Author Archives: Bill Rossi

About Bill Rossi

Bill Rossi has over 25 years of experience in dental practice management. He and his associates are actively involved in the ongoing management of over 240 practices.

Shelly Is Interviewed By Howard Farran

Our own Shelly Ryan was recently interviewed as a guess speaker on Howard Speaks. They discussed Shelly’s insights on going back to the basics of dental practice management, including how to create and use checklists effectively.


Checklist #1 – Case Presentation

Checklist #2 – Unpaid Claims Tracking Report

Checklist #3 – Unscheduled Treatment

Checklist #4 – Morning Huddle

Checklist #5 – Monthly Collections Tracking

Checklist #6 – New Patients & Marketing

Checklist #7 – Patient Flow & Financials

Checklist #8 – Ten Point Recall System

Checklist #9 – Scheduling & Capacity



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.

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).

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%.

Good Golly, Do Your Goals!

goal settingYou hear it from me every year because I see it work every year! Doctors with written practice goals, team participation in setting the goals and good management support do better every year. It’s almost spooky it works so well.

So, do yourself a favor. Sit down with the Goal Worksheet (see below) for 30 minutes to an hour. Be realistic and optimistic. Be true to what you really want. Maybe more money may not be as important to you as more time off or a happier, more harmonious workplace. Describe in writing your perfect practice!

How good can you stand it?!

Click on this link to download your goal setting worksheet:


Doctor, What Is Your Practice’s Regeneration Rate?

(Statistical Snapshot from APM’s Database):

Is your dental practice growingPresumably, the bigger a practice’s Active Patient base is, the more referrals it will generate per year.

More people saying good stuff about you. Also, the bigger your practice is, the more new patients it needs to replenish itself. Through normal attrition, a practice with 2,000 patients will lose more per year than one with 1,000.

We measure a practice’s regeneration rate by dividing the total number of new patients per year by the active patient count.

Regeneration rate


For the average practice in our database, the regeneration ratio is about 11% per year. Strong patient flow growth is usually indicated by a ratio of 20% or more.

If your practice has a low regeneration rate, it’s very likely that your practice will shrink over time. Our analysis of the “average lifetime” of a patient in a practice is about 9 years, which, coincidentally or not, matches up pretty closely with the average replenishment rate.

Replenishment rates in our data base range from about 4% to over 30%. As with most statistics, we use them to just help frame an issue. When we are managing a practice, we are looking for the movement of the numbers—the statistical trends are more important than just the reading.

Want To Know Your Regeneration Rate? Your consultant can assist you in getting an updated Active Patient Count (2-year criteria), calculating your ratio and interpreting the results.

If you want to refine things further and you’ve been tracking new patient sources closely, you can look at your pure “referral ratio”, which would be a reading on the number of referrals you get per 100 active patients per year.

Speaking of Referrals: If you go with the general assumption that about 1 out of 10 patients refer you to another in a given year, then ask yourself, “What would happen with practice growth if I could just get 2 or 3 out of 10 patients to send another patient in per year?”