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Home>Business Resource Center >Industry Solutions >Dental

Software and Hardware
Patient Relations
Marketing and Advertising
Employment and Training
Billing and Accounts Receivable
Vendor Relations and Purchasing
Dental Insurance
Dental Communication
Work/Life Balance
Temporary Practice Coverage

Overview

In addition to providing the best of care, dentists with smaller practices spend a lot of time tunneling through fiscal and organizational protocols. Receivables, co-pay, reimbursement, certification - this brand of jargon becomes routine language in for the entrepreneurial professional. The lucky ones have managerial support to untangle gnarly issues; others rely on willing spouses, receptionists and assistants, often only part-time. So responsibility for financial, staffing and administrative chores, coupled with patient care duties, may fall mostly to the owner.

Given that the American dental industry is thriving, plenty of professionals find themselves in this position. The most recent statistics from the American Dental Association reveal that approximately 180,000 dentists are practicing nationwide. A report from Hoovers, a subsidiary of Dun & Bradstreet, estimates annual revenues of these businesses at $70 billion. According to the U.S. Bureau of Labor Statistics, one out of every five health care establishments is a dentist's office, with the usual staffing pattern consisting of only one dentist plus support personnel such as dental hygienists and assistants.

The upshot of these facts and figures is this: A significant percentage of dentists head up small operations, which nonetheless require deft, comprehensive management to stay profitable. Fortunately, this feat is entirely doable.

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Software & Hardware

The American Dental Association estimates that on average, U.S. dental practices see close to 90 cases per week. Each person walking through the door generates reams of paperwork, including charts, invoices, insurance filings and other related records.

To this end, trend research shows a growing number of dentists are relying on high-tech tools to manage operations, with prescription tracking, billing, test orders and results, and clinical notes comprising common applications.

As hardware goes, some experts maintain that practitioners are quick to realize the benefits of high-tech instruments. In-house network servers are appearing in practice groups of every size, while mobile technologies have proven invaluable to dentists requiring off-site access to patient information.

A software primer

Health care providers would do well to conduct a bit of research before selecting EMR or other practice management software systems - simply because the choices out there are mind-boggling. Here are several key points to keep in mind:

• Before shopping for software, pin down the practice's needs by talking with coworkers. Experts also suggest consulting colleagues with similar-sized operations and in similar disciplines to ascertain what works effectively for them. Many programs target individual specialties; a family dentist may have different priorities than an oral surgeon. When possible, it's always a good idea to request demonstrations of several products in order to compare. For online subscription services, some vendors offer trial memberships.

  When making a purchase, here are some points to ponder, among others:

• Who will be using the software?
• Does the program allow for practice expansion (e.g. addition of another healthcare provider or office)?
• Will the software allow access from off-site locations?
• Can the system field scheduling changes and adjustments?
• Does the program recognize all applicable diagnosis and procedure codes utilized in the practice?
• Go for software products that multi-task across systems and are compatible with existing programs and hardware. Some packages offer productivity features across the board, including bookkeeping and accounting, patient information management, multi-provider scheduling, electronic faxing and electronic prescriptions.

For most dental practitioners basic software functions also should address:

• Advanced clinical charting
• Auto clinical notes
• Treatment planning
• Periodontal charting
• Periodontal screening and recording (PSR) examinations
• Prescription writing
• Billing, collection and electronic claims
• Appointment scheduling

Document management, off-site software synchronization capabilities, custom report templates and document imaging components come with better products. Many suppliers will provide sample or demo CDs - a good way to test-drive a program.


Licenses for practice management software can carry a hefty price tag, starting at a couple thousand dollars and soaring into the five-digit range. Leases and payment schedules typically are options, coming in at figures that are easier to live with, especially for new practices.

• Weigh online services against in-house systems. Some industry analysts agree that Internet practice management applications may be the best choice for smaller operations lacking IT staff - simply because they provide round-the-clock support. Setup fees generally run under $1,000, and are even free with some providers. Monthly payments can run under $100, though some providers charge additional fees for data transfer, exit (quitting the service) and support beyond the basic plan. What's more, relying on the Web can cause real problems when the Internet goes down.

To conduct a cost/service comparison among providers anywhere in the world, check out The List of ISPs (www.thelist.com), a detailed rundown of thousands of Internet companies. The searchable data base includes contact information, product summaries, prices and links to individual corporate Web sites. Many of those listed offer free trials.

Locally-hosted software, with data stored on an in-house system's network server or a computer's hard drive, allows for complete control of practice management software. On the flip side, HIPAA's data security standards are so tight, software needed to meet these requirements - firewalls, SSL (Secure Sockets Layer), access control - can get expensive. In addition, frequent updates are a must, as is a reliable backup system in the event of a crash.

• Invest in antivirus solutions suitable to a corporate network. Given issues of patient confidentiality, sensitive medical files and e-mail's vulnerability, standard consumer products likely will not suffice. Most experts stress that antiviral software for medical/dental practices must include three elements: the basic program, a detection/removal engine and a signature virus-recognition file. Consistent monitoring and updates to insure complete protection are critical, and most major programs include these services.

Hard facts on hardware
Desktop computers are standard issue in most dental practices, but hardware designed specifically for the industry can save time and space, as wells as improve workflow. Here are some examples:

• Side cabinet computer. Stored out of sight close to the treatment area, this device requires adequate ventilation and enough room for both the computer and an uninterruptible power supply.
• Wall-mounted computer/touch display. When storage space is tight, wall mounted devices are a good option. These models typically come with additional wiring and adaptors to connect the microscope to a video capture card. Flat panel touch displays are particularly suited to the patient check-in area.
• Chair-mounted computer/touch display. This hardware allows the display to swing from side to side, providing access to both the assistant and dentist. What's more, the absence of a keyboard makes infection control much easier.
• Wireless keyboard. As a laptop tool, this device works well in treatment rooms where desk space is a premium.
• Dual keyboards. This hardware permits the dentist and assistant to enter information sequentially.

For infrastructure utilities, such as network servers, pundits suggest that product diversity, easy access to technical support, the notion of full data control and manageable purchase/service costs seem to be making in-house systems a lot more doable.

Nonetheless, many small-practice owners find the subjects of servers and server software well nigh incomprehensible. That said, the wisest strategy is to consult with an expert before investing in a system. Considerations should include practice size, as well as the type of functions the server will handle. In other words, big, complicated jobs require a more complex technology

Remember that server operating systems, as well as server software, require client access licenses. A reputable vendor will be able to assist with the obtaining the proper authorizations.

Outside office walls, laptop computers, including notebooks and mini-notebooks still top the list of preferred MCDs (mobile clinical devices) with a growing number of practitioners deploying them as patient care tools. Even so, some researchers consider PDAs (portable digital assistants) and smartphones, the up-and-coming hardware gadgets for dental pros. Not surprisingly, the most common chores include schedule management, data base access, e-mail, e-prescribing and research.

Consider the following tips when shopping for a personal digital assistant:

• Decide how high-tech to go. For simple tasks, such as accessing calendars and contact lists away from the office, an inexpensive model costing under $150 may suffice. For more complex tasks - reading and editing documents or patient records, for instance - opt for higher-end models ($1,000-plus) with expanded functions.
• Make sure the PDA screen is readable by testing it both inside and outdoors.
• Confirm that the PDA model under consideration can accommodate cutting-edge software.
• For very expensive systems, consider insurance.
• Products such as Bluetooth, Wi-Fi and other wireless systems allow e-mail/Internet access from hotspots in coffee shops, airports and Internet cafes.
• A PDA keyboard is invaluable for editing files and composing e-mail. Pen-based interfaces work well when writing tasks are minimal.
• If the PDA has an expansion slot (allowing additional applications), purchase an extra card for data backup
• Consider a PDA/phone (smartphone, for instance) instead of a simple handheld PDA. This will allow synchronization of schedules and contact lists with the office PC system.
• Look into PDAs (e.g. Blackberry) with embedded Internet capabilities, a growing technical trend in the health care fields. This allows easy transmission of large e-mails with attachments; receipt of real-time data away from the office; instant access to business applications and databases; and shortened response time to staff and patients while away from the practice.

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Patient Relations [top]

As vital as patients are to any dental practice, not much data is available regarding the impact of good patient/dentist relations - but there are plenty of articles, editorials and books on the subject. Aside from a very appropriate emphasis on the practice's technical excellence, however, most literature boils down to one basic principle: Treat every patient as a valued individual.

The following suggestions represent a summary of sound advice from leading health care providers and industry analysts. While clearly the dentist/patient relationship goes much farther than a standard business transaction, aspects of good customer service can apply to the dental industry, too.

• Solid business practices lay the groundwork for good patient relations. Though glitches happen in the most efficient practices, savvy professionals make every effort not to give patients cause to complain. Accurate scheduling; clear, reliable telephone and e-mail messaging; prompt feedback on procedures and tests; and coordinated communication among dental team members build patient confidence and satisfaction.

Studies suggest that inadequate billing procedures may wreak havoc with patient relations. Given this, staff persons responsible for invoicing and other financial matters must take particular care to be sensitive and equitable in dealing with patients. In addition, all bills should be concise, complete and easy to understand.

If inferior practice management software or outdated record-keeping systems are causing snafus, look into new programs, or seek the advice of a qualified IT professional. A relatively small investment can make the difference between losing - and holding on to - a significant number of patients.

• Create a pleasant ambience in the reception area. Many patients are a bit nervous anyway, and long spells in the waiting room don't do much to increase patient satisfaction. Still, delays sometimes are unavoidable. If patients cannot be seen promptly, the receptionist should inform them of the situation upon their arrival, and then provide a projected time.

To further ease the situation, stock the place with current general interest magazines; books and toys for children; and a television tuned to a news channel. In the absence of a TV, think about soft, piped-in music.

Indirect lighting (lamps rather than overheads), large windows and clean, comfortable furniture likewise work well to soothe and relax tense patients.

• Allow time for patient education. Be generous with information concerning a patient's particular issues and invite questions. Keep answers clear, understandable and light on medical jargon. Better yet, supplement these discussions with simple brochures on dental hygiene and care.
• Treat patients as individuals. A dentist may have drilled thousands of teeth and performed hundreds of root canals, but for patients, these procedures may be new territory. Take time to address their fears during treatment, and follow up with phone calls or e-mails.
• Add a "human" touch. Jot some notes about the patient's job, family, school, hobbies and other personal circumstances in their charts; then bring up a topic during the appointment. People feel nurtured when they believe their health care providers care about them
• Don't just talk. Listen. Observe. By allowing patients to speak freely and taking note of body language, astute professionals can gain insight on how best to approach treatment on an individualized basis. Being a good listener also invites the patient's trust.
• Use specific language when taking patient histories. Too often, unclear or imprecise questions elicit incomplete information, leading to miscommunication and misunderstanding between the dentist and patient.
• Keep tabs on current patients, even when they have not been to the office for a while. Checking in via e-mail, an occasional phone call or an annual "state-of-the-patient" appointment are strategies that can warm up the most tepid practitioner/patient relationship.
• Train support staff to value all patients. While dental reception areas can be hotbeds of activity, this is never an excuse for brusqueness or rude disregard of patients waiting to see their physicians. Recognize and reward personnel who interact with patients in a warm, respectful manner.
• Treat office personnel with respect. In the long run, being fair and courteous to staff impacts patients positively as well. A happy employee is more likely to be pleasant to others.
• Accept personal limitations. No matter how service-focused a practitioner may be, everyone has weaknesses. Irritable or complaining patients can trigger impatience, distress - even anger - in their care providers. Make a concerted effort to keep emotions under control, a technique that, admittedly, requires a healthy dose of patience.

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Marketing and Advertising [top]

Aside from excellent patient care, many analysts suggest that an organized marketing strategy is a powerful business builder. In addition to standard methods, such as referrals and the patient grapevine, today's practitioners have a range of sophisticated tools to spread the word about their practices.

Though multi-leveled by nature, a good marketing plan need not be complex or costly. For the most part, publicity begins within the practice itself, so getting started is simple. After that, print and electronic media continue the job.

Busy professionals have found - through experience -that a public relations consultant can do all the legwork, a service well worth the money. Even so, for those who prefer to do their own marketing, experts make the following recommendations:

In the office and treatment areas

• Provide a clean waiting room. Stained carpeting and dusty furniture sends the wrong message about practice standards.
• Monitor reading materials. In offices where children may accompany their parents (e.g. pediatrician, dentist, family practice), make sure all publications are G-rated. Survey magazine covers for content - an article talking about the pros and cons of chemotherapy, for instance, could cause a lot of anxiety in a patient whose oncologist is treating him for lung cancer.
• Train staff to be positive, professional and friendly. No news spreads faster than tales of a rude receptionist or indifferent hygienist. This brand of advertising results in lost revenue and a tarnished public image. Always address inappropriate behavior in staff members directly and without delay.
• Provide accessible office hours. Given that many patients have full time jobs, dentists operating strictly on a 9 to 5 basis may be at a distinct disadvantage. Solo practitioners might consider starting office hours at noon one or two days a week and staying open until 7 p.m. Group practitioners could alternate rotations with colleagues to offer extended coverage.

Make the news

• Create a media kit. A media or press kit is a collection of print and/or audiovisual material promoting a particular product, service or individual. Target sectors include newspapers, television, radio, periodicals, community groups and any other business, group or organization that might generate business.

A dental practice kit might contain: the dentist's biography, including education, credentials, awards and experience; brochures or fact sheets on the practice; news articles featuring the practice or dentist; business cards, contact numbers, and Web and e-mail addresses; and CDs presenting the practice's history, services and accomplishments.

Practices with Web sites often provide electronic counterparts to print kits.

• Contact local newspapers. Any positive development within a practice - office relocation or expansion, new hires, awards or recognitions, free screenings, special events (e.g. practice anniversary) - merits area press coverage. A public relations professional will know the standard procedures, but do-it-yourselfers should get in touch with the appropriate department editors for guidance; health/science, features, local/regional and life-style editors typically are the best people to contact.
• Paid ads, particularly useful for new practices and relocation, also work well. In this case, someone in the newspaper's sales division can help with the process.
• Write a press release. A well-crafted announcement or news story, preferably sent via e-mail, often works more effectively than a telephone call. Busy editors appreciate not having to dig for story details, and a solid release does the job for them. When putting one together, observe the following guidelines:
• Find an angle. A story about a state-of-the-art drill, for instance, is more interesting when it leads off with an unusual detail. Is it the only one in the area? Is it painless? Does it mean a cost savings for patients? In other words, transform an otherwise dull announcement into real news.

• Capture the reader's interest. Provide important details in the headline and first couple sentences, with finer points following the hard information.

• Write in a "media" style. Announcements slated for a particular newspaper, for instance, should follow that publication's format. Use published articles in the same vein as your story as models.

• Use direct quotes. This lends both human interest and credibility to a press release. 

• Be truthful and objective. Go with the facts and avoid injecting personal opinion. Remember, this is a news story, not an editorial. Avoid exaggeration, overstatement and emotional language.

• Use active voice. Passive voice makes for monotony, while active voice engages the reader. For instance, "Dr. Smile promoted her to assistant office manager," is much stronger than, "She was promoted to assistant office manager by Dr. Smile." 

• Use words sparingly. Go light on adjectives and repeated phrases, telling a tight story in concise language. Avoid using exclamation points in general, and never more than one at a time.

• Avoid medical jargon. Unless the press release is headed for a scholarly journal, use laymen's terms to describe equipment, procedures, job functions, etc. Otherwise, readers may give up before they finish the story.

• End with a boilerplate. This is simply a short paragraph with information about services, staff and practice/personal history.

• Never submit a release in all upper case letters. A busy editor won't even read it.
• Use proper grammar. Stay away from slang and most importantly, run a spelling check. Before submission, have someone do a thorough proofreading.
• Follow a standard format. Here is a sample template:

Headline (80 characters or less). All words capitalized except prepositions/articles less than three characters
City, State, Month, Day, Year -- Lead sentence or sentences. The reader should get most of the information in the first paragraph.
Detail paragraphs (who, what, when, where, why, how). Two or three short paragraphs can include direct quotes and specifics. Keep it brief; the entire release should be 300-600 words.
Final paragraph Additional information such as deadlines, telephone numbers, e-mail addresses, etc.
Boilerplate Practice/personal information
Contact Name
Practice Name
Phone
E-mail
Web site

• Use the telephone book. Don't underestimate the power of the Yellow Pages. Experts suggest that phone book ads allow medical professionals to target market segmentation - the division of the market into demographic groups. Researchers suggest that, on average, advertisers realize earnings of $27 on every dollar they invest, primarily because they're reaching potential clients when they're looking for those particular products and services.

Electronic media and the Internet

• Launch a television or radio PR campaign. While fees for local commercial production vary according to market costs, ad executives say well-placed commercials (e.g. on television, around news broadcasts or in prime time; on radio, during morning and evening peak drive times) target a broader range of demographic groups than do print ads.

If the marketing budget is tight, consider pitching a news story. For example, a piece about specialized or expanded services, a professional award or a revolutionary cleaning process may well warrant some air time.

• Invest in the Internet. Dentists who've grown successful practices know a user-friendly Web site goes a long way toward effectively marketing services. With more and more people using the Internet to research products and services (and to read their newspapers), overlooking this cyber-tool is foolhardy indeed.

The cost for using a Web host - a company that operates the site - can run as little as a couple dollars a month. Web designer services, however, cost more, from a few hundred dollars at the low end, up into the thousands. The more capabilities the site possesses, the higher the price.

Besides providing general information about a practice, a Web site allows the posting of press releases, event information, e-zine articles, breaking news, patient education information, blogs, e-mail, digital video features, sound bytes, links to other sites and much more.

• Get involved in social networking. Not so long ago, online networking was a phenomenon busy healthcare professionals simply dismissed. These days, though, sites such as Facebook and LinkedIn are drawing thousands of visitors every day - with businesses of every type putting up pages.

As a marketing tool, the concept is ideal. User A shares information with 30 or 40 "friends," who in turn make it available to their friends - and so on. Cheap, convenient and personalized, social networking sites present an abundance of PR opportunities. Users can:

• Establish personal branding through logos, pictures and videos
• Examine marketing possibilities in the U.S. and abroad
• Share news about services, practice changes, staff additions, etc.
• Connect with fellow practitioners
• Exchange professional knowledge and information 
• Conduct staff searches 

While joining a popular site such as Facebook is a good way to sample the networking scene, some sites do target certain professions. In the dental industry, for instance, NewDocs.com is the leading social network specifically for dentistry. Free to join, NewDocs.com melds social aspects with business function by providing an ADA members-only forum.
Dentist Network (www.dentist-networks.com), a relatively new site, features a blog, news section and a professional directory, as well as a social networking venue.

Get help from the pros

The strategies listed to this point represent a mere fraction of the methods available to promote dental businesses. Still, those who find the prospect of marketing completely unattractive may want to hire a professional marketing/PR consultant. Their job is to provide as much positive exposure for clients as possible - from ad placement and media opportunities, to publicity (such as speaking engagements) in the community at large.

Quality marketing firms or consultants should possess:

• A solid performance history in health care disciplines
• An extensive network of electronic-media relationships
• A good relationship with area journalists and news personnel

Professional-level materials, including media kits, brochures, press releases, digital products, etc. Always ask to see samples.

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Employment and Training [top]

Have you decided if you are going to start a new practice in a new location or purchase an existing dental office, complete with patients, an established location/reputation, and existing staff, a physical location complete with equipment, etc.? If you are purchasing an existing business, you can probably stop reading and get busy being a dentist/small business owner as you have already done your due diligence and inherited an existing enterprise that is purportedly functioning well. If you are starting your dental practice from scratch in a new location, hopefully you have done your homework on the geographical population demographics, competition, etc., and the time it takes to establish a practice as well as the cost/payback ratio’s you can probably expect for the first 5 years. This “make” vs. “buy” decision is probably one of the biggest decisions you face as you begin to use the dental doctoring skills you learned and are anxious to use. Don’t forget that you are also a business owner and you are faced with economic, budget, marketing, human resource, etc., roles that you must now also successfully navigate.

If you are starting your own practice from scratch, you will eventually have to hire staff as you open and grow your new dental office. In today’s environment, it is probably best to minimize the number of full-time “employees” on your payroll. Not only do you have a number of tax obligations (social security, Medicare, unemployment, etc.), but legislation requiring paid benefits continues to place the burden of things like medical insurance, paid days off for sick leave, paid holidays, etc., squarely on the backs even small business employers. If you think the part-time employee model is best for your business needs, you might target segments of the population that could be interested in continuing to work but a life-change has taken them out of the “9 to 5” work world and they have a spouse whose full-time job provides all the required benefits. Job sharing sometimes works really well for new parents who must provide their own child care and are looking for flexible, part-time employment. So might the person who has just retired but who doesn’t want to get out of the game completely.

The flip side of this suggestion is that some research shows that the success of dental offices is determined by how well the customers/patients are treated by the staff/personnel in the office—how friendly they are and how “cared for” your patients feel. So, part-time employment may not get you the staff that will achieve high levels of “pleased patients.”

Depending on the size of your practice, (including number of existing patients and the attrition/new patient acquisition rates in your business assumptions {or projected if you are a new start-up office} the square footage of your office, number of projected days of dental hygiene, and the number of “operatories”), you will have to employ staff which will likely be comprised of Certified Dental Assistants, Dental Technicians, Certified Dental Hygienists, possibly a Certified Orthodontic Assistant, and certainly a patient friendly receptionist who will be the primary contact point for your patients over the phone or when they enter your office. It is also a good idea to pay well for a receptionist who can also handle all of the billing for the insurance claims that your office will file on behalf of your patients—problems with insurance claims not only will render poor patient satisfaction, but will retard your cash flow. In today’s world, it is also a “must” to make certain that every person you are hiring (or engaging) is fully fluent, functional, trained, and adept at using today’s tools to perform work in a virtual world. This training should include knowing how to maintain the integrity of e-files, systems, e-storage, and all forms of communication medium so that, as required by HIPPA, the integrity of your clients’ information/data/medical histories, is uncompromised.

So, if you need to hire (or replace) people who have the skills, certification, training, and experience noted above, where do you find them? A quick internet search will give you the contact information for schools which provide training in your State or geography (and they usually have a referral service for alumni). Also, with today’s social media reach, using your private list of key contacts by simply letting them know you have a specific need for an employee will probably satisfy your talent needs faster than you can imagine. If you use your search engine to query “employment agencies near {zip code}” not only will you get names of a variety of hiring agencies (aka “headhunters”) who can relatively quickly provide you with suitable candidates at a reasonable cost, but you will also see a number of boards on which you may post your “opening” at virtually no cost. If you use this tool, be prepared for an avalanche of candidates—the point being, be selective.

For more ideas on how to find the people you need, please refer to the Human Resource for additional suggestions.

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Billing & Accounts Receivable [top]

With excellence of patient care the top priority in today's dentistry practices, industry analysts point out that invoicing and accounts receivable practices just don't get enough attention. Because the health care disciplines pump billions of dollars into the economy, the situation is especially ironic.

Billing and accounts receivable functions work hand in hand. To keep the receivable column lean, billing systems must be consistent and on the mark. The literature on this subject abounds, and the following strategies represent some of the best the experts have to offer.

Tame the receivable column

• Find out why patients are behind on payments. In some cases, they may have been unable to cover expensive procedures, such as root canals, bridgework or oral surgery.
• Be scrupulous in posting receipts. Record all transactions immediately, even if this means daily attention to the task. Check with responsible personnel frequently to ensure all receivables are posted, including those that fall outside of patient revenues. If staffing is too tight to do this consistently, consider hiring a bookkeeper or accountant.
• Conduct regular in-depth reviews with accounting personnel. For example, it's smart to compare the practice's collection percentage and average collection period to established benchmarks, as well as to review ending A/R reports. This practice allows identification of positive and negative trends.
• Purchase or update accounting software. The right programs will effectively track billing and receivables, which makes a huge difference in the bottom line. Many easy-to-use products on today's market enable almost any employee to keep accurate records. When implementing a new system, participate in any training or support program the manufacturer offers.

Collect what's owed

• Communicate invoice procedures and expectations. Instruct personnel at the check-out desk to explain payment terms to the patients before they leave the office.
• Require immediate payment. This practice has become almost universal, for good reason. When insurance reimbursement, co-pays and deductibles are in the picture, delayed collection can spawn errors throughout the billing system.
• Establish a consistent invoicing protocol. Invoices should be complete, with all services dated and itemized. Use a simple format with clear due dates and payment terms. Include contact information should the patient require assistance. Most important, send invoices the same day each month to keep the receivable flow steady.
• When an account is delinquent, work with the patient to find a solution. Because providing patient care is the mission of any practice, many dental professionals prefer to arrange some sort of payment plan.

One strategy consists of asking patients to sign an agreement with, for instance, a monthly payment of 10 or 15 percent of the original amount owed. A caution, though: All written and verbal communication concerning this sort of situation should be clear, friendly and non-threatening.

• Fully document, track and back up telephone calls, correspondence and e-mails attempting to arrange payment on delinquent accounts. This includes a patient's promise - or refusal to pay.
• When nothing else works, get tough. Sometimes, delinquent patients ignore telephone calls, polite letters and all attempts to resolve the problem for weeks, months and longer. The practice may have no other alternative than to turn matters over to a collection agency.

The procedure for this distasteful chore typically involves flagging offenders as "cash only" patients for subsequent visits, thus allowing them to continue care without further risk to the practice.

If delinquency continues, the practice may give a notice period (10 days, for example) before discontinuing services. When the outstanding sum is significant, small claims court can be an option.

For patients truly in need, however, practitioners may try extending payment terms, especially when the individual is trying to meet obligations.

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Vendor Relations & Purchasing [top]

In the realm of dentistry practice, the purchase of provisions and equipment happens on nearly a daily basis. The high price of everything - from office and exam room supplies, to furniture, pharmaceuticals, computers, x-ray machines, imaging tools and kitchen gadgets - can drain a smaller operation's resources, especially in new practices.

Happily, industry pundits say several practical strategies based on corporate models can significantly expedite purchasing tasks. Chief among these are an efficient inventory management system and effective communication with vendors.

Get a grip on inventory

Unplanned and last-minute purchasing habits can nickel-and-dime a practice to insolvency. To avoid cash leaks, or deluges in some cases, set up a few universal protocols.

• Devise a standard inventory management system. A large number of software packages feature inventory tracking components, which personnel can master with a bit of training. Many small to mid-size practices report saving hundreds to thousands of dollars a year just from keeping tabs on supplies.
• Appoint one staff person to research all purchases prior to buying. With so much information available via the Internet, price comparisons on software systems, computers and medical appliances are simpler than ever. Some vendor Web sites can pinpoint estimated costs almost to the penny, and many offer free product demonstrations.
• Assess current stock. It's not unusual for a practice owner to discover that support staff is ordering 20-pound copy paper for routine jobs when the 15-pound counterpart would do just as well; or that the office pens cost $6 apiece, when multi-packs of a cheaper brand would suffice.
• Join a purchasing group for greater discount opportunity. These operations allow considerable savings on routine purchases such as office and cleaning supplies.
• Buy online. Internet retailers frequently offer products at lower costs than their bricks-and-mortar cousins, primarily because online operations carry minimal overhead.
• Demand product back-up. Repair service and warranty coverage are musts when purchasing items such as machinery or network hardware. Research the vendor's services regarding product guarantees, ongoing tech support and the availability of repair.
• Maintain meticulous vendor files and routinely review them. Include full contact information, invoice/payment dates and product particulars. Every six months or so, compare the data with new market prices for the same product or services. If current costs are too high, seek several competitive bids.

Vendor relations: Honesty works

A variation of the Golden Rule serves nicely here: "Communicate with vendors as you would want them to communicate with you." The revised adage implies many criteria - honesty, clarity and negotiation, to name a few, that will benefit both vendor and purchaser.

• When dealing with a number of pharmaceutical representatives, consider hosting a single lunch or reception, with time set aside to speak with each sales rep individually. This method, rather than separate appointments, saves both vendor and practitioner a lot of time and energy.
• Ask vendors for consideration based on anticipated future purchases. To be competitive, major suppliers offer significant discounts if they expect clients to add or upgrade products in the next year or two. The best results come from assertive negotiation, with the buyer clearly communicating long term goals around the purchase. This strategy likewise applies to large-volume or repeat orders.
• Approach negotiations with a written list of pertinent questions.
  • What support comes with the initial purchase?
  • Will the vendor install equipment (e.g. network hardware, copy centers)?
  • Will the vendor provide training services for the practice's staff?
  • Will new personnel receive training on equipment or software programs?
  • For new ERM systems, will the vendor provide data transfer assistance?
  • What benefits come with future purchases (e.g. additional training, discounts)?

• Be assertive about payment terms. Do not hesitate to request a larger payment window, or lower monthly fees. As businesspersons, vendors understand the value of flexibility.

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Dental Insurance [top]

Newly-minted dentistry practitioners typically find that malpractice coverage takes a hefty bite out of annual income. And, according to a report from the American Dental Association, while awards against dentists - typically $30,000 to $50,000 - average about 10 percent of the size of medical malpractice claims, the cost and emotional duress of a professional liability suit is no less traumatic.

Then, there's all the other coverage. Dentists who own practices must consider employee benefits, as well as protection of property, equipment, data and earnings. Given the significant costs involved, it follows that systematic research should precede all purchases, whether the product is malpractice or business insurance.

For the most part, using an experienced agent specializing in policies for dental practitioners is the best way to go. Even so, insurance experts have published numerous guidelines and in-depth articles on the subject for those want to learn more. What follows is a primer of sorts, with information culled from scores of government and industry sectors.

Malpractice Insurance: A Necessary Evil

Without adequate protection against lawsuits, small- or mid-size practices might well face financial ruin. Malpractice insurance can avert this disaster, covering dentists and other personnel from liability claims related to patient treatment. Although now a federal legislative issue under individual state regulation, the general product categories under the malpractice umbrella are:

• Claims-Made Coverage: These policies cover alleged acts of malpractice that take place and are reported to the provider only while the policy is in effect. Premiums tend to rise annually until peaking at five to seven coverage years. A dentist with a clean record may enjoy lower premiums, because costs are predicated on history, as well as on current experience. Policy owners also may increase liability limits when the need arises.

A word of caution, though: claims-made products cover incidents occurring and reported only during the policy's effective period. When changing providers, a tail policy - a separate purchase from the old carrier - will cover mishaps taking place during the coverage period, but that go unreported until after the policy lapses. Retroactive (prior-acts) coverage, which the new carrier can provide, serves the same purpose.

• Occurrence Coverage: This policy type protects the insured against any incident, no matter when it's reported. In turn, liability limits are based on those effective at the time of the event. Premiums ride on future projections, rather than on current experience, which leads to widely varying rates. On the upside, neither retroactive nor tail coverage is necessary when terminating this type of policy.
• Claims-Paid Coverage: With these policies, premiums are based solely on claims settled during the previous year and projected for the current year, typically with some restrictions. Health care professionals switching from this product to another, or terminating coverage entirely, often must obtain costly tail policies.

Business Coverage: Nothing to Ignore

With the focus on malpractice insurance, health care entrepreneurs may pay less attention to insurance programs covering business operations. This is not a good idea. Even solo practices involve equipment, patient files and office space - add an employee or two, and other coverage comes into play. Many industry experts deem the following products as critical protection.

• Employment practices liability insurance offers general coverage for employment-related claims (sexual harassment, discrimination, wrongful termination, etc.). According to the Insurance Information Institute, a nonprofit organization with the mission to increase the general public's understanding of insurance issues, premium rates depend on practice type, number of staff and risk factors such as prior law suits.
• A business owner's policy (BOP), preferably one tailored to dental practices, typically covers equipment and property (including electronic data), liability (slips, falls and other accidents) and company vehicles. A number of riders providing for a practice's unique needs are available with most plans, so it's critical to speak with a business insurance specialist before making a final decision. Workers compensation, which provides financial coverage when an employee cannot work due to injuries sustained on the job also falls under this umbrella; but individual state rules vary insofar as the employer's obligation to offer this benefit to employees.

The Insurance Information Institute points out that adding business interruption insurance to a BOP makes a lot of sense. This type of protection covers ongoing costs when a practice cannot function after a loss, as well as making up for lost revenues.

• Life, disability and long-term-care insurance protect assets, income and family members when the insured practice owner cannot work. The range of products in this category is extensive (e.g. whole life, term, universal, annuities), allowing considerable flexibility in selection and premium costs.

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Dental Communication [top]

Dentists who wish they could take their practices with them wherever they go can pretty much have things their way. Communication technology continues to spawn mobile gadgets with capabilities that range from simple telephone connection to e-mail, instant messaging, word processing and record keeping.

What's more, many of these devices allow practitioners to review and maneuver office-based patient files from virtually anywhere on the road, as long as Internet access is available. Industry pundits agree that this level of connectivity can't help but facilitate and enhance patient care.

Hardware and Software, Take-Out Style

Designers and manufacturers are scrambling to accommodate the growing dentistry market with an almost dizzying array of hardware, software and online support.

The following products are particularly suited to the needs of dental professionals.

• Personal Digital Assistant. Typically referred to as PDAs, the granddaddies of today's more sophisticated lines has been around since the early 1990s. At their most basic, these handheld computers manage contact and to-do lists, as well as appointment calendars. Some models accommodate additional software, such as medical dictionaries, reference manuals, coders, drug databases and medical calculators - add-ons that allow on-the-spot research. Wireless PDAs may also feature e-mail, Web browsing and cellular phone service (see smartphone).

Data synchronization takes place between PDAs and desktop computers via cable or wireless connection, thus allowing continual data transfer and update. Costs for these devices range from less than $100 for basic versions to upwards of $500 for those with wireless connectivity.

Software prices run the gamut, fluctuating with the level of technical sophistication. Full practice suites are relatively expensive, but can include medical/technical dictionaries, diagnostic software, charting capabilities and much more. On the other hand, individual products (e.g. a mobile drug reference) can run less than $100.

Smartphone. A smartphone is a cell phone with information access, offering digital voice service and various combinations of touch screen, e-mail, pager, text messaging, Internet, voice recognition, organizer, camera (still and/or video), MP3, television and video player. The most promising medical applications for this technology, say some pundits, are functions such as e-prescribing and point-of-care charge capture.

The first model, hitting the market in 1994, combined a telephone with a PDA, a marriage that made the gadget both pricey and cumbersome. By contrast, at around $100 to $800, the 21st century version is lightweight, versatile and fairly cheap, considering its capabilities.

Like their PDA cousins, smartphones can accommodate a multitude of software products geared to the health-care professions. The difference is the level of support. Because smartphones have Internet capabilities (as do wireless PDAs) a bounty of online resources is always on hand. For this reason, the range of mobile programs specifically geared to smartphones is expanding at a dizzying speed.

• Mobile medical reference guides. Among the most popular apps for the BlackBerry smartphone genre, these provide access to information on specific drug/narcotic products, interactions, dosage particulars, pricing and more. Leading manufacturers such as QxMD and Epocrates Rx have designed the software to provide on-the-spot, continuously updated search capabilities - the main advantage over print guides.
• Patient data management and charge capture.These mobile software productspermit dentists and other medical professionals to access patient information and backend data from the hospital, home, or anywhere in the field.
• Digital image viewing. This software allows dentists to view patient x-rays and other diagnostic visual data from any location.
• Dictation programs. This type of mobile application allows healthcare providers to record patient encounters outside of the office (e.g. clinics, emergency situations).

As costs go, smartphone mobile communications programs start at under $10, ranging upwards of $100. Even so, a quick Internet search will turn up scores of medical libraries, hospitals, medical schools, government agencies and private corporations that offer free downloadable medical software covering hundreds of subject areas.

• Tablet PC. Also a wireless mobile device, a tablet PC enables dentists to take notes via keyboard or by using digital pens or styluses directly on the screen. They then can download the information written chair-side into practice databases.

While they do not have the flexibility of smartphones and PDA appliances, tablet PCs do have larger screens, about the size of a standard sheet of paper. For this reason, practitioners accustomed to jotting notes on charts find it easier to record and view information on tablets.

Even more important is the tablet's potential for patient communication and education. Practitioners can use these devices to share results, such as x-ray images, when discussing treatment options with patients. Because they are completely functional laptops, tablets accommodate full keyboards, allowing users to install and utilize practice-management programs, electronic record keeping, word processing or any other type of software.

Some models also include voice recognition software, which translates spoken remarks into text notes on the screen, or digitally records voice dictation for wireless transfer to a transcription service.

Like PDAs and smartphones, tablet PCs allow secure, seamless, wireless connection to desktops, EMR systems, private practice servers and other devices

Security: Keeping patient data confidential

With so much sensitive information stored in PDAs, smartphones and tablet PCs, it's not surprising that the HIPAA (Health Insurance Portability and Accountability Act) has raised concerns around patient privacy and security. In response, the National Institute of Standards and Technology has established guidelines regarding the use of mobile devices in the work place.

Practitioners should:

• Purchase software programs users themselves can install (this avoids third-party snooping).
• Provide proper storage facilities for devices and accessories.
• Monitor password selection, encryption and use.
• Establish procedures for reporting lost or stolen PDAs, Smartphones and other devices.
• Enforce all rules regarding proper use of office and mobile appliances.

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Work/Life Balance [top]

By definition, burnout is a sense of emotional and physical exhaustion resulting from work-related stressors such as personnel difficulties, over-packed schedules and other demanding situations. Burnout can lead to a multitude of problems, including chronic fatigue, volatile emotions and depression. Susceptibility to ailments such as colds, fevers and headache increases as well.

Unfortunately, experts suggest that medical professionals - including entrepreneurial dentists - are particularly prone to burnout. While avoiding this condition requires a degree of self-discipline, most mental health professionals and career counselors insist that a few routine measures can take care of the situation - preferably before it becomes too much to manage. The process starts with basic common sense.

• Attend to physical needs. Adequate sleep, a wholesome diet, exercise and rest during minor illness can head off eventual burnout. Likewise, it's important to go through regular screening for conditions inherent to various life stages (e.g. mammogram, prostate screenings).
• Pursue outside interests. It's tempting to spend down time catching up with professional reading - or sprawled in an easy chair watching television. Instead, try a new hobby or sports activity, preferably with friends and family.
• Try to communicate. When nerves are tight or emotions are raging, it's time to talk about it. Sometimes a confidante is the answer - a former mentor, dental school classmate or older colleague, for instance. Persons of faith may turn to their pastor or rabbi.
• Consult a professional. Career coaches, attorneys and financial planners can help alleviate business stressors, but a mental help professional can be a valuable resource for ongoing depression or anxiety.
• Join a support group. Highly confidential in nature, professional facilitators typically run these groups, with the job of helping participants honestly share professional and personal matters. Keep in mind, though, that different dynamics make up individual groups, so some trial and error might be in order.
• Control practice demands. Explore strategies for time and workload management. Hiring a dental assistant, office help or a nurse can help, as does capping patient enrollment.
• Be objective about economic ups and downs. After all, the fluctuating market can drive anyone to despair. Keep the situation in perspective - things will eventually improve.

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Temporary Practice Coverage [top]

No matter how tireless the practitioner, everyone needs time away from the office. Unfortunately, dentists in small practices find real vacations - let alone sick days - are almost impossible, because no one is available to fill in..

Until now, medical staffing agencies have proved a godsend to physicians, but locum tenens placements, or temporary practice coverage, is a relatively recent development in the dental industry. In the last couple years, however, agencies such as Locum Tenens USA have begun providing temporary coverage, as well as permanent positions, to established practices. This includes specialists such as orthodontists, pedodontists, periodontists and prosthodontists.

While staffing walk clients through the hiring process, certain measures can make the experience more successful for both the hiring professional and the substitute. Experts say to:

• Arrange coverage at least two to three months prior to a planned absence.
• Thoroughly review the subbing dentist's qualifications and experience, as well as all employment contracts, particularly regarding cancellation policies.
• Inform patients of the temporary reassignment of their care, providing the dentist's name and background information.
• If money is an issue, limit hiring costs by cutting back office hours during planned absences.
• Substitutes should receive all pertinent contact information, including phone numbers for other staff, specialists for referrals, local hospital emergency departments and patients.
• Discuss "problem" patients with the substitute prior to departure.
• Make up a checklist for the temporary dentist. Items might include lab protocols, prescription policies, patient communication, etc.
• Provide review forms for studies, consults and labs; require initials or a signature.
• Provide patient follow-up forms to be completed by the subbing dentist. This provides continuity of treatment and reduces the likelihood of errors.

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