How I increased my net revenue almost 200k last year without picking up a hand-piece..

So I'm going to post this because I think it can help many on here.

I'm sure a lot of this has probably already been said in other forums or threads but I've been off Dentaltown for a while (I've been crazy busy) so I just wanted to share this. I have a very busy practice in N. Raleigh(5 ops) that I would say is 80 % insurance. Most of the other 20% are on our in house membership plan. I have a second office in Downtown Raleigh.

The year before last, I cut back my clinical hours to 3 days a week (I was getting a little burned out and wanted to have more time to RUN my practices and pursue other ventures). I now work 2 days a week in my N. Raleigh practice and 1 day a week in my Downtown Raleigh office. I thought I was gonna take a pay hit as my total weekly hours went down and my associates hours went up. Boy, was I wrong. By giving myself more time to actually run my practice and analyze things I increased my bottom line revenue by almost 200k.

First I started looking at my fees and what codes I was using most. I realized (as some of you have I'm sure) that only really 10 codes made around 90% of my revenue and HALF of these were preventative. If you don't know what your top 10 codes are then you should run an analysis. I then started negotiating with the insurance companies. While I had a stalemate with some, others gave me up to a 10% increase just for calling. I also knew exactly how to negotiate with them as for me I only cared about those 10 codes. I notice some companies will fluff the numbers by giving higher reimbursement rates for codes rarely used. I know there are companies that do this which is great, but I just did it myself. I could tell that a call from the actual dentist went further with some of the insurance companies.

Second, since my practice had been opened for 7 years I wanted to see how we were doing with our Pano re-takes. I assumed Pano's could be taken every 5 years but when I started looking through the insurance information on my patients charts I noticed that nearly half of the insurance companies allowed Pano's every 3 years. When I looked through 2 weeks of schedule I noticed that around 30-40% of my patients were allowed a Panorex by their insurance. This added around $300-$500/day. {edit, for the past 4 years are so we have advocated pano's every 3 years. I assumed that insurance only paid for them every 5 years so we didnt take them on insurance patients except every 5 years. Actually in some cases they werent even taking them every 5 years.. When I did my research I realized many were paying every 3 years so we changed it to 3 years. We have always taken pano's every 3 years for our un-insured patient who are in our in-house membership plan. For the record, I checked the ADA recommendations and for Bitewings/PA they recommend them every 6-12 months for HIGH risk people and every 2-3 years for Low risk. For pano's they recommend them every 3-5 years depending on risk just like the bitewings. I take a set of bitewings and 2 PA's every year as I'm sure most do. As for Pano's I currently have a patient at UNC pathology with a 15mm lesion in the posterior mandible that wasnt there on his pano 3 years ago. That solidified my decision. No I am not un-ethical, I am on the conservative side of the spectrum. I stopped placing sealants for years after attending a course by Dr. Christensens wife where she advised that they often do more harm than good. She made some good points so I just stopped placing them bc I felt they werent in the best interest of my patients, although insurance covers them. I recently began placing them again when the ADA came out with a paper STRONGLY supporting them, even in cases where incipient lesions were present. My point with this is that I wasnt doing Pano's because I ASSUMED insurance didnt cover them but when I checked I realized that often time it does. My professional opinion is that more information I can have the better for the patient so for years I have recommended to do a pano every 3 years. We should all be aware of what insurance covers, we shouldnt let that dictate how we run our practice, but I was leaving that off the table simply because I assumed they werent covered and my patients wouldnt want them as a result)

We also began separating out our bitewings and panos by taking bitewings at the first appointment and pano's at the second. NEVER TAKE THEM ON THE SAME DAY. They downgrade to a FMX and pay you around $50 less.

We also added anterior PA's to our bitewings and found that they were paid by insurance 1/3 of the time and we found a lot of additional pathology to treat. Splitting out the pano and bitewings and adding PA's added another roughly $100/day

Third, I HATE no shows.. Everyday I had around 2-3 total between my 2 hygiene columns. I have tried EVERYTHING and there is just no way that I have found to prevent some no shows (I have an idea to solve this for dentistry as one of my future ventures but that is for another day). I've been doing hour long prophy's because that is what EVERYONE says in every lecture I've ever been to. Well.. I finally said enough with that. My hygienist were often finishing well before an hour and by moving the prophy time to 50 minutes I could schedule 2 extra cleanings/day. My hygienist still finished on time and I had no reduction in treatment scheduled. Turns out 50 minutes is plenty of time for them to have a good conversation... I'm not saying your wrong if you're doing hour long prophy's, I'm just saying for me, changing to 50 minute prophys for adults added over $300/day to my net collections and my patients were still just as happy.

fourth, adult fluoride. We started offering adult fluoride for $25. I made sure that EVERY hygiene patient was explained that this would extend the life of their restorative work (which I completely agree with) and would reduce their risk for caries. I would say we had around 4 of these/day totaling $100/day

The last thing I did was put my hygienist on production. I did this so that they would make more money and stay on top of the xrays and fluoride. I also didnt want any pushback from the 50 minute hygiene appointments since they would be working harder. I looked at the 3 prior months (prior to making these changes)and set a production scale where they would have made exactly what they made with their hourly pay. Hygienist production included EVERYTHING they did except the exam (cleaning, X-rays, fluoride, sealants, Velscope etc..) With the higher production they would be doing the following 3 months I knew they would make more. The formula I came up with was $18/hour (for an experienced, $15/hour for a new grad) plus 10% of gross production (un-adjusted). By doing Un-adjusted they have a built in raise every year as we do an annual 3% increase in fees.

So yes, my Net at that office went up nearly 200k as I added almost a $1000/day to the bottom line without picking up a handpiece.. I work at that office 2 days a week and do VERY well and even better than I did when I worked 4 days per week.

There's far too little regulatory oversight relating to "dental insurance". Here's a report aimed directly at the public. Independent dentists are well-positioned to give patients advice. Even on a one-on-one basis, we can impact a positive difference for the public welfare.

http://blog.dentistthemenace.com/2016/07/dental-insurance-rip-offs-consumers.html

Michael W Davis, DDS

Santa Fe, NM

United Concordia Region 20 in Pittsburgh:

D2740= 566.10

D2752= 563.50

After over 10 years without a fee increase United Concordia DROPPED our fees LOWER...

I would LOVE to get $700 for a crown OP....

Yes the fees suck, but I still make a nice living on them.i know I work harder than you do, but it's a trade off for living where I want. Our state was on delta and changed to MetLife Jan 1. I took an immediate hit to my salary. I am thinking hard about dropping it, but I know I wil lose a lot of pt if I do. It is a dilemma for sure.

Matthew McMasters, D.D.S.

Dentistry is still doable now paying loans back. But there will be a tipping point where one cannot move for a higher salary and be indebted even more-so.

I do have a few friends that work the Community Health route and hearing them talk makes me sad. They have no desire to go open their own as their debt is to high, and they will stick with CH route for a long time. Indentured servants it is.

Is John Williams the dean that used to be at UNC?

I remember the ECU school being sold to the dentists as a way of increasing "access to care", turns out the same issue they had with UNC is happening at ECU. Non of the kids are staying in small communities, they are all still going to Raleigh, Charlotte, Asheville, etc.

They could have just increased the class size at UNC and not had to have built a whole new school. At least IU has gotten that part right if they felt they needed more students.

The rumblings I've heard from some NC dentists is that these community care centers that ECU built were supposed to treat the indigent population. But it turns out they are seeing FFS, PPO, Medicaid mostly with some indigent patients. While their centers are popping up all over the state and possibly violating the dental practice law of NC where a dentist needs to own a dental facility and not a university.

Dentists can't start anything now to compete with Delta in my opinion, that ship has sailed. Instead, I think the biggest issue to try to move forward is strongly worded legislation that says no insurance company can withhold the check from a dentist if the dentist isn't participating. Once that happens, Delta must compete based on their fee schedule, not by strong arming dentists who feel they can't move out of Delta because they won't get the check if they are out of network.

I don't think Delta Dental is advancing oral health care at all. They make it difficult to provide quality care due to the low reimbursement rates; they try to force dentists to participate in their networks by steering patients to go in network; they don't deal fairly with the people that are actually doing the work to provide the oral health care. They are unrealistic with the time and expense involved in delivering quality care. These factors do not advance oral health care--they contribute to its decline.

I had a patient that worked for Delta Dental tell me about a year ago that even though Delta Dental is a non-profit, they made so much money that they didn't know what to do with it. Meanwhile, there are many dentists struggling to make payments on their student loans, despite living very modest lives. There is something very wrong with this picture.

Perhaps many of the people who post often on Dental Town are not aware because they are fortunate enough to be able to practice under different conditions, but there are many young dentists who are forced to work like slaves. These dentists are expected to work long hours often without lunch or bathroom breaks. I once developed a UTI working under these conditions for a corporate office that bombarded me with patients. A few months after working for them, I sprained my neck having to see so many patients. It hurt every time I tried to turn my neck side to side and took about 1.5 weeks to resolve, but I was expected to work through the pain. I was also on call 24/7 every other week and was threatened by the corporate office with a lawsuit for breach of contract if I refused to perform dental services without pay. I was able to escape those abusive working conditions to open my own office, but not without many challenges.

The above realities don't get depicted in articles about dentistry or the lives of the average dentist. I get the sense that there are many dentists who experience the same or similar struggles, but don't share it because when they do, they are made to feel like failures or that something is wrong with them. Meanwhile, dental insurance companies make record profits and corporate dental chains treat dentists like indentured servants. The ultimate losers are the patients and dentists who get trapped in this system.

you called state board without even seeing patient? There will always be difference in opinion among dentists. We should not be throwing each other under the bus. nothing good comes out of that.

I dunno. I used to think people that did that were over treating... Til I saw a few days ago a patient that needs 20 fillings. Yes 20. 14 years old. The X-rays do show the decay but I speficially took intra oral photos of the lesions because I was afraid that some doc will throw me under the bus for overtreating.

There is a dentist in my town who has grossly overtreated some patients, who I have later examined or have seen their x-rays. The latest is a 5th grader who was (mis)diagnosed as needing 14 fillings, most of which were MOD's. My neighboring dentist was seen for a second opinion, since the mom thought it was excessive. When I looked at the digital films, I could see only about 4-5 with incipient lesions but most did not have anything visible. I understand that a clinical exam needed to be done to be complete, but it could not have varied much. I called the state dental association, they won't touch it with a barge pole unless he is an ADA member. State dental board is useless. I don't feel right sitting by and not doing anything. Any ideas?

Does anyone know of any state where the independent dentists have formed a co-op? I think this would be useful for buying power, and to negotiate with the ins. companies.In Arkansas, with Delta, you cannot be paid on a tooth for a period of two years after initial treatment, regardless if it is a different surface you're working on. Did anybody else realize this?!?! How much longer are we going to take all the risk, and liability, only to have the ins. companies continue to cut back our reimbursements? The biggest employers in my area have Delta, so not taking it is not an option, right now. How about if we, as dentists, start our own insurance company, and cut out the middle man?

The last three practices I have looked at have all had significant Delta Dental Premier patient bases.

Most relatively new docs, or even docs acquiring a mature practice may not be Premier providers. What are the implications?

If a buyer wants to purchase a practice base and they are not a Premier provider that will affect reimbursement clearly but also really adversely affect the valuation of the practice UNLESS the buyer is Premier.

Many brokers with available practices full of Delta Dental Premier patient base do not even comment on this or seemingly have no idea or speculation on how to address this in a potential acquisition it seems. Some even say the practice is still worth the same regardless(as if the blame falls here on an acquiring doctor not being registered with Delta)

Scenario 1..........practice all delta dental premier, collects 500k, if acquired do these patients stay on board? How is that factored into valuation?

Any comments in general? Seems like this will be more and more common with practice acquisitions I would imagine

THANKS!

Chop at least 35% off the delta collections to get a better idea of the PPO rates. It could be higher depending on the office fees for that area.

In Michigan there are "Legacy" Premier providers that have good fee schedules and are being grandfathered in with what they already had in place. New Premier providers have a much lower fee schedule that is barely higher than PPO so you might as well take PPO since it's almost the same fee schedule as PPO anyway.

So this is how bad the pittsburgh areas' ins plans are: I LOVE THE DELTA FEE SCHEDULE. They pay more than 70% of all the local insurances around here. More than met life,aetna, guardian, etc etc. I know how this sounds but tis the truth. And here is the real pisser, in WVA, the same plans pay WAY more than if based in PA. Go friggin figure. And,no, FFS will not work here in my market, not unless you want out ofdentistry. So for all you peeps practicing in the west, enjoy the fat reimbursements you get from your insurances, that is not our reality here. Sorry for the rant....

John Basile DDS

johnbasiledds@gmail.com

Starting to become cranky........and unapologetic

A lot of insurance patients are being moved to HMO-type plans, Delta included (Delta Care). HMO is a tough road to go down. Delta PPO (Delta Premier is a dying animal) is decreasing allowable fees and many offices are forgiving co pays. A very difficult dental landscape to do a start up. I hope you have deep pockets!

Boy, I am. May have to sell my soul and sign up for insurance plans................haven't had to do that in 27 years of pvt practice, but with all the competition and being out of network, feels like my practice is dying.

Pat

Opportunity is missed by most people because it's dressed in overalls and it looks like work.

T.A. Edison

I went to a musical and in the playbill there was an ad placed by a general DDS that said buy 6 veneers, get 2 free.

To get to this level

Curriculum should be a 12month cert course

LDS not DDS

Then the scope of marketing is limitless since its viewed commodity.The reason Dentist get annoyed is due to the amount of time and money invested for DDS

The Corp chains has a lot of share in

making the profession stoop to this level

$59 cleaning exam They made it fam

I wouldn't lose any sleep over it. Me and a competing coworker poach pts. off each other all the time. Its a cut-throat environment where the only person that matters is YOU.

Hello All,

I have been looking for a practice for about 4-6 months now. The searches keep coming up short. I know I am being very diligently, and I hope not TOO picky. I want to make a good investment. The problem is the supply is very small. I never really see a new practice in the market. I have been playing with the idea of doing a start-up in a more rural area of Ohio. With some population mapping, there are areas where there are no dentists within a 15 mile radius. I know start-ups are insanely risky. I'd love any advice from anyone who decided one way or the other. Also, is it possible the end of the year is just the worst time to buy? Thank you so much.

Would you say the Dental Climate in Washington/Oregon is ok? I actually want to relocate to either Georgia or a Northeast state like Maine; however, due to wife, she would like to stay on West Coast. I have applications sent into the State of Washington; however, I feel like that state will be "ok." Some dentists in my study group told me Oregon isn't good for small business or setting up shop. I dunno much more about that. They also said Washington is filled with ex-Californians that live or open up their own dental shop.

Anyways, anything is better than California.