Just say no to DIY braces

Do Yourself a Favor and Don’t “Do it Yourself Braces” 

By Alan D. Shoopak, D.M.D.

You read that correctly. There are companies out there that are selling products and services that enable unsuspecting patients to “Do it Yourself” or “DIY” braces at home.  As a medical professional with over 30-year years of practice experience, let me be very specific as to WHY this DIY is a very, very bad idea. In a day when apps seem to fix everything with a touch of a smartphone, straightening teeth is not something you want take lightly. There is a reason the average Orthodontist has over 10 years of education and training, in addition to multiple years of real-patient practice. Straightening teeth safely, correctly and effectively takes a special professional—your neighborhood Orthodontist. 

Dr. Shoopak’s Reasons Why DIY Braces is a bad idea: 

-If you move teeth inappropriately you can severely damage the bone and soft tissue that can lead to gum disease and tooth loss. 

-Your home space is not regulated by the Department of Health, nor equipped and maintained by trained medical professionals and technicians to perform the necessary procedures. 

-By law, Certified Orthodontic Technicians aren’t even allowed to place Orthodontic brackets into your mouth without direct supervision of a licensed dentist.  

-Without proper training and real world experience the impression material can be aspirated into the lungs and be lethal. 

-The molds needed to determine what adjustments your teeth might need with the use of braces, wires etc. are only “usable” if they obtain all of the soft tissue and teeth surfaces. Only a trained technician would know what a proper and “usable” impression is. 

-Bad impressions could lead to improvements that will cause an irregular bite, and result in irregular or “uneven wearing of teeth”. This can also affect speech and chewing. 

This is a DIY Braces case that was presented by the American Journal of Orthodontics and Dentofacial Orthopedics  (Warning: Graphic Images) http://ajodoblog.blogspot.com/2014/08/editorial-comment_28.html 

About Alan D. Shoopak, D.M.D.

Dr. Shoopak is the founder of Orthodontic Specialists of Florida, with more than 34 offices throughout Florida. Dr. Shoopak attended the University of Tampa where he received his Bachelor of Science degree. He graduated from Tufts School of Dental Medicine in Boston in 1982, and earned his Orthodontic Certificate in 1984. Dr. Shoopak is a member of the American Association of Orthodontists, the Southern Association of Orthodontists and the Florida Association of Orthodontists as well as other local, regional and national Dental Associations. 

The real return from strong business processes and automation

On a regular basis, we discuss the importance and usefulness of good business systems and automated processes in the orthodontic and dental practice.  We talk in general terms about time savings, accuracy and ability to direct people to the most productive tasks, but how does that actually translate into dollars in your pocket?  Lately, as I have spent time with practices that do not utilize these systems versus those that embrace them, I have been absolutely amazed by the dollar value added by implementing technology in the orthodontic practice.

Let me give you a simple example of a stark difference created by automated systems: refunds.

Invisalign: Is it right for my practice?

One question we deal with regularly from clients relates to Invisalign.  Questions arise because the cost for Invisalign cases does not flow in the same way as the cost for a standard treatment case.

As a quick background, Invisalign offers a series of clear retainers to help straighten teeth.  Put in the first retainer and after a period of tooth movement, you pop that retainer out and put the next one in your mouth.  For us, this has proven popular with adult patients who want straighter teeth, but appreciate the aesthetic component of having the clear retainers instead of metal brackets.

We don’t comment on treatment so none of this post relates to the efficacy of treatment under this method.  Rather, the issue at hand is the payment for the Invisalign product. 

The #1 practice killer

On a regular basis, we have seen practices suffer –and sometimes die—because of one of the great practice killers out there: lack of communication.  In fact, it may be the top practice killer that I know of since so many negative situations have no communication or miscommunication at its heart.

In our own practices, this has come up a lot recently.  For example, in Mexico, we made the very difficult decision to close one of our offices.  Since that time, the closure has been an absolute comedy of errors (without the funny part) because at the time we told our staff about the closure, the people involved all went in their own direction and no one spoke up to coordinate the closure.  Some staff showed up at the office as if nothing had been announced.  Some immediately left and some patients were left in the middle – that vast majority of whom were concerned and upset because no one had spoken to them.

Over time, the reasons for poor communication emerge and most often it is linked to fear.  People in key positions are afraid to get sued, afraid to make a mistake, afraid to show weakness or something similar.  On countless occasions, I have had doctors tell me that they do not want to share bad results with the staff because if they do, the staff might quit or rebel.  Then, that would throw the practice into chaos.  

What throws a practice into chaos is no one knowing what is going on.  Then people take action that may or may not be beneficial to the practice.  Here’s one example:

In a practice in Oklahoma, the doctor initiated a promotion to give roses to all of the new female patients and their mothers.  The thought was that the practice would become known around town as the one that gives out roses to their patients and that would become a hook or keystone for that practice.  As you might expect, this promotion was less-than-successful.   Getting roses does not influence people to go to a dental office and the plan was so poorly promoted that hardly anyone knew that it was a promotion.  The doctor didn’t communicate with the manager that the program would have to be shuttered or reworked so the manager placed a bulk, fixed monthly order for roses to save on the per-unit cost.  After some time, the office began to look like a florist shop with all of the roses in there.  Or, a funeral home given the lack of patients from that promotion.

While a number of people have successfully employed the strategy of “ignore it and the problem may go away (or the person with the problem will forget about it),” that doesn’t seem to ever work for the rest of us. In countless situations, no news has not been good news.  It’s helpful to be the initiator and director of communication.  The results will be surprising.

If you ever have any questions about your practice including how to improve communication or correcting a situation caused by a lack of communication, please contact us.

Evaluating a practice management company

We have been away for several months because we took advantage of an opportunity to get deeply involved with a group practice that had some needs for which our services were a good fit.  

Far more interesting are the reasons that the opportunity came about.  This practice had been affiliated with a practice management company (also known as a MSO or DMSO).  At some point in the middle of last year, the management company encountered some financial issues and stopped paying a number of bills.  What started as a delay to pay for what I will term “luxury” type services – services that could be eliminated in difficult times – evolved into failure to pay the most basic of invoices on things like supplies and rent (rent!).  

If you are a practice looking for an organization to handle the business management of your practice, you obviously need to look first at the financial arrangement and time commitment laid out in the contract, but here are some areas of concern/potential red flags:

We've moved!

As part of our effort to improve our service offerings to you, we have partnered with Diversified Practice Solutions to add new solutions and improved pricing for your dental and orthodontic practice.

Please visit us at www.DiversifiedPractice.com for updated content and solutions for your practice.

UPDATE: We haven't moved.  We're going to hang out right here for the time being.

Staff training: Reps, reps and more reps

One of the final staff training tips we mentioned in our post from last month involves ensuring that someone learning a role actually has a chance to perform that function.  

Here, the theory is quite simple and obvious: if you do something 100 times, you should expect to be better at it on the 100^th try than you were on the first.  Unfortunately, the simple theory and ostensibly simple practice becomes difficult to execute because various roadblocks keep popping up.  

Here are some of the most common reasons we hear when we find out that a person doesn’t get the repetitions that he or she need to improve:

3 tips for using tech to improve productivity

In a recent post, we discussed using technology to assist staff in being more productive and more accurate.  Here are some specifics on how to accomplish that.  We’ve already talked about using some free software tools for training and basic camera technology to make sure that owners can keep in touch with everything happening in the office. 

Now, we discuss some additional areas of backlog where technology can assist you in keeping the number of staff and hours down while enhancing the happiness of your patient base:

Convenience as a marketing tool

A client in Mexico with a successful single-office orthodontic practice decided to open a second office in a different city.  Because his first practice was so busy, her practice was open 2 days per month in the new office.  After a few months, she called Diversified Practice Solutions looking for a new marketing strategy.  The office had set up some cross promotion with other businesses, had some ads on the inside of buses and a good referral program. The practice only had 6 consultations seen each month and that just wasn’t enough to merit the investment in the facility. 

As we discussed the issues with the practice, I mentioned that the problem may have nothing to do with marketing and that the lack of new patients might be cured with some operational improvements.

The response from the doctor was expected.  How could there be operational problems?  Of the 6 new patient consultations each month, she executed contracts with all 6.  What more could possibly be done beyond that?  Clearly, something needed to change about the budget.

Just need to talk through an issue? We are here for you.

Sometimes you just need to bounce ideas off someone.  In your practice, for treatment decisions, you probably have peers or mentors that you can contact to share x-rays and discuss different options.  But what about business decisions?  You don’t always need the full blown service or to sign a long term contract or even a face-to-face meeting.

Let me give you an example from my personal experience.  We have a general dental client that is trying to find the right balance of insurance carriers with which to work.  Since this was a new state for us, I needed to get some key questions answered about offerings for different demographic groups.  Internet searches didn’t provide good answers so I looked for someone to answer a couple of questions to point me in the right direction.  The result were people requiring fees just to talk (as much as $250 for 30 minutes!) or giving half an answer, but looking for cash before giving the full answer (and if that answer was “I don’t know,” my head would have shot through the roof).  

We were able to get the problem solved with no cost to the client (because that’s what we do), but the fees and obstacles thrown up were completely unnecessary.

That’s where Diversified Practice Solutions and MyPracticeEngine.com come into play.  If you want to talk through a problem in your practice, want a demographic study on a market, have some questions about setting up promotions or electronic marketing, call us.  There’s no charge and no obligation.  Plus, we’ll do our best to answer your question as fully as possible and not withhold information in expectation of payment.  Of course, if the process becomes more involved or you need us to handle something long term, only then would we talk about an exchange of fee for service.

Try us today by e-mailing bpalmisano2@gmail.com.  Doing so won’t hurt financially or emotionally.  

Team training tips

In our earlier piece on giving the proper resources to the staff, we discussed training, technology and repetitions as tools to improve employee performance.  Here, we dig deeper into training.  

Obviously, training takes a number of forms and can be conveyed in a bunch of ways, but we will point out some useful techniques that we’ve seen used.  Hopefully, you can use them to apply within your own practice.  Here are some of our favorites:

Don't throw people at a problem. Do this instead.

When writing pieces, I generally do not find anything more useful than taking a real life situation and relaying the results of examination of that problem into the wild for public consumption.  Our latest example comes from a dental practice on the gulf coast of Mississippi.  

Here, a dentist has a practice in a startup phase.  It is in that limbo phase of being larger and more mature than a startup practice, but not quite to the point of constant busyness.  There are some heavy activity periods and still others where there are no patients in the office.  This office is in a shopping mall so it tends to get more walk-in traffic than a practice that might be seen at an office that is located in a medical complex or out of the way location.  A potential patient might be moving from the Apple Store to the Disney Store, see the office sign or remember that they need a cleaning and stop in at the front desk.  For this reason, the practice will occasionally have some pretty busy times if a few folks come in at once without an appointment.

The doctor in the practice worries, and properly so, that patients will come in, see a line or find they are waiting too long.  They will decide to delay the appointment and maybe make that appointment with another doctor closer to home.   To deal with this, the doctor suggested that we place extra staff at the front desk at all times.  So, if things got busy, all patients could be handled and no one would be lost. 

Of course, if things did not get busy AND front desk staff wasn’t using that time to do things like market to potential new patients, that would result in cost just running higher. 

A much better solution would be to give the tools to the existing staff to enable them to handle more patients.  We’ll get into more detail on each of these, but specifically:

Alternative paths to practice ownership

In a recent survey by a major supplier, over 2/3 of dentists coming out of school had a strong interest in owning his or her own dental practice.  That certainly makes sense.  If a doctor wants to develop his or her own craft and/or achieve the best possible financial return on the investment in dental school, ownership is the way to go.

That path from graduation to ownership is fraught with pitfalls.  Among the top issues, getting financing has become an extraordinarily challenging process.  Especially since the financial crisis of 2008, finding loans requires outstanding credit, material down payments and liquid collateral.  

On top of that, if you are opening a brand new office, choosing a location is an uncertain proposition.  Even the world’s largest retailer, Wal-Mart, has not perfected site selection.  They regularly go through store closings.  Given that, imagine the challenges faced by a single-office dentist in finding the right location that will continue to be the right location 5 to 10 years in the future.

If purchasing a practice, there’s the uncertain nature of the existing patient base.  Maybe the previous doctor had some treatment headaches that will pass to the new owner or the receivables are a mess and essentially hidden from the purchaser until that purchaser tries to collect (this, sadly, is not terribly uncommon).

Those are simply the top ones. There are a number of other things that arise when employing the traditional build or purchase methodology.  While the traditional method works quite well for some, others seek alternative methodologies that may alleviate some of these headaches.  Here are 3 of those alternatives:

Marketing: It's everyone's job

We recently had a situation with one of our new clients that just begged for a more in-depth discussion.  Results in the practice had been particularly weak and a number of metrics had deteriorated noticeably.  Fewer new patients were making appointments, fewer showing up and a smaller percentage of those that did show up were signing contracts. 

While discussing the issues with the doctor, he said something along the lines of “the problem is clearly Person x (Note, this person’s real name is not person x.  The name has been changed to protect his/her identity).  He is in charge of marketing.”

And it is this quote that gives me pause because everyone in a dental or orthodontic practice needs to be involved in marketing in one way or the other.  Yes, you may have one person or an agency assigned to help you develop ideas and make sure those ideas move forward and become reality.  But that doesn’t mean that everyone can sit back and wait for new patients to roll in the door.  Rather, that marketing person is merely one part of the process.  Everyone can and has to participate meaningfully in the process.  

Specifically, keep the following in mind:

Are my patient receivables a problem?

A question from one of our intrepid readers: 

“How do you tell if your practice receivables are out of control?”

Outstanding question.  Of course, the answer is in the data and there are quite a number of ways to determine whether or not your receivables are under control or require some additional work. 

Considering a change of strategy? Read this first.

In quite a number of practices with which we work, we get suggestions for changes based on comments from patients.  Examples of these suggestions include adding whitening products, change of operating hours or changes to patient flow.

Usually, the suggestions are prefaced with a comment along the lines of “Everyone wants us to…” followed by the specific suggestion.  

Before lurching into major changes and the marketing campaigns that support them, please make sure you keep the following things in mind:

Patient financial records a disaster? Here's what to do

In our last post, we discussed some ways to organize your receivables system to make sure that you get off to the right start to control past due amounts and deal with any amounts that may become delinquent.  

But what about a situation where you initially did not have a plan or execute a plan?  The aging analysis has never been reviewed, there’s been no follow up, patients are seen without regard for their financial status. The assumption is that everything will work out OK.  And in a lot of cases, you don’t know what to collect because you have no idea what is owed.  That’s certainly not an ideal situation, but fear not.  Do not abandon hope.  The situation can be salvaged and turned around. 

Take the following steps as soon as humanly possible:

Train your patients and other receivable tips

In our last post, we mentioned that a key part of achieving monthly payment/6 week scheduling harmony is an effective receivables system.  Obviously, collecting money is both fun (actually having the money) and undesirable (asking for the money when it is past due).  

This is especially true when you have monthly payment or other convenient payment plans intended to ease the financial burden on the patient.  This is extraordinarily true if you decide to allow payments to be made after treatment is completed.

But here are some tips for easing the undesirable part and creating more of the fun part.

Achieving payment plan/patient scheduling harmony

Here, we examine one of the more common conundrums in orthodontic practices today.  Quite a number of practices believe firmly in offering patients a monthly payment plan that allows that patient to fit the monthly obligation into his or her budget.  Those of us at My Practice Engine fall into that method of thinking.  Combine this with the fact that over time, technology has allowed doctors to see patients less frequently.  In the distant past, patients had to consistently be seen on a monthly basis.  Now, sites regularly discuss 5-8 week intervals between appointments.

Very clearly, reducing the frequency of appointments is a win-win for all involved.  For a patient, having to make fewer visits to the doctor’s office is almost always preferred.  For the practice, seeing the patient less frees up time to see other patients.  Just doing the math, if you see patients every 4 weeks and then move to seeing them every 6 weeks, you now have increased the total number of monthly patients you can see by 33%.  That’s without adding chairs, space, staff or any other cost.

The problem that arises comes from the fact that practices intertwine the monthly payment and the frequency of visits.  As a result, a practice charging a monthly fee will see patients on a monthly basis so that they can make sure to collect that monthly amount.  This eliminates the possibility of the office using all of that wonderful technology available for treatment.  Here are some of the objections and solutions raised when discussing monthly payment and non-monthly visits.

Please note that we will not be discussing the quality of outcomes or movement of teeth using one method or another.  There are a number of outstanding sources for that type of discussion.  This is not one of them.

Keep small problems small

In one of our client practices, we recently ran into a technical problem that affected all 14 offices in that client’s group of offices.  Before we could begin to investigate the cause and solutions of the problem, our client requested that we involve his legal team and 2 sets of accounting firms to investigate and solve the problem.  Certainly, involving them would lead to some type of action being taken – and enormous fees being run up.

But are those fees merited.  At this point, we’re not even sure of the underlying cause of this technical issue.  The matter could simply be that a clumsy engineer at the service provider tripped over the power cord and cut us off.  Or, there could be more sinister forces at work with that client being the subject of an undercover investigation by a federal law enforcement agency and they are gradually shutting off services before swooping in with guns drawn.  The solution most probably lies somewhere in between.

Before you haul out a bazooka to solve a problem where a fly swatter will do, please take the following steps: