Category Archives: Dental Practice Management

Balancing PPO Participation

For many practices, PPO participation is their biggest “expense” after staff wages (or even greater than wages in some cases). Historically, practice collection percentages have been 95%+ (of gross production). Now it’s not uncommon to see collection percentages of 70%-80%…and sometimes less.

Most dentists join a PPO in the hopes of gaining and retaining patients. No dentist likes to lose patients and when you do lose a patient because you’re “not on their network”, it can be a powerful inducement to sign up for the PPO.

Once you are participating with a PPO, it’s easy to feel there is no other choice. But, please note the data below. Most PPO’s have participation of 45%-60% of offices in this particular survey. Granted, that’s the majority of offices. But for any of the individual PPO’s noted, 40% – 55% of offices aren’t participating. So for every plan you feel you must have, keep in mind there are a lot of Doctors that are surviving without having it.

And, if you aren’t participating in any PPO’s but your practice is foundering, maybe some participation would be worthwhile.

Insurance companies have the upper hand but things don’t have to all go their way! You do have power. Don’t assume that you have to be participating as much as you are. For most practices, a reasonable mix of PPO’s is what makes most sense. As practices mature and succeed, they are likely able to cut back on PPO participation. And, if you’re mostly busy, it doesn’t make sense to work at deep discounts.

Decisions regarding PPO participation involve serious risks and rewards. Too often Doctors will sign up with a PPO too quickly, or when they decide to leave PPO’s, leave them too recklessly. Every office must carefully consider its PPO participation. Smart moves here can add more to your bottom line than practically any other thing you can do. These stats are from a survey of 59 East Coast offices’* PPO participation:

PPO % of Offices Participating:

  • BCBS 54%
  • MetLife 46%
  • Aetna 51%
  • Cigna 58%
  • United Concordia 58%
  • Other 61%

Number of Listed PPO’s Responding Offices Participate With:

  • 5/5  =  26%
  • 4/5  =  16%
  • 3/5  =  14%
  • 2/5  =  14%
  • 1/5  =  9%
  • 0/5  =  21%

44% of offices participated in 2-4 plans, with 30% participating in 0-1 plans and 26% participating in all 5 plans.

Do You Want More New Patients?

To Move the Numbers, You Have to Do a Number of Things

Of course, almost every dentist wants more new patients and everyone is looking for the quickest, fastest way to do it…the “Silver Bullet”. As you probably have heard Bill say many times before, “It is possible to get more new patients but you have to actually do something.”

Let’s talk about a recent case history—by recent I mean over the last 2 years. This practice has worked hard on a number of fronts: they polished up their website, got updated photos, made sure their online directories were straight, kept somewhat active with Facebook, experimented with Pay per Click and “Conversion Factors” on the website (e.g. offers and testimonials).

The staff was coached on “New Patient Readiness” making it more likely that patients’ phone calls or website visits turned into patients inside the office.

They even did call tracking to find out when new patients were calling in and the success rate in converting them.

They also used all the features on their digital communication system (in this case Demand Force).

The net result was the patients increased enough that now they’re getting over six months “extra” new patients per year (and their Continuing Care numbers are going up too). Practice production is up over 15% this year.

For most solo practices, an increase of 6-10 new patients a month is all they want or need to keep their practice cruising. For this Doctor, it wasn’t just one thing. It wasn’t all that expensive or hard though either.

That’s why we believe in “Checklists”. We use Checklists to insure Continuing Care effectiveness, Collections effectiveness and so on. When our clients work with our “New Patient/ Marketing Checklist” and complete it each month, we see the best results. Every office should have a person in charge of their marketing efforts—if you’re serious about bringing in new patients, you have to designate a person to be in charge of that, just like there should be a specific person in charge of Continuing Care, Collections, etc. That’s how you insure that those advances on many fronts actually happen. Otherwise, they’re just good ideas (Thank you notes aren’t sent, reviews aren’t tracked or added to, website visitors aren’t converted into patients, etc.).

Are you serious about giving your marketing a push? Call me and we’ll come up with a specific plan for your office. It’s my job to support your staff, coach them and give them the advice they need to be successful. I also keep them accountable but I’m accountable too. Together we can make things happen.

The Dental Dow: Still Cruising Through 2015

Bill Rossi, President of Advanced Practice Management

Bill Rossi, President of Advanced Practice Management

Comparing the first half of this year to last year for the sample mature area practices, we find practice production is up 6% and collections are up 5.5%, continuing the trend from the first quarter.

Total patient flow (as measured by exams) is up 3.5% with new patient exams up 6%. Crown and bridge is up 2.7%. The gross collection percentage for the sampled practices is 85%, consistent with last year. I guess we can be happy that it hasn’t slipped another notch this year.

The trend to fuller Doctor and hygiene schedules continues too with Doctor downtime reduced by 15% and hygiene downtime by about 5%. Back in the ‘90’s, 6% used to be sort of assumed background growth. Now, this is the best trend in many years and over 75% of sampled practices showed growth.

Digital Communications: What Is It? What Good Is It?




Use of this technology in dental offices has almost doubled in the last three years. 38% of area dentists now have it.

  1. If you haven’t got it, you’re probably looking into it and it is worthwhile to look into.
  2. If you have it, chances are you’re not using it to its full capabilities. That’s worth looking into.

Contrary to what the sales representative will tell you, Digital Communication is not an all-purpose cure to cancellations and failures. It can help keep a practice busier but we cannot prove yet that it reduces no-shows. We do know, however, that it frees up front desk time and we also know that clients have benefitted from its many applications:

  1. Patients really like text and email confirmations—it’s part of showing people you
    are keeping up with technology.
  2. This gives your front desk team more time to make appointments because they spend less time confirming them.
  3. It gives you the capability of getting surveys from patients, which is good feedback but, as importantly, can help you get more testimonials for your website online reviews. We know that testimonials are important conversion factors for converting website visitors into patients. Think of your own behavior when you shop for hotels and how you look at reviews.
  4. Promote services such as Invisalign: Example: a client of ours from Rochester used an email and text announcement to promote their “Invisalign Day”. They feel that this was responsible for 15 patient Invisalign starts.
  5. Fill last minute openings: Examples: A client in Wisconsin emails patients (RevenueWell) when they have last-minute openings in the hygiene schedule. They offer whitening (bite-down trays from Patterson) to the first person to respond and fill the appointment. “Last minute openings. Come out and get that checkup you’ve been putting off and you’ll get free professional-strength whitening…” Another client in Houston, TX uses digital email and texting (Demand Force) to announce last minute openings in their hygiene schedule. Their incentive is free movie tickets. They said some patients actually wait to schedule when they know they can get free movie tickets. Not all bad because it means that there are a lot of patients eagerly standing by to fill last-minute openings. You should not overdo it, but if you even do this once or twice a month to fill 2-8 hygiene slots as a result, it is a pretty good payoff.

There are many applications for digital communications and they’re growing! My associate, Kelly Larson stays on top of the constant changes and keeps a summary grid of the various digital communication companies to help you compare their offerings. Generally, they charge about $300/mo. Most arrangements are month-to-month (companies are no longer asking for one or two year contracts).

Dealing With Patient Complaints: An Opportunity In Disguise

(Dentists, Please Share This With Your Teams)

dealing with patient complaints

We’ve written before about how getting positive online reviews can enhance web presence and is a strong “conversion factor” that turns website visitors into patients. With patients being able to complain online as well, we have a double-edged sword. A negative complaint can be seen by who knows how many people! Dealing with negative online reviews is a whole discussion in itself.

This article focuses on dealing with face-to-face patient complaints. However, if you get a negative online review, you can sometimes call that patient and use this same process. We’ve seen situations where the patient has taken the negative review down once their complaint was satisfied.

Naturally, if complaints are handled wrong, you can lose patients. More importantly, patients that complain are also more likely to be loyal patients and refer others if the complaint is handled well. If someone is dissatisfied they will probably tell others. I have heard over the years many different statistics on this, but you can assume for every complaint you hear there are other people who hear or voice the same complaint. Complaints are sort of your “canary in a coal mine” for patient relations.

Our statistics show that the typical dental practice loses about 12% of its patients per year. Probably about half of those lost are due to something the Doctor or staff did. The other half are due to factors beyond the practice’s control, like the patient moving or insurance changes.

Remember this six step process:
1) Prepare
2) Listen
3) Build Rapport
4) Develop A Solution
5) Confirm & Close
6) Follow Through

1) Prepare

Maintain an alert and upright posture. Pen in hand. Be ready to listen with an Adult state of mind.

  • Child (emotional)
  • Parent (judgmental and rigid)
  • Adult (rational and solution-seeking)

When a complainer calls, they are in an emotional (child) state. They may have rehearsed a speech in their mind. They feel abused, cheated, or uncared for. Therefore, the person hearing the “child” may unconsciously start adopting a parent state. That’s when you’ll hear things like “Our policy is…”; “You should have…”; “You don’t know what you’re talking about…”; “It’s your responsibility to know your insurance, etc.” By keeping an adult state of mind, you let the child vent then, eventually, through your own behavior, they will start to come to the adult state.

2) Listen

Take notes. Acknowledge that you are hearing; “Tell me more.”; “Then what happened?”; “I see.”; “I understand that could be very distressing.”

3) Rapport

Use the patient’s name. State your purpose, “I want to find a solution you are happy with.”; or “I’ll help you get to the bottom of this.”; or “We certainly want to do everything we can to make this right for you.” Restate the person’s complaint. “I’ve taken notes and what I heard you tell me was… Do I have that right?”

4) Solution

“Here are a couple of things we may want to consider.”; “Would it help if I found out about _____ for you?” And, of course, “What would you like to have done so we can resolve this?”

5) Confirm & Close

“So here’s what I am going to do.” (find out, fix, or make sure “it doesn’t happen again”). “How does that sound to you?” Make sure that you note any specific actions and timeline and who’s going to do what by when.

6) Follow Through!

Make very sure you follow up on your promises. Example: “Your fees are too high!” A typical response (usually proposed by consultants and dental journal writers) is, “Mrs. Jones, we only use the finest materials and for the quality of care we deliver, blah blah blah.” Or, “Dentistry is inexpensive when you compare it to medical or buying suits or some other things (that are implied to be less important, thus indirectly putting the
patient down.)

Instead: “Gosh, I can tell you are unhappy with this. Can you tell me more?”
“Well, Bill, it’s my job to help ensure that you are happy with our services. You obviously
feel our fees are high and I’d like your suggestions on how we can go about looking at this.”

The patient might feel the fees are high because they can’t afford things in which case, of course, you work with financial arrangements. They might feel they are higher compared to other offices in which case you might say, “Would you like us to check our
fees against other offices or show you what information we have about that?” Or, in many cases, the patient just may want to be acknowledged and they don’t really want you to do anything except understand them. If the fees are indeed high even compared to other offices, then you can explain why. “Our fees are a little higher than average and I wanted to explain to you why they are if that’s what you’d like me to do.” Then (and only then) you could go into things about the quality of the lab, the time the Doctor spends, the Continuing Ed or technology, and so on.

In Conclusion:

No one likes to hear complaints, but dealing with them tactfully is a critical “customer service” skill.

The Dental Dow Jones – 1st Quarter 2015


dental dow first quarter is upFor the mature area practices sampled, practice production was up 6.1% and collections were up 6.7% compared to the first quarter of 2014. This is the most growth in these indices since 2004.

Patient flow was up 5.1% with new patients up over 10%. Again, the most significant jump in patient flow we’ve seen in years.

One quarter doesn’t a year make but this is certainly good news. It’s also nice to see that downtime in the Doctors’ schedules is down 11% and in the hygiene schedules down 6.5%.

Associate Interview Suggestions

Question marks - Faq conceptLocating and signing a good associate is an important process. There are few other relationships that can have more impact on your life (your professional life for sure). I have seen many smart Dentists stumble in this process and lose a good potential associate. Or worse, not do a complete enough interview and be stuck in a “Bad Marriage”. So, I’ve developed a brief list of suggestions.

General Approach: Ask the associate what their long and short term goals are. Get a picture of what their picture is. Then, share your “pictures.”

In this way, you can see if both your expectations match by focusing on the positive aspects of getting together. This will help you work through anything that may be a problem or barrier.

Only once you’ve “shared pictures” should you then get down to specifics to do with associate compensation percentages, benefits, and other nitty gritty details.

Finding the right associate is a sort of courtship process. You don’t want to bring out the “prenup” too quickly. If legal details are brought up too soon, that can make things a contest. In fact, you do not want to prepare an associate contract until you are pretty much decided that you both want to practice together. Go for the handshake first, the lawyers second.

Sample Questions To Ask An Associate Candidate

Long-Term Questions:

  • What are your long term/big picture goals?
  • How much would you like to make?
  • How much would you like to work?
  • What kind of dentistry do you like to do?
  • What kind of technology is important to you?
  • What would be your ideal work week?
  • How much vacation time will you want?
  • “Tell me about yourself” (family, hobbies…you just want to see if the associate will reveal themselves to you).
  • How involved would you like to be in leading the staff?
  • Do you have any particular areas of administrative or clinical interests that you’d like to help our practice with?
  • Is practice ownership important to you? If so, what sort of timeline do you have in mind?
  • Are you working with any particular advisors or accountants?
  • What other opportunities are you looking at?
  • How does my opportunity rank with your other opportunities?
  • What sort of dental experience do you have (if there are other offices that they’ve associated with or worked in). What did you like or not like about those experiences?
  • What are the very most important things that you are looking for in a place to practice?

You can sometimes agree to disagree. You don’t have to see everything exactly the same way. One of the benefits of having an associate is to have someone who sees things differently than you do or has different interests.

Short-Term Questions:

  • What would you like to see happen in the coming year regarding (things like the above, hours worked, visits and so on).
  • What sort of compensation did you have in mind?
  • Would you be willing to work evenings, Fridays or Saturday hours?
  • Are you willing to be “on call” on weekends?
  • Are you O.K. with occasionally doing prophies?

Clinically-Related Questions:

  • What is your opinion on amalgams vs. composites?
  • What conditions, in your opinion, warrant the recommendation of a crown?
  • When are implants indicated?
  • What are your thoughts regarding ortho?
  • How much time do you like to have for a crown prep? Seating?
  • Are you into Cad Cam (Cerec)?

In summary, the best associate interview is a dialogue. A conversation. After the interview, make notes as to what the associate said was important. Chances are you’ll need more than one interview to really sort out how compatible you are. It also makes sense to have the candidate spend as much time as possible in the office observing. In fact, their willingness to take time to come and observe is an important sign of their interest and commitment.

PPOs & Practice Transitions

As published in The Profitable Dentist, Summer 2015

Delta PPO and Dental Practice TransitionsOne has to consider many factors when purchasing a practice and now PPO participation has to be taken into account. This becomes even more important when you’re dealing with practice mergers. It is increasingly common to see exiting practices not sold outright but sold to and blended with another practice. I have worked with many of my clients through this merger process and have described below some scenarios to illustrate the high stakes involved.

Example: A practice purchases another practice that’s participating in a large PPO that the purchasing practice isn’t. Does the buyer 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 even further reduced co-payments.

If you are a Delta Premier Provider (the “Regular Delta” – not with Delta PPO) and you buy a practice that’s with Delta PPO, those patients will experience a transition as they blend into your practice. This has to be handled tactfully or the patients whom you are assuming the care of will bounce out of the practice. On the other hand, if you join Delta PPO and have a lot of regular Delta Premier patients, you will experience steeper discounts on patients you already have. This can be terrifically expensive, even more expensive than the actual practice purchase in some cases.

Even worse is going into the situation without knowing what PPOs in which each practice participates. Sometimes the owners of a practice don’t even know for which plans they are providers. This is particularly true with PPO networks like Dentemax, Connection, DHA and others that include multiple insurance companies. For example, you may be contracted directly with MetLife or you might be indirectly contracted through one of these PPO network groups.

If you’re purchasing a practice that has a lot more PPO participation than you do, you and your staff have to be ready to take these patients through transition (much as if you were leaving a PPO). However, this is more delicate because you don’t have patient loyalty working for you (yet). On the other hand, when you purchase another practice, you’re “topping off” yours, and it puts you in a better position to dump PPOs and take some patient loss. As you can see, all this can be quite complex.

Another scenario: The practice you’re purchasing participates with the same PPOs. Okay, but you want to compare both practices’ PPO fee schedules. PPOs do pay different doctors differently! The practice you’re purchasing might be getting better reimbursements on the same PPO than you are (or vice versa). Obviously, you would want to negotiate with the PPO (if you’re going to participate) to ensure that you get the better fee schedule of the two for continued participation, even if you are bringing the selling doctor over.

If you’re not doing a merger but an outright practice purchase, it’s very important to get a specific list of all the PPOs the selling doctor is participating with and the fee schedules. Of course, you want to look at all practice write-offs too. Some practices don’t do a good job of itemizing the write-offs so it’s hard to track how many are due to the various PPOs.

Before purchasing a practice, you may want to call the relevant PPOs and negotiate the fee schedules in advance. If you’ve gone ahead and purchased a practice, you have an opportunity very early in the credentialing process to negotiate. PPOs tend to be a bit more willing to negotiate before you sign up.

A practice purchase can be a great way to go. It offers a much quicker start or move in your career than building from a scratch. There is less risk and more predictability.

Practice mergers can be the best deal in dentistry. If the conditions are right, practice mergers are THE very best way to build your practice. This typically consists of absorbing an older doctor’s practice into yours with, perhaps, the older doctor working in your practice for a while through the transition phase.

In conclusion, If you are buying a practice (outright or in a merger), the right “PPO Plays” can make many, many thousands of dollars difference to your bottom line. No smart buyer will overlook the PPO situation.

Bill Rossi is president of Advanced Practice Management. He and his associates are actively involved in the ongoing management of over 250 Upper Midwest dental offices. You may contact Bill at 952-921-3360 or through

The Dental Dow Jones – 1st Quarter 2015

Off To A Good Start!

For the mature area practices sampled, practice production was up 6.1% and collections were up 6.7% compared to the first quarter of 2014. This is the most growth in these indices since 2004.

Patient flow was up 5.1% with new patients up over 10%. Again, the most significant jump in patient flow we’ve seen in years.

One quarter doesn’t a year make but this is certainly good news. It’s also nice to see that downtime in the Doctors’ schedules is down 11% and in the hygiene schedules down 6.5%.