Change Reaction: Connecting the Dots

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CONNECTING THE DOTS

Over the years, I have had an opportunity to interview staff and spend time in

different departments within the orthodontic office. As the consultant coming in, it

is easy to see how everything interconnects and how every process builds on each

other. However, quite often staff get involved in specific tasks or goals they are

trying to accomplish for the day and never realize how the whole picture is

affected. For instance, let’s talk about the late patient. What happens when the

patient is late? The appointment coordinators have one goal, the doctors have

another goal and then the assistants have yet another goal. The assistants are

thinking, “O my gosh, if we take this late patient, the next patient will be late and it

is not fair to them.” The doctor is thinking about productivity and efficiency, “If

we reschedule the patient, we will get behind in their treatment plan.” The

appointment coordinators are thinking, “Oh my gosh, what am I going to tell that

mom.” Or, “Gee, we don’t even have an opening for 2 weeks.” No matter what

the situation is, everyone has a different viewpoint depending upon what position

they hold in the office.

Sometimes people feel more comfortable staying within their own area. They only

want to do things one-way verses forcing their mind to expand beyond their world.

I’d like to take you through an exercise that illustrates this. The goal of this

exercise is to connect all nine dots by drawing four straight lines without lifting

your pencil or retracing a line.

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Now, I’ll illustrate the answer. As you can see, it was necessary to think outside of

the box to meet this challenge. Thinking outside the box takes your team to a

higher level and enables you to be more productive as a team.

• • • • • • • • •

• • • • • • • • •

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Now I would like to talk about the five major systems in the office and how all of

this interconnect. The first thing we are going to talk about is scheduling. What I

am going to discuss is how the doctor, the business staff, the new patient

coordinators and the assistants all play a role in making the schedule work. When

we have a lack of systems and standards within the schedule, what kind of results

can we expect? You can probably come up with many suggestions, but the two

things I see happen are stress and conflict. Let’s talk about how we can avoid

additional stress and conflict by having everyone on the team do their part in

making the schedule work.

If your office has a very organized schedule it is certainly not something that

happened overnight. I’m sure you worked on it year after year. Quite often I go to

offices and find a lack of teamwork. When we fix the schedule, guess what

happens to the teamwork? All of a sudden people are getting along better, and

teamwork improves. The schedule is the hub of the practice. It keeps things

rolling.

What I want to talk about today is what role each one of you plays in the schedule.

Let’s start with the leader. The doctor will sometimes say to me, “I don’t

understand why we seem to be slammed at 3:30 and are sitting around twiddling

their thumbs at 1:30?” Often, we want to blame this strictly on the appointment

coordinator, but the doctor plays a role in making the schedule work. The first

thing the doctor has to do is to set the standards and enforce them. A lack of

standards leads to chaos. Many practices have the assistants take the next patient

up. If one assistant takes 45 minutes to do a procedure and it takes the next person

15 minutes to do the same procedure, the schedule won’t work. It is up to the

doctor to make the clinical team accountable for standardized procedure times.

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SCHEDULING LACK OF SYSTEMS AND STANDARDS RESULT IN: 1. 2. HOW EVERYONE PLAYS A ROLE IN MAKING THE SCHEDULE WORK:

DOCTOR: BUS. STAFF: NEW PT COORD: ASSISTANTS:

The second thing the doctor does is controls the mechanics in the office. One of

the things I look at as a consultant is how many visits it takes to complete a case.

I hope you are tracking your number of visits per case at the deband appointment.

A key element in improving your production is reducing the number of visits per

case. Some offices take 35 or 45 visits to finish treatment. Patients can be in

braces 3 to 4 years. It is impossible to have good appointment book control unless

you average 20 or less visits per case. Learn what the most efficient doctors in

orthodontics are doing. It is the doctor’s responsibility to continually work on their

mechanics so they can achieve an average of 20 visits per case or less. This is the

foundation to controlling the schedule.

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Number 3 is the doctor empowers the staff to coordinate the patient flow. I hope

that you have a team that is truly empowered. The doctor should be focused on the

patient and their treatment plan. Doctors, we have to get the staff empowered to do

the other duties. My staff teases me because I am a master of empowerment. I tell

them, “you are empowered”. It allows me to accomplish more in the areas that

only I can do as the leader.

Next, the doctor provides the training. To be very honest with you, when I ask the

staff, “How much time do you spend monthly together in training sessions?” What

do you think the answer is? Unfortunately, many of them say “none”. It is

absolutely essential that you do training together. This is also one of the things the

doctor determines. They set the stage because it is up to the doctor to schedule the

time and determine the areas that need focus. When the doctor overhears Susie

say, “I’m sorry we can’t see you Mrs. Jones because the doctor will be in Hilton

Head next week golfing,” it’s time to ask yourself, “have we provided the

training?”

The next thing is excellent treatment planning. I had a doctor call me just a few

weeks ago and he said, “My schedule is out of control, and I am not finishing my

cases on time. I think I want a consultation, but I don’t think there is anything you

can do for me because I need to correct these things myself.”

Obviously, this doctor knew what was going on. I asked him what he thought was

causing him to go over the estimated target date. He said he was so busy that he

never sits down and writes out the treatment plans. He has the patient come in,

puts the braces on and just goes from there. Obviously, he knows what he needs to

do, but he is not taking the time to set goals and write a plan. It all starts with

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treatment planning and communicating the procedure to be done on the next

appointment at each visit.

The second part is the business staff. The people making the appointments. What

do we need from them? For example, let’s say you have the mother at the front

desk and the patient needs a bonding appointment. Let’s assume you only do those

appointments before 3:00 p.m. in the afternoon. Mom says, “Harold is a straight A

student and he cannot miss school. There is just no way I am taking him out of

school.” The appointment coordinator is looking at the schedule, and she is feeling

the stressed. “Well what about next Wednesday at 3:30?” The mom leaves and

she is happy, but the appointment coordinator is sitting there thinking, “they are

going to kill me.” “I am not supposed to put that type of appointment in there at

3:30 in the afternoon.” What happens next? That morning rolls around, you have

a morning huddle and she hopes and prays to God that nobody notices it. The

assistants leave the huddle and go to the lab or the lounge area. Guess who they

are talking about? We typically blame the appointment problems on the person

doing the scheduling.

The number one responsibility of the appointment coordinator is to follow the

scheduling template. If the template needs adjusting, change it. Quite often I find

that the appointment coordinators are not following the template 30% of the time

or more. The template won’t work unless it is followed.

The second responsibility of the business staff or appointment coordinator is to use

excellent scripting. The appointment coordinators have to be taught excellent

scripting because we all know that how we say things makes a big difference. A

lot of one-doctor offices that I work with don’t see new patients after 3:00 PM

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because the doctor is very busy doing quick checks. When talking with the new

patient they say, “The doctor sees new patients prior to 3:00 PM and the reason for

that is that the doctor needs to have uninterrupted time with you. This is a very

important appointment and the doctor will be giving you a lot of information.”

Once trained with proper scripting, it is the appointment coordinator’s

responsibility to use it. If you want to improve your scripting, then I would

empower an experienced staff member who is very good at scripting to role-play

with you and give you feedback. This helps you to learn very quickly. The key to

being an excellent orthodontic staff member is to be trainable and to have a thirst

for learning. Our Appointment Coordinator Course entitled “Scheduling for

Success” has over 30 pages of scripting that can be invaluable to your front desk

staff.

The third item is that the appointment coordinators communicate daily to the

assistants. For example, if the appointment coordinator feels forced to make an

appointment outside of the template, instead of sitting around and thinking, “Oh

my gosh, they are going to kill me,” she should openly communicate with the

clinical person that is involved. “Susie, I know this is outside of the template,

however, let me tell you what happened.” When someone has the attitude at the

front desk that they don’t really care what the clinical people think, then front to

back conflict occurs. It is very important for the front desk people to communicate

with the assistants about the schedule on a daily basis.

The fourth item is to forecast the schedule. Recently I covered this forecaster with

a staff member that had a very good question, “Charlene, we are going to have one

doctor most of the month of July and I am concerned about exams and

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production.” A good treatment coordinator sees the big picture. It was a very

good question. I asked her what were the new patient start goals for the month.

She told me. Then I asked her to count the number of exam and start appointment

in the template for July. The number in the template supported the goals.

Production turned out to be fine even with one doctor out of the office.

SCHEDULE FORECASTER FOR 2019 The purpose of forecasting the schedule is to create smooth flowing days. Light

days and heavy days create stress in the office. It also creates front to back

tension. It is important to put a structure in place to prevent this from occurring.

On the next page there is a schedule forecaster for the year. Use this format to

create your own in years to come. The instructions for using this are as follows:

1. Mark off all weeks and days the office will be closed for seeing patients.

2. Record the number of patients seen on the patient days on the line next to the

date.

3. Post this by the scheduling computers.

4. Project where patients will be scheduled at your morning huddle.

5. Look at how being out one-week effects the schedule six weeks out.

6. This enables you to plan how the patients will be scheduled. Being proactive

verses reactive reduces stress.

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What about the new patient coordinator? What role does that person play in the

scheduling?

Number one is that they should communicate the scheduling guidelines up front.

Communicating the scheduling guidelines up front is really the new patient

coordinator’s/treatment coordinators responsibility. I have sat in on hundreds of

initial exams in other offices where people say, “The first time you come in to get

your braces on, we will see you in the morning but then after that we are going to

see you after school.” Of course, we all know that we can’t see everybody

between 3 – 5 PM and deliver quality care. It is important to communicate your

practice guidelines up front and put them in writing.

Secondly the treatment coordinator must tell the truth. Be honest with them about

how appointments are scheduled. Some offices even have a color-coded printout

of how they schedule certain types of appointments during certain times of the day.

This is put in the new patient package. It is a good visual tool to have at the front

desk. It is very easy to communicate when they have that color-coded visual aid

and you simply say, “The doctor needs a red, green or yellow appointment

scheduled for Johnny’s next visit.”

The third important role the new patient coordinator makes in scheduling is to

focus on filling the start appointments each day. A new patient coordinator who is

focused on filling the start appointments daily affects production in a positive way.

What about the assistants? What role do they play in making this schedule work?

Number one is that they are accountable for learning to do the procedures in a

timely manner. For example, fitting bands. I will ask the assistant, “I would like

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to observe the bonding process. Are you going to fit bands first?” She will

typically respond by saying yes. I will then ask her to come and get me once the

bands are fitted so I can observe the prep for bonding. Sometimes she is back in

as little as 8 minutes and sometimes I have sat there for 45 minutes or an hour

waiting for her return. I’m thinking, “She is still out there fitting bands.” Well, in

her defense, what has happened is there have been no training sessions, no time

guidelines, and no standards set. She is taking a long time to fit the bands, which

is uncomfortable for the patient and not efficient. It is essential to time all the

procedures and set goals for the assistants. The assistants need to be held

accountable for procedure times, which reduces conflict. If the assistants feel like

someone is not carrying their weight, conflict occurs.

Number two is to be flexible to changes. We all know that part of this is

personality. But change is not easy and we are creatures of habit. What happens is

we think change is going to happen overnight. So, you need to have a system in

place to support those changes for at least 21 days. Change does not occur

immediately. It is a process.

When you don’t have efficient clinical systems, what results can you expect?

Heavy patient flow and higher overhead. CLINICAL SYSTEMS LACK OF SYSTEMS AND STANDARDS RESULT IN: 1. 2.

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HOW EVERYONE PLAYS A ROLE IN MAKING THE SCHEDULE WORK:

DOCTOR: BUS. STAFF: NEW PT COORD: ASSISTANTS:

Let’s talk about how the doctor plays a role in making the clinical system run

smoothly. Number one is that the doctor is responsible to train staff and give them

feedback. I interview assistants all the time who have been working in the same

practice for years. When I ask how they would rate the feedback they receive.

Often, they say, “needs improvement”. They don’t know if they are doing well or

if they need improvement. It is the doctor’s responsibility to give the staff

members feedback on their performance so that they can continue to grow in their

profession.

The second responsibility of the doctor is to invest in the right equipment.

Inadequate equipment and a lack of instruments leads to inefficiency. I want to

encourage you to reinvest in your practice. Many practices suffer from high bond

failures because the staff are working with broken, outdated or inadequate

equipment.

Number 3 . . . the doctor controls the over-runs. How do you think staff members

feel when they see a patient on the schedule that has been in braces over 2 ½ - 3

years and has had 18 broken appointments and 25 emergencies? Can you really

get pumped up to go out there and see that patient? It becomes very discouraging

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to the clinical team, but there is very little they can do about it because the doctor

controls the overruns and makes the decisions about patient cooperation.

If you are using headgear and elastics, what do you do if the patient isn’t wearing

them? If they haven’t worn them for 6 months, what do you do? The response is

usually, “We hang in there for another 6 months.” Does the behavior change?

Usually not. So, look at putting some non-compliant therapies into the treatment

planning. Even if it is not the first choice, these options are needed because a

percentage of patients are not going to comply.

Number 4 . . . the doctor sets standards for quality and speed of procedures. It is

the doctor’s responsibility to clearly communicate the procedure time goals and

quality expected to all clinical team members. These items should be in writing in

a procedure manual.

Number 5 . . . is invest in continuing education for the staff. Highly capable

assistants have had a lot of continuing education. Continuing education is an

excellent investment for the team.

How does the business staff play a role in clinical systems? What can they do?

Some people don’t think the business staff plays any role but they do, and it is an

important one.

Number one . . . they need to have a knowledge of how to question emergency

patients. If I have no clinical knowledge – how can I question a patient or parent

on emergencies?

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One of the things I recommend is that the clinical team create a cheat sheet or

questionnaire so when a business staff member does get that emergency patient on

the phone, it prompts them through the questions that the clinical team wants to

have asked. They can’t always identify the problem. Someone may make it sound

like something it isn’t. At least the business staff will know that their

responsibility is to ask the right questions. They can’t control the answers, but

they can learn to ask the question.

Number two is to have some understanding of the clinical procedures. Quite often

doctors purchase our clinical training course “Basic Training 101” just to have the

business staff take it so they can acquire some knowledge of clinical procedures

and have a better understanding of what is happening so they can answer questions

properly. I think this is a great idea.

Number three is having the charts ready. Whatever the business staff is

responsible for getting prepared for the next day be it the schedule, the charts or

whatever, it is essential that it get done on time. This prevents front to back

conflict. When the business staff fail to complete these duties, the clinical systems

do not run smoothly. You can be certain that front to back conflict will occur.

Number four is to communicate changes in the daily schedule as they happen. If

patients are calling in and there are changes in the schedule, communicating those

changes to the clinical team is critical. If the appointment coordinator takes the

attitude, “what does it matter, they can do it”, conflict occurs.

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What about the New Patient Coordinators in the clinical system?

#1 They educate the patients and parents up-front. The better education you

have initially, it results in better patient cooperation and fewer emergencies during

treatment.

#2 They need to have an excellent understanding of clinical procedures. The

new patient coordinator’s knowledge of the clinical treatment facilitates better

patient cooperation. It is her role to educate the patient at the first one-or-two

appointments.

#3 Cross training to do some clinical procedures is valuable. For example,

records or even x-rays. When you have a treatment coordinator who can do

absolutely nothing clinically, you can lose a lot of flexibility. It is nice to have the

option of taking at least part of the records at the exam. The cross-training

checklist is a good exercise to see how well cross-trained your team is currently.

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CROSSTRAINING CHECKLIST Cross-trained staff members are a valuable asset to the team. Give each team member a copy of this checklist to complete. Make it fun. See how many people can help out in how many different areas of the practice. (staff member) is trained to perform the following duties:

BUSINESS OFFICE: ______ Greet patients in the reception room ______ Order business supplies ______ Run monthly reports (production,

collections, etc.) ______ Keep front office tidy ______ Sort mail each day ______ Follow-up on broken appointments ______ Keep on top of recalls ______ Collect payments ______ Confirm insurance ______ Send monthly statements ______ Assist in patient flow ______ Answer financial questions ______ Process auto payment

______ Turn on computers ______ Open up the office ______ Change messages ______ Schedule appointments ______ Set-up the schedule ______ Post payments ______ Run day sheets ______ Make deposits ______ Submit insurance claims ______ Close the office ______ Conduct new patient process ______ Conduct a deband conference ______ Process letters

CLINIC: ______ Keep track of inventory and stock

each item ______ Clean and stock units ______ Set-up brackets for bondings each

day ______ Instrument and handpiece

maintenance ______ Take impressions ______ Fit bands ______ 5-minute scan ______ Perform deband procedures

______ Take an emergency call ______ Keep on top of treatment overruns ______ Assist doctor in progress updates ______ Keep patient flow running

smoothly ______ Seat bonded retainers ______ Take X-rays and photos ______ Change arch wires ______ Patient education at bonding ______ Assist doctor with clear aligner

patients

LAB: ______ Trim models ______ Make Essex retainer ______ Print 3D models ______ Make Hawley retainer

______ Set-up indirect bonds ______ Assist in taking records ______ Know how to take care of a

simple emergency

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Now, let’s talk about the role the assistants play in the clinical system.

#1 They track all emergencies. Tracking personal performance is the only way

to really improve your skills and also to reduce and target where your emergency

problems are coming from. It is a wonderful tool to help you track emergencies in

the practice.

EMERGENCY TRACKING FORM Sample

Patient’s Name: Date: Bands/Bonds Off Band(s) off tooth: # # # # # # Bond(s) off tooth: # # # # # # Product on tooth or appliance?

Which assistant prepped the tooth?

Patient’s comments:

Poking Wire

Wire type?

Who inserted the wire?

Other Emergency

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#2 Focus on being a team player. We all know what it is like to be running

behind schedule and to hear someone behind you helping you with your tray or

doing something to support you and the team. It is such a good feeling to give and

to receive. It is also frustrating to watch someone walking out the door at 3:30

p.m. just when the after-school rush begins.

#3 A willingness to learn the procedures and practice them as a team. What

happens when you do not have a training program? An assistant can be trained by

3 different people and told 3 different ways of doing things. It is essential to have

a systematic training program for all clinical assistants to go through when they

join the practice. Then it is the assistant’s responsibility to maintain that

standardization after they are fully trained. We created a 40-day clinical assistant

training course called “Basic Training 101” that is getting excellent results for that

very reason. It is a systematic method that can be used repeatedly as new clinical

staff are hired so that everyone has the exact same training. This allows you to

maintain consistency.

#4 Continue their education and move towards certification. In many practices

I visit, there may be 1 or 2 assistants that are certified and the others are not really

moving towards any kind of certification. Moving towards certification elevates

the professionalism of the individual and makes an excellent impression on the

patient. Patients and parents want to know what kind of credentials qualify you to

do a job.

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Everyone plays an important role in the new patient process:

If this system is not fine-tuned what happens? Reduced case acceptance and

lowered production. Your team can feel very busy and yet be experiencing

reduced production. If you see 70 patients in a day, but start no one, your

production is zero.

NEW PATIENT PROCESS LACK OF SYSTEMS AND STANDARDS RESULT IN: 1. 2. HOW EVERYONE PLAYS A ROLE IN MAKING THE SCHEDULE WORK:

DOCTOR: BUS. STAFF: NEW PT COORD: ASSISTANTS:

So where does the doctor fit into this process?

#1 The doctor provides the training. As I’ve mentioned several times during

this program, the doctor provides the time and resources for training.

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#2 The doctor needs to get in the exam on time. This is the most challenging

thing for a solo orthodontist with a large patient load. But, people count the faults

of those who keep them waiting. If you keep the new patient waiting, they will

sometimes choose another office that makes a good impression by being on time.

You are building trust at the exam. The patient is trusting that you will see them

on time.

#3 The doctor must be decisive about the treatment plan. Either you are

passionate about orthodontics or not. No one has ever died from having crooked

teeth. When I hear a doctor say to a patient, “Well, whenever you want to get

started….” I always tell them that that their scripting needs to be changed right

away. Statements like, “This is an excellent time to get started.” Or “My next

available date to get David started is.” Confirm your decision to start orthodontic

treatment to the patient and the parent.

I have had treatment coordinators pull me to the side saying, “Charlene we have

got do something because the doctor is talking people out of treatment.” The

doctor must be passionate about orthodontic treatment or case acceptance goes

down.

#4 Financially supports the image of the practice. It is extremely important to

continue to invest in all the things that go into supporting the image of the practice.

Some doctors have not reinvested money into the office for years, and the practice

looks out of date. This often results in the new patient numbers slipping.

Remember, “Image brings them to the door and quality keeps them there.”

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#5 Build rapport with the patients and parents. Do you know what people base

their buying decisions upon? HOW THEY FEEL. People make buying decisions

based upon how they feel. When people feel good about the people in your office,

they feel good about referring people to your office. The doctor can be extremely

skilled and have all kinds of talent as an orthodontist, but if they don’t make a

friend with the patient, people will often leave and go to another office.

Now let’s look at how the business staff play a role in the new patient process:

#1 They must be committed to excellent telephone skills. That is the first

interview with the new patient. You never get a second chance to make a good

first impression. The business staff works together with the new patient treatment

coordinators.

One of the things that I recommend is that the people taking the new patient calls

have a slip that prompts them through that new patient call. When people hang up

that phone – how should they feel? Like they can’t wait to get to your office.

Before they hang up that phone they should know something about the doctor, the

staff and what their first visit will entail. That is why I like the “on hold”

infomercials about the office. Everyone has been in a situation where you have

called an office and hung up the phone thinking how do they ever get any patients.

That person sounded terrible. People should feel excited and enthusiastic about

coming to your practice. What sets the stage for that enthusiasm? The staff

member’s attitude.

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NEW PATIENT INFORMATION SLIP

PATIENT’S NAME _____________________________

Thank you for choosing our office. I need to gather some information that will take about five (5) minutes. Is this a good time for you? How did you hear about our office? Do you have any friends or family members that are patients? No Yes, Have you (or the child’s name) seen another orthodontist? No Yes Who is your (or the child’s name) general dentist? We will be happy to contact Dr. ‘s office (the dentist) and let them know you have made an appointment and how much we appreciate their referral. We will also check to see the date of your (or the child’s name) last cleaning and x-rays.

** If Adult Appointment – Ask ** What particular concerns do you have about your teeth that encouraged you to phone our office?

** If Child Appointment – Ask These Questions ** How does __________ feel about getting braces? Do you have any particular concerns? Besides you, will anyone else be involved in the decision to begin _______ treatment?

No Yes,

Dr. likes to make his/her patient’s feel welcome, he/she would like to know what ______________’s interests are.

** Go To Computer Screen ** Please excuse me for just a moment while I put some information into the computer so I can make your appointment. Enter basic name, address and phone number into the computer.

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** Pull Up Next Available NP Appointment ** Do you have a particular day of the week that works best for you? Then offer two options. My first available appointment is ______________. (move on once appointment is established) If Dr. says that ____________ is ready to start treatment, the next step is to take diagnostic records, scan, photos, & x-rays. We can save you a trip by taking those during this visit. We will need to allow an additional half-hour for this. Would this be of interest for you?

No Yes If you have insurance coverage, please bring in your card and we will be happy to verify your benefits or I’d be happy to take it now if that works for you. Please plan on being here for approximately one hour, Dr. will tell you if treatment is needed, approximately how long the treatment time would be and our treatment coordinator will discuss fees and payment options with you. Please visit our website for directions to our office. Is there anything else I can provide for you? Thank you for calling our office. I am sure you will enjoy your visit here. Dr. is a very nice person and a great orthodontist. We will see you on __________________. Have a great day!!!!

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#2 Know how to answer questions with confidence. When you are hired, one

of the first things, if you are going to be answering the phone, is to have a

list of the frequently asked questions. Be trained on those questions, know

how to answer them and have someone give you a quiz to make sure you

know the answers. What happens when you know the answer? What kind

of image do you project? CONFIDENCE.

#3 They give compliments. Complimenting people makes them feel good when

they are in your office. That may be the only compliment they have received that

month. Adolescents report that the most positive experience they remember is

their orthodontic experience. When they come to the orthodontic office quite often

they are going to offices where they have happy, friendly staff/doctors. They treat

them all the same and they don’t have that experience at home and in the schools.

#4 Use scripting to fill the schedule book evenly. If you have all your new

patient exams filled at 4:00 for 8 weeks and you have openings during the day,

what happens? It affects productivity and efficiency in the office. Use the

scripting to get the new patient exams filled evenly throughout the day.

Next is the new patient coordinator who obviously plays a very important role in

this new patient process:

#1 Committed to training and scripting. Committed to learning the training and

scripting needed to be effective. We conduct a workshop once a year for new

patient coordinators. The course is also offered as a home study course. Hundreds

of coordinators have reported how much they benefit just from the scripting they

learn.

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#2 Does the follow-up work and keeps their statistics. An effective coordinator

understands the value of building relationships and keeping accurate records of

their results. Practice management decisions can be made by evaluating good

records.

#3 Asks for referrals daily. The treatment coordinator has a great opportunity

to market the practice. One of their best opportunities to do this is while

discussing estimated orthodontic insurance benefits. You should say, “Ms. Jones, I

don’t know if you are aware of it or not, but your company offers some of the best

orthodontic insurance benefits that we see in this area. If you have any co-workers

who have been thinking about taking advantage of the benefits, please have them

give me call. We would be happy to make them an appointment.”

This is a very effective way to obtain referrals from people they work with that

also have good insurance benefits. If the coordinator who does that every time

they get to that line, it will really help build referrals in the office.

I was training a new coordinator a couple of years ago and she just started on the

team and was young. She had a lady come in who was a mother of a patient who

had just finished treatment and had a perfect paying history. The mother is coming

in now to get braces herself. The company she worked for had a benefit of $2,500

for orthodontics even for adults. I watch this new treatment coordinator sit down

and say to the woman that the total treatment fee is $4,500 and your estimated

insurance benefit is $2,500 so that leaves your balance at $2,000. Then she said

they would need $850 down and that would leave 24 payments of $29.00 a month.

I’m sure the woman was thinking, “Gee, I guess I will have to use the finance plan

or have to wait until my husband gets his bonus check.” The patient went ahead

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and agreed to having records taken that day which shocked me. When the patient

left I told the treatment coordinator that we needed to talk. I told her that with the

perfect paying history and the incredible insurance benefits that we should

probably offer her no money down and 18 months to pay. Then I told her what to

say when she got to the insurance line about the great benefits.

She calls the lady back in after records and she tells the patient that they can work

out the finances a little better. She goes through the whole insurance script

beautifully. I was really proud of her. The woman said, “That is such good news,

thank you, thank you. I am going on a retreat this weekend with 15 women I work

with that all have this insurance. I can’t wait to tell them about your office.” CHA

CHING. What a great opportunity to ask for referrals.

What do the assistants do in the new patient process?

#1 Supportive of getting the doctor in the exam on time. There is often a tug of

war when it is time for the doctor to leave the treatment area to see an exam.

Remember – no starts equals no production. The new patient visit is the

foundation to practice growth.

#2 Have an efficient system for taking records. Having the new patient

coordinator come to the edge of the treatment area and say, “can anyone take

records?” is not an efficient system. This creates stress and potential conflict. If

this is happening in your practice, take time to reconsider your options. A better

plan is needed.

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#3 Builds rapport at the first appointment with the patient. In most cases the

assistant is the first person the patient deals with clinically and it is so important to

make that good impression in the chair.

#4 Willing to cross train if needed. Quite often an assistant is cross –trained to

see new patients and consultations as a back-up. This frequently comes in handy.

If you have a lack of systems in this area what are the results: People do not show

up for their appointments and loss of profits.

COLLECTION SYSTEM LACK OF SYSTEMS AND STANDARDS RESULT IN: 1. 2. HOW EVERYONE PLAYS A ROLE IN MAKING THE SCHEDULE WORK:

DOCTOR: BUS. STAFF: NEW PT COORD: ASSISTANTS:

Two things that we don’t want to happen. So how can the doctor play a role in the

collections system?

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#1 The doctor empowers the staff. The financial coordinator needs to be

empowered to get the job done. In some offices the financial coordinator has to

show the doctor every delinquent account and they can’t make a decision to do

anything until the doctor looks at it. That is very inefficient. The doctor needs to

empower the staff to handle the collections system.

#2 Supports consistency in the system. The financial coordinator needs a set

system of procedures for handling 10, 20, 30, 60 and 90 days past due accounts. It

is very frustrating for the staff member who asks the doctor, “can I send Mrs.

Brown the over 90 days past due letter, doctor” to hear, “well, she goes to my

Church, let’s hold off on that letter.” If you have no consistency, you have no

system.

#3 Offers training for the financial coordinator. In order to be effective at

scripting and setting up a system, the financial coordinator needs training. And the

doctor supports this taking place.

What is the business staff’s role?

#1 The Financial Coordinator follows the collections and insurance system.

You can have a beautiful system set up but if the financial coordinator is not

following it, what good is it? The system falls through the cracks.

#2 Report their progress monthly. They are looking at their progress on a

weekly basis. The doctor should review the past due patients and insurance

monthly.

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EVALUATING YOUR CURRENT COLLECTION SITUATION Number of Contracts Number of Contracts Past Due Number of Open Accounts Number of Accounts Past Due Run a report of your: Total a. Delinquent over 30 only accounts b. Delinquent over 60 only accounts c. Delinquent over 90 only accounts

(The total of a, b, & c divided by your total number of contracts equals your percentage of past due contracts.)

Sample Chart of Past Due Contracts # of Contracts

5% 10% 15% 20% 25%

300 15 30 45 60 75 400 20 40 60 80 100 500 25 50 75 100 125 600 30 60 90 120 150 700 35 70 105 140 175

Excellent------------------------------------------------------------------→Needs Improvement Other Areas to Evaluate: 1. What was your amount written off for bad debts last year? Ideally, 2% or less of gross

collections? (i.e. $800,000 collections /$16,000 or less written off)

2. Do you have old past due accounts that need to be written off?

3. How many patients in retainers have accounts that are past due?

4. How many contracts are paid out and the patients are still in braces over their target

date?

5. Are your insurance accounts current?

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#3 Be open to more efficient systems. Electronic filing for example or paying

bills on the computer. Keeping up to date with systems requires on going change.

The New Patient Coordinator – what is their role?

#1 Communicate the value for the fee. They should present the treatment as a

lifetime investment.

#2 Clearly communicates the office guidelines. They make sure that the patient

fully understands their options and the office guidelines.

#3 Gives the doctor and staff feedback regarding the reaction to fees and

payment arrangements. This is a key role that treatment coordinators play.

Depending on your situation, you may need to reassess payment options in your

practice in order to keep a healthy percentage of case acceptance.

The Assistants

#1 In many offices the assistants play a role in getting the patient or responsible

party back to the financial coordinator. For example, you have a patient coming in

today who is past due on their account and the financial coordinator needs to speak

to them. The assistant is not going to ask for a payment but she can say, “Mrs.

Jones, the financial coordinator needs to speak with you.”

#2 Make sure daily fees are charged accurately. Items like broken retainers and

other per visit charges in the clinical area. The assistant can help to make sure they

are charged accurately.

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#3 To have an understanding of how insurance and finances work. It is

important for all the team members to have an understanding of how finances are

handled in your office. When you are at the soccer or baseball field and a mother

asks you what financial arrangements your office has, you need to know what your

payment options are like orthodontic fee plan. You don’t need to know how to

write up a contract, but it is nice for the assistants to know if insurance co-

payments are accepted and things like that.

If you do not have good marketing system two things result: You have few

patients coming in the door and you have a frustrated team. When the new patient

numbers are dropping, the doctor gets stressed and typically when the doctor is not

happy, no body is happy.

MARKETING SYSTEM LACK OF SYSTEMS AND STANDARDS RESULT IN: 1. 2. HOW EVERYONE PLAYS A ROLE IN MAKING THE SCHEDULE WORK:

DOCTOR: BUS. STAFF: NEW PT COORD: ASSISTANTS:

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Doctor’s Role is to:

#1 Lead the vision for the office plan. If the doctor says, “the new patient

numbers are down and I can’t afford to give raises until they go up”, the team gets

frustrated. They need to lead in a new direction with hope and goals.

#2 They empower the staff with a budget. I work with many staff members

who say they are very frustrated because the doctor says he wants more new

patients, but they do not have a budget to market with. They talk about great ideas,

but nothing ever happens. I suggest a budget of 2-3% if you would like to attract

more new patients. A 4-6% budget is needed for an aggressive plan that includes

external advertising. You need to decide where you want to position your practice.

#3 Delegates the duties and allocates the time. Practices who are serious about

marketing have a marketing coordinator who works 10-20 hours per week.

#4 Spends time with referring doctors and staff. The doctors who quit spending

time with other offices are at high risk of losing referrals. It does take a

commitment and an understanding from the entire team that the doctors have to

take phone calls from referring doctors in order for the practice to continue to

thrive. Relationships are built through contact.

#5 Creates an empowering environment for the staff. If the staff aren’t happy,

when patients come to the office they know it. One of the most effective

marketing tools you can have is a happy and enthusiastic team. People love to feel

energy in an office.

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The Business Staff:

#1 Develop excellent customer service skills to be used on the phone and at the

front desk.

#2 Smile a lot and learn people’s names. There is no sweeter sound to a person

than the sound of their own name.

#3 They also keep up with the observation recall system. If you have people

on the team who let those systems fall through the cracks, it would make a

difference in the starts in the office. The recall system is vital to fueling the

practice.

The New Patient Coordinator:

#1 Develops an excellent tour of the office. Many offices are moving towards

doing the tour on the computer. The tour should consist of all the benefits of

choosing your office.

#2 New patient coordinator/treatment coordinators work to make the goals.

They should have written goals for exams and starts each month.

And finally, the Assistants. What role do they play in the marketing system?

#1 Being gentle with patients. When people come to the practice and they have

an uncomfortable experience (someone slips with an instrument) it decreases

referrals.

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#2 Remember individual, personal details. People feel important when you

remember to ask about their last ballgame or their piano recital they told you about

at the last visit.

#3 Communicates to the patient in an empowering way. Have the scripting

skills to get the message across and still make the patient feel good in the process.

#4 Give the patient their undivided attention. They like for you to pay attention

to them. Many orthodontic referrals today are coming from the kids. The

assistants play a huge role in making the kids feel important.

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MARKETING CALENDAR

I recommend setting up a Marketing Calendar each year. The following is a sample

design. Establish a target date for implementation of each idea.

MARKETING CALENDAR FOR

KIDS

PARENTS

STAFF

COMMUNITY

REFERRING

OFFICES JAN

Appt. Card Contest

Visit 5 Offices

FEB Valentine’s Day Contest

Order Hand Mirrors (Gift for Parents)

Dental Health Mth. Display Booth (mall)

Invite Staff in 5 Offices

MAR Decorate for St. Patrick’s Day

Pot Luck Dinner

Invite Staff in 5 Offices

APR Easter Contest

Contest for Parents

No Patient Day- Springs Clean & Eat Pizza

Invite Staff in 5 Offices

MAY Vacation Postcard Contest

Speaking Engagement for Women’s Legion

Office Open House

JUN Swimming Party

Swimming Party for the Family

Progressive Concepts Course, Myrtle Beach, SC

Sponsor Softball Team

Sponsor Continuing Ed. Course

JUL Decorate for 4th

Wear Red, White and Blue

Visit 5 Offices

AUG Staff Baby Picture Contest

Office Swimming Party

Sponsor Community Blood Drive

Invite Staff in 5 Offices

SEP Back to School Pencils/Book Covers

SURPRISE! Slow 1st week of school - Day Off with pay!

Invite Staff in 5 Offices

OCT Halloween Contest

Invite Staff in 5 Offices

NOV Skating Party

Skating Party

Decorate for Thanksgiving

Invite Staff in 5 Offices

DEC CHRISTMAS PARTY - Decorate Office for Kids

Sponsor a Needy Family for the Holidays

Deliver Holiday Goodies to Offices

GENERAL IDEAS: 1. Office T-shirts 2. No-No Bag at Deband 3. Thank You Notes for Referrals 4. Banding Calls

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Well, that concludes our discussion of the five major systems in your practice and

what important roles each of you on the team play in all of the systems. I hope you

will take the time to complete the several analysis and quizzes either today or at

future staff meetings. They are excellent evaluations that will help you continue to

grow as a team and a successful practice

I want to encourage you to take these ideas I’ve just shared with you through this

video and put them into action right away. Remember that winners take action

within 72 hours and get results.

Thank you so much for your time and your participation. Our progressive

concepts’ team continues to work towards our goal to educate and serve. If there is

anything we can do to help your team with your practice management needs,

please give us a call.

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PRACTICE SYSTEMS ANALYSIS QUIZ Answer the Following Questions True (T) Or False (F)

SCHEDULING

____ 1. We rarely get a complaint from patients regarding waiting to be seen. ____ 2. We have an organized scheduling template. ____ 3. We focus on reducing repairs. ____ 4. We can get key production appointments scheduled in ten days. ____ 5. We have appointment book guidelines that we follow.

Total number rated True _____ Total number rated False _______

CLINICAL

____ 1. We have our band and bond failures under control at 5% or less. ____ 2. We have a good system to direct the doctor patient to patient. ____ 3. Our efficiency and harmony is not disrupted by front to back conflict. ____ 4. Our assistants share equally in the patient load. ____ 5. We do an excellent job of informing our patients and parents throughout

treatment. Total number rated True _____ Total number rated False _______

NEW PATIENT PROCESS

____ 1. We are quite pleased with our case acceptance. ____ 2. We know we project an excellent image. ____ 3. Our new patients are not kept waiting longer than 5 minutes for the doctor or

coordinator. ____ 4. We offer same day starts. ____ 5. Our payment plans and fees are affordable to the majority of our patient base. Total number rated True _____ Total number rated False _______

MARKETING

____ 1. We have a written annual marketing plan. ____ 2. We have an annual marketing budget. ____ 3. Our staff has allocated time to market.

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____ 4. We are pleased with our new patient numbers. ____ 5. Both our office image and quality of results are excellent. Total number rated True _____ Total number rated False _______ COLLECTIONS

____ 1. We promote auto payment. ____ 2. We are insurance friendly. ____ 3. We have less than 5% of our accounts past due. ____ 4. We fully inform the responsible party up front regarding finances and

collections.

Total number rated True _____ Total number rated False _______

Grand total rated True _______ Grand total rated False ________

Rating Scale: 25-22 true answers is excellent 21-18 true answers is good 17 or less true answers, indicates you need to get to work immediately on the key systems in your office to enhance the atmosphere and production for everyone involved. Review your answers and set target dates for implementation.

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WHAT ARE YOU WILLING TO DO?

WHAT AREAS IN YOUR PRACTICE COULD BENEFIT FROM CLEARER

STANDARDS?

1.

2.

3.

WHAT AREAS IN YOUR PRACTICE COULD BENEFIT FROM CLEARER

ACCOUNTABILITY?

1.

2.

3.

LIST THE SPECIFIC AREAS THAT ARE A SOURCE OF FRUSTRATION AND STRESS

FOR YOU?

1.

2.

3.

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WHAT SYSTEM COULD YOU PUT INTO PLACE TO ELIMINATE THE STRESS AND

FRUSTRATION?

1.

2.

3.

WHAT ARE YOU WILLING TO DO?

BY WHAT DATE?

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POP QUIZ

Circle the point value that accurately applies to each question concerning

your office.

Point Values

Yes Sometimes No

Do you hear a lot of laughter in your office? 3 2 1

Does the staff smile a lot? 3 2 1

Do you look forward to doing fun things together 3 2 1

Are birthdays celebrated in your office? 3 2 1

Is there a lot of communication at your staff meetings? 3 2 1

Does the staff look forward to staff meetings? 3 2 1

Are you continuously learning together as a team? 3 2 1

How do people react when a mistake is made? (supportive = yes,

apathetic = sometimes fearful = no)

3

2

1 Does the staff come forth with lots of ideas? 3 2 1

Do you have lunch together often? 3 2 1

TOTALS (add your circled answers to get column totals)

Scoring: 24 or more in the “Yes” column is EXCELLENT. 21-23 in the “Yes” column is GOOD. 18-20 in the “Yes” column is AVERAGE (never strive to be average).

Less than 18 in the “Yes” column means your team NEEDS FOCUS on team spirit.