I recently had the pleasure of hearing bestselling author John Maxwell give a presentation in Orlando.  Mr. Maxwell is a world-renowned leadership expert.  One of his principles, as explained in his book “The 17 Laws of Teamwork,” is what he calls the “Law of Mount Everest: As the challenge escalates, the need for teamwork elevates.”

The following scenarios can cause a mountain of challenges:

1. Record-setting production.  It might seem counterintuitive to think that high production is a problem, but working at full capacity puts a stress on your systems.  You have to book patients farther out, and any unexpected staff absence can compromise your efficiency and customer service.
2. You hire a new employee.  A new team member may be a welcome addition.  There are challenges, however, when integrating a new personality into a dental office environment, which is essentially a tight-knit family.  The new employee will also take up some of everyone’s time because proper training is essential.
3. A new doctor joins the practice.  Bringing in a new doctor opens a world of possibilities—and potential pitfalls.  Never underestimate the interpersonal challenges involved when a new doctor comes on board.

In each of these situations, the management mountain is harder to climb.  The status quo management model may not work considering these new realities.  

To deal with these issues proactively, you should:

1. Hold more team meetings (even brief ones).
2. Communicate more regularly with the team via brief memos (bullet points are fine).
3. Review expectations and job descriptions (and bring them up to date as needed).
4. Analyze your overall staffing situation (and hire additional help if warranted.)

You should be proud of scaling new heights, but at the same time you need to be mindful of the need to nurture and train the team that helped get you there.

What are the patient’s payment options?  Can the patient use HSA/FSA? 

The answer is that the patient can use HSA/FSA to pay the practice in full and then reimburse their HSA/FSA when the insurance reimbursement check is received.

According to the IRS website:  “If amounts were distributed during the year from an HSA because of a mistake of fact due to reasonable cause, the account beneficiary may repay the mistaken distribution no later than the due date of the tax return (not counting extensions) following the first year the account beneficiary knew or should have known the distribution was a mistake.”  

This rule covers the scenario where a patient charges 100% of the dental treatment fee to their HSA/FSA because the exact insurance reimbursement amount is unknown at the time of treatment, and the insurance company subsequently sends the patient a check for partial reimbursement.  The IRS has a form for this purpose.

It would be easier for the patient to put the full treatment amount on their credit card and subsequently get reimbursed to the extent allowed by the insurance company. 

There is another very good option.  According to CareCredit®, if the practice is out of network with the patient’s dental insurance carrier, the patient can charge the full amount of the fee to CareCredit®. When the patient receives partial reimbursement from the insurance company, the patient has the option of putting those funds toward early repayment of the CareCredit® balance.  

The patient is not obligated to use those funds to accelerate CareCredit®repayment, of course.  The patient only needs to pay off their CareCredit® balance within the prescribed interest free period to avoid interest charges.

By being aware of these payment options, practices can be best prepared when dealing with out-of-network insurance questions.

1. Think of a hygiene visit as the cheapest form of dental insurance.  The best way to protect your oral health and avoid major dental problems in the future is to have regular check-ups, including hygiene visits. 
2. Hygiene visits help protect your investment in dental treatment.  Keep up with your dental hygiene appointments to get the most out of the dental care you have received.
3. Losing teeth is not a natural part of the aging process.  With proper care, you can keep your teeth indefinitely, even a lifetime. 
4. Periodontal (gum) disease is often a “silent disease.”  Just as many people are unaware that they have high blood pressure, gum disease often does not have noticeable symptoms until it reaches an advanced stage.  Dental hygiene visits help keep your gums healthy.
5. Oral health is part of overall health.  There is an increasing body of knowledge showing relationships between good oral health and overall health.  For example, gum disease may make it harder for patients to control diabetes.  While more research is needed, gum disease has also been associated with other systemic diseases.  Our motto is, “healthy mouth/healthy body.”

Enjoy the fresh and clean feeling in your mouth after a dental hygiene visit, but remember, it’s so much more than a cleaning.  

There is an old joke among entrepreneurs: “I lose money on every transaction, but I make it up in volume.” There are times when this principle applies to dental insurance reimbursement.  The insurance companies are actually making it easier for dentists to decide to drop insurance plans because reimbursement rates are low, especially in light of cumulative double-digit inflation over the last two years, which makes the cost of delivering services higher than ever.  You can only discount fees so much before profits turn to losses.

In spite of these economic realities, however, there are other considerations.  I listen to many recorded calls to dental practices (with the appropriate HIPAA announcement that calls are recorded for training and quality assurance.)  The most common opening question from prospective patients is, “Do you accept the XYZ insurance plan?”  If the answer is “No, we are not in network with that plan,” the phone call often ends abruptly.  It’s an insurance hang up, in more ways than one.

If you want to get off of insurance plans, do the following:

1. Build up your fee-for-service practice.  If you truly want to have a niche practice, focused on quality and not beholden to insurance companies, then you need to create that successful brand before you start culling the herd.   Two ways of accomplishing this goal are by offering a strong mix of profitable services and encouraging your uninsured patients to refer their family and friends.
2. Start by eliminating the plan that affects that fewest patients and provides the least reimbursement.  Assess the impact on your practice before dropping other plans.
3. Provide sufficient lead time for the transition.  I do not recommend sending a letter to large numbers of patients telling them that you no longer accept their plan.  Instead, inform patients verbally and in writing as they come in for appointments that at a time certain in the future, the change will be made.  As new patients call, of course, they should also receive this information.  
4. Train the team.  Using the right verbal skills is essential.  You want to be clear and confident with patients, not apologetic.  You are making the change to maintain high standards, which in itself is a benefit to patients.

There is a certain amount of agony and soul searching that goes into the decision to drop insurance plans, but the payoff is sheer delight—the ecstasy of not having fees dictated by a third party.  Some dentists have handled the transition poorly and harmed their practices; but, when done, correctly, the decision is liberating.  Dentists who have been fee for service for several years would never go back to the old way of doing business.

One caveat:  The process is fraught with landmines.  If you would like to have a complimentary conversation with me about this topic, feel free to contact me.

David Schwab, Ph.D. is a practice management consultant, coach, mentor, and seminar speaker.  Contact: www.davidschwab.com. (407) 324-1333.  dschwabphd@me.com

(This article first appeared in the Collier& Associates newsletter and is reproduced with permission.  I highly recommend this financial and business newsletter.  For more information, click here): https://www.collieradvisors.com/newsletter/information-and-subscription/

Most dental team training programs have a glaring omission: clinical team members are often not trained to answer patients’ questions regarding fees.  Administrative team members at the front deal with these questions every day, and many are quite adept at explaining value for the dollar with regard to proposed treatment.  However, when patients turn to an assistant or a hygienist chairside and express concern about dental fees, the clinical staff are often unprepared.

It is common for back-office team members to be uncomfortable with these types of questions.  They may respond by saying, “You have to speak to someone up front about that,” which is a true statement except that it is often conveyed in a halting tone that betrays a lack of confidence.  The effect that financial questions have on assistants and hygienists is similar to Superman being exposed to kryptonite.  Over the years, the super-human caped crusader was unstoppable—until he was exposed to material from Krypton, his home planet.  Back-office team members should not lose their superpowers when a patient asks why a procedure seems so expensive.

Here are three very good answers when patients ask about fees chairside.  My comments are in italics.

1.  Our fees reflect the quality of care provided uniquely to you. Dr. Smile uses only the best materials and technology.  This statement brims with confidence and reinforces value for the dollar. 
2. It’s a great investment in your health.  You deserve it.  Patients need to hear again from their trusted assistant or hygienist that the proposed treatment is in their best interest.
3. Patients tell us all the time that they wish they had decided sooner to have the treatment.  Let’s go to the front and you can speak to Julie about different financial options.  This transition is seamless and can be used with any of these answers.

Clinical team members are not expected to make financial arrangements or discuss fees in depth with patients.  However, their verbal responses to patients’ questions about fees and body language are very important.  The deer-in-the-headlights look is an expression of anxiety.    When all dental team members are properly trained to handle the money question and respond succinctly with rock-solid confidence, patients feel more comfortable moving forward with recommended treatment.  Practices owe it to the team and the patients to provide such training.

The Consumer Price Index went up 5.4% in July, the largest jump in 13 years. In addition, according to Moody’s Analytics, the U.S. is experiencing “the strongest wage growth in a quarter century.”

Inflation is overhead on steroids. Dental staff salaries and benefits are the largest overhead line items in dental practices.

It’s time to analyze the numbers in your dental practice and raise fees. You want to be fair to your patients, of course, and large increases for fee-for-service patients can lead to pushback. The goal is to proceed methodically, raise some fees more than others; but make sure that the average increase keeps the overhead monster from eating into your profits. 

You cannot afford to “hold the line” on fee increases when your suppliers and your staff are demanding more from you. I’ve been going over numbers with my dental clients and making recommendations. Plan now and put a new fee schedule in place no later than January.

Today, let’s discuss today the selling doctor’s concerns. If you’re the selling doctor, one of your big concerns is, “I don’t want to make a mistake. I want to find someone who’s the right fit.”  I will tell you, trust your instincts. Don’t ignore any red flags. No, nobody’s perfect, but if something’s nagging at you, if you’re not sleeping at night, if you’re worried that maybe you’re not making the right decision, don’t do the deal. You absolutely want to make sure you find the right person. Don’t settle.  You don’t have to sell to this person. They’ll always be another seller who comes along.

How do you determine if something is a good fit, if it’s going to work out, if

this person really is going to be compatible with you and share your values?

I like to use scenarios, hypothetical situations. I give both the associate and the seller a scenario. Maybe it involves, “How would you deal with this situation as it relates to a patient?” Or, “How would you deal with this other situation as it relates to a member of the staff?” They work on these scenarios independently. Then we come together by phone, by Zoom, and sometimes in person, and we discuss.

You learn so much: you learn how people think, you learn how they prioritize.

You learn how they process information, and, most importantly, you learn about their values–by using these scenarios, these hypothetical situations. It’s so important because you gain many valuable psychological insights and that helps you make the right decision.

I enjoy using these scenarios and being the facilitator to make this work out. 

In the second part of my three-part series, I’m going to discuss the concerns facing the associate.

The pandemic has placed us all in the jar, so to speak.  We yearn for perspective, but we don’t know what we don’t know.  Through it all, we have marvelously adapted.  There are countless new protocols in dental offices, and patients have, for the most part, admirably adjusted. 

The Covid crisis is the most significant disruption to daily life and security since World War II.  The very act of coping causes us stress.  One day, we will look back and gain perspective on how our world of certainty was thrown off its axis but still managed to right itself.  For now, we soldier on.

For years we tried to educate those patients who had only sporadic contact with the dental profession.  We wanted to bring them in, show them all that modern dentistry has to offer, and turn them into high dental IQ patients who take responsibility for their oral health and consequently also garner general health benefits.

It turns out that there was a larger cohort, those loyal patients of record who would not be denied dental care.  They could not wait for offices to re-open; schedules filled quickly as patients rushed back to dental offices.

As dental practices work through the backlog of pent-up demand, the time is now to plan for the future.  The post-pandemic dental practice needs to rebrand itself.  Patients now have a better understanding of dentistry as an overall healthcare service.  Practices need to build on that understanding and redouble marketing and education efforts.

The future of dentistry is bright, but it will not write itself.  It’s time to think about emerging from the jar, surveying the landscape, and planning for success throughout the rest of this year and into the next.

Schedule me.