How does the future of dentistry impact my practice?
In my first article, I shared with you notes from the AADGP conference and the presentation given by the ADA Director. In this article, I will take the ideas shared by the ADA and take each one and turn it into an action plan.
Finding #1: 80% of the work the ADA is doing focuses on the environment dentists work in, such as advocacy and legislation
The ADA can afford to hire the best and brightest economist who is investing in surveys and data collection that is available to all dentists. Thanks to this level of investment by a national organization, dentists can better understand their environment and the many changes that are occurring. The old curse, “May you live in interesting times” seems perfectly appropriate. Everything we thought we knew about people’s dental habits and how insurance works is in flux. If you don’t stay on top of these changes, you won’t be able to make good decisions about your office.
It costs $522 / year to join the ADA. Think of it like crowdfunding the economists and lobbyists who can first of all get a big picture view of our profession and secondly represent dentist interests (which generally represent the patients best interests) when laws and regulations are being discussed. For dental practices, there are two items on your to do list:
- Join and remain a member of the ADA
- Visit the Health Policy Center on a twice a year basis to stay on top of current research
Finding #2: Dental spending is flat, adults are not going to the dentist and those with dental insurance spend $300/yr on average
Look at your last year’s collections vs. the year prior, did you have an increase? Next, look at your active patients (last visit within 2 years) did that number increase?* If these numbers stayed about the same, then you are experiencing exactly what the ADA is finding nationally. This means it is more challenging to run your business because the market itself is not growing. And, although we often look forward to attracting new patients with dental insurance, hoping they will at least use their $1000 maximum each year, these patients just aren’t spending like they used to. Even worse, its been easy to believe that if people just had a higher benefit level, they would say yes to more dentistry. That has been proven false as well.
So, what to do? Recognize that we are operating in a highly competitive environment. This means you have to step up your marketing and your customer service as well as the clinical care you provide. Look at your marketing, do you have a set budget for your online, yellow pages, events and other marketing programs you participate in? And, are you tracking the performance of each so you make sure you are getting the results you pay for? You may have to hire a consultant or marketing agency to set you up so you can receive the necessary new patient flow to fill your treatment columns. Next, beyond just getting new patients in the door, you need to provide quality care of the procedures your community requests. Finally, investing in staff training brings a full team approach to customer service.
* Do you know how to run these reports? If you are a Dentrix user – here’s a quick review:
To see your production and collection the last couple years, run the Provider AR Totals Report – once for this year, again for the year prior. Look at the Net Production and Net Payments columns to compare years.
To find your active patient numbers, use the Practice Advisor Report – be sure to set the definition of “active patient” in the Practice Advisor Setup first (I generally define an active patient as having a last visit date within the last 2 years).
Finding #3: Dentist earnings are flat, dental school debt is high but grads won’t let debt dictate their employment options
Think about the idea that reduced earnings for dentists will change future students’ expectations. This brings to mind how opinions have changed regarding going to law school. Over the last ten years, most people have realized the dismal job market for attorneys dropped law school enrollment like a rock. And so those headed into law school now understand that they will have a tough challenge in finding work. Already, the culture of the millennial suggests that as a whole, they prefer to work to live and seem less interested in practice ownership. As incomes for dentists perhaps continue to drop, what other affects will we see?
Instead of focusing on the macroeconomic changes this could bring, lets think about how understanding recent dental graduates could impact you. Dentist owners of practices that have associate dentists can use this information to improve their hiring and management approaches. Knowing that your recent graduate is dealing with $250,000 of debt, you could partner up with a local banker or financial planner to meet with your associates and help them manage their finances wisely. You can regularly encourage their financial understanding through private meetings where you can share your experiences and help them learn how to live beneath their means.
Understanding the financial impact, but also the value of matching demographics to the office, you may want to refine your recruiting process to highlight the people on your team now and set up time for existing associates to meet candidates. This may end up as a section on your website highlighting the personal characteristics of dentists and other staff to help new hires connect and create strong relationships.
Finding #4: What Medicaid increase will impact your state?
The ADA is forecasting changes in Medicaid enrollment on a state by state basis. Most states are expected to have major increases. If you’re not accepting Medicaid now (most general practitioners do not) then do you see yourself joining Medicaid in the future? You can look up the current reimbursement rates and know that you will receive about $0.35 on the $1.00 which has generally been a good reason not to participate. But what if you were mandated to join? You would need to know how to handle this program.
So, on your list of things to do, you may want to find a local dentist that does accept Medicaid and take him or her out to dinner. Ask questions and begin to understand what it takes to make this program work in a dental practice. Imagine you started accepting this program in your office now, what training would your team need? Your front desk team would need to learn the co-pay requirements, what procedures must be submitted for pre-determinations and how to follow up on outstanding claims. At the same time, your clinical team needs to understand the limitations on what treatments will be reimbursed and what xrays can be charged.
You can anticipate the ethical challenges your team will face as well. You need a plan in place for handling patients in pain when you are required to wait on average 4 weeks for a pre-determination to provide extraction of thirds under sedation. And, how will you coach your hygienists when scaling and root planing is not a covered benefit, but the patient presents with 6mm pockets?
Next, look at your dental chairs, how many do you have? One way dentists treating Medicaid can make it work is by seeing more volume to make up for the poor reimbursement. You may want to consider how the layout of your office could be arranged to add another 1-2 more chairs? If you know you need to make changes to your physical office simply to update it someday for esthetic reasons, you may want to look at options to add dental chairs as well. And, once you have 7 chairs rather than 4, you will need the additional staff to make them productive. This just drastically increased the size of your staff. As staff size increases, management expertise should as well. No longer can you meet with your one assistant, two part time hygienists and your office manager in your office over lunch when all of a sudden you have 10-12 people on the team!
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Keeping current with industry information is just one way to run a successful dental practice. If you’re interested in new ideas on running a dental practice, please subscribe to my weekly blog. One of the biggest challenges to managing a dental practice is managing dental insurance. With dental insurance handled, then dental marketing for new patients becomes a primary focus. In today’s day of online reviews, handling patient complaints well is essential. As your practice grows, hiring dental staff becomes more important. With 18+ years of dental practice management experience, I’m open to your questions to help you run a successful dental office.