Monthly Archives: August 2022

Balancing PPO Participation

FEBRUARY 15, 2016 

By Bill RossiFor many practices, PPO participation is their biggest expense after staff wages (or even greater than staff wages in some cases).  Historically, dental practice collection percentages had been 95%+ (of gross production).  Now it’s not uncommon to see collection percentages at 70-80%…and sometimes less.Most dentists join a PPO in the hopes of gaining or retaining patients.  No dentist likes to lose patients, and when you do lose a patient because you’re not in the network, it can be a powerful inducement to sign up for a PPO.Once you’re participating in a PPO, it’s easy to feel there’s no other choice.  However, you don’t have to take everything the PPOs dish out.In many areas, the PPOs will have the majority of the providers in the area but no PPO has 100% of the providers.  Therefore, it is possible to survive and thrive outside the participation of any one PPO.  For most doctors, it’s a matter of having the right balance.As a general rule of thumb, if you’re collecting less than 90% of your gross production, this should be reviewed.  If you’re collecting less than 80%, chances are very high that you would benefit by cutting back on PPO participation.  It is possible to cut the PPOs and keep the patients!For example, take a look at your own practice.  You probably have patients that are already seeing you out of network.When deciding where to cut back on PPO participation, look first for plans that are 15% or less of your patient base and have ­­­­­­­­­­­­­­­­­­­­­­­­­­­­fee allowances with greater than a 30% discount.Providers have more options in a marketplace that has a greater variety of PPOs.  You don’t have to be chained to any one PPO.The worst case scenario is to be in an area where 90% of the insurance is through just one company.  That makes it tough!  Fortunately, that’s not the case everywhere.  Cut back one at a time.You may be participating with group plans that include multiple PPOs.  There can be “PPO creep” on these plans where you can sign up for several plans and then find out several more had been added despite the fact that you didn’t directly contract with them.Sometimes you’re better off directly participating in the PPO network and sometimes you’re better off just dropping the network altogether.  And to add to the complexity, sometimes the PPO network pays better out of network than it does in network.If you are netting less than 35% of your collections and gross staff wages are in line(<27%) and you don’t have extraordinary equipment/facility expenses, then the PPO’s are the likely culprit.PPOs are sort of like the casinos in Las Vegas.  The “House” has all the odds in its favor.  However, as a player, you can play smart, and sometimes you don’t have to play at all!  You have more power than you think.For most practices, two to four plans are the right mix.  You can adjust the participation in plans just like you’re adjusting ballast in a hot air balloon.  Cut back the plans one by one until you have the right mix of profitability and busyness.  Every year negotiate fees for the plans with which you have contracts (a topic beyond the scope of this article).It’s been my experience that most doctors join a plan too impulsively or leave a plan too irrationally.  This is a serious issue and deserves serious analysis.  A good look at your PPO situation can do more for your bottom line than almost everything else.  You can add $1,000’s and even $10,000’s to your annual profits.We all know that hard work, integrity and skill make a difference in your success, but don’t forget the other component, courage.  Serious consideration and a bit of courage can save you a lot of sweat and stress.Bill Rossi and his team at Advanced Practice Management are actively involved in the ongoing management of over 220 dental offices in the Upper Midwest and monitor over $30,000,000 per month in Dental activity.  They are nationally recognized experts in dealing with PPO issues.

“PPO Transition: Lose the Discounts, Keep the Patients!”

by: Bill RossiGoing through a PPO transition is serious business. It is one of those moves in dental practice management that has substantial risks and rewards like adding an associate or building a new facility.So as dentists “balance” their PPO participation and decide to peel off some of them, I offer the following suggestions based on many years of helping clients through this process.It’s always better to talk face to face with patients about this transition. Letters are rarely thoroughly read, sound self-serving and can confuse and irritate patients.I know because a long time ago I used to help write those letters! I found it wasn’t the best approach.However, if a doctor insists on writing letters, we suggest sending them out a small batch at a time and following up with phone calls—just like you would with a recall notice. In this way, you can adapt and tailor your message. A mass sending of letters can seriously damage a practice.Remember, the goal when a client leaves a PPO is not just to minimize the loss of patients; it’s to slow down any loss. That gives the practice time to “heal up.” So, if the practice is otherwise well managed and has decent new patient flow, it will be fine.Slowing down the loss is another reason not to send letters. If you do things face-to-face, you’ll see every patient at least one more time. Face-to-face communication is always best especially when it’s a potentially difficult subject.As far as deciding which PPOs to peel off, it’s not just a matter of which ones have the lowest fee schedule. There are other key factors, such as the number of patients on the plan, out-of-network benefits for the PPO (plans with good out-of-network benefits are easier dumped than plans with no or puny out-of-network benefits), how many of the doctor’s patients are on the plan and how many new patients are brought in through the PPO.If the conditions are right and things are handled well (the staff coached, the groundwork done, etc.) a PPO transition should result in less than 30% of lost patients from that plan in the first year. However, I ask my clients, “If you lost 50% of the patients on this plan, would you be okay?” That is sort of a gut check.We keep very close track of the statistics before and after a PPO transition. We watch new patients, total patient flow and, of course, production and collections, as well as some other key statistics. That is how our approach to transition has evolved. Doctor, you do have the power to peel off bad PPOs!Bill Rossi is President of Advanced Practice Management. He and his team are actively involved in the ongoing management of over 220 dental practices. He has over 35 years in practice management, has been a contributor to Dental Economics, Excellence in Dentistry, The Madow Brothers Audio Series and Dentaltown CE.Mr. Rossi is an ally for private independent practices in a profession increasingly impinged on by corporate dentistry and PPOs.

According to Bill Rossi of Advanced Practice Management, There Seems to be a Law of Diminishing Returns by Adding the Next PPO

Practices with little or no insurance participation generally see fewer new patients than practices with more participation. However, is there a point where there are diminishing returns with increased PPO participation? Anecdotally, he (and we) have noticed that practices that participate in almost every PPO available don’t see a proportionally greater number of new patients, and sometimes even see a drop. So, he looked into his company’s considerable database to measure this statistically.To summarize the results: Practices that have no or very little PPO participation tend to have significantly less new patients. On the other hand, practices with deep PPO participation do not see proportional increases in new patients to account for the added write-offs. The data shows the best position is to have a modest amount of PPO participation. For most practices this would mean a collection percentage of 80% to 90%. The moral is don’t be quick to sign up for the umpteenth PPO. It won’t be worthwhile

Negotiating PPO Reimbursements

In case you weren’t able to attend our recent Scottsdale, AZ seminar, here are some recommendations from practice management consultant, Bill Rossi.  There can be a lot of money to be made if you handle this correctly:

  1. Do your homework. To get a sense of your fee reductions, prepare a spreadsheet with vertical columns going left to right listing first your top procedures by frequency.  The second column will be your full fee for each procedure.  The remaining columns would be for each PPO plan and their reduced reimbursement for each procedure.  Add the totals at the bottom of each column to see how much of a percentage discount you’re taking in the aggregate from each PPO.

If you haven’t done so recently, raise your fees.  This will give you more ammunition to argue the PPO reimbursements are too low.If you are aware of other doctors’ reimbursement levels, use it to your advantage against the insurance companies.  For instance, an office employee who used to work in another office may tell you that the other doctor’s reimbursements are higher than yours.  This is not privileged information.

  1. Call and negotiate. The doctor should be the one making the call, not an office manager and not an out-of-state management consultant.  You will be the most effective, as you are the only one who can make a credible threat of dropping that plan.

If you call saying you want to renegotiate, you may be given the run-around.  So, if necessary, tell whomever answers the phone that you’re a new doctor thinking about signing up with their network.  When you get through to the network manager, explain who you really are.Do not be demanding and argumentative.  Approach this in the likeable style of detective Columbo and consider the following kinds of lines: “Maybe I’m missing something, but I have to ask, is it true you are paying others more for the exact same procedures?” and “Delta is paying $800 for a crown and Aetna is paying $750.  That’s more than what you’re paying.  Can’t you do any better?  Can’t you help me with this?”Use specific fees to make your case, and then ask them to review all of your reimbursements.  Then, pin them down.  Take their name, when you should expect to hear from them and how you can follow up with them in the future.Finally, review the results to verify that they didn’t raise some reimbursements but lower others.

  1. Odds of success. In Bill’s experience, you might be successful one-third to one-half of the time – even with Delta.  It is well worth the effort.  If for example, Aetna represents 15% of your practice and you can get a 10% raise, then on $100,000 of monthly production, you will earn an additional $1,500 of free money each month going forward.  Get into the habit of doing this with each of your plans each year.

In the next Newsletter, we will summarize Bill’s recommendations for dropping a lousy PPO and limiting the fallout.

Dropping a Low Paying PPO Plan and Limiting the Damage

In the January 15th Newsletter, we summarized how to best negotiate higher PPO reimbursements based on Bill Rossi’s lecture at our Scottsdale, AZ seminar in late December.  What follows is Bill’s advice for dropping a PPO plan and limiting the fallout.  Dropping a plan is a serious business decision and demands careful consideration.  This is not an ideal topic for this Newsletter, as the short format of the Newsletter items doesn’t adequately capture the nuances involved.  With that said, here are some recommendations:Don’t drop a plan out of anger.  Do it rationally.  Before dropping, always try to renegotiate.Ironically, dentists with the most PPO participation (usually 5 or more) are the ones least inclined to drop even though they are in the best position to do so.  It’s not unusual to see these dentists collecting less than 75% of what they produce. If this applies to you, it is time to start peeling off some of them.You don’t necessarily start with dropping the PPOs with the lowest fee schedule.  That is a major factor, but the ideal PPO to drop represents a small portion of your patient base (say 10% or less) and has decent out of network benefits.  The process of dropping this smaller PPO is going to be a “dress rehearsal” for the bigger ones you may later decide to drop.When giving your notice to leave network participation, always be polite and leave the door open for the PPO to pay you more. Sometimes, if they didn’t negotiate earlier, they will now.  In any case, keep the communications professional and positive.Ask them to send written confirmation to you confirming the date of the transition. Before the transition date, do not start telling patients.  Do not send letters!  These letters often aren’t fully understood and can sound sanctimonious.  Instead, train your staff to deal with patients both face-to-face and over the phone.  They have to know how to tactfully address both old and new patients about your participation as “out-of-network providers.”  There are many nuances to this that go beyond what we can discuss here.  It’s best to get professional help through this process.Be supportive of your staff.  The more confident they are, the more calmly they will deal with this transition with patients and the better the patients will accept the change.  Keep in mind that’s it’s very likely you’re already seeing patients from various PPOs on an out-of-network basis.  Patients are generally more loyal than you think.   Very few offices will be completely out of PPO participation.  The goal is to find the right balance.It is also very important that you have a plan to fortify your practice.  That is, you can’t just drop the PPO and do nothing else.  You want to build up the practice through advertising, adding services, and tuning up your systems.The bottom line: If you handle things right, chances are you’ll lose the discounts and you’ll keep the majority of the patients in any given plan.  There are substantial risks and rewards in leaving a PPO.  However, it’s probably easier and less risky than you think it is. There are few decisions that you can make that will add more to your bottom line, not just this year, but for years to come.  You can’t “outrun” the discounts forever.Massachusetts Dentists:  Before you sign up with the “New” Delta, or drop Delta altogether, it is very important to discuss the nuances of these decisions.  Collier subscribers can call Bill Rossi at (952) 921-3360 if you’d like to discuss this and get the “inside baseball” analysis of what’s happening.

Three Case Studies Show How Dropping a PPO Plan Increases Profits

Practice management consultant, Bill Rossi of Advanced Practice Management, has shared some numbers for three practices that he helped guide through dropping the same large national PPO plan.  In each case (one on the East Coast, one in the Midwest and one on the West Coast), the PPO discounted fees about 30% and the PPO patients comprised about 33% of the practice.  In each case, production and collections increased in the months following the drop.  Here are the numbers:Case History #110 Months Before Drop           7 Months After Drop          Gain/MoProduction/mo                     $192,755                                   $203,487                      $10,732Collections/mo                     $112,853                                   $133,968                      $21,115Patient flow (exams/mo)            308                                           320Case History #212 Months Before Drop           6 Months After Drop           Gain/MoProduction/mo                     $84,759                                   $93,130                            $8,371Collections/mo                     $79,005                                   $93,422                         $14,417Patient flow (exams/mo)         240                                           251Case History #35 Months Before Drop               7 Months After Drop*        Gain/MoProduction/mo                     $134,645                                   $138,551                          $3,906Collections/mo                     $106,262                                   $111,323                         $5,061Patient flow (exams/mo)           268                                           249*Dr. working fewer hours this yearAccording to Rossi, these case histories are representative of his clients’ outcomes, though he is careful to say that every case is different.  In our own experience, based on informal polling of doctors who have dropped a PPO, in almost every case, they were very pleased with their decisions.  (The exceptions were unique situations such as the practice being located in a one company town, and it couldn’t handle the huge patient loss after it dropped that company’s PPO.)In each of the above cases, the patient retention has been better than the doctor and staff expected.  There is always some patient loss and some hassles as the practice goes through the transition, but even in the worst case scenario, the practice can always sign back up.  One large national dental insurer might threaten that they won’t take a practice back for two years, but Rossi believes that is probably a bluff.Given the cost of PPO participation, we’re dumfounded that more doctors aren’t taking action and renegotiating or dropping all PPOs that discount fees by 20% or more.  Fear is the likely culprit.  Every dentist is out of network with some plans, yet still manages to treat patients who have those plans.  It is definitely possible to cut back on PPOs and stay busy.It’s high time that dentists turn the tide on PPOs.  Make it a goal to peel back one or two in the coming year.  Until more dentists get proactive, PPO reimbursements will continue

Is Your Practice Primed To Drop One Or More PPOs?

Is Your Practice Primed To Drop One Or More PPOs?

PPO write-offs are one of the biggest practice management issues dentists face.  Dropping PPOs can add tens of thousands of dollars to the bottom line.  In fact, the impact on net profits is magnified beyond the simple percentage increase in the fee reimbursement by going out-of-network.  For example, if overhead remains fixed at 60% of revenue, then a 10% increase in fee income translates into a 25% increase in the bottom line.  We asked Bill Rossi, a practice management consultant and PPO expert, for the practice attributes he looks for before recommending that his clients drop a PPO. Here is Bill’s response:

While the rewards can be great, you never want to go off half-cocked.  We want to make sure the practice is ready.  Here are the signs I look for:

  • On a scale of 1-10 for personal busyness, you rank yourself at a “8” or more. For example, are you attracting at least 20 comprehensive exam new patients per month per full-time doctor?  Are you checking two or more hygienists per day?  If you’re maxed out, why work at a discount?
  • Your hygiene is booked out and it’s hard for new patients to get in.
  • You do not want to add additional hygiene time because you do not want any more exam interruptions.
  • You cannot add additional hygiene time because there is no more room in the facility.
  • You will be cutting back on Doctor capacity (e.g. a Doctor retiring and not being replaced).
  • Do you have a good team? Low turnover?
  • On a scale of 1-10, would you rank your administrative staff at a “7” or better?
  • Do you have PPOs that are paying you less than 70% of your fees and are less than 20% of your practice?
  • Do you have up-to-date equipment and technology and décor?
  • Is your Active Patient Count 1,500 or more per Full Time Doctor? (The number of unique patients that have had a visit in the last two years)

It’s a lot easier to join a PPO than to drop it.  But, if you’re collecting less than 80% of your gross production, you should seriously look into your options.

In an upcoming Newsletter, Bill will explain how to fortify your practice before and during the PPO transition process.

Bill Rossi, President of APM can be reached at or (952) 921-3360.

Fortifying Your Practice Through A PPO Transition

By Bill Rossi:

This article is a follow-up to “Is Your Practice Primed to Drop One or More PPOs?” which appeared in the October 15th Newsletter. 

So you’ve pulled the trigger and decided to drop a PPO.  It’s important that you don’t just leave PPO participation.  You have to be working toward something.  The stimulation of a PPO transition can help create a “Practice Renaissance.”

You’ll be adding thousands to your collections each month – plow some of that back into strengthening the practice through:

  • Taking good care of your team: Chances are, they have some trepidation about the transition. Let them know that as they make progress leaving a PPO, and on the above, that there are rewards for them too.  Give them a stake in the practice’s success.  Perhaps they share in, say, 15% of the practice’s increase in collections over the next 12 months.  Or, add a group bonus or celebration for collections over a certain target.
  • Continuing Ed: Learn new procedures to keep more procedures in house.
  • Team Continuing Ed: Keep you and the team psyched up and energized to present the treatment you already can provide.
  • Tune-up your Recall System: Do not assume that your team has this nailed down. This is the number one way you’ll keep patient flow strong and your active patient base active. 75% of your hygiene patients should be committed to their next appointment.  You have to actually measure  Many offices overestimate how well they are doing.  Set up a well-planned pattern for contacting patients due and past due including calls, emails and texts.  Put someone in charge of monitoring this, your most important administrative system.
  • Make the best use of your digital communications: (e.g., Lighthouse, SolutionReach, RevenueWell, etc.): Set up quarterly email blasts to patients on topics such as implants, Dental Health Month, your team, seasonal events and so on.
  • Have a “Clinical Protocol Meeting”: Go over all of the procedures your practice does with team members.  Refine and reassert your clinical guidelines.  See my article on Clinical Calibration ( If you do more for the people you see, you don’t have to see more and more people on the PPO treadmill.
  • Ask the hygienists to light up and track use of the intraoral cameras: This should be done for the majority of your adult hygiene patients.  Over half of intraoral cameras are used less than five times per week.  And make sure every hygienist has a working intraoral camera.
  • Train your administrative team on how to tactfully deal with financial arrangements for patients in and out of network. They have to know how to do this.  Talk them through how they will handle patients’ questions, such as, “Do you take my insurance?,” “Will insurance cover this?, “Why did you drop my PPO?,” and “Can I remain a patient?”  One good all-purpose phrase is, “No insurance covers 100% of recommended treatment, but it certainly helps and you’re lucky to have it.  Here’s how your insurance works here . . .
  • Google Reviews matter: Pick someone in your office to run the campaign to get these. At least 50 per full time Doctor is a worthwhile goal.
  • Update your website: If it’s been more than three years, it’s time!
  • Train your administrative team to tactfully welcome patients into the practice, whatever their insurance.
  • Don’t send letters! (unless the PPO does). It is best to talk to patients face to face. Assume that most of your patients will want to stay and act accordingly. I can assure you Doctor, that patients like you for more than your “Network Status.”  You will keep more than you think.  If a patient does decide to leave, be graceful about it and let them know, “They are always welcome back if their circumstances change…” Some will come back.

Dentists have spent the last 20 years signing up. Congratulations on starting to “un-sign” up and taking back control from the PPOs.

Evaluate PPOs When Building Your Practice By Purchase

Our 2014 practice economic survey published last month revealed that most practices are now operating at only 80-89% of optimal capacity, defined as being as busy as the doctor wants to be, doing the kind of dentistry the doctor wants to be doing. This means that the average doctor is losing $100,000-$200,000 in profits annually, compared to what she would be making at 100% of capacity.

Many doctors have attacked their busyness problem by increasing external marketing expenses or, even worse, signing up for or increasing managed care participation. However, we recommend a much more cost-effective strategy: purchase a nearby competitor’s practice and merge it into your practice’s existing location.

This allows doctors to build practice volume to the desired level as quickly as possible. Since fixed overhead costs such as rent, equipment, utilities, insurance, etc. have already been covered, incremental overhead (usually just supplies, lab, and additional labor) usually runs only 30-40% of the additional volume purchased. As a result, the purchasing doctor can bring 60-70% of the added volume to the bottom line as increased profit, before taking into account annual debt service costs. These annual debt service costs on practice purchases typically run no more than 10-15% of the incremental added collections, and then only for the typical 7-year buyout period. As a result, a purchasing doctor can usually generate a net profit of 45-60% on the added volume purchased, even after paying the related debt service.

While the economics make adding another practice through purchase a “slam dunk” financially, doctors must carefully analyze the impact of managed care before cutting the deal. Doctors who “leap before they look” can lose thousands of dollars to unforeseen managed care implications, says Bill Rossi, a practice management expert.* As the trend toward group practice continues, Rossi has seen an increased number of practices grow by purchasing one or more additional practices. Rossi has worked with dozens of clients through this practice purchase/merger process and describes below some important managed care issues that must be carefully considered and successfully navigated.

For example, what if you’re purchasing another practice that’s participating in a large PPO that your practice is not? Do you join that PPO for the sake of having a smoother transition?

Continuing with this example, let’s say you’re a Delta Premier provider. In many parts of the country, patients with Delta Dental insurance have the option of going to a Delta Premier provider and getting that level of benefits, or going to a Delta PPO provider where they have the incentive of reduced co-payments.

If you are a Delta Premier provider (the “regular Delta,” not with Delta PPOs) and you buy a practice that’s with Delta PPO, those patients will experience a transition as they blend into your practice. This must be handled carefully, or the patients you are assuming the care of may leave your practice.

On the other hand, if you join Delta PPO and have a significant number of Dental Premier patients, you will experience deeper discounts on the patients you already have. This can be terribly expensive, in fact even more expensive than the actual practice purchase in some cases!

It’s very important to get a specific list of all PPOs the selling doctor is participating in, along with the related fee schedules, as part of your due diligence related to the purchase. Unfortunately, many doctors purchase without knowing what PPOs the practice participates in. Sometimes, even the current owner isn’t aware of the plans for which they are a provider!

Even if the practice you’re purchasing participates with the same PPOs, be sure to compare both practices’ PPO fee schedules. Believe it or not, PPOs do pay different fees for the same procedures to different providers! The practice you are purchasing might be getting higher (or lower) reimbursements than your practice. Obviously, doctors would want to negotiate with the PPO (if you’re going to continue to participate) to ensure that you get the higher fee schedule of the two, even if you are bringing the selling doctor over to work in your practice.

If you’re purchasing a practice that has significantly more PPO participation than your practice does, make sure that you and your staff are ready to take these patients through the transition, much the same as if you were leaving a PPO. However, this situation is significantly more delicate, because you don’t have the patient loyalty working for you yet.

On the other hand, if you’re purchasing another practice to “top off” yours, it puts you in a better position to dump PPOs and take some patient loss. As you can see, successfully navigating the managed care issues in a practice transition can be quite complicated.

In conclusion, the right “PPO plays” can add thousands of dollars to your bottom line when you are buying a practice. Make sure you perform the due diligence to determine all the facts and then implement a carefully planned strategy to come out ahead.

7 Steps To Boost Your Practice Profits While Reducing Managed Care (PPOs)

By Bill Rossi*

In last month’s article, Managed Care Update, we discussed strategies to minimize patient loss, and slow it down, when reducing managed care (PPO) participation. However, that’s not enough. Doctors need concrete plans to rebuild their practice in order to counteract the patient loss and add mightily to their bottom line. This requires developing a plan for seeing more patients (measured by total exams) and doing more for the patients you do see (measured by production per exam).

Seeing More Patients

An over-dependence on PPOs to keep your schedule full causes other parts of the practice to atrophy. It’s time to get your practice in shape!

While it isn’t easy to increase new patient numbers, it’s certainly possible with a little hard work. Here are the top strategies to make it happen, ranked in order of cost-effectiveness:

1. Increase Internal Marketing

Virtually every doctor recognizes that internal marketing is the most cost-effective way to build his practice. Yet fewer than 10% of doctors feel they do a “good job” in generating patient referrals. It’s time to get good at it! Doctors must become more comfortable in asking satisfied patients to refer their family members, friends, and colleagues to the practice. This should be done at appropriate times (when a new patient joins the practice, when a patient compliments you or your staff, and upon completion of major cases). To get comfortable, consider this simply as an invitation to join your practice. And, add: “Please don’t keep our practice a secret”!

Finally, the doctor should encourage staff members to refer new patients from their family, friends and colleagues. Be sure to establish a bonus program to reward their referrals.

2. Improve Practice Signage

One of the best ways to attract more new patients is through adding or increasing practice signage to improve visibility. Remember, signage is the silent salesperson, providing a 24/7 365 days a year image touting your practice. So, find out what legal restrictions (if any) your locality has on office signage and maximize your exposure with a well-lit sign.

I’ve seen patient numbers double simply through adding improved signage. So, get a sign up, so you don’t have to “sign up.”

3. Upgrade Your Practice Facility

Remodeling and/or implementing cosmetic upgrades to your office facility (new paint, carpet, wallpaper, etc.) is almost always a wise investment. Your practice will typically grow 10-15% through increased patient referrals, and improved case acceptance of upper-level procedures, providing a great return on investment.

That means a large, attractive internally-lit sign, along with an engaging “storefront.” Your visibility isn’t just a matter of the signage, it’s the whole presence of your office!

4. Improve Your Online Presence

Doctors should enhance their online presence by upgrading their practice website, adding video testimonials, and original photographs of actual cases. This will help improve search engine optimization (SEO) as well as attract new patients. Also, increase favorable patient reviews since our research indicates that having 10 or more favorable (five-star) Google reviews can add measurably to your new patient flow.

5. Practice Purchase/Merger

If dropping managed care reduces the practice to operating at 70% or less of capacity, the doctor should purchase a practice and merge it into his own. Through treating the additional patients in your existing space, the purchaser can often generate incremental profits of 60-70% on the added volume before debt service, since there are no additional fixed costs, and the incremental lab, supply and labor costs are usually minimal. Even after deducting debt service payments, most doctors can still generate a 50% profit margin on the added volume purchased, making this a “slam dunk” investment.

6. Boost Hygiene Department

Most of your patient flow comes from continuing care in the hygiene department. Many doctors feel they are already doing a good job with their continuing care system, but most aren’t. For best results, use a “continuing care checklist” in order to track these statistics on a monthly basis:

  • How many hygiene patients confirm their next appointment while in the office? Your “appoint ahead” percentage should be 75%+.
  • How many cards, texts, and emails went out to patients that are due and past due?
  • How many past due recall patients were actually scheduled?
  • Are the hygienists helping with calling and confirming patients?

Digital communication options such as Revenue WellLighthouse, etc. can be very helpful, but don’t stop sending postcards. And whatever you do, don’t stop using the phone!

For the typical general practice, it’s not hard to increase the number of hygiene recall visits by five or so per week; that’s 20 per month, which will represent a 10% or more increase in patient flow for the average practice. Call Bill Rossi at Advanced Practice Management (952.921.3360), for a complimentary 10-minute continuing care checkup.

7. Ramp Up External Marketing

Doctors heavily involved in managed care often boast they’re spending little, if any, money on marketing. They complain they can’t afford to, because of overhead concerns. In reality, these doctors are already spending tens of thousands of dollars on managed care fee adjustments monthly, which is actually just a “marketing expense.” These doctors are always better off spending more time, energy, effort, and money on marketing to boost their new patient flow, rather than simply standing by while managed care companies bite off a bigger part of their practice profits each year.

As a rough rule of thumb, it costs about $300 in marketing expenses for each new patient brought in. Direct-mail, pay-per-click, and online advertising do work, but doctors have to stay with them long enough to figure out what works best in their practice environment. $300 is cheap when you compare it to how much it costs for you to continue writing off 30%+ per year in PPO discounts. Too many general dentists end up working 2-3 months a year for free, due to PPO write-offs. It’s costing you big money, you’re just not writing a check for it!

Next month, we’ll discuss how doctors can increase production on the patients they already have, to offset patients lost when reducing managed care (PPO) participation.