understand the need to prevent and intervene at an early stage vs. wait and watch; not only does the patient gain an improved level of health but the dental hygiene production will increase. Establish periodontal and the various preventive protocols today. Now is the time to cease treating the periodontal patient with a prophy appointment and begin to utilize the preventive measures according to the new CAMBRA guidelines.

Another area in dentistry that has changed in the past decade or more is selling home care products. Many decades ago we wrote a prescription or sent our patients to a pharmacy with names of products written on a piece of paper. Our knowledge and research over the past few decades states that 70% of these patients returned to our dental office and never took time to get the prescription filled. Patients seldom took that piece of paper with them to purchase the specific product recommended. When patients have the toothbrush they are to use and shown in the dental office how to use that new power toothbrush they are more likely to use the brush effectively.

This is the one area of your dental practice that has a net profit of about a 70%. You can spend hours preparing a crown or bridge and you have lab fees to pay at the end. The ROI (return on investment) for home care products sold in the dental office is about 70%. We want patients to buy their home care products from the experts, the people who know which toothpaste, toothbrush, mouth rinse, etc., is appropriate for each individual patient to use at home. The sales person at the local drug store and even the pharmacist is not the person to educate a patient about xylitol and its benefits, let alone what type of silica is appropriate to use on the expensive restorations your dental patient just paid for.

By engaging and empowering the entire team, your dental business is certain to excel in many ways. You will create a cohesive team and a dental practice based on excellence and the extraordinary. Realizing the potential of your dental hygiene team and creating a thriving profit center inside this valuable department of your business is essential to building the dental practice you have always dreamed of. This assures you long-term relationships along side your success.

Your team and the dental hygiene department are all very important assets to the health, profitability and success of your dental practice.

10 areas of Profitability in the Dental Hygiene Department

  1. Perform oral health care assessments that include the review of patients’ health history, dental charting, oral cancer screening, periodontal assessments, biofilm assessment, saliva pH test, smile analysis, xerostomia, etc.
  2. Expose and interpret dental radiographs (x-rays); co-diagnose
  3. Non-surgical periodontal procedures, antimicrobial agents, laser therapy, etc.
  5. Apply cavity-preventive agents such as fluorides varnish and sealants to the teeth;
  6. Administer local anesthetic and/or nitrous oxide analgesia;
  7. Educate patients on proper oral  hygiene techniques to maintain healthy teeth and gums and recommend home care products
  8. Discuss whitening treatment and take impressions when applicable
  9. Administer smoking cessation programs; and
  10. Counsel patients on the importance of good nutrition for maintaining