Dentists Beware: The Government May Want To Tell You How To Manage Your Practice

dentists' hands in chainsThe North Carolina Senate recently upheld Senate Bill 655, which would require the North Carolina Board of Dental Examiners to examine all business contracts entered into by dental practices in their state.

No other state in the union has implemented such restrictions on dental practice management, or sought such inclusive authority over how dentists manage their business.

Talk about the far-reaching arm of the government!

As reported by Dr. Clifton Cameron in the Fay Observer –

“As a practicing dentist in Fayetteville, I know how this legislation will impact dentistry in North Carolina.

When my partner and I established our practice in 2008, we quickly realized dental school taught us much about clinical care, but little about running a business. And the dental industry, much like the rest of the health care industry, is changing and becoming more complex.

So like many small-business owners, we looked to outside companies to help finance the practice, manage billing, handle payroll, file insurance and execute other administrative tasks. The arrangement helped our dental practice operate so efficiently that we can charge lower rates and accept dental insurance from patients.

Instead of helping foster lower fees for patients and wider insurance acceptance, Senate Bill 655 would require dentists to personally handle all the administrative tasks of their practices.

The bill would forbid dentists from taking advantage of the types of business services that millions of small businesses use. Many dentists like me would be forced to spend less time on patient care and more time on managing the complexities of a modern dental practice.

Senate Bill 655 would give the Dental Board complete control of how dentists in North Carolina run their practices so they can keep fees charged to patients artificially high and insurance acceptance artificially low.”

The North Carolina State Board of Dental Examiners position on on Management Agreements with dental practices is as follows:

“The Board has become increasingly concerned about the expanding scope and nature of management company services and agreements, and their impact on the control of dental practices by the licensed dentists.

The bundled services offered by management companies typically involve some combination of (1) administrative management services; and (2) financial management services.

Based on its knowledge of the operations of dental practices, and after reviewing management arrangements with dental practices for almost ten (10) years, the Board has identified features of management arrangements which it has determined to be highly likely to create a situation where the ownership, management, supervision or control of a dental practice is impermissibly conveyed to an unlicensed person or organization because either separately or when bundled, those features interfere with the licensed dentists’ professional decision-making and their exercise of clinical skill, judgment and supervision in the dental practice.”

Have you read about this story? What are your thoughts about the government and a State Board of Dental Examiners dictating how you administrate your dental practice?

We look forward to hearing your thoughts on this subject.

For more on this story see: Op-ed: Legislation would restrict dentistry in the state and the North Carolina State Board of Dental Examiners position at www.ncdentalboard.org (opens in a pdf file).

Dental Practice Management: North Carolina Senate Bill Wants Dentists To Do It Themselves

Senate ruling on dental practice managementLast week in our post, Dentists Beware: The Government May Want To Tell You How To Manage Your Practice, we reported on the story of the North Carolina Senate and Senate Bill 655, which would require the North Carolina Board of Dental Examiners to examine all business contracts entered into by dental practices in their state.

Dr. Clifton Cameron, a dentist in North Carolina reported to the Fay Observer that, “Senate Bill 655 would give the Dental Board complete control of how dentists in North Carolina run their practices so they can keep fees charged to patients artificially high and insurance acceptance artificially low.”

We wrote that we couldn’t find the reasoning behind such a move by the NC Senate and Board of Dental Examiners, but the Board did post the following to their website:

“The Board has become increasingly concerned about the expanding scope and nature of management company services and agreements, and their impact on the control of dental practices by the licensed dentists.

The bundled services offered by management companies typically involve some combination of (1) administrative management services; and (2) financial management services.

Based on its knowledge of the operations of dental practices, and after reviewing management arrangements with dental practices for almost ten (10) years, the Board has identified features of management arrangements which it has determined to be highly likely to create a situation where the ownership, management, supervision or control of a dental practice is impermissibly conveyed to an unlicensed person or organization because either separately or when bundled, those features interfere with the licensed dentists’ professional decision-making and their exercise of clinical skill, judgment and supervision in the dental practice.”

After we ran our original story, several doctors commented. A New Jersey dentist wrote:

“In New Jersey, the state board already forbids outside management. My partner and I spend about 20-30 per week running my business instead of on continuing education or, patient care.

The real argument isn’t whether or not I could be one of the practices recruited by management companies, but the unfair advantage it would bring to my practice over anothers’. Lower overhead, decreased fees, increased insurance acceptance, large marketing budgets would destroy competition and lower practice values and access to care.

Management companies specify laboratory selection, supply selection, employee selection, and continuing education budgets. While they bring lower overhead, they take money from the practice as well. If you fail to be attractive, your practice cannot contract with them.

Giving this advantage to a small percentage of dentists is unfair to the majority of dentists that do not wish to join or would not be accepted. I have 10 dentists within a 0.5 mile radius. We can’t all be Aspen Dental Centers. The other 9 practices would suffer, and that wouldn’t be fair.

This is about the only aspect of dental life in New Jersey that makes practicing here worthwhile. Defeat it. Resist, North Carolina!”

Another dentist responded with:

“Have they gone mad over there? Sounds like there’s something they are not telling us about…It sounds like the insurance companies are in bed with the politicians again….”

Indeed, it could be a game changer that would impact North Carolina dentists and how they manage their dental practices. The North Carolina Office of Research, Demonstrations and Rural Health Development reports that there is already a severe shortage of primary health care providers in North Carolina, particularly in the State’s rural areas.

But perhaps this isn’t about patient care at all — or making dental practices transparent.  Perhaps this is about lawmakers just playing politics.

Dental Marketing: $151,200 with Google Offers and Groupon

This is the final article in our dental marketing series on Internet dental coupon marketing.  Today we boil it all down to just how profitable this new dental marketing vector can be.

First, let’s start with a quick review of the offer and the results:

1. The basic offer — $59 for a $421 dental package.
2. That’s an 85% savings to consumers who buy within the allotted time.
3. The purchase window was 23 hours.
4. The number of offers (dental packages) available was 300.
5. The number of packages sold was 51 — or 17% of the available offers.
6. Total dollars grossed in the test was $3,009, which was split evenly — $1,504 each for Mt. Tabor Dental and Google.

(Click here to view the full ad)

What’s important to note in the results above are that 51 packages were sold for a gross income to Mt. Tabor Dental of $1,504. On the surface, this tells us that the practice now has about $29.50 available to service each of 51 new patients.

However, what most people don’t realize is the concept of “Breakage.

Not all the coupons will be redeemed with the allotted time period. The reality is that people forget to use their coupons, and breakage can run from 30% to 50%. Meanwhile the practice is using the cash immediately. (This is the same game that American Express has been playing with Traveler’s Checks for the last 60 years.)

I think we can safely assume a 30% breakage rate. This turns our 51 packages purchased to just 36, giving $41.77 to cover the service cost of each patient. Now most of you are now trying to calculate how much money you are going to lose on each of these new patients when you only have $41.77 to deliver an exam, X-rays and a bite-and-boil home tooth whitening kit.

Don’t bother!

The reality is that Mt. Tabor Dental has now identified 51 potential new patients who are willing to pay $59 each.

The average new patient in the US is worth about $975 in gross production in the first nine months of treatment. Take out delivery cost of 10%, 4% collections loss and 9% universal expenses (cotton balls) and your net marginal profit is about $750. Knock off another $50 to cover any additional initial delivery costs and you end up with $700 per patient in your pocket.

Assuming a 30% breakage loss on coupon utilization, you net 36 new patients at $700 net each for a total of $25,200. For those real pessimists in the crowd who will say that half of those bottom-feeding coupon patients won’t accept your treatment plan and stay for at least nine months, well ok, you just made $12,600.

Now do you see any good reason why you wouldn’t run this or a similar Internet coupon ad with Google or Groupon every month for the next year?

Think about a possible $151,200 net to your bottom line over the next 21 months…

Could You Run Your Family or Dental Practice This Way?

Could You Run Your Family or Dental Practice This Way?

The following was passed on to me by one of our readers . . .

Interesting Perspective on the American Debt

If you’ve been watching the world news lately, here’s some math to consider…

  • U.S. income: $2,170,000,000,000
  • New debt: $ 1,650,000,000,000
  • Federal budget: $3,820,000,000,000
  • National debt: $14,271,000,000,000
  • Budget cut: $ 2, 100,000,000,000 ( CBO estimated )/ Annualized over 10 years (210,000,000,000)

It helps to think about these numbers in terms that we can relate to. Let’s remove eight zeros from these numbers and pretend this is the family budget for the fictitious Smith family.

  • Total annual income for the Smith family: $21,700
  • Amount of money the Smith family spent: $38,200
  • Amount of new debt added to the credit card: $16,500
  • Outstanding balance on the credit card: $142,710
  • Amount cut from the budget: $210

So in effect last month Congress, or in this example the SMITH family, sat down at the kitchen table and agreed to cut $210 from its annual budget.

What family would cut $210 of spending in order to solve $16,500 in deficit spending?

Now I believe that this does not take into consideration the interest on that credit card!

It is an obvious expression of the frustration almost all of us have with the current political process and the resulting economic mayhem that we are being forced to endure.

At this point the market collapse has seen over one trillion dollars of American investors’ capital investment and dentists’ retirement funding vanish in the last two weeks.

Dentist Treatment Options: Patient Quotas

Last year, we discussed how New York state was opposed to patient quotas for dentists in the article, Dentist Treatment Options: NY Opposes Patient Quotas for Dentists.

Dentists and dental associations were outraged when Invisalign announced that dentists would only be able to offer the orthodontic treatment if they began at least 10 cases per year.

Though Invisalign ultimately withdrew this controversial “provider requirement” (read about Invisalign dropping dentist requirements), the backlash kept on coming.

Many were horrified by the idea that a manufacturer could prevent a dental practitioner from offering a treatment modality to their patients.

New York was so disturbed by this precedent that Governor David A. Paterson signed into law, Chapter 504 of the Laws of 2010, a bill that “prohibits corporations and manufacturers from setting quotas on dentists who use the corporation’s product or service.”

The bill essentially states that a manufacturer may not set quotas on dentists who wish to use the manufacturer’s product. Here’s the text of the New York state legislature bill:

“The commissioner shall promulgate regulations to require that a manufacturer or other entity selling, leasing, or otherwise providing any drug, device, or health care service shall not, directly or indirectly, establish as a condition for the use by a dentist of such drug, device, or health care service that the dentist meet any quota for the number of patients on whom the dentist uses the drug, device, or health care service and that a dentist shall not, directly or indirectly, request or receive from any manufacturer or other entity a drug, device, or health care service having a condition that the dentist meet any quota for the number of patients on whom the dentist uses the drug, device, or health care service.”

The bill, A.10943/S.7614, was sponsored by Richard Gottfried, chair of the Assembly Health Committee, and Carl Kruger, chair of the Senate Finance Committee.

The bill was passed and signed into law even though there was strong lobbying against it.

I want to hear your thoughts. Do you feel that other states should take the same action as NY? Are you dealing with any companies who have established a proficiency quota?

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