The Dental Specialist and Referrals

Here is another guest post from our client Dr. Lurie. We are so fortunate to have him share the wisdom he gained for five decades as a dental specialist.

It seems to me that the dynamic of a specialist obtaining referrals has changed.  As we have all noted, private solo practice in the specialties has greatly decreased.  I have heard estimates of less than 7%.  As a retired Oral and Maxillofacial Surgeon, I have personally noted the change in referral patterns and, I think, understand what must be done to encourage referrals.  This wisdom comes from fifty years of practice.  No longer is it enough to take a generalist to lunch, or to have an annual Christmas party.  I think that the whole picture has to be viewed and rearranged.

Firstly, the specialist has to be extremely well trained. He has to be able to get the "word out" about how well trained he is. I would suggest  a curriculum vitae be sent with the announcement of the opening of his practice.  This is important and should be of the highest standards befitting the degree of their excellent training.  While it is important to let folks know where you are located, phone, email etc…, it is paramount to let them understand your qualifications.  This should be updated periodically as new honors and leadership positions occur.  Obviously, with social networking as keen as it is, it is imperative to have the correct team to help in this initial matter.  I have discussed the team concept in one of my previous articles (The Team of Retirement).  This is the first impact that you will have on your referring base.

It is to be assumed that most specialists will be joining an existing practice.  I would still recommend that this initial information (CV and other marketing) get out there so that the new "person" is not relying on the reputation of the existing practice.  Obviously, if the doctor is solo, then it speaks for itself. 

Incidentally, most of these ideas would apply to a generalist starting practice with the obvious difference being that his target marketing prospects would be different.

In the beginning of the practice, personal visits to the referral base is mandatory.  Now the doctor can place the name with the face.    I would also suggest that care be taken to find a convenient time to visit the doctor----check with his front desk and get to know them well.  Lunch is always good if it is possible but a coffee break at an off-time can usually be arranged.  You might want to stop in unannounced just to meet the front office, introduce yourself and make the appointment with them in person.  These first months will require a great deal of leg work and it is wise to plan this out so that you still have proper time to cover your new office and schedule (keep in mind the new IRS standard mileage rates as well – note all of your travel in a journal regularly).  It will be also mandatory that your new staff be well versed in what you are doing so that things run smoothly while you are out and about.  Again, the proper team will be helpful in putting that staff together.  Nobody said it would be easy. 

As time progresses, I would suggest a series of "Munch and Learn" sessions in your office.  This now completes the circle of announcement, face to face, and seeing your office location.  There should be a wall that displays your credentials-----do not make it obnoxiously obvious, but it is a must.  These sessions should be an hour or less and eventually may lead to further interactions (study clubs, etc…) which I will discuss in another article.  Keep them low-key with simple refreshments.  You might want to invite a speaker, present yourself, or even have one of the detail persons from a company at these gatherings.  It does not always have to be about your specialty per se, but could be a practice management tidbit, accounting novelty, equipment demonstration etc. 

I invented a little item that was a big hit and I will share it with you.  After a patient was seen, treated and eventually discharged, I sent them a thank-you note.  What?!? A thank-you note from a surgeon to a patient.  At the same time, a reminder note went to the generalist so that his patient could be kept in his system for recall and follow-up.  Too often, these patients were late in there general check-up because the referring office thought the patient was still under treatment.  Just a little tidbit but it was effective for me.  The marketing angle is to engage the patients to refer to you directly.  Obviously, you then have an opportunity to reciprocate with your referral base if the patient is not "attached" to a GP.  Always, always, always, try to market with your patients. 

I think that the specialist should take a look at the reports that he sends to the referring doctor so that they are sent in good time and are relevant.  I had a personal, handwritten quick note that went out the same day the patient was treated so that the doctor knew that treatment was on-going and active.  If it was a major case, this was followed by a complete operative note etc. so that it could be filed in the patient’s permanent chart.  This is just another means to get your name in front of the generalist and to establish good lines of communication.  This obviously can be done by email, fax etc.  The important thing is to document the treatment clearly and always ask for his feedback if necessary.

These are just a few ideas about getting started and I hope they are of help.  Please do not hesitate to send me you thoughts or questions.  It would be my honor to be of help.

More Mistakes Made and Lessons Learned next time.

Dr. Donald B. Lurie, DDS

email:   donald.lurie@att.net

Phone:     717-235-0764

Cell:         410-218-2228

New Mileage Rates Released by IRS

The IRS has released the 2014 optional standard mileage rates that employees, self-employed individuals, and other taxpayers can use to compute deductible costs of operating automobiles (including vans, pickups and panel trucks) for business, medical, moving and charitable purposes.

The 2014 standard mileage rate is 56 cents per mile for business uses and 23.5 cents per mile for medical and moving uses. It remains at 14 cents per mile for charitable uses. For purposes of computing the allowance under an FAVR plan, the standard automobile cost may not exceed $28,200 ($30,400 for trucks and vans).

The updated rates are effective for deductible transportation expenses paid or incurred on or after January 1, 2014, and for mileage allowances or reimbursements paid to, or transportation expenses paid or incurred by, an employee or a charitable volunteer on or after January 1, 2014. 

In This Season of Thanks, This is How One Dentist Gives Back to His Community

Here is another guest blog from our client Dr. Don Lurie.

It seems to me that in this season of the year, our thoughts should turn to the ideals and morals of our history, of our parents and grandparents and even of the faith that has united and nourished us.  We all hear the expression ""I want to give back" but it is something that has to be nurtured, reflected upon, and then acted upon.  It must be sincere.  I guess that the sentimentality of this season of the year has given me the desire to share thoughts about this so-called "giving back." 

Last month, I discussed mentoring to both our younger practitioners and even to our patients.  This should be extended to anyone who might think that our experience, knowledge, and professional bearing might give them insight into their future and to help shape their career attitude to enable the practitioner to love his practice, his patients and staff, and to guard against the cynicism of just practicing for the dollar.  It is most difficult in this current climate to have these "noble" feelings and it is quite difficult to find the words to just address them.  I almost want to quote scripture to help me find the words and to share what I feel in my heart.  In my blog titled Mentoring Equals Outreach, I have started to share the ideal of gift giving and of thanks giving.  I have also suggested that this is, if sincere, a great function for marketing of your practice.  But do you know what? It just makes you feel good and that good feeling should be expanded.  As it was handed down to us by someone or at some place, the good that we have done, are doing, and should continue to do (even in retirement)  expresses who we really are and what is dear to our hearts.

A local group of friends and myself have started an outreach to patients who have difficulty getting around.  Their caretakers must spend time taking them to doctor visits, going to the pharmacy or many other mundane daily activities.  The caretakers, who are saints, are usually other elderly family, friends or neighbors who can only do so much and who, in turn, need to have a break.  Some of the doctor visits are just to have a BP, pulse, and other vital signs on an interim basis until their thorough check-up is due with their primary care physician.  These are easy visits for us since it is something that we do on a daily basis in our practice.  These folks welcome us, enjoy our visit, and feel like it is a social hour.  And you are right - it is a social hour of love and togetherness.  After taking vital signs, the doctor is called and, in 99 % of the time, that is all he wanted to know.  The patient is told to keep his normal appointment and the caretaker is told of the request also.  Actually, the caretaker has an hour off (haircut, personal errands) etc…  The group that I am in consists of active practitioners, nurses, retired docs, other health professionals including one EMT person (who gives one full day/week to this endeavor).  We call it a ministry or an outreach program but it so simple, so necessary, and has just been a joy to be part of it. And guess what? We learn from our visits, gain life experience in our conversations, and get more out of the visit than the shut-ins.  We now have increased our group to include non-professional types for things like drug store errands, haircuts, shopping, lunch, or just a plan visit so that the folks can change the scenery.  Our visitation includes seniors, recovering adults, folks home from the hospital, etc...  "There but for the grace of God, go I."

Next week is Thanksgiving.  Let it be a joy to share your love with family, extended family, and all your loved ones.  And when you are saying Grace at this festive meal, start thinking about how you are giving or going to give back.  I seems to me that this is what Thanksgiving is all about.

I would love to hear from you and share your ideas and experiences.  More Mistakes Made and Lessons Learned next time.

Dr.Donald B. Lurie

donald.lurie@att.net    

Phone:   717-235-0764

Cell:       410-218-2228

Several IRS Tax Court Rulings Dentists Should be Aware of... (if for no other reason than to dispel the myth that the IRS is humorless).

A Bike Sharing Program Isn't Mass Transit

Employee Benefits—Bike Sharing: Expenses an employee incurs by participating in a "bike share program" do not qualify for the favorable tax treatment provided for qualified transportation fringe benefits. According to IRC Sec. 132(a)(5), employers that provide their employees with transportation benefits can exclude those benefits from employees' gross incomes if the benefits are qualified transportation fringes as defined in IRC Sec. 132(f)(1) . A qualified transportation fringe includes any transit pass that entitles a person to transportation on mass transit facilities. A bike share program is not a mass transit facility. Information Letter 2013-0032. 

You Would Imagine They Could Have Thought of a Better Business Purpose...

Travel Expenses for Good Night's Rest: A self-employed tax return preparer that operated out of her home was denied a deduction for travel expenses that were necessary "just to get rest" from the stress of her neighborhood and harassment by clients that called her home at any hour. The Tax Court said that a taxpayer's choice of where to live is personal and her travel to get a good night's rest was a personal, not a business, expense. Meals and entertainment expenses claimed for meals with clients and a catered client party were denied as a business purpose was not established. Joyce Linzy , TC Memo 2013-219 (Tax Ct.).

Bad News for an Independent Contractor Deemed by IRS to be an Employee

Income Tax—SEP Contribution Disallowed: The taxpayer signed a letter of appointment with the British Consulate General (BCG) to serve a three-year term as a trade officer. He was referred to as "self-employed for tax purposes" in the letter and so filed a Schedule C reporting his income and related expenses and took a deduction for a SEP contribution based on his BCG earnings. After finding that the taxpayer was a common law employee of BCG and not self-employed, the Tax Court disallowed his SEP contribution and imposed a 6% excise tax on the excess contribution. On review of that decision, the 9th Circuit agreed that taxpayer was a common law employee. As such, he was not an employer under IRC Sec. 401(c)(4) with respect to his BCG earnings and could not contribute to a SEP and deduct his contributions based on those earnings. Rosenfeld v. Comm. , 112 AFTR 2d 2013-5638 (9th Cir.).

Dental Mentoring Equals Dental Outreach

Here is another guest post from our client, Dr. Donald Lurie.

It seems to me that part of the continuing attempt to refresh and recharge our enjoyment of practice is the chance to be a mentor.  In these times, there is an obvious decrease in the ability to sit back and enjoy the practice of dentistry and medicine.  Interference from many sources,  stress of compliance, making the numbers work are so problematic that the doctor can lose focus on one of the things that brought him into private practice in the first place.  These are indeed difficult times.  The solo practitioner is almost extinct and the mega practices have their own set of problems from a morale standpoint.  

One of the areas that I found to be energizing and helpful was mentoring.  It started with teaching of residents in the early years of practice.  This was a great way to relate and to also keep current.  As all teachers know, you learn more from teaching than as a student.  Not only is it challenging, but it is a great reward to bring the missing link to the "new doc" - experience.  To be in a group and acknowledge an "ah ha" moment is so rewarding.  For those who are fortunate enough to be in a university city with medical and dental students, there is ample opportunity to give (and to relate).  You will find that the student is greatly appreciative that you took the time to help and point the way.  You will also find that you return to the office or to your home with an exhilarating feeling yourself - remember, "it is better to give that receive."  From another view, these contacts become friends, referral sources, and associates that may lead to other projects and outreach possibilities. This is just another example of a means to refresh and recharge.

Knowing how good the feeling is to give a gift to someone, I also had a grand time in mentoring patients of mine.  Actually, my staff also enjoyed it and related to the mission.  There were numerous opportunities where a young patient, entering college, had no idea of his major or area of interest.  This was an opportunity to chat and just become a friend and counselor. We would actually make an appointment in a off time (lunch etc.) to meet and advise.  Did it happen every day?  No, but often enough that we were invited to many graduations (and even some weddings).  I am convinced that we know more than just how to be a good doctor and this ability can be a wonderful way to have that "feel good" day or moment.  So you want to talk about marketing.  This, if done from the heart, is number one in my mind. 

So, it seems to me that you can make some fun out of you practice and have it actually become a source of an outreach program.

I would love to hear from you and share your ideas and experiences.  

More Mistakes Made and Lessons Learned next time.

Dr. Donald B. Lurie

donald.lurie@att.net 

Phone:  717-235-0764

Cell:      410-218-2228

Making a Dental Associate A 50/50 Equity Partner

Lately we have been hearing from dentists and associates about the feasibility of creating a 50/50 partnership. Before this is contemplated there are some questions to be answered and considerations to be weighed.

Here are a few that we feel are important:

•   Is your practice large enough patient base wise for two full-time doctors?
•  Is the physical space larger enough for two doctors to work at the same time or will you be doing a split schedule?
• Is your business house (the practice systems, processes, etc.) in order?
• Is your personal house (any legal issues with either party such as pending divorce) in order?
• How long has the associate worked with you and are you comfortable with his/her practice style?
• Why did you hire the associate in the first place? Was it simply for coverage so you could cut back, or was it to have an in-house buyer when you are ready to retire?
• How does the associate’s patient base compare to yours? In other words has the associate been given insurance based patients and smaller/routine cases compared to your fee for service bigger ticket cases.
• Is the associate going to be a 50% owner immediately or over a period of years?
• As the original owner allowing a 50/50 partnership, are you willing to give up or share control of the practice you built?
• Is the associate capable or willing to take over any administrative duties you currently perform?
• Does the associate get along well with your staff and patients?
• Has the associate added to the growth of your practice?
• How will you share the new patients?
• Does the new doctor perform any procedures that the seller doesn’t and vice-versa?

For further information, please contact our friendly and wise Dental CPAs at (800) 772-1065 or info@dentalcpas.com

Dentists Who Represent Themselves When Leasing Office Space Have Fools For Clients

 This is a guest post from our friends at the Dental Attorneys. 

Putting the final touches on a lease agreement you just negotiated, with what you believe are very favorable terms, is a time to celebrate. Dream office. Great location. Generous tenant improvement allowances. In fact, you’re feeling great and you want to shout with glee about it. There’s just one minor issue you don’t know about: the landlord feels the same way. There’s no wondering why the landlord feels the way he does either, since there weren’t any lawyers to deal with and the dentist thinks he essentially got everything he was after. That dentist just doesn’t know it yet, but by representing himself without a lawyer representing him, problems will likely be inevitable and costly.

Dentists should remember they treat patients. Lawyers negotiate contracts.

Once the lease is signed, you and the landlord often have opposite goals. The landlord wants the lease in effect as soon as possible so he can begin collecting rent from you, even if it’s going to take three, four or even five months to “build out” the office space to your specific conditions. You just want to get into a nice, attractive new space and start running your practice. But how would you know that if a contractor lags on building out your space, he should be the one paying the rent for that extra time, not you. And neither the landlord, nor the contractor, is likely to tell you this, either.

When leasing space for that dream office, you should try to gain every concession possible from the landlord so that when it comes time to pay that first month’s rent, it isn’t overwhelming.

If your landlord is building out the space, he will try to economize on every item, reducing his costs and increasing his net profit on top of the cash already paid to him, a lot of cash for the initial and standard five- or 10-year lease agreement. Your ultimate goals may be the same – long-term financial efficiency, but again, you are at opposite ends of the spectrum when it comes to your dream office.

If you and your attorney agree that the landlord will build out the space and act as a general contractor, you should be prepared to tell him what type of cabinetry you want, whether you want Berber carpeting or tile flooring and where you do and do not want your restrooms located. You should have every detail spelled out: sinks, staff break rooms, patient waiting areas, built-in desks, areas for administrative duties, and the like. But, again, you treat dental patients. Lawyers advise clients on leases. It is sort of like asking an MD to fill a cavity, or you to perform breast enhancement surgery. Competent lawyers are the ones you should turn to when negotiating a lease because the handful who specialize in dental practice law, know all the nondental items you don’t.

With lawyer in tow, and you deciding to take an active role in the building out of your office, there are many issues and items that must be addressed.

In the paragraphs that follow, the authors examine common lease issues that most dentists don’t know about when negotiating their leases.

Office Build-Out Issues

Most leases provide the dentist with a limited time to complete the build out of their space, and the landlord will even try to start the build out period before the lease is even signed. Therefore, you should require that the landlord have a limited time to review your plans, and you should put penalties in your construction contract so that your contractor has to pay your rent if he doesn’t finish on time.

Another common build-out issue is the tenant improvement allowance the landlord gives you. When you negotiate the rent, the landlord will rent the space based upon the leasable square footage, typically measured from the exterior walls of the entire unit. However, the landlord will routinely give the dentist a tenant improvement allowance based upon the usable square footage, causing the tenant improvement allowance to be 10-20% less than had it been based on the leasable square footage. Always insist that the tenant improvement allowance be based upon what you are leasing, i.e., leasable square footage.

Rent Increases

Nearly all leases have rent escalation clauses, which are either contractual in nature or that are tied to one of any number of commonly used economic indexes, such as the consumer price index, cost of funds, and others you know from watching Lou Dobbs on CNN. This is what you and your landlord will be negotiating and, with any luck, your lawyer can talk him into tying such increases to one of the less volatile indexes. There should always be a ceiling on such increases, just as the landlord will insist on a floor for the same indexes.

Damage to Office

Earthquakes, fires, floods, even riots are part of the landscape in California. The authors have noticed all too often in their practice that one of the victims of these calamities is the dental practice owner. The typical lease provides that if the dental lease office is damaged, the lease remains in effect if the landlord elects to rebuild, but imposes no time limit on when it is to be rebuilt. Some leases even require the tenant, or the tenant’s insurance company, to continue paying the rent while the office is unusable. While most of the time rent is abated, even the highly motivated landlord can have difficulty rebuilding, usually because of building permit delays (in the case of widespread destruction) or because insurance companies won’t pay enough to cover the cost to rebuild. The authors have seen numerous situations where a dentist, tired of waiting for the landlord to rebuild, built out a new office at a significant cost only to have the landlord call back two or even three years later and tell the dentist he must return and start paying rent because the dentist’s lease was still in effect.

The solution? Insist on having the landlord start repairs within a certain time period (e.g., 90 days) and complete the repairs by a certain date (e.g.,, 180 days). If the landlord fails to meet these goals, you should have the option to terminate the lease so you can move onto a new location.

Subordination Clauses

The subordination clause is an almost invisible clause in most leases because of the intricacies of the mortgage foreclosure clauses. These clauses typically require that your lease will become subordinate to any new financing the landlord places on his or her building. If our real estate bubble ever bursts, many landlords will lose their buildings as rents decrease and they can’t pay the mortgage. If a lender forecloses and there is a new owner, the new landlord does not have to honor your subordinated lease, and you may lose your dental office space. However, most landlords will allow modification to these clauses during lease negotiations because they know they won’t own the building if this ever becomes an issue. Therefore, always ask the landlord for a waiver of such clauses.

Assignment Clauses

A typical landlord wants to control who occupies his or her space and will insert clauses that virtually destroy a dentist’s ability to sell his or her dental practice.

For instance, it is common to have recapture clauses in the lease, allowing the landlord to cancel the lease if asked to assign it to the dentist buying your practice. They almost always have a clause making the lease renewal options personal in nature, so that when you try to sell your dental practice, you only can assign the lease through the current expiration date. If this is the case, the buyer’s lender won’t finance the sale because they want the lease to last as long as the lender’s loan will be in effect (i.e., 7-10 years). Many landlords may insert clauses that give the landlord a right to claim a portion of the profits you receive from the sale of your dental practice.

Virtually all standard form leases contain provisions which keep the original tenant on the hook for the rent through the expiration of the term, including all option periods. This occurs whether the lease specifically states this, or if the lease is silent as to when the tenant is released from liability, by operation of law. You want to ask the landlord to release you from liability, either at the time you sell your dental practice or at the end of the current lease term, so that you don’t remain liable throughout the entire lease term. Even if the landlord won’t release a tenant at the time of assignment, they usually will allow a release at the end of the then-lease term, based on the argument that if the buyer is a bad tenant, the landlord has lease remedies which allow the landlord to deny the buyer the right to renew the lease term.

Recapture clauses should be negotiated out of leases, as should all options - personal language. Leases should not give the landlord any right to make a claim upon the purchase price you received for your practice. You should try to obtain a release of liability to avoid the nightmare of a default occurring well after you have retired and are unable to take over the office.

These assignment clauses can destroy the nest egg you are building in a successful dental practice. This is why it is so important, whether you are buying a dental practice or building one from scratch, to have an attorney with experience in the dental field assist you with your lease negotiations.

The list of legal “dos” and “don’ts” for dentists astounds most of them when we sit down for an initial conference on selling, buying, relocating, leasing, or otherwise affecting the ownership of a dental practice.

It is often said that he who represents himself has a fool for a client. As the reader can tell from the points raised above, a dentist representing himself rather than utilizing an experienced dental attorney can miss issues which could make their dental practice relatively worthless. With such a valuable investment as a dental practice, it obviously is in the dentist’s best interest to retain the services of an expert in the leasing area.

Jason P. Wood, B.A., J.D. and Patrick J. Wood, B.A., J.D.

jason@dentalattorneys.com or pat@dentalattorneys.com | (800) 499-1474 | www.dentalattorneys.com

Jason is an associate attorney in the law firm of Wood & Delgado, and Patrick is the founder and senior partner of Wood & Delgado, a law firm which specializes in representing dentists for their business transaction needs. Wood & Delgado represents dentists in California, Nevada and Colorado.

How a Dentist Can Balance the Chaos - Ten Tips to Create a Better Work Life Balance

Here is another guest post from our friends at ETS Dental by Tiffany Worstell. 

I feel like I should start a support group with this introduction, but…

Hi, my name is Tiffany and I suffer from horrible work/life balance.  I work full time, am taking classes online, and I am raising two kids.  Throw into the mix household chores, two dogs, Girl Scouts, viola lessons, marching band, and a plethora of other projects going on at any given time, and you have a snapshot of my life.   Just writing this down is making me nervous.  What am I forgetting that needs to be taken care of or done tonight?!

Crazy thing about my little chaotic snapshot above is I know I am not alone. Life is crazy anymore.  Looking around my office, each one of us has a handful or two of other activities and responsibilities.  Chances are your office is the same way.  Life happens regardless of your title or position.

So, how do you balance it all?  Initially, I started looking for sites with tips, but I decided it was better to get real life answers so I took my question to my colleagues and Facebook followers.  Some answers were almost universal; some were a little more unique.  Here are some highlights….

Ten things you can do to create a better work life balance

1. Limit the amounts of time that you do work stuff at home or vice versa.
2. Use a calendar!  Scheduling events makes it easier to know what is coming up and plan accordingly.  Google Calendar is a favorite for many of those that responded.
3.  Create lists.  Do what must be done first.  Do what you do not want to do and get it out of the way.  Once something is completed, check it off and move on to the next.
4. Turn off your alerts; do not be a slave to your phone.  Check your emails on your own terms; not with every beep, buzz, or blinking light.
5. Take some time for what makes you happy: read a book, watch a movie, go for a run, exercise, or go out for a drink with a friend.
6. Find some peace.  Pray.  Meditate.  Get a massage. 
7. Get help!  This was a tough one for me, but there is no reason that my kids couldn’t straighten up the house while they are waiting for me to get home or wash the dishes from breakfast.  They even like starting dinner once in a while. 
8. Don’t be afraid to let go.  One of my Facebook friends said it best, “When I was working full time, was a full time graduate student and a single mom I achieved balance by letting go of things that do NOT last-dishes, dust and laundry.  Instead, I chose football practice, school activities and a kid flick.”
9. Say no.  I struggle with this one, but it is okay to not do everything all of the time.  If something is not important to you, let it go and focus on what needs your attention.
10. Find what works for you.  Take advantage of the time you have; I study on my lunch breaks and can knock out a good bit of my reading without interruptions which helps me immensely.  A colleague wrote, “Having the opportunity to work remotely is a huge thing for me.  It helps me not to feel guilty about going to my kids’ activities (games, etc.) and I make up my time in the evenings when they are engrossed with homework.  Sometimes they will come and hang out in my office as they do their homework and we’ll all be ‘working’ together.” 

I guess I have some pretty smart colleagues and friends!  Of course this is only a small sampling of the ideas out there; what do you to do to make your own chaos work?  I would love to hear what works for you.    

"Life is too short to wake up in the morning with regrets, so love the people who treat you right, forget about the ones who don't, and believe that everything happens for a reason. If you get a chance, take it. If it changes your life, let it. Nobody said life would be easy, they just promised it would be worth it. 
-Harvey Mackay 

Tiffany Worstell is a nationwide Recruiter for Dental Staff at ETS Dental. She can be reached at tworstell@etsdental.com or 540-491-9112. ETS Dental is a Dental Recruiting firm specializing in finding and placing General Dentists, Dental Specialists, and Dental Staff throughout the United States. www.etsdental.com

What Can a Dentist Do When a Patient Complains That Their Fees Are Too High?

Here is a guest blog from our friend Sandy Pardue who can be reached at info@classicpractice.com or by phone at (800) 928-9289.


When a patient says, your fees are too high show surprise and say, Our fees are too high? and wait for their response to see what they have on their mind. Sometimes people do not say what they mean. They might think it should cost less, or they may think they cannot pay the whole fee now. This is what you must find out.

Ask:

• What do you think was too high?
• What would have been a fair fee in your mind?
• I suppose it is possible a mistake could have been made, etc.

They may be asking to reduce the fee. If they are a senior citizen over the age of 65, you can tell them they are entitled to a five percent discount. For anyone else however, tell them, {{Mr(s). _, I know it may seem that way but our fees are really in line and we are proud of our fees.}}

I'm glad you are concerned about the cost because that is one of our advantages for the quality work we do. People remember poor quality more than they remember a fair fee and Dr. really does quality work.
Dr. is an excellent dentist and he has such a good reputation. He really tries to go the extra mile to take care of his patients. He is always available to you. Dr. Tooth is here on Saturdays, Sundays and holidays when necessary. He takes such good care of his patients.
Back to the fees, Dr. Tooth keeps the fees in line in the acceptable (or average) range. He stands behind everything he does.

Or:
We charge very fair fees for the highest quality of service and treatment and we always go that extra mile to take good care of you. We will make sure you get the best of treatment.
If they insist your fees are higher than others, show them our fee comparison schedules (which by the way, shows nothing about the high quality we deliver). __ Mr(s)., I am glad you brought that up and I appreciate how you feel. Our fees are very fair fees especially compared to others in this area and nationally. Here, I'll show you a comparison of our fees with others if you like. (Show them a list of fees compared with other offices in the area and around the nation for the services they are getting.) Also, Dr. Tooth is well recognized for his excellent work. Our fees are not higher than others across the nation. Use the fee comparison schedules.

If your fee is higher (which is very rare) say, Our fee is only two or three percent more than the average and less than the U.C.R. (Usual and Customarily Reported). We definitely do make the extra effort to give you excellent service and quality. Our extra service is worth more, but we don't charge for it.

Or,
Are you concerned about a small extra fee, or the high quality of service? If you pay too little and don't get what you need or want, you waste your time and money. You know, you get what you pay for.
It is very important to get why they are upset and handle it with good communication skills.

If They Want to Change Dentists Because of Fees

If you fail with the above say, Let me have Dr. Tooth call you. I know he will care how you feel. If they refuse, have the doctor call them anyway.

If they are really solid and will not budge say, I will tell Dr. Tooth and I know he will miss you. We'll still have your records on file, so if you ever have an emergency or any problems at all, just give us a call.

Join Sandy in New Orleans for one of her Spice Up Your Practice seminars for many more practice building ideas, team training and organizational systems to grow your practice. Call her at 800-928-9289 or visit her website at www.classicpractice.com. She is looking forward to speaking with you!

Dentists - Charge the Batteries and Change the Scene

Here is another guest post from our client Dr. Lurie on his "Mistakes Made and Lessons Learned".

It seems to me that in the course of practice, there comes a time to charge the batteries and change the scene. This can be both physical as well as mental (emotional). Allow me to ramble on this one for a few minutes. You leave the house at the same hour every day for a routine drive to the office, usually over the same route, and arrive at a destination that you have seen every day, with the same people, decor, aroma, and basic schedule. This goes on for days, weeks, months and years. It is, of course, the office and we accept this as our workplace and how it fits into our daily routine of work. Now, think about the few days that were different. Perhaps there was a traffic jam, an early morning meeting, a half day of continuing education, a birthday celebration that the entire staff is helping to celebrate. Was not this a day that was different and "charged the batteries"?

This leads me to think about ways and efforts that can be incorporated into our work lives that can do this on an occasion and have long lasting effects and advantages.  I remember a time when I could not stand my private office.  It was the same four walls that I worked in for many years.  I wasn't even aware that it was dragging me down until my wife popped in one day and suggested that we must do something about this.  And then, we turned it into an office project with the staff and a decorator, with input from everyone.  Of course, this would come back to haunt me later on.  Anyway, it was fun and it really did give me a tremendous emotional lift and it became a place where I could recharge the batteries, work, and interact with the patients in a non-dental setting.  So this is an example of a physical change.  Gradually, these changes took place in the waiting room, the business office, and, most importantly, the staff lounge.  This was a tremendous boost for all of us and we had again, found a sanctuary that we all could share.  Incidentally, this became the room for the "dreaded staff meetings" that I discussed in a previous blog.  But you get my point - a fun way to change the monotony of the place where so many hours are spent.   The added benefit of "team" input was great and this, of course, adds the emotional benefit of the revision.  The energy in the office was off the wall and lasted for years as we all became closer, knowing that this was our project and our stamp.  Obviously, our staff turn-over was minimal and staff was on-board for many years.  So the uplift in decor helped in many directions. 

With this in mind, I tried to think of things that would keep us energized and focused.  These would fall into the mental (emotional) category.  An example would include all special occasions that the staff wanted to share----birthdays, anniversaries, and other celebrations were welcomed and planned.  The planning of the event was the key and time was set aside in the work day for this.  I think that this is part of the whole recharging of the battery that I mentioned earlier.  The routine was changed, the day was different, and the effect lasted for quite some time.  These are just examples but I think you get the picture.  One could add: trips, meetings (both professional and social - i.e.museum of art trip with spouses), or joining with another office for a continuing education evening, or a fashion show at a department store, etc...  The possibilities are endless but I urge you to consider them for your own peace of mind and to add the activity of "fun" into the practice. 

Another area that I found had a profound effect on managing stress was an activity that we called "Mentoring of the Patients" and I will tease you with this and discuss it in my next article.

More Mistakes Mad and Lessons Learned next time.  As always, I would love to hear from you and share your ideas and experiences.

Dr. Donald B. Lurie

donald.lurie@att.net

Phone:  717-235-0764

Cell:      410-218-2228

Dentists - What to Know Before You Accept an Associate Position

This is a guest post from our friend Morgan Pace at ETS Dental.

Finding a new associate position can be a daunting process for both new and experienced dentists. While making a good impression on an interview is important, it is equally important to learn as much as possible about the practice. Here is a compilation of questions from job seekers who I have worked with over the years. I hope that this list will make the decision process less intimidating.

Relationship
-Employee or Independent Contractor?
-Employee at will?
-Is the doctor open to restrictive covenant in case of future ownership?
-Is the doctor going to stay on PT for some time or can he, if needed (After purchase)?

Type of Practice 
-How the practice is set up (family, Pedo, or dentures)? Pedo: what age?
-Age of the practice?
-When/what do you refer out?
-Place or Restore Implants? Which system?
-# of operatories
-# of Hygienists. Hrs of operation?
-# assistants
-Will the associate have their own assistant?
-How much is the practice overhead?
-How long has each employee been there?
-What does the practice do to market itself?
-How many FT and PT staff?

Patients
-What is the patient pool like?
-Have the number of active patient records been reviewed?
-Is the practice growing or declining in number of patients seen, new patients attracted, and young patients?
-Average number of cancellations per week?
-Average number of patients seen by associate per day?
-How far ahead is the doctor book filled?
-How far ahead is the associate book filled?
-How far ahead is the hygienist’s book filled?
-Discounts/Bartering/payment plans?
-PPO type of insurance? Insurances: accept all kinds or just selected ones?
-How much is the discounted price of the PPO compared to the fee schedule?
-Medicare or Medicaid acceptance?
-How much of the practice relies upon capitation programs, PPOs, HMOs, Medicare or Medicaid?
-What percent is FFS, cash and discounted PPO?
-When was the last fee increase?
-Are the fees low, high or average for the immediate area?
-Do you offer patients credit?

Schedule 
-Days, hours, on call, etc.
-How many office hours and days per week is the office open?

Duties
-Job description (separate document) or general description
-Is the associate expected to check hygiene of other doctor’s patients? If yes, will the associate be compensated for it?
-Will the associate be expected to perform hygiene/prophy?
-Does the doctor do any procedures other than regular general dentistry?
-What were the most of the cases being done by the associate?
-Will the associate be placing Implants for the practice?

Facilities
-Supplies, equipment, support, etc...
-What type of PMS (Software) is used?
-Implant surgical set up? Who finances to get that set up if NOT already in place?
-What is the square footage of the office? Can it be expanded?
-Average age of equipment?
-Is the practice left-handed, right-handed, or ambidextrous?
-Do you have a confirmation system for appointments?
-How do you deal with NO Show?
-Digital X-ray?
-Intraoral Digital Camera?

Term of contract 
-How long?
-What is the required notice period should either party wish to terminate the relationship?

Compensation
-Is there a guaranteed salary, draw, daily rate or hourly rate?
-Is commission determined from collections or production?
-If collections, what is the collections rate in the practice?
-What percentage of production/collections is used to calculate income?
-Is there a chance to increase compensation in the future?
-Is the associate responsible for my own lab fees and expenses?
-Taxes withheld?
-How will the associate be paid? (Weekly/bi-weekly/monthly)
-How much on average was the last associate making?
-What was the average associate production per day?
-Does the associate production include hygiene exams and x-rays?
-Can I get a fee schedule of the practice?

Benefits
-Medical Insurance: health and dental?
-Malpractice insurance?
-Disabilities insurance?
-Required CE courses? How much and for how many hours a year? Are they paid for/reimbursed? Is there a stipend?
-Retirement?
-Sick days…….. # allow per yr…..
-Personal days/vacations…..# per yr allow……
-Holidays?
-What benefits are given to the staff?

Expenses
-Define, list, when paid, lab, etc…..
-What Lab do you use? Use different lab for different lab orders?
-Will the practice support the acquisition loan (in case of future ownership), pay the overhead expenses and can afford a reasonable income?

Other Questions and Notes:
-What is your practice Philosophy and Goals? For the Practice and with new pt’s tx?
-% of implant surgeries
-Have you had associate before? How many? How long they stayed? What was the reason for the associate resignation?
-How do you advertise?
-Will most dental insurance dictate pt’s Tx plan?
-Do you deal a lot with EMERGENCY pt? Separate operatories for that?
-Average number of emergencies per week?
-Will I be doing hygiene/prophy when I don’t have pt?
-Who determines how long I have when spending with new pt/initial exam and record?
-Do I have a separate apt to do comprehensive exams and record, or do I perform the TP when pt comes in for cleaning?
-How long does a hygienist spend on their recalls?
-Is there a particular doctor in the area who is your main competitor?
-Who sees the patient first (Doctor, hygienist, associate)?
-Why was the partnership offer turned down by an associate (if applicable)?
-Will I be able to visit the office during regular working hours?
-Does the doctor have a report showing how much treatment is treatment planned?

Partnership/Buy in/Sale
-Discussion/Formula/Price
-What is the time frame for an associate position before we can talk about partnership/buy in/buy out?
-Is there an option for future ownership? Are you considering a move out of state?

Restrictive Covenant
-Define


Morgan Pace is the Southeastern U.S. Account Executive and Senior Recruiter for ETS Dental. He can be reached at mpace@etsdental.com or 540-491-9102. ETS Dental is a Dental Recruiting firm specializing in finding and placing General Dentists, Dental Specialists, and Dental Staff throughout the United States. www.etsdental.com 

The Four Most Common Mistakes Dentists Make When Hiring a Website Developer

This is a guest post from our friend Kim Grimsley, an intellectual property attorney at Oliver & Grimsley.

We meet a lot of clients that fail to obtain a written agreement, or blindly sign the form provided by the developer - and when a dispute arises, only too late realize the problems created by that lack of diligence.  This post addresses critical provisions in a website development agreement.

First, you want to make sure you will own the material and content created by the developer.  Thus, you want a provision in the agreement (which must be in writing) that recognizes that the developer’s work for you is considered a “work made for hire” and you want a copyright and intellectual property assignment as well.  These clauses ensure that, although the developer is not your employee, you are the owner of the website materials and intellectual property rights.  You do not want to find that your website designer created something unique for you only to discover the same unique layout on another website.  Many businesses are surprised to learn that in the absence of this statement in a written agreement, an independent contractor (in this case the website developer) typically is the owner of work they create, and the business at most would be a licensee of the material. This means you don’t own the work; rather, you only have permission to use it. 

Second, you want to have a provision in the contract that states that the work on the website is the website developer’s original work and/or that the developer has the necessary permission/licenses from the owners to use the work on your site.  For instance, the website developer may place photographs on your website – you want the developer to represent that the developer has the right to use those photographs on your website (i.e. either the developer took the photos or it has the permission to use them).  If the developer uses photographs owned by a third party on your website without the third party’s permission, the third party could claim you are infringing on their copyright by displaying their work on your website without their permission, and would demand you cease use of the photos and may demand damages as well.  Thus, have your website developer represent the work is original or that he has permissions to use all work on your website.

Third, make sure to have an indemnification provision in your agreement.  This provision should provide that the developer will indemnify you in the event you incur damages or a loss due to a third party claim that you are infringing their intellectual property rights – where they claim the work on your website is actually their material.  For example, a business thinks the graphics on its site are original, however, it receives a cease and desist letter from a third party alleging that its use of the works on its website without the third party’s authorization is copyright infringement and demands damages.  Under Copyright Law, if the third party is the owner of a registered copyright in the work, the business as an unauthorized user could be subject to statutory damages ranging from $700 to $30,000 for unintentional infringement, and up to $150,000 for willful infringement. Thus, if material placed on your website by your developer is subject to a claim or legal action for infringement, you want your developer to indemnify you for these actions since you are relying on their knowledge, creativity and skill in developing and designing your website.

Finally, it is important that you make sure that the developer periodically delivers all source codes and native files to you, and that you control all passwords and access to critical website assets, such as the domain registration.  You want to make sure that such files and access rights cannot be withheld in the event of a dispute.  Thus, if a dispute arises, the developer's sole remedy should be money damages.  You should not be prevented from transferring the work done (to the point of a dispute) to a new developer, so you can finish your site, and deal with the dispute separately.  

For more information, please contact Kim Grimsley at Oliver & Grimsley, LLC -  kim@olivergrimsley.com 

Dentist and Spouse Roles - Financially Speaking

Here is another guest blog from our client Dr. Lurie.

It seems to me... the role of the wife (spouse) in a dental practice has not been discussed enough.  We take it for granted that the husband and wife are on the same page, but this is not necessarily so and has cropped up in discussions at many study clubs. Since I have written several articles on retirement preparation, I would like to interject that retirement begins with the start-up of practice. The role (or roles) of the doctor and spouse will obviously play a big part in the success and continuation of the practice and for the eventual plan that the team for retirement carry out.

There are several different scenarios to look into.  The doctor (male) with a non-working wife seems to be a common model.  When a good marriage is present, stable and open, financial interests will be discussed and the future planned for, with budgets for essentials and "fun", including shopping, vacation, hobbies etc...  Even with the so-called good marriage, sometimes the mate does not think that the cash flow will ever change or diminish and that status quo just continues.  Unfortunately, this does not always happen.  One of the problems is the lack of communication between the two.  Or worse, in unstable marriages, the lack of caring about the communication.  This can be a prelude for disaster.  Credit card debt is the killer and many doctors and wives are falling into the credit card debt chaos that then makes the practice a place where there is pressure to pay the personal debt along with the overhead of the practice itself (which, in today's times is getting more and more burdensome even for the mega practices.). One can only hope that the two can sit down and get a handle on this. Then, if needed, meet with the financial adviser to face the crisis and the facts.  Sometimes, it is the doctor who is the one who abuses the credit cards, or it may be the wife - or worse, both of them.  This added strain then makes the practice a pressure cooker and the joy of dentistry begins to fade.  We find that the emphasis is on paying the debt (at the sacrifice of quality) rather than reinvesting into the practice and escalating its return.  If the parties are not able to resolve this, then the situation might be doomed (as many of you know.) 

I have been there and was able, early on, to get the adviser to help us (and to reign me in since I was the abuser.)  We actually went a step further.  My wife started working in the office one day per week.  This was a great benefit in several ways.  The most important one was that she saw how hard I worked and what the overhead margin was all about.  It also enabled her to meet with the staff and she was directly under the supervision of the office manager.  This was made quite clear in the beginning.  She then was better qualified to work our personal household budget and to maintain our entertainment budget on a level compatible with the office.  The second benefit that we obtained was social security benefits that now (in retirement) really come in handy.  I was lucky (in that this conference with my team ) was early in my years of practice and marriage. 

Obviously, every practice (and doctor) has differences.  Not all doctors can have their wife in the office with them.  It can cause problems with staff if not addressed properly.  Conversely, it may be a benefit with staff knowing that the spouse is there. The communication and the personalities of the entire staff and doctor are the key. My Dental CPA has told me countless number of cases where credit card spending has caused practices to fail.  I urge you to look at this carefully and adjust wisely.  Remember that the beginning of practice is the beginning of retirement. There are many facets to this discussion and this is but one of them.  I wanted to share with you my personal story.

It seems to me… that we may have many variations on this.  I would love to hear from you and share experiences.

More Mistakes Made and Lessons Learned next time.

Dr. Donald B. Lurie

donald.lurie@att.net

Phone:  717-235-0764

Cell:      410-218-2228