How can fee-for-service practices compete with insurance-driven practices?

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Recently, an online dental discussion group brought up this topic:

How can fee-for-service practices compete with those who are in network?

There were a lot of ideas from the group like:

Have the dentist call the new patient the night before to say she is looking forward to meeting them.

Get up from the desk and walking around to greet patients as they enter.

Recognize special events in their lives.

Acknowledge when you are behind schedule.

Provide stellar customer service.

All good suggestions. But if it comes down to numbers, you won’t be able to compete simply on that level. There are TWO DISTINCTIONS above all else that will give you an edge.

The FIRST DISTINCTION is to identify what makes you distinctive. What do you provide that your insurance-driven colleagues can’t or don’t. Are there services that you are particularly known for such as TMJ therapy, sleep apnea solutions or sedation dentistry? Is your specialization one that is unique and notable? Do you offer second opinion consultations? Do you have a comfort dog at the practice?Without something compelling, you are just another dentist. Whatever that distinction is, name it and claim it. Identify who your audience is and above all else, remember the second distinction.

SECOND DISTINCTION: Build your entire practice around this question:”How can we make our patients lives better than when they first walked in?”  You see, no one goes to the dentist for no reason. People have complicated lives and one of the last things on their list is you, the dentist. They only contact you when they believe you can help solve a problem they have – then they want you to go away. And their expectations are usually low because their previous experiences (in an insurance-driven office) were probably less than stellar in part because no one cared to learn about what was important to them. So, the more you and your team develop exceptional behavioral and problem-solving skills, the more you will learn about your patients and what they care about. Everything you do from there is built around that objective: “How can we make your life better than when you walked in?” Identify the answer to this question and remember it throughout each stage of the process. Provide individualized care, fashioned just for them and keep going back to what problem, in quality of life terms, you are helping them solve.

All the other things such as calling patients to find out how they are feeling, acknowledging birthdays or asking about their vacation, even filing insurance on their behalf are nice but it won’t keep a patient from switching practices because they have insurance.

What will make the difference is your unrelenting desire to solve your patient’s problem so they feel good about the experience and can go on with their lives. That is what will distinguish you from everyone else in the marketplace and for a lot of people, that is worth the difference they are willing to pay from what insurance will cover.  It’s really very easy once all the systems and the right people with the right skills are supporting you.

We help dentists evolve their practice to this new model.

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High Cost of Doing Nothing Part 2: Underperforming Staff

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All too often, dentists choose to ignore underperforming staff instead of addressing the problem. Why? Because doing nothing seems like a better option than going through the time and hassle of correcting the situation. But ignorance is not bliss.

High cost of doing nothingWhether your employees are texting during work hours, slacking on the little things, stirring you-know-what among staff or committing major errors, your under-performing employees, to put it harshly, are stealing from you. The focus and energy these employees sap from the practice deprive you of much more.

You can not be as effective in your role when you are worrying about whether your staff is doing their job. Add to that the internal conflict that can develop when an employee doesn’t pull her own weight or “gets away” with it and others have to pick up the slack. The rest of the team begin to resent it and factions form. The next thing you know, trust and teamwork has eroded and you have a full blown dysfunctional team.

When all you wanted was to avoid all the hassles, you end up spending more time managing the inefficiencies and conflict.

Enough already. You can no longer afford to work with people who are inefficient, ineffective, and cost your practice time, money and negative energy.

The first step is to admit your role in allowing it to occur, take a big breath, then set out your plan for a course correction.

          Use this step-by-step approach to do away with under-performers

Define your expectations:
Expectations are reasonable only when they are clearly conveyed and that is where you should begin. Before you decide to let anyone go, apologize for your lack of leadership. Then clearly convey your expectations and give your staff the opportunity to demonstrate their ability to change and perform at a higher level.

There are a number of areas that come up often in discussions with dentists and may have been overlooked in your employee manual. While they may seem like a no-brainer, you simply have to spell it out for them. These details have to do with work ethic, performance, code of conduct, and dress code. Bring your group together and discuss them along with other important expectations. Here’s a partial list:

-Dress and personal hygiene
-What is and is not appropriate to discuss with patients
-Cell phone use during work hours and breaks
-What to do when there is down time
-Calling in “sick”: advance notice and when it is appropriate NOT to come to work
-Showing up on time and being prepared before the work day begins
-Unacceptable behavior with fellow team members (ie: non-communication, triangulation, favoritism, tattling, passive-aggressive behavior, raising your voice)
-Responsibility to identify, call attention to, and catch errors before they happen – no matter who’s job it may be

Once these expectations are clear, everyone must agree upon them. You must also outline the consequences if the expectations are not met and emphasize that you will hold each person accountable.

Follow through with consequences:
Whatever your approach, stick to it. For instance, if you establish a one strike rule, one violation equals one strike. That’s it. You formally put them on notice, in writing, and monitor improvement with a specific deadline for a follow up evaluation.

Cut them loose:
Seriously. Fire employees who don’t get with the program. Get rid of the bad energy, increase your chances for a healthy and productive team. Your documentation will provide the support and justification for letting them go and it will demonstrate to the rest of the team that you are committed to a higher standard.

Provide lots of positive feedback and recognition:
Start establishing a culture of excellence by continually recognizing those who are performing at a high level.
-Verbally mention their performance in the moment, in front of patients and co-workers.
-Take time during team meetings to call attention to a team member’s exemplary work.
-Plan on recognizing high performance with unexpected recognition such as a gift card, or one time bonus to show appreciation to the group or individually.

If you aren’t getting your money’s worth, make a change in the way you address staff who aren’t living up to your standards and expectations. Start today because there IS a high cost for doing nothing.

Mercury Aligns With Mars

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Do you promote yourself as a holistic or a mercury-free dentist? If you do, then you know that working with this special group of patients brings a unique set of challenges. Recently, I conducted a Team Teleconference with a group who was struggling with how to best serve these patients.

Their goal:  To better understand these patients and learn how to connect with them more successfully. In other words, how can we align with what they want?

Here’s the email they sent me to establish the agenda for our session:

Holistic calls seem to always be the challenging call in our office. The patients are always very detail oriented  and can really throw us off with some of the questions asked. Another problem we face is they take so much time on the phone. I immediately guide them to our holistic website and walk them through our holistic approach when removing Amalgam.
 
There seems to always be a lack of understanding by the patient about what is involved. What I constantly hear from these patients is that they don’t want to have an exam, (don’t want) x rays and just (want to) have their amalgam removed.
 
How can we efficiently handle these calls? How can we handle these conversations to help the patient better understand why the exam and digital X rays are important? How do I get these patients to understand our process without coming off “rude” or “condescending”?

Keep in mind we do offer the consult as a last resort to help convert the call to a future appointment.

Our session brought about some clarity by breaking down the knowns and unknowns.
To start, the team identified some common themes that emerge when working with these patients:

1) They do a lot of personal research on the Internet.
We know that there is an equal amount of incorrect information as there is accurate information out there and each patient will struggle to discern what is fact and what is fiction. When they call your practice, they already have a set of beliefs which may or may not be correct. If what you tell them goes against what they have begun to believe, they will experience some internal conflict.

2) They self-diagnose or have been told by a trusted authority that the mercury in their mouth is;

1) toxic and 2) may be making them sick.
This may or may not be true in their case but you will not change their belief system in a short phone call. It is what it is. Gaining clarity about what they believe is essential and you must use this as the CONTEXT for which you will begin your relationship with them.

3) They are apprehensive and slow to trust.
They may believe you want to perform other procedures that aren’t necessary or will also be harmful. Some individuals may have had negative experiences with health professionals in the past, which leads to their distrust. They have a story and you must take the time to learn what that is.

4) They are health-focused.
Some of these patients place high importance on their diet and their exercise regimen – sometimes to the point of obsession. On the other hand, they may have a multitude of health issues and their life revolves around illness and doctor appointments. This is a part of the story you will uncover and must understand in order to determine IF you can help them, and if so, HOW you will offer to help them.

Because of these issues, they will consume more time than your typical patient, asking questions  and discussing their unique circumstances. There is no way you will change this. If you are going to serve this special group, you MUST be prepared to take the time required to fully understand them.

Also, there is a BIG difference between being efficient, and being effective. Efficiency relates to paper and processes while effectiveness relates to working with people. And effectiveness can’t be measured by whether or not you convert the phone call to an appointment. Not all callers are ones you will want to invite to become your patients. You must know when to cut your losses.

During our session, we broke it down into bite-size pieces to come up with a more effective way to work with these patients when they call.

What do they want?
In quality of life terms, what are these patients hoping you will help them with?

-They want to feel better
-They want peace of mind in knowing the possible toxins are gone

Above anything else, this is what you are providing. The procedure of removing the amalgam fillings will simply be the means by which you will help them get there.

How do they want you to accomplish this?
-They want it done in the least amount of steps necessary
-They want the safest procedure possible
-They want it done for the least amount of money

What don’t they understand?
-They’ve been told or read something they have come to believe that is different from what we tell them.
-Why xrays are necessary.
-Why a thorough exam is both clinically necessary and required by law.

How can you help them get what they want?

Because you don’t know what might be necessary just by talking with them on the phone and the approach requires a thoughtful process considering their unique situation, you will need to provide the context for why this is important in their case. Experiment with the following process and refine it as you get more successful:

1) Find out more about their unique situation – learn their story
When a caller begins the conversation by asking about mercury-free dentistry or removing amalgam, find out why they have an interest. It’s as simple as saying;

“That’s a great question. You’ve called the right place. Tell me a little more about your situation and let’s see how I can help you.”

2) Be quiet, listen, and take notes.
The patient will choose to tell you those things that are most important and can provide you with the foundation for how you will relate what they want with what you offer.

(Sidenote: if the caller begins by telling you every little detail that happened years ago, there are several ways in which to determine whether you must 1) disengage because of red flags, 2)  focus the caller, or 3) offer to refer them to a source of reliable information (like your web site), and call them back at a later time. More on this in a separate article.)

3) Use what you have discovered to provide context to the solutions you recommend.
It doesn’t matter that the protocol you use for each person is the same. You must make what you recommend unique to their particular situation. Remember to:

-refer to them by name
-acknowledge what you have heard
-explain what you recommend based on what you have heard
-get their approval

Here’s an example:

“Barbara, because you mentioned you suspect the mercury in your mouth may be causing some of your health issues, Dr. Holistic will want to learn all about those concerns. She will also want to evaluate what other things might be occurring in your mouth that you would want to be aware of and whether they may be contributing to your problem. I would like to suggest we arrange a time for you to come in to discuss your concerns with Dr. Holistic and she can to determine what diagnostic tests may be appropriate to discover the best way to help you. These may likely include xrays to see what the human eye can’t see going on under the surface. How does that sound?”

(Another sidenote: the subject of xrays and some patient’s reluctance to allow them is another layer of the story. You must peel back this layer in order to understand why this is a problem for them. Don’t assume you know what it’s about. Stay curious and relate to what they are telling you. If you would like to know more about how to address this issue, contact me for a primer on the subject.)

The TAKE HOME MESSAGEs:

Stop telling and start listening.

Use what you learn to create the framework for how you will help them.

Make it personal and unique to their situation.

You can use this same approach with ANY patient. It will help you connect more personally to each caller, begin to develop trust and help you establish a strong relationship from the very beginning.

Doc, I Want a Raise!

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Brush them!A recent poll conducted by Real Money magazine reveals that 71% of the respondents want a raise this year. The clients we work with will often give us two perspectives;

1) A call from a dentist wanting help with performance reviews. It’s time for raises and the staff is pressuring the dentist for a review. Or the dentist is panicked because she promised reviews six weeks ago, but has been avoiding it because it takes so much time. Or the dentist feels reviews and raises just create trouble and is tempted to just give everyone an across-the-board raise to get it over with.

2) A call from a team member wanting to know how to get her (or his) dentist to do performance reviews. She might complain that he keeps rescheduling them, and she needs some valuable feedback. She may feel she is entitled to earn more money because she believes she’s carrying a big load. Or the dentist promised a review after six months but she’s been working there ump-teen years without any feedback.

Here are some thoughts from Sandy Roth about this timely topic:

I’ve written several essays on the issue of compensation and performance evaluations. By now you know that we encourage our clients to compensate staff based on merit and work performance, not length of service or time of the year. For that reason, it is essential to establish a system of reviewing the performance of every member of the team at regular intervals. But how do you structure such an evaluation? And how can these evaluations be done without becoming a huge burden for the
dentist?

The process can be made simple if the preliminary work has been done. We can’t talk about evaluations without mentioning that a Statement of Performance Expectations must be in place for each employee. A Statement of Performance Expectations is quite different from a traditional job description.The job description was a union invention which outlined exactly what the employee was expected to do and thus guarding her from having to do anything more. This mentality makes no sense in dentistry, where each person is expected to grow and change as the needs of the client and practice change.

Whereas a job description outlines the employee’s tasks and limits the scope of her influence, a Statement of Performance Expectation widens her sphere of influence by suggesting ways she might have a greater impact on the success of the practice. When a Statement of Performance Expectations is appropriately in place for each employee, performance evaluations are a breeze.

The next step is to involve each employee in her (or his) own evaluation. The process is amazingly simple and wonderfully healthy. The employee begins by evaluating her own performance, using the Statement of Performance Expectations as a guide. Simultaneously, the dentist (and in more sophisticated teams, other team members) evaluate the team member’s performance, using the same guide. The employee, dentist and other relevant team members all participate in the Performance Review meeting, during which each of the participants contributes his or her perspective on the employee’s impact on the success of the practice. This meeting is held discussion style and everyone gets an opportunity to contribute.

At the conclusion of the meeting, new goals are set, new expectations are identified, new training and learning opportunities are planned, and supportive commitments are made to the employee. Finally, the next Performance Review meeting date is set.

The following structure outlines some of the categories of expectations which you might want to consider. Use this list as a starting point and add your own ideas. For each area, identify first the expectation then the actual level of performance or mastery.

Evaluation of Clinical Effectiveness or Administrative Accuracy/Efficiency
Clinical Acumen – Diagnostic Skills – Clinical Intervention Skills – Clinical Information Skills – Clinical Strategy Skills – Clinical Collaboration – Information Transfer – Administrative Efficiency and Accuracy – Record-keeping and Tracking

Evaluation of Client Relationship Effectiveness
Listening Skills – Questioning and Learning Skills – Other Communications Skills – Ability to focus on the patient – Sensitivity to patients and their issues – Ability to develop and advance healthy relationships – Ability to transfer information to the team – Ability to handle difficult patients – Social skills – Feedback from patients

Evaluation of Team Participation
Listening Skills – Questioning and Learning Skills – Other Communications Skills – Collaborative Skills – Conflict resolution skills – Respect for others – Finesse

Evaluation of Practice Alignment
Alignment with practice vision – Problem-solving skills – Willingness to commit to the success of others – Planning and strategizing skills – Ability to spot trends and stay aware of changes – Growth patterns/Personal commitment to learning

Please note that some evaluation points are duplicated under more than one evaluation category. It is not unusual for a team member to be extremely effective with patients and out of whack with the rest of the team. These differences are worthy of notation.

Obviously, the expectations will be different for each member of the team, depending on her (or his) role and level of responsibility, and, of course, not all team members will have clinical responsibilities. So, you must individualize the Performance Evaluation categories and items to reflect the expectations of the individual team member.

Don’t fall into the trap of believing that every team member should have the same expectations and evaluation criteria. Although they are entitled to equal respect and attention, no two team members are the same, nor will they ever be. For that reason, the Statement of Performance Expectations as well as the evaluations for two team members who occupy essentially the same position will necessarily be different in some significant ways. The important thing is to set a time for evaluations and involve everyone in the process.

If you haven’t yet created Performance Expectation Statements for your employees, it is not too late. ProSynergy’s Hiring Kit is packed with information to help you learn how to create, even remedially, great relationships with your staff.

Top 5 professional habits you should commit to in 2014

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With every new year, comes an overwhelming amount of commentary on new year resolutions and goals. A lot of them are common sense no brainers mixed with an equal amount of recommendations we know are unattainable. Reflecting upon 2013, I would like to shift the conversation to some things I believe have become overlooked.

I have discovered that many people have forgotten the basics. It annoys me when the professionals I work with don’t afford me these common courtesies. If you want to gain respect from your colleagues, patients, customers and employees and you want them to offer you the same respect in return, it is absolutely essential that you follow these very basic rules of business etiquette in 2014.

Here are my TOP 5 No-Brainers every business professional should commit to in the new year:

Number 5: Don’t interrupt.
Of course, there are some exceptions to this rule and if you made it through high school, you can surely figure out what those are. I’m talking about people who cut you off in mid-sentence because they believe what they have to say is more important than what you are expressing. It indicates they are not listening. It comes off as rude, disrespectful and confrontational. If you are guilty of this, listen more, talk less. If someone else violates this rule, let them know you weren’t finished with your thought.

Number 4: Do what you say and say what you do.
If you tell someone you are going to do something, don’t just talk about it. Do it! If you aren’t sure you will follow through, don’t commit to it. How many times have you been disappointed by someone who has said they were going to do something then dropped the ball? And it adds additional insult when they don’t give you the courtesy of letting you know, which leads me to 4a:

4a) If you commit to something then discover it was unrealistic or you can’t follow through, own it.   It’s as simple as saying you’ve discovered you’ve bitten off more than you can chew or your time commitments have gotten the best of you. You will continue to earn respect from your peers, co-workers, and employees when you are honest with them about your shortcomings.

Number 3: If you change your mind, say so.
Everyone has that right. But changing your mind and not telling us is not OK. People will have different expectations and you will inevitably disappoint them – possibly make them angry – if you don’t tell them your thinking has changed. We will continue to think you have your original mindset unless you tell us otherwise.

Number 2: If you are in a meeting or conversation, DO NOT LOOK AT YOUR CELL PHONE!
We’ve all been on the receiving side of someone who shifts their attention from us to their “next-best friend”. Why would anyone think this is appropriate? This is rude and disrespectful. Period. But it is occurring at epic proportions these days. Just because others engage in this behavior doesn’t mean it’s OK. It says they could care less about what’s happening outside the edges of their smartphone screen – so why should we? Business owners and CEOs can often be the biggest violators of this. Regardless of how important someone is, your time is equally important. If someone does this to you, stop talking until they look up and tell them you’d be happy to continue when they aren’t pre-occupied. Let’s shut this behavior down in 2014.

Number 1: Reply to emails. And do it in a timely manner.
Just like the sign in the public bathroom stall that says; “please flush after use”, this is so basic that I shouldn’t have to mention it. That being said, a large percentage of the emails I send out go unanswered. If email isn’t your thing, tell people up front or simply don’t give out your email address. Otherwise, people expect an acknowledgement or reply – THAT’S WHY WE SEND EMAILS! If you don’t reply, it’s the same as saying you don’t care or the sender isn’t worth your time. Your lack of response indicates your lack of interest which erodes your credibility, regardless of your position or role in any business.

Are you starting to see a pattern here? Every one of these has to do with professional courtesy and respect. And if we want people to respect us and behave in a certain way, we have to commit to that behavior ourselves. That is the hallmark of a leader. And yes, these are basic. That’s where we have to begin to build a solid foundation of professionalism, gain respect from others and to further develop our effective communication skills.

Do you have something you would like to add to this list? Let’s start a dialog and spread the word in 2014.

Great Expectations

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girl full of dreams      It’s prom season! If you or your children have gone through the prom experience, you know there are a lot of expectations about this life event – your date, the friends you will go with, what you will wear, the transportation to get you there, where you will have dinner beforehand and what afterparty you will attend. If you were like me, my expectations for this magical night were not the same as my reality.

What does this have to do with dentistry? While as teens, we gave a lot of thought to prom and we discussed it at length with our friends and our parents, the expectations our patients have may not be as thought-out or clear.  BUT THEY DO HAVE EXPECTATIONS.

These expectations aren’t tattooed on their forehead – they are internal. And they are formed over a period of time based on previous experiences. Patients rarely leave a practice and move on if they are happy with their dentist. Consider that most people who call your practice are recycled patients who, with the exception of having just moved to the area or their dentist has retired, have likely not had their needs or expectations met.

In a recent Facilitator Study Club teleconference, we discussed this topic and gathered a list of some expectations patients might typically have:

Time: How much time do they think it will take? Do they want an appointment quickly? Do they want to get in and get out quickly or do they want the dentist to spend a lot of time explaining or answering questions?

Conditions and treatment: What do they believe the dentist will find? What do they hope the dentist will find? What do they believe the solution will be?

Pain or discomfort: Do they think it will hurt? Do they expect it not to hurt? Are they hoping to have sedation?

The practice: Do they expect simply the basics or do they anticipate amenities like refreshments, entertainment options, warm blankets and the like? What about clinical standards?

Communication: How do they expect to be treated? Do they have a certain way they wish to be addressed? Are they accustomed to getting a reminder call, or text, or email about their next appointment? Do they like to interact socially or prefer you cut to the chase? Would they prefer more specifics and detail or just the bottom line?

Fees: How much do they believe it will cost? What are they prepared to pay? What role are they thinking insurance will play in their decision-making? How do they expect to pay for their treatment?

I’m sure you can come up with your own extensive list.

If you don’t know what your patient’s expectations are, how will you ever be able to meet, or better yet, exceed them? You would hate to find out what those expectations are by disappointing them. And more important, if your patient’s expectations are unrealistic, you would want to know sooner rather than later so you can prevent misunderstandings before they occur.

Your patients will tell you their expectations if they believe you:

1)    are genuinely interested

2)    will do your best to meet or exceed those expectations

How do you find out? The natural answer is YOU ASK.  But as simple as this sounds, it is often overlooked and not practiced consistently.  We see this play itself out in practices all the time. Team members guess, make things up, base it on assumptions, which are based on previous experiences with patients. Our own personal expectations or preferences may also play into our assumptions.

And because some patients may not be good at expressing their expectations without prompting, it is essential for you to create a curious culture and a framework for finding out. Make time at the onset of the relationship to have a conversation with your patient about what they expect and come to an understanding about what you can and, in some cases, cannot do. Don’t hand them a form to fill out. Instead, you might use a questionnaire as a guide to help you in this process. (If you would like a sample questionnaire, email me). Allocate time in the schedule for these conversations and assign the responsibility to the most behaviorally gifted person on your team. Provide this team member with additional support and training as well as the private space in which to have these conversations with patients.

The fact that you work at understanding your patients in this way sets you apart from most other practices. Through this information-gathering conversation, patients become clearer about what is important to them, you become clearer about how to serve them better and you establish the foundation of a strong relationship with more successful outcomes. Less patients will move on to be recycled again somewhere else.

NEXT TIME: Conveying practice expectations to patients.

Contact me for a copy of our sample questionnaire or to learn more about the Facilitator Study Club,