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Practice Management: Have a Backup Plan Dr. Douglas Carlsen

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Early in my dental career a friend, Dr. Stan Sanchez, related his plan to enlarge his small start-up office by purchasing a practice from a retiring dentist.

The retiring dentist demanded to sell his owned space along with the practice. In the wildly inflationary world of the early 80s, financing the cost of both the office space and the practice was impossible. No other buyers were interested in the practice. Rather than give up on the purchase, Dr. Sanchez formulated three options:
  1. Purchase the seller’s charts and stay at Dr. Sanchez’s existing facility. Though it was small, Sanchez had an option to enlarge into an adjoining space.
  2. Sublease a larger unit from a colleague who was leaving an existing building.
  3. Enter a lease-purchase agreement with the seller.

I’ll never forget Dr. Sanchez’s comment, “For anything in life, always have a backup plan.” The three options were presented to the seller and both parties quickly settled on the third option. Sanchez paid off the lease-purchase within a few years and has practiced in the facility for more than 20 years.

This concept can be applied to many areas. Let’s first look at major headaches dentists occasionally encounter, then how backup plan thinking assists a normal day’s patient interactions.

Loss of the Primary Front Desk Person
The “indispensable one” is the only one who knows how to completely utilize your software. This employee might leave on her own, or because of layoff or firing.

Backup Plan I: Cross train! Make sure other employees know your software. These staff members should enter procedures, payments, produce insurance reports and documents, run day sheets, produce and drop off bank deposits, schedule patients, and properly back up data. Typically secondary front-desk staff members are trained in the software, but in small offices assistants, hygienists, or doctors may have to learn it.

Backup Plan II: If there isn’t anyone in the office who has software knowledge, Melinda Dyches, field training manager for Dentrix (Henry Schein) suggests the following: Immediately call your software trainer. If you plan on firing the employee, you might wish to send select people, including a replacement person, to an off-site seminar. Dentrix, for example, provides online Webinars and one-on-one online training for doctors. Your software trainer will assist in implementing a transition timetable for doctor and new staff, and be available for in-office training when your new not-so-indispensable front desk person starts.

If you plan to fire your front desk person, plan out your separation with a qualified employment law or labor law attorney that represents employers.

Embezzlement
You cannot truly grasp how insidious this element is until you realize it’s happening to you. My guess is that it occurs more frequently than we all think.

Preventive plan: Check your software’s audit trail. Look for unusual cash transactions, deletions, and adjustments. Often an embezzler will charge out a false procedure, collect the money and then delete it at a later date, leaving a normal cash flow. The audit needs to be done monthly – have your front desk run three random days for you to check. Keep them random!

Make sure all staff members have separate login passwords.

Finalize all day sheets at the end of the day, making it impossible to change entries without an audit trail.

Make sure the doctor authorizes all adjustments or discounts.

Separate the office’s financial functions: The employee who receives payments should not be the employee who maintains accounts receivable or makes bank deposits.

Require all staff to take regular vacations. Embezzlers often wish to never leave the office for fear someone might notice irregularities.

For complete information on this topic, visit http://webstore.lexi.com/Reference-Handbooks-for-Dentists to order Dr. Don Lewis’ book, Employee Embezzlement and Fraud in the Dental Office.

Computer Data Loss
We all have data backup devices, yet for many offices the backup process requires a complete reinstallation of new drivers for networking, digital radiography and database access software. This can take hours to implement. What if one of your prized digital operatories crashes due to a network software glitch? No charting, digital radiography or scheduling can occur until the system is evaluated and repaired.

Backup Plan: An instant backup system, involving the use of a prepared laptop computer that has every crucial updated software program installed from all office computers: operatory, front office and server, is a must. A simple plug-in via network cable and USB port can keep the operatory in operation until your local IT geek appears. This laptop can even keep the office running under the worst scenario – burglary and loss of all computers.

Be sure to maintain the security of this laptop. Truecrypt for Windows 7, Vista, and XP prevents a thief from reading the hard drive even after physical removal.¹

Office Flood or Fire
Backup Plan: Beyond having a strong data backup, make sure you have adequate business insurance. Don’t skimp on this insurance, as it is not expensive and can make a rebuild less stressful.
Further Backup: Identify one or two friends’/colleagues’ offices that you might be able to work out of for several months while your office is repaired or rebuilt. You might have to work off-hours and weekends, yet you will salvage your patient base and sanity.

The Sick Employee
Preventive plan: Rather than provide sick leave, provide well pay of six days per year. If the employee uses it all, fine. Any time left over is paid at the end of the year with a separate check.
Backup Plan: Again, cross train. If you can survive with one less employee for a day, that will be your least stressful option. If you absolutely need a temp, normally the most reliable temp is a hygienist. Have your permanent hygienist fill in at the front desk or with assisting, while a temporary hygienist performs the hygiene duties. In today’s paperless offices, most hygienists are scheduling recalls and many are processing insurance claims in the operatory. It is a small step further to schedule all patients and receive and post payments. Of course, to have an experienced assistant or front desk temporary available to fill the exact position works well.

Diagnosis and Treatment Planning
It always makes sense to flow-chart an involved treatment plan, planning for contingencies. For example:
  • A bruxer cannot tolerate increased vertical dimension to build back posterior and anterior tooth structure. Preventive Plan: Use a temporary appliance for a certain time period before prepping teeth. What if the case is seated and the patient develops problems? Backup Plan: Have a TMD specialist on hand to refer cases to when things go south.
  • Mrs. Classtwo blows out her new six anterior Empress case, opening a can of beans two weeks after placement. Preventive Plan: Warn patients of such behavior before you begin large overjet cases. Should you refer out overjet cases? Backup Plan: Do you next try Lava or the strongest PFM crowns you can find? Did you make an appliance for her to wear at night?
Treatment Payment Arrangements
Here the patient needs options. Make sure assorted financial arrangements are available. There might be just as many people who would wish to take a five percent discount and pay at the time of scheduling as those needing CareCredit or bank financing.
  • If the patient does not pay according to your practice policy, what can you do? Backup Plan: CareCredit can be used after treatment. Often deadbeats can obtain assistance from relatives or use eBay for fast cash. What about the use of collection agencies? Find an aggressive, honest attorney instead.
  • If you suffer from over-120-day accounts receivable mayhem, as do many practices, what is your backup to reduce the total? Many offices offer 30-50 percent off for immediate payment.
Post-op Instructions
It always makes sense to warn the patient after deep restorations of the chance of possible root canal therapy. Enter the information into the chart and have the patient sign.
  • Backup Plan for unforeseen problems after treatment: Have specialists available for further treatment when appropriate. If the case needs to be redone, with weakened patient trust, do you refer to another doctor? How much do you refund, if anything. I always felt full refunds, including the lab fee, were the least expensive insurance I could buy. I had good malpractice coverage, yet inordinate time and stress is involved with even a peer review case, way short of an actual suit.
Thinking in terms of what might go wrong and developing different avenues of “attack” frees up your spirit to accomplish wonderful dentistry with the confidence that if all doesn’t go to plan, you have alternatives.

References
1. G. Guess, “An Instant Backup Recovery,” Facets (San Diego County Dental Society Journal), November 2008, 19 and January/February 2009, 20.
Author’s Bio
Douglas Carlsen, DDS, owner of Golich Carlsen, retired at age 53 from private practice and clinical lecturing at UCLA School of Dentistry. He writes and lectures nationally on financial topics from the point of view of one that was able to retire early on his own terms. Dr. Carlsen consults with dentists, CPAs, and planners on business systems, personal finance and retirement scenarios. Visit his Web site: www.golichcarlsen.com; call 760-535-1621 or e-mail at drcarlsen@gmail.com.
 
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