Category Archives: Dental Practice Management

Delta Games

Toward the end of 2016 Delta of Massachusetts announced that there was going to be a new, for profit Delta. The new Delta will basically offer the Delta PPO schedule only. The better paying (although still discounted) Delta Premier will fade away.

Doctors are told that if they don’t opt-in they will be out of the Delta networks and as the plans turn over, the checks will go to the patients.

For the typical Delta Premier Provider Dentist in Massachusetts this means that Delta write-offs will nearly double. I talked to doctors who will see their write-offs from Delta go from $250,000 per year to nearly half a million. Ouch! Apparently the new “For Profit” Delta will make its profits from squeezing dentists. That is why probably that at the Yankee Meeting, Delta actually had an armed guard at their booth. True!

As you probably know I have written and spoken a lot regarding PPOs. (FYI Dentaltown just released my “PPO Plays” CE: I also recently did a podcast with Ben Tuinei at We are increasingly fielding calls about PPO concerns from dentists all over the country. Minnesota was one of the first to feel the sting of PPO write-offs, audits, etc. Insurance companies basically are creating a race to the bottom with their fees.

Now there are about a half dozen states that no longer offer Delta Premier. For example, if you buy a practice in California it will be considered a new “entity.” Even if you were/are a Premier dentist the practice has to now be on the PPO fee schedule. This affects practice values dramatically since the buyer will not have the same profit profile as the seller.

So the big question on everyone’s mind is . . . Will Delta PPO be the only Delta in the future?

One comfort, of sorts, is that apparently Delta is losing market share. Other insurance companies are taking a bigger cut of the market, so that is why Delta is putting pressure on their provider network. It would be good to see Delta’s “monopoly” diluted.

For many U.S. dentists, Delta is not as big a deal as it is in the Minneapolis/St. Paul area. Delta might be 20- 40% of the national market instead of 60-80%.

What Can You Do About This?

Smart management always puts the time and money where it can get the biggest return. We can do nothing about controlling the insurance market, but we will do all the things we can to make your practice strong so there is less compulsion to sign up for PPOs. Delta is not the only one nicking your bottom line.

As I said in an earlier Bulletin, it’s a matter of the right balance. Most practices will participate in some PPOs, but in my opinion very few practices should participate in all of them! Our research shows that at a certain point, additional PPOs just mean additional discounts, not additional new patient flow.

You have more power than you think. We’ve helped many dental practices successfully balance their PPO participation. If you are writing off over 25% of your production you are working the first 3 months of each year for free! It probably doesn’t have to be that way. Learn more! Contact Bill Rossi at 952- 921-3360 or


PPO Plays Dentaltown

Hey Friends of APM…check out Bill‘s latest Dentaltown session with Howard Farran!

Dentaltown Learning Online is pleased to present, “PPO Plays” by Bill Rossi of Advanced Practice Management. The AGD # is 550 and there are 1.5 credits given for this course. We believe that private independent practice is the best way to deliver dentistry. It’s best for the patients, the Doctors and the staff. We further believe that sound management helps the Doctor thrive in a profession that is increasingly impinged on by Corporate Dentistry, PPOs, and other interests. Through our ongoing work in helping to manage over 220 offices in the Upper Midwest area, and

advise to Dentists across the country on “PPO Plays”, we have the information that helps level the playing field between the Dentists and insurance companies. It’s time for you to get your game on. It is not unusual to see dental offices write off 10%, 20%, 30% and more of their production due to PPO participation. After staff expenses, PPO write offs are among the biggest “expense” that a practice can have. PPOs are a reality of the current marketplace. So, the smart practitioner needs to know how to best deal with them. You have more power than you think you do. The right decisions here can add $1,000s to your bottom line and add greatly to your sense of control and security in the practice. Whatever your situation is, there is no question that you will have to make decisions about joining and leaving PPOs. Making the right moves as you participate with PPOs ensure a healthy bottom line and practice independence going into the future. This hour of CE will give you and your staff the basics you need to level the playing field with the “big guys” at the PPOs. Any dentist thinking about accepting or leaving PPOs should view this CE course.


If you are confused, you are not alone!

This is a flow chart that Shelly Ryan and Heidi Benson put together to help us and our clients understand the plethora of state-related plans. Call or email if you’d like the more legible “Full sized” version.


Area Economic Dental Trends:

“Knowledge is Power” and we are on a mission to make sure you survive and thrive in a marketplace increasingly encroached upon by insurance/PPOs and large scale competition.

Our recent survey shows that PPOs are once again at the top of the list as far as issues you and your colleagues are facing. Yet in the last year, fewer than 5% of area offices actually dropped a PPO.

We are not purists. We feel that every office should have the right balance of PPOs for their area. We often see, though, that doctors are much deeper into PPO participation than they need to be. If you haven’t negotiated with your PPOs, you may be leaving money on the table. If you’re collecting less than 80%, you should seriously look into peeling back PPO participation. We can show you how you can lose the discounts and keep the patients!

Other Trends:

  • Metro Wages remain pretty much the same this year compared to last year. Outstate Wages are up 4%.
  • Digital Communications are now in 50% of the marketplace practices. We’ve seen this to be very handy. Patients like text confirmations. Email blasts help get the word out about the services you provide and help you keep on top of seasonal opportunities (back-to-school, yearend insurance/flex plan notices, etc.).

    The leaders in our area are (in descending order of market share): Lighthouse (33%), RevenueWell (21%) and Solution Reach (12%).

  • Despite the fact that Delta pushes hard on dentists charging at the seat, not the prep appointment, 59% of dentists in our area charge at the prep, 41% at the seat.


Save Money! Run Smoothly!

When Heidi does her “Administrative Tools” check-up, she’ll look into things like:

  • Claims Processing (typically saving practices $150 – $300/mo.).
  • Credit Card Expenses: Many offices are spending more than they should on bank charges – banks make it complicated so you can’t really see what they are costing you.
  • Third Party Financing: Some options are better than others. Kinder to the patients and less expensive to you – think alternatives to Care Credit.
  • Answering Services. This is an old idea that is coming back again. We think it will help bring in more new patients.
  • Everything and every way to make your administrative staff’s job easier and save (or make) you money.

Just call (952-921-3360) Heidi to “Get it done!”

Your Statistician

Your StatisticianEver wonder about the effect of evening hours on a practice in attracting new patients? How about Friday afternoons? How important are Google Reviews to bringing in new patients really? Do practices with higher PPO participation really get more new patients than those with more mid-range or low participation? What are the properties of practices that attract more than average new patients and those that attract fewer?

We monitor over $30 Million dollars’ worth of dental activity per month in over 220 offices with over 300 Dentists represented. That’s a lot of data to sift through but I’ve found the guy who can do it!

I brought on Anantha Santhanam. He did analysis work for the Mayo Clinic and is attending the Carlson School of Management. Now he is working for you because everyone on my team is on your team.

In our consulting meetings this year we will be bringing you up to date on this research.

This is another example of how you, as an Independent Practitioner, get top notch management support from us.


Production per Exam (from our APM Database): This is a measurement of the range and depth of dental services accepted and delivered.

Your Statistician 2

How goes it with Physicians?

sulivanFor 33 years, Bill Sullivan has been the Executive Vice President of Dr. John Najarian’s Medical Research Foundation. The Institute for Basic and Applied Research in Surgery (IBARS) provides additional funding support to the Department of Surgery at the University of Minnesota with an emphasis on Solid Organ Transplantation, Surgical Oncology and Cardio-Vascular Surgery.

As with Dental School, most physicians graduating from Medical School have a total debt load of approximately $300,000.

Three “cataclysmic financial events” occur when many students graduate from Medical School. About one third marry another medical student, effectively doubling their tuition debt load. Next, Medical Students tend to buy homes they cannot realistically afford. And third, it is not at all uncommon for Medical Students to have a baby, effectively taking one of the wage earners out of the full-time practice of medicine.

Painfully, healthcare economists have calculated if a medical school couple assumes a “non-dischargeable” debt load of approximately $1 million dollars, over the course of a 42 year professional career, there is “great likelihood” they will not be able to retire their tuition obligation.

The average income of a Mpls./St. Paul Family Practitioner is $177,600, but new grads often earn less than $100,000/year in their first 3 years.*

This has resulted in the non-too-subtle self-segregation that is taking place between the ranks of the primary care physicians and the specialists. Recognizing the extraordinary costs involved, many students are gravitating to higher paying sub-specialty disciplines which, in turn, render the relative salary structure of the general practitioner to disproportionately fall behind.


Economists, political strategists, and business leaders have argued for years to expand the base of the insurance pyramid. Enrolling young, healthy candidates would help offset the exploding costs of health care costs today.

At the national level, this desired-for goal has not played out. In fact, young people remain reluctant to sign up for healthcare insurance. Even with a bitter pill of an annual Income Tax penalty assessed to those without healthcare insurance, many argue it is simply cheaper to “pay the penalty.” What the nation has witnessed over the past two years is a disproportionate enrollment among young and middle-aged participants whose needs for healthcare are defined by a host of chronic medical problems.

While some states have done an aggressive job of moving many off of the Medicaid roles by offering healthcare insurance subsidies, the sad fact remains that too often young people today suffer a disproportionate number of problems related to obesity, diabetes, early onset heart disease; all problems typically associated with an older population.


  • The “financially advantaged” will always be able to receive care, most likely from a concierge physicians’ service. Painfully, 40% of physicians 55 years of age and older are opting out of Medicare participation and this number is growing. This is very bad news for aging Baby Boomers who are bound to need increased health care.
  • The “financially disadvantaged” will receive care via Federal programs implemented at the State and Local levels.
  • Sadly, the majority of Americans will fall into a system of quasi-rationing. Of course they will be treated, but there will be long lines of other patients ahead of them, “Justice delayed is justice denied!” and “Healthcare delayed is healthcare denied!”

* The mean income for a General Dentist in Mpls./St. Paul is $189,000. The range for means throughout Minnesota is $183,490 to $224,830. Source: U.S. Bureau of Labor Statistics, 2014 data.

Time to Recalibrate Your Incentives

BillMost incentives need to be adjusted each year taking into account factors like:

  • Additional staff
  • Raises given to staff
    (Both of the above items change the Overhead landscape and therefore the incentive targets)
  • New practice goals & projects
  • Upcoming performance reviews

So call us and we will help you retune your bonus targets.

About a third of area practices have their staff on an incentive. If the conditions are right, we highly recommend incentives. It gives the staff a stake in the practice success. However, sometimes incentives get to the point where they are no longer stimulating performance. They go from being a “nice bonus”, to being expected, to being taken for granted and a “right.”

Sometimes it makes sense to discontinue an incentive that’s no longer helping to foster a harmonious and productive team and that extra edge of performance that we are always looking for. This is best done in conjunction with performance reviews because you can “buy-out” from an incentive by awarding increases and then change the game according to the practice’s situation – or just let it lie fallow for a while.

Productive Performance Reviews: As many of you have heard me say, I feel that a productive performance review should not be a bureaucratic “grading” process. Everybody hates that.

Instead, I feel that a performance review should be a cross between a “Wedding Anniversary” and “Let’s Make a Deal.” That is, the employee should be thanked and honored for their contributions for the past year. Recognition matters to high performing employees. So when you give a raise, it is helpful to give it with praise – in a bouquet. Then you’ll get more of what you want (happy employees). The “Let’s Make a Deal” part is where you outline 3 to 5 concrete things for the employee that you want their help with,

“So Debbie, I am very happy with how you’ve gone beyond the call to increase your skills this year, are flexible in working hours, always willing to lend a hand and always cheerful. That’s why I am giving you a 4% raise this year…

Now, for the coming year, here is where I need your help…”

Then outline to your employee what you’d like them to do.

  • Get the Continuing Ed to add to their skills (for example, the front desk to learn more about QuickBooks or the Practice Management software)
  • Flexibility in working evening hours
  • More use of the intra-oral camera
  • Better front desk collections
  • Be more punctual

Be very specific and concrete. Note the requests and then the next year, if they’ve made progress in those areas, thank them. In fact, don’t wait until next year! Tell them right away if you see a change in behavior (or don’t!).

As practice owners, you have an automatic “incentive” program. You know your career, your livelihood is at stake. Employees are a step or two removed from the harsh realities and from the rewards. You don’t need anyone to motivate you to grow, to get better, etc. Create an environment so good employees can flourish. Valuable team members are always adding to their skills, always helpful, pleasant and hardworking. If you don’t recognize those qualities in an employee, they will go somewhere where they can be recognized!

Oh, and one more thing, an important part of the performance review process is to ask the employee, “What can I do to help support you in doing your job and in being happy at work?” and then really listen to what they have to say. You don’t have to grant everything that’s asked for but if you take what they say under consideration, they’ll know that. At the very least, you’re less likely to be surprised by having someone unexpectedly quit.

Smart Wage Decisions: I believe it’s best to take a look at staff wages as a percentage of collections at least once per year for the sake of determining how much will be available for wages and raises. If your total gross wages were running at about 25% of collections, for example, last year and they are 23.5% now (because your collections grew) then you are in a position to give raises. If staff salaries have crept up to 27% or 28%, then it’s time to hold off until your practice revenue catches up.

Using this very simple method, you can keep the biggest part of your overhead (staff wages) under control.

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




Most successful dentists know that they can’t do it all. With the encroachment of corporate dentistry and PPOs, it sure helps to have Professional Management on your side. Our mission is to support Independent Private Practitioners. We know that for many of you, one of the main reasons that you got into Dentistry was so that you could be independent and create the practice you want to have. That is why our management approach is never canned and is always customized to your philosophy, resources and talents.

If you look at all of our clients collectively, by being with Advanced Practice Management, you are already part of a big group. We monitor over $30,000,000 per month of dental activity and seen this way, we are big guys too. However, you, the Doctor, are always the one in control, not the suits. We think that makes all the difference and it is difference for the good.

However, the growth of the large group practices should shake any smart private practitioner out of complacency.

From the Owner’s point of view, DSO’s/large group practices have the following advantages:

  1. Group purchasing power. Reduced equipment and supply costs.
  2. The ability to, in effect, collectively bargain with insurance companies to get better reimbursement (whereas it’s illegal for you and your colleagues or study club friends to do so).
  3. Professional Marketing Resources.
  4. Standardization of systems (an advantage vs. no systems but a disadvantage if you want systems that fit for your practice vs. your practice fitting into a system!).

From a Consumer Point of View, Large Group Practices offer the following advantages:

  1. Expanded and more convenient hours.
  2. Wider PPO network participation.
  3. Access and visibility (most of the common multi-location groups are well-located with street leveling parking in high traffic areas.
  4. Perceived up-to-date technology.
  5. Wide range of services in one entity (less need to go elsewhere for Endo, Ortho, etc.).

So how do you deal with this? Most of you don’t want to work
Saturdays, evenings or even Friday afternoons. Most of you don’t
want to, and shouldn’t, join every PPO. I am not a purist; some
insurance participation is usually necessary but it’s a matter of the
right balance for your practice – something I’ve discussed many
times elsewhere.


Your advantages:

  1. Continuity in caregivers. Your patients are more likely to see
    the same providers from visit to visit. What are the
    implications of this for you in terms of staff happiness and
  2. Truly personalized service. You are not working off
    approaches dictated by the “suits.” You know your patients
    and community.
  3. The ability to adapt. You can make decisions regarding
    personnel, technology, services, etc. quickly. You don’t have
    to wait for a bureaucracy to move!
  4. Customized Care: You set your own criteria and standards for
    treatment. The Doctor decides what’s best.