That was then; this is now

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The global
economy has changed, and the dental world is forced to change. too. Once
thought by most to be recession-proof, dental practices are being
impacted by the economic downturn in many ways. Today’s economic
conditions are unpredictable and have placed new challenges on staff and
resources. As the economy continues to fluctuate, dentists are
uncertain about what actions to take.

That was then …

the past two decades, I have witnessed many changes in our profession.
The combination of innovation and entrepreneurship has led to
significant breakthroughs. The emergence of cosmetic dentistry and the
growth of implant dentistry created a renaissance in the dental

But that was then …

As dentistry continues to
evolve in a new economy, it is even more critical to keep an eye on the
business side of the practice. Most practices continue to manage
themselves as they did when the economy was far different and much more
robust. In the current market, today’s dentist is wondering what should
be done to manage day-to-day pressures while running the practice. In a
world of “that was then,” you can no longer afford to practice the way
you once did. Practices are working harder to maintain production
levels, and doctors’ investment portfolios have declined and only just
recently started to climb back up. While there is a strong desire to
increase doctor income, no one is sure exactly how to make this happen.

is now …

The new economy has shown us a new era of dentistry.
Practices will no longer automatically find success by hanging out a
shingle. Even dental insurance is no longer a guarantee that patients
will come to a practice. Patients with insurance, similar to other
consumers, are cutting back on spending. Unlike medicine,dentistry
almost always comes with a co-payment or out-of-pocket cost. Given that a
great deal of dentistry is not based on emergencies or pain,many
patients are deciding to hold on to their money rather than spend it.
Some of the changes Levin Group has seen in the last 18 months include:

  • An
    increase in no-shows and last-minute cancellations
  • A
    decrease in the number of patients preappointing for hygiene services
  • A
    large decrease in cosmetic services
  • A
    minor decrease in implant services
  • A
    decrease in the number of new patients and overall case acceptance
  • An
    increase in practice overhead percentage
  • A
    decrease in doctor income
  • A decrease
    in the number of staff pay increases

observations illustrate how dental practices need to be more efficient
than ever in their operations to maintain profitability. During this
time of transition, the key factors contributing to “this is now”

1. Bring in new patients through internal
: They’re already there in your practice. They have
the knowledge to help you build your practice. They’re more effective
than Yellow Pages ads or radio commercials. They are your current

Most are happy to refer their friends and family — but
you have to ask. If current patients aren’t aware that your office is
accepting new patients, it’s doubtful you will receive many referrals.
You and your team need to communicate that the practice is actively
looking to provide excellent oral health care to more patients. Signs,
scripting, and patient incentive programs are good strategies to boost
patient referrals.

Once you receive referrals, be sure to call and
thank any patients who refered their friends and families. Levin Group
recommends that the dentist be the one to make the call. Patients who
receive these phone calls are motivated to continue referring others.

Reactivate inactive patients
: One of the key principles of
practice management is to retain patients. I recommend the following
methods for keeping patients engaged, as well as for reactivating those
who have become idle over the last 18 months.

  • Identify
    inactive patients
    — Use a software system or perform a
    manual chart audit to generate a report of inactive patients from the
    past 18 months. Based on the number of active and total patients in the
    average practice, this task should not take too much time and is well
    worth the effort.
  • Contact inactive patients
    — Make telephone contact first. It is always more beneficial to talk to
    patients in person, since the goal is to motivate them to make an
    appointment. The telephone call also creates an opportunity to refer to
    the appointment more as periodontal maintenance and an oral cancer exam
    rather than a simple cleaning. Don’t limit the call to basic services.
    If you do, you may not create value in the mind of inactive patients who
    have already allowed their dental visits to lapse.

phone call sequence should be three calls over a three-week period. This
has worked extremely well for many practices, allowing them to activate
a large majority of patients who have not presented to the practice in
the past 18 months. It is also important to track these patients
separately to be sure that they keep their appointments because their
value for the practice or amount of dentistry performed may be lower
than that of an active patient.

3. Increase elective
services/promote comprehensive dentistry
: As patients begin to
stabilize financially, practices should continue to present cosmetic and
elective dentistry. I know some dentists may balk at this, saying, “My
patients are struggling. They don’t have money for ‘extras.'” I
understand this perspective, but let me make a few salient points.

not everyone has been affected by the economic downturn. Some patients
are doing quite well and will want to invest in a better smile and
quality of life. Others may have a major life event (wedding, reunion,
job interview) where they want to look their best. Even if patients turn
down treatment now, they may accept it later. Sometimes, it takes more
than one case presentation for patients to say “yes.” This isn’t the
time to hunker down, but rather move forward with making your practice
vision a reality.

4. Make treatment affordable for
No matter what the economy, you should make it easy
and convenient for patients to accept your services. The more financial
options your practice offers, the better the outcome for everyone. To
ensure patients can afford and feel comfortable with payments, try to
offer the following options:

  • Pay half up front,
    half before completion of treatment
  • 5%
    courtesy for full payment in advance for larger cases
  • Credit
  • Outside patient financing

no mistake — patient financing matters! According to a recent study by
Hiner & Partners, 73% of patients surveyed indicated they felt their
dental office was looking out for them if financing options were
offered. Therefore, offering flexible financing options through an
outside patient financing company such as CareCredit® that understands
the needs of dental offices is a good way to increase patient trust.

Streamline operations through high-performance systems
: Many
dentists do not realize that a practice without outstanding documented
systems will never reach its true potential. An average practice
operates at approximately 30% below its potential due to a lack of
adequate systems.

Major management systems can be broken down into
five categories:

  • Scheduling
  • Patient
    finance and collections
  • Practice
    financial management
  • Case presentation
  • Hygiene

of these systems is a practice’s key component, with the exception of
hygiene for some specialty practices. But all five systems are
integrated to make it virtually impossible to change one without
affecting the others. For instance, scheduling affects practice finance
and hygiene affects case presentation.

Redefine practice

In the past, dentists could accumulate enough savings
over a reasonable number of years. However, my warning is that this will
no longer be the case in the “this is now” economy. If dentists
continue to operate practices “the way it was then” versus “the way it
is now,” today’s dentists can expect to work 10 years beyond what they

When a dentist can redefine practice operations to adapt
to a changing environment, achievements are more appropriately aligned
and a renewed sense of satisfaction is gained.

By Roger P. Levin, DDS, is chairman and CEO of
Levin Group, a dental management consulting firm that is dedicated to
improving the lives of dentists via a diverse portfolio of lifetime
services and solutions.

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