PRACTICE MANAGEMENT How to Turn a Practice Plateau into a Launchpad By: Sally McKenzie, CMC, President, McKenzie Management The Hurrier I Go, the Behinder I Get! Don’t you just want to pummel a punching bag when you hear about practices doing over a million dollars a year per doctor? Meanwhile your production numbers remain frozen on some primeval plateau month after month. What’s wrong with this picture? Well, just because your practice has hit a plateau doesn’t mean you’re doomed to live in the shadow of the high flyers. You might just need to reengineer your practice systems, personnel, or structure, but the sun is ready to shine on your practice. Gaining Ground, Losing Face Unfortunately, some practices wait till year-end to take a really good look at their practice performance only to discover that they’ve been stuck on a plateau for the whole year! Those that review their numbers every month will see the plateau as it’s approaching and can put a program of recovery into place right away. More often than not, a practice will slide into a plateau because both the doctor and the staff have exhausted their knowledge of how to make the practice grow. The only way to avoid the practice plateau is to find flaws in your systems and then constantly monitor the practice for those flaws. Following is what McKenzie Management has found over the last 22 years as the most prevalent causes of the practice plateau: • Business staff turnover • Lack of training of business staff • No expectation levels of systems • Lack of practice performance measurements • Unclear job descriptions resulting in no accountability • Decreased patient retention • Unscheduled treatment not being tracked and scheduled • New treatment services not added to the practice mix • Not being clinically efficient • Not reviewing fees for increase • No practice vision Which Came First, the Egg…or the Turkey? The trouble is, all these causes and indicators are interdependent. Why is business staff turnover such a problem? For starters, compulsive hiring decisions are often made, placing a person whose temperament or skill level is not conducive to the job that needs to be done. Then again, without a clear job description, it’s impossible to determine the exact right fit between a job candidate and a staff position, accountability for practice systems or measurements for job performance. To regain control we need to stop and see where we are. Let’s start with expectations. If you do not have specific expectations of a particular system, you cannot communicate those expectations to 58 DentalTown Magazine your employee. It should come as no surprise, then, that the employee doesn’t quite know what to deliver. Once an employee has been given the necessary training and understands how the expectation for a particular system fits into the practice vision, they’ve got the tools to deliver that level of performance. Don’t worry about the appearance of being a demanding boss. You are actually doing your staff a favor and making it easier for them to succeed at their jobs. Taking this idea a step further, the practice needs to have systems in place whose success is not dependent on any one person, but on the system itself. It is critical that doctor and staff understand how systems should be performing, compared with not only industry standards but with the practice vision. Such goals would include 95% patient retention; 98% collection ratio; 85% case acceptance; 33% hygiene to practice production; 75% emergency patient conversion to comprehensive exam; and less than .5 hygiene openings per day. Take Charge or Take Cover! Discussing the issue of accountability–or the lack thereof–we are reminded of a rather distressing situation: recall is the principle vehicle for patient retention, but it is the most neglected management system in a dental practice. As a result, the incidence of patients not being retained often exceeds that of new patients coming into the practice. If the doctor in this practice had hired a patient coordinator for an average of 15 hours a week, she would have been able to handle a recall system of up to 1,000 patients. At the rate of $15 an hour, it wouldn’t have taken many recall appointments to make her salary a profitable investment. If recall is the weakest link, then unscheduled treatment runs a close second. Using the Unscheduled Treatment Plan Report only for filling holes in the schedule, the scheduling coordinator is being reactive instead of proactive. She needs to be taught to think of this report as a record of unproduced revenues. Now, give her a definitive script that will likely result in her being able to schedule treatment. Your scheduling coordinator should make at least five ‘sales’ calls a day, and should report at your monthly meeting how much unscheduled treatment has been added to the list that month, and how much has been scheduled and taken off. Speaking of valuable tools, the Production by Provider Report from your computer system is a dynamic means of determining the number of each type of procedure you performed over a specified period of time. Your business assistant should be accountable for generating this year-to-date report every month for each doctor and hygienist, so they can determine how their production compares with the same time periods last year as well as with production goals that have been established for this year. August 2002 Case in point, in the past six months Holly Hygienist has taken 319 bitewings and done 1,039 prophys. If the practice philosophy is to take bitewings once a year on recall patients, then the number of bitewings is 20% below practice expectations. According to Dr. Allan Monack, Consultant and Hygiene Clinical Director of McKenzie Management, 33% of hygiene production should be derived from periodontal therapy...namely the 4000 insurance codes such as #4910 and #4341. Holly was averaging a pitiful 6%. Before we leave the clinical area, let’s take a look at new treatment services not being added to the treatment mix. Practices that have stagnated may have been doing the same-old thing, i.e. crowns, fillings, and prophys year after year. Dentists who are doing interceptive perio, root canals, veneers, bleaching, and implants become recharged and their enthusiasm is infectious. Efficient time use, as a treatment service, often falls casualty to inefficient planning. Dr. Phil Devore, Consultant and Clinical Director of McKenzie Management states that some doctors may reuse the same bur five times, alternating it with other burs during a single preparation instead of using each bur until finished with it. They also get up from their chair numerous times during patient procedures, or have their assistants leave the treatment room to retrieve items that should have been set up in the first place. Clinical time and motion studies reveal three more reasons for a production plateau: 1) slow treatment room turnaround; 2) underutilization of chair-side assistants; and 3) poor planning for armentaria and procedural protocols. Balancing Act While you’re sitting on top of a practice plateau, give some thought to your fees. What you need to do is calculate your production per hour (PPH) along with a PPH analysis of every procedure you offer. This is much easier to figure out than you think. Just take your fee, divided by the amount of time it takes to do the procedure=production per minute x 60 minutes=pph. Once a year you should implement fee increases following an analysis of comparative fees in your area. Finally, you may want to challenge yourself to reduce your procedure time. Remember, the door to success has two signs, PUSH and PULL. The trick is to recognize when to do which. Sally McKenzie, Certified Management Consultant, is a nationally-known lecturer, author. She is President of McKenzie Management, which provides in-office analysis of the business, clinical, and hygiene department; conducts on-site staff training; and offers a full line of educational management books, audiotapes, and videos. To receive Sally's FREE weekly and monthly email newsletter, email her at sallymckenziemgmt.com or call Sally toll-free at 877-777-6151, or sign up at her website www.mckenziemgmt.com. Is Owning a Practice more than you Bargained for? Don’t you just want to go to Work, do Dentistry and go Home?(on time) PU Pic The McKenzie Management TEAM makes your Practice Perfect! 1-877-777-6151 Sally McKenzie, CMC President August 2002 www.mckenziemgmt.com DentalTown Magazine 59