2017 is the year of...

New Year, New Resolutions, New Approach
If you are like most folks, you probably make a New Year’s resolution. This year, shake it up a bit….and make a resolution for your practice — one that is reasonable to achieve and that will check many boxes on your “to do” list. 

Are you accountable for the decisions you make regarding your business? Not only are you the one who hires and fires, but you are also responsible for the evaluation of job performance; yours and your employees. Do you hold your staff accountable as well? 

If your answer to either question is no, you have more than likely identified the basic underlying cause of staff tension and dissension: lack of accountability. Productive and effective practices with effective teams have a clear sense of accountability in terms of what each staff member’s role is within the practice and how their job performance will be evaluated.

Now is the perfect time to reevaluate your systems, reorganize and make modifications where needed to streamline the process, to get to the end of 2017 in the best possible shape… Implementing documented, step-by-step systems protects you and your team from being overwhelmed. Systems provide consistency and continuity, thereby decreasing stress in the practice for everyone. 

Make Accountability a Management Tool
Many dentists don't like dealing with the administrative side of the business, really with all the regulations and requirements these days, who does? But it’s vital for you to
do so for the health of your practice. Your practice is a business and this concept must be communicated and respected by your team. Create a business culture and help
them understand that your goal as a practice is to provide excellent dental care to patients, but also to do it in a cost-effective, efficient, compliant, professional manner.
Being successful in today’s economy requires a business savvy team and you are the head of the operation. Operational control requires management techniques. You
need to develop systems that work and delegate responsibilities to staff. Create a manual and put in writing what each job in your practice entails — the skills, abilities,
responsibilities, and duties you want the position to encompass. Your team members should know what is expected of them when they are hired. If you didn’t provide
this essential employee information on hiring, spell it out now! A written job description for the position should include job duties and responsibilities, skills needed to perform
those duties, who they will be reporting to, how often they will be evaluated, who will be evaluating them, and the training plan in place (if any) for the position.

In other words, make accountability a management tool just like the other tools you use in your practice. Implement a fair and accurate process for evaluating job performance, and then tie behavior to real consequences and rewards. Expectations should be spelled out in advance in clear written language. Performance tracking and evaluations
processes should be included. I highly recommend the “praise in public; criticize in private” approach and following through with real consequences based on actual performance expectations being met or not.

Your office should have or develop adequate training guides and training sessions, and adequate documentation. Your office needs to implement standards that can be monitored and mechanisms to get feedback. You are not productive unless you are producing dentistry, so you can’t afford to micromanage; but on the flip side you can’t afford to let the staff run the show either. Ultimately, you are liable for everything that happens in your business; somewhere in between you must strike a balance. Adopt a management style that integrates well with your employees, patients and yourself.

Housekeeping & the Worker Bees
If you already have systems in place, now is the time to reevaluate. I like to call it “housekeeping.” It’s a necessary chore no one looks forward to, but these things need to be done at least yearly if not more. At some point, you may not want to be the housekeeper – and you can appoint or hire someone to manage those chores. But, before you pass the torch, make sure you have established exactly how you want things. No one has more risk if things aren’t done properly than you. Establish your vision, verify compliance and then let the worker bees take over and implement your
plan. Your plan should be reevaluated, modified and updated so you are ready for any nonclinical challenge that may come your way. Once your plan is established, you will
have a mechanism to evaluate how well your staff is doing. 

Start with the basics. You might think it sounds ridiculous to ask, but are your credentials up to date? Now is a good time to double check. Did you renew your biennial dental license and CDS? Is your continuing education documented? I can’t believe how many dentists call NJDA and ask if we have a list of their completed CE courses. It is your responsibility to document your class attendance. If you don’t personally handle that, assign the task to a staff member. 

Did your DEA expire? How about the NJ PMP? Are you registered with a secure user name and password? Is the appropriate staff in your office registered? If you haven’t
registered, go to https://newjersey.pmpaware.net/, a secure website maintained by Appriss. If you have questions please contact the Appriss help desk at (844) 465-4767
or NJRxReport@appriss.com.

How about your insurance policies, personal and professional, are they still what you need? Do you need more or less coverage? Are you paying too much? Assign a
staff member to keep these items in check and/or remind you to assess these things yearly. Document this task as part of their job description so that you can followup
when evaluating their job performance.

Do Your Crunches – Or Assign a Staff Member to
do Them for You!
One driving force that affects your bottom line is your overhead. Now is the time to look at all the things that you include in overhead. At the very least you want to control
costs or reduce expenses. Crunch your numbers monthly, quarterly, and annually. Staff is your largest expense. Do you have the most recent labor and workforce posters
displayed? Have you updated their employment information and tax withholdings? Are your employees up to date on necessary vaccinations? How about their credentials and certifications – are they current and displayed as required? Your employees are your second family. They work hard to make you more successful, treat them well and maintain a balanced approach to management. Discuss expectations, goals and office
policies. Establish office protocols and job descriptions.

Never Assume…Communicate
Communication is key, don’t assume because they have been with you for a while that they can read your mind. At any given time, one or more staff members are likely doing
something that you would not be too happy about if you discovered it. It's the nature of the beast. Correcting and directing staff doesn't have to be an emotional or unpleasant activity. Being "Dr. Nice" doesn’t mean your staff can walk all over you. Get involved early in the process, set specific goals for your employees and address issues as they come up. Communicate your expectations and provide oversight and guidance. That's
why it is so important to have a written policy and protocol for correcting and disciplining staff. Create an employee handbook and spell out your office policies.

Develop Bench Marks for Employee Success
Poor performance drains overhead. In tight times and with the increase in discounted fee insurance reimbursement, overhead control is critical to your long-term success.
People are your most valuable assets. Invest in them first to see how they can help you. Get them the training they need to improve performance, or let them work somewhere else. I know that sounds harsh, but you cannot afford to support unproductive staff. 75% of a dental practice's success comes from staff effort. Give each staff member a job description with clear tasks they are accountable for. When year-end comes, you will have measurable tasks and assignments for which to gauge your staffs’ performance.

Here are bench marks that the most financially successful offices use:
• Salary ratios: Overall 20-24%
• Lab: 8-10%
• Dental supplies: 56%
• Facility: 46% for renters; 58% for owners
• General administrative: 6-10%
• Marketing: 25%
• Doctor salary: 20-25%
• Retirement, reinvestment, capital expenditures: 20-25%

If you are considering a raise for a staff member, base it on these things: Your local economy; is it growing? Slowing? Look at your practice's annual revenue trend for
the past 5 years: Is it growing? Flat? Declining?

What is the demand for staff locally? Are there other positions for them to go to if they don’t get a salary increase? What is the local wage for their position? Check with your local placement agencies or temp agencies. Ask your accountant or other local dentists or colleagues. You can also check some dental industry resources; i.e., RDH
eVillage for hygiene and DANB for assistants. 

Now sit down and really look at how well each staff member performed their duties. I use the grading system as it just seems to simplify the process. Grade them A, B,
C or below. A’s get the highest percentage, B’s the next, and C’s get the cost of living (CPI%). Anything lower than a C gets NO raise and a 90-day improvement action plan.
This is ONLY if the practice has increased. If the practice has been flat or declined, DO NOT GIVE RAISES!!! Do this every year. It will help to give you a clearer picture of
how your practice is doing and it will establish your priorities and expectations with staff. Of course this is just my approach; you can do it any way that you see fit.

A Fresh Look at Fees
Let’s talk about fees. Every year you should revisit your fees. Has the cost of practicing gone up? Has your lease, mortgage or rent increased? Has the cost of materials or
your lab fees escalated? For most practitioners, the answer to one or all is yes and if that is the case INCREASE YOUR FEES! You are not gouging your patients. You will not offend them. You can’t stay in business if your overhead exceeds your income.
Insurance carriers take note that you haven’t increased your fees and that gives them leverage to maintain or lower theirs as well. How much does it really cost you to
provide services to your patients? Are you really looking at the nuts and bolts and breaking it down so that your fees make sense? If you don’t increase your entire fee
schedule, then increase the most commonly used codes. Just a few dollars will do wonders for your bottom line if you have everything else under control.

Look at your participation with insurance carriers. Does it still make sense? Are the major carriers in your geographic area still major players for your patient pool? Things change yearly. Patients get different benefits every year. Gone are the times where they had the same plan, same company year after year. Your participation needs to make sense. You are agreeing to a heavily discounted fee – it has to make sense financially. You cannot make up for the heavily discounted fees in volume unless you change your practice model. If the majority of your practice is heavily discounted, then that’s your new UCR. Can you make the numbers work with the discounted fee if it is the majority of your practice? 

If you are on PPOs, you absolutely must be running efficiently. Would you consider a quality low-cost lab if necessary? How do you offset the write-offs if you can’t increase volume? Understand your numbers so you can establish a plan. Some of the PPO fees barely cover your lab costs. Seriously look at your rate of case acceptance.
Again, put systems in place to assign staff members to this task. They should be working with insurance carriers, scrutinizing the EOBs and scheduling patient’s to minimize your losses. Again, when it comes time for performance review, you have something to base your decisions on.

Market Your Practice
Since we are now holding staff accountable for the things you physically can’t get to on a daily basis – start looking at your marketing and advertising budget and again assign
a specific staff member the task of researching/reevaluating your website, social media, ad campaigns and such. Implement a referral incentive and take advantage of internal marketing. Again, this should be staff-driven and there should be metrics to determine performance. You want to increase patient flow with no/little increase to your bottom line. This is easily measured and a great way to qualify to your staff where there is growth or lack thereof.

Assign staff the task of negotiating the best price for all equipment, technology, products and services. Again, another measurable metric that you can incentivize for better performance. I suggest once per year you get a competitive bid for supplies, technology, support, and marketing. 

Since you’re in the task assignment mode – assign HIPAA and OSHA manuals to team members as well. Of course you have the final oversight but by delegating that duty
you can use your time more wisely and again you have additional ways to evaluate performance.

Live Every Day Like It’s the First!
Relationships based on trust, confidence, and accountability work. As the team leader, it is vital that you begin to establish that relationship on day one and then treat every day as day one! Begin today to create an environment and develop skills you need to have the happy, productive, compliant and effective team you deserve and desire.