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October 29, 2007

Dentist Fights for Patient Privacy Rights

Hands Off My Patient Files!

A Canadian dentist has decided it's time to take a stand to protect his patients -- from the dental board!

As part of its regular dental practice inspections, the Quebec Order of Dentists sometimes takes original patient files, keeping them for as long as four months before returning them to the dental office. (That's if they're returned on time, of course.)

Dr. Herten-Graven has refused to turn over patient files, arguing that doing so could violate his patients' privacy. Moreover, the doctor asks, what if a file is gone but the patient needs treatment? His lawyer acknowledges that dentists are required to provide access to charts and files, books and registers, but adds, "There's nothing in the professional code that says he or she has to surrender original documents."

It's a balancing act between regulating medical professionals and respecting the privacy of patient records. "The right to regulate the profession overrides the patients' right to privacy in the same way that the police, if they get a search warrant, overrule privacy rights," said David Fraser, a Toronto lawyer who focuses on privacy concerns. "But the organization should not be demanding documents just for the sake of demanding documents."

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October 24, 2007

Dental Practice Signage: It's Worth a Shot!

Update on Dr. Jeff Clay's Sign: Redneck Target Practice

Just received the following email from Dr. Jeff Clay in Shady Spring, West Virginia, updating me on his marketing and especially his dental practice signs, both standard and electronic:


Thanks to your guidance and leadership, I do a lot of external marketing in my practice. I do radio, phone book, ChrisAd brochure, IDA website,, Hycomb quarterly newsletter, Dr Jeff Clay's Dental Signage and there's the new LED digital sign I sent you pictures of last year. Well, all that work (combined with internal marketing) is yielding an average of 67 new patients a month YTD.

The most glaring difference is the numbers I am seeing from my sign. In 2006 with my old sign, I had 36 patients say that the sign is how they heard about us. Through the end of August 2007, I have had almost double that number (69), with last month setting the record. Last month, 19 new patients put on their registration form they heard about us through our sign. The sign cost $40K, but I am feeling better about it all the time. Just thought you might find this interesting.

Sure would love to see you and Suzanne some time. I have great respect for the two of you and the great difference you have made in my professional life.

Jeff Clay, DDSShoot This Sign

P.S. Here is a story for you! Just to keep up the redneck traditions of West "By God" Virginia, my new sign has been up since December 2006. One night earlier this month, a "good ole redneck boy" drove by the sign and put three bullet holes through it. Dental signage bullet holes The holes are less than the size of your fist and not very noticeable. I am considering a partner and if that happens, we will likely change the sign face anyway. I am probably going to live with it for a while until I see what I am going to do about this partner idea. If I can get 19 new patients a month from it, I don't care if they shoot some more holes in it! :-)

Just click on the photos to see close-ups of the damage to the doctor's sign.

October 22, 2007

Dentists Love Oral Conscious Sedation Dentistry

Survey Finds OCS a Top Priority among Dentists

In our most recent survey, we asked dentists if they offer their patients oral conscious sedation. Two out of three dentists reported that their dental practices offer OCS. A quarter of dentists don't feel comfortable offering sedation. And 8% said that they wished they were able to offer OCS, but regulations in their state made it too difficult to implement in their practice.Oral Conscious Sedation Dentistry

When it comes to sedation, urban dentists are the most conservative, and rural dentists the most liberal. Rural dentists are most likely to offer sedation. In addition, urban dentists were most likely to wish they were able to offer oral conscious sedation.

Gender differences were minimal, but still significant. Female dentists were more likely to feel uncomfortable offering OCS than their male colleagues. In addition, male dentists are more likely to offer OCS at their practices.

"Oral conscious sedation is an excellent tool for the fearful patient that has not been to the dentist in years," commented a New Jersey dentist. "The regulations are overly onerous. More rules and regulations won't prevent irresponsible behavior--it will only prevent many competent practitioners from utilizing this modality," complained a Maryland pediatric dentist. "I think the training provided by DOCS (Dental Organization for Conscious Sedation) is both adequate and excellent. I oppose the new regulations proposed by the ADA," wrote a Michigan dentist.

Read the full oral conscious sedation survey results.

October 16, 2007

A Good Dentist Deserves a Reasonable Fee Increase

by Jim Du Molin

"Okay, I'm ready to raise my fees... Now what?"

This is the third (and final) installment in my series about dental fees. First we discussed the role dental patients play. Last week, I talked about insurance companies. And now that I've convinced you that it's time to raise your dental fees, let's move on to how you should do that.

One of the toughest questions we face in dentistry is "How much should we raise our fees?"

We've previously discussed the fee restrictions imposed by insurance companies, especially those which may have the effect of imposing a ceiling on dentists who choose to indenture themselves to a pre-set fee structure. We also dealt with the more subtle issue of overcoming fee objections from patients by enhancing the perceived value of the dentistry.

In this section, we look at the question of how much of a fee increase is reasonable, other limitations aside. There are three key elements to consider.

  1. Is your practice producing a reasonable economic return?

  2. What has been the inflation rate for your cost of providing service since your last fee increase?

  3. Are you being adequately compensated for the quality of materials you use and your personal experience in providing your primary treatments?

How large a fee increase you "need" will depend on whether you need to increase profits, or merely maintain profits in the face of inflation.

Is your practice producing a reasonable economic return? If your practice is running a chronic monthly deficit, clearly the answer is "no." On the other hand, are you narrowly avoiding a deficit in the practice by under compensating yourself?

In either case, the practice is not realizing a reasonable return and we must address the basic issue of economic survival. You are providing a necessary health care service to the community. However, to continue doing so, you must be able to pay all of your bills each month and take home a reasonable personal income.

How much is "reasonable"? A reasonable income compensates you for the risks you have taken. These include the cost of your education, the cost of purchasing a practice and/or equipment, operating loans taken against your practice, and the investment in time and energy that you and your family have made to establish your practice.

Just as important, a "reasonable" income includes setting aside enough each month to provide for retirement and/or financial independence. Ninety-two percent of the dentists in America continue to work past the age of 65. Some of them are doing so because they enjoy treating patients. In reality, many probably do not have a choice, and must continue working to maintain their lifestyle.

Raising fees alone may not increase profits enough to eliminate your chronic monthly practice deficit, fully cover your personal lifestyle needs, and allow you to accumulate the funds needed for long-term financial independence. That's a big bill to fill. However, fees are a primary strategy.

The unique thing about raising fees as a strategy to increase profits is that, assuming collections are well managed, virtually 100% of a fee increase goes straight to bottom-line profits.

In contrast, most other strategies for increasing profits require an increase in production, and that means additional costs in the areas of treatment supplies, lab fees, and staff costs. Moreover, it means the dentist or other providers in the practice have to see more patients.

Raising fees gives you more dollars without doing more work. That means more profits without increasing stress.

The second element in the fees equation is the dental inflation rate since your last fee increase. This is the percentage increase in your overall operating expenses, including staff salaries, rent, insurance cost, supplies and lab fees. It is important to remember that inflation acts as a hidden tax on your income. If the cost of providing your services goes up by 5% and you raise your fees only 3%, the 2% difference comes out of your pocket.

To calculate the inflation rate for dentistry, take an estimated consumer inflation rate of 2.5% and divide it by 12 to get the monthly average rate of inflation (0.20). Then multiple the monthly consumer inflation rate by the number of months since your last fee increase (lets say 6 months) to generate consumer inflation since your last fee increase (0.20 X 6 = 1.2).

Unfortunately we can't stop there. According to the ADA, dental inflation traditionally runs at about 1.74 times consumer inflation. (If anyone has seen a recently updated dental inflation rate from the ADA, please feel free to email me.) So we have to almost double the consumer rate of inflation to get the true rate of dental inflation. Another way to look at it is that you are currently discounting your fee by the rate of dental inflation since your last fee increase.

The final and one of the most important areas to consider in setting your fees is "How much more should you be compensated for the quality of materials you use and your experience in providing treatment?"

The real issue we are addressing here is that not all dentists are created equal. How should you be compensated, relative to other dentists, for the fact that you have years of experience, obtain an extraordinary number of hours of continuing education per year, and/or maintain the latest technology in materials and equipment?

Shouldn't your higher level of experience, training and technical delivery warrant a premium when setting your fees? Is this worth an additional 3%, 6% or even 10% over less experienced and less qualified practitioners in your area? Only you know how you compare in this area.

How much of a fee increase is the "right" amount? Assuming that your fees were reasonable a year ago, a simple 3.5% to 4% increase to cover inflation on your costs is a reasonable place to start. Of course, if your fees have not kept pace with inflation for two or more years, a larger increase may be necessary to catch up.

On top of this, add whatever premium you feel is warranted for the quality of materials you use and your experience as a practitioner. This is a highly subjective matter, and there is no "right" answer.

Some doctors will need to add a third layer to their fee increase to derive a reasonable economic return. These are the doctors who need to increase the bottom line so that the practice is profitable and compensates the dentist fairly.

You deserve to take home enough income to keep up with inflationary increases in your personal living expenses such as food, clothing, and child care, and also put away some dollars for financial independence.

Remember that quality treatment must be supported by fees. The fees you charge should adequately compensate you and allow you to maintain your staff, facilities and continuing education at the highest levels.

October 14, 2007

How Dentists Refer Braces Patients to Orthodontists

Some Dentists Enjoy Orthodontics, While Others Are Glad to Refer PatientsReferring Orthodontic Patients

In our most recent survey, we asked dentists what percentage of orthodontic cases they refer to an orthodontist. One in four dentists reports that they treat most braces patients themselves. On the other hand, one in three refers out all orthodontic patients.

"It's a win for everyone!" said an Illinois dentist who refers out all orthodontics. "Patients are well served, we are looked upon as caring, and orthodontists are geared specifically to do this." A Georgia general dentist disagreed, stating, "I don't need to refer for 95% of cases or more."

One Califonria dentist summarized his attitude: "I am happy to refer out those cases which I don't feel competent to treat or which I just don't want to treat for whatever reason. Having been actively treating orthodontic cases in my general practice for over twenty years now there are not a lot of cases which I refer out. Ortho provides me with a change of pace from the daily drill and fill routine."

Read the full orthodontist referral survey results.

October 08, 2007

Dental Pain? Maybe These Hot Peppers Will Help

When hot red peppers were discovered in the New World, it didn't take long for them to make their way into savory dishes across the world. In recent years, researchers have discovered medical benefits to capsaicin, the chemical compound that gives hot peppers their heat. It's led to topical pain relievers designed to treat conditions such as arthritis.

Well, now dentistry is getting in on the action! New research suggests dental patients may soon be able to skip both pain and numbness. Rats treated with capsaicin and a lidocaine derivative maintained sensation in their paws, but didn't react to pain. Researchers hope to soon ease the pain, not just of dental patients, but of other patients too. (Pain-free childbirth, anyone?)

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Dentists Dating Patients

Dentists and Dating Dental Patients

It Happens More Than You Might Think...

In a recent Wealthy Dentist survey, we asked dentists if they have ever been romantically involved with a patient at their dental practice. One in five dentists reports having dated a patient. The remaining 80% do not date their dental patients.

"It crosses the professional barrier and can cause problems down the road," said one Florida dentist. "It happens," observed a Connecticut dentist. "I married one 51 years ago and am still married to her," boasted one happy New York dentist.

Dental Insurance and Fee-Setting

by Jim Du Molin

Setting Dental Fees (and Dealing with Insurance Companies)

An auto mechanic changing a muffler has more control over the fees he charges than many doctors.

Last week I discussed how to handle dental patients and dental fees. Now it's time to discuss insurance companies.

I remember asking doctors to explain exactly what procedures they followed when they increased their fees. Each explained that he took his old fee schedule and guesstimated a general 3%-6% increase in fees on those services he performed most. The next step, in about 80% of the cases, was to send the new fee schedule to the insurance company for approval.

At this point I would jump in and ask a series of questions:

  1. Why are you sending your fee schedule to an insurance company for approval?

  2. Is the insurance company a partner in your practice?

  3. How much money did the insurance company invest in your practice? Do they chip in extra cash at the end of the month if collections are short of what it costs you to run the practice?

I would then ask, "Was your new fee schedule rejected by an insurance company within the last year?" Over half the doctors I asked said yes.

One doctor explained that his fee increases had been rejected three times by an insurance company and each time the process took two months. After six months, he still hadn't gotten approval. Each time he was rejected, the insurance company explained that his fees were 1.5% to 4% over what is considered the usual and customary fee for practitioners in his zip code area.

When the doctor called the insurance company to ask what he could charge on specific treatments, relative to other practitioners in his zip code, he was informed that that information was confidential and that he would have to just keep guessing until he got it right.

At this point, most doctors come to the conclusion that the deck is stacked against them. What does your zip code have to do with what you need to charge your patients to economically perform treatment? Does everyone else in your zip code have the same overhead expenses, use the same quality of materials, invest in the same level of continuing education for their staff, and have the same amount of experience that you have in providing a given treatment?

Before we take this discussion any further, I want to be clear that not all insurance companies treat the participating doctors in this manner. Additionally, dental prepayment plans have dramatically increased the affordability of and thus the availability of dental treatment to the public.

In exchange for the patient referral and the automatic assignment of benefits, many doctors have signed agreements stating that "they may not charge a patient from DLT Dental Insurance Company a rate higher than their usual and customary fee for a specific treatment." However, an increasing number of doctors are finding themselves being squeezed by increasing operational costs on one side, and the amount they are allowed to charge as specified by their PPO and HMO agreements on the other side.

Dental care treatment costs increase annually at a rate of 4% to 4.5% as compared to the general inflation rate of 2.5%. Many insurance companies are holding fee increases to the 2.5% level, which leaves the remaining 2% increase in operating costs to come from the doctor's pocket. In a practice producing $360,000 a year, with 50% of the patients on prepaid-fee controlled programs, the loss to the doctor will be approximately $3,600.

What are your choices?

Your first choice is to resign as a preferred provider from the offending prepaid plans. Resigning does not necessarily mean you will lose the patients who carry this plan. What it does mean is that the patient will have to pay you first and seek reimbursement from the insurance carrier directly. It is interesting to see how much faster the patient is reimbursed for treatment than when the doctor takes assignment and files through the practice.

We want to be clear that we are not recommending that every doctor drop his insurance company affiliations. However, if only 10% to 20% of your patients are on fee-controlled prepayment plans, you might find it to your advantage to ask these people to file for reimbursement directly with the carrier. For the most part, the verbal skills of your staff in explaining your new policy to patients is the key to successfully implementing this change.

If 40% or more of your patient base is on a controlled-fee insurance plan, the thought of dropping the plans may be a little frightening. There may be a less scary alternative: two fee structures.

Now before we go much further, we want to qualify these comments with the admonition to check your insurance plan agreements very carefully. Also, check any state or local regulations which may govern your fees. Your dental society is one of the best sources of advice in this area.

Many of your insurance company agreements stipulate that "you may not charge a patient with DLT Dental Insurance Company a rate higher than your usual and customary fee for a specific treatment." The reverse of this is also true - you may charge a DLT patient less than your usual and customary fee.

The logical result is two fee structures: one fee structure for DLT insurance company patients, and a higher fee structure for "usual and customary" patients. In implementing this strategy, there are two aspects to consider, one practical and one ethical.

On the practical side, you need a method to identify different fee structures with different patients. This is one place where a computer system is invaluable. Most systems allow multiple fee structures, with the appropriate structure being assigned to the patient at the time of initial data entry for insurance and billing. Many doctors have found that the multiple fee handling features can pay for the entire computer system.

For non-computerized practices, a simple color-coded sticker on the inside of the patient's chart can act as a reminder to the doctor and staff of which fee structure to use.

The question that usually comes up at this point is what to tell the patient when you have just quoted her a crown fee of $632 and she asks, "Why doctor, my cousin Mary was here just last week, and you did her crown for only $580. Why am I paying more?" First you must recognize that the chance of this happening, even in a small town, is rare. But if it should happen, deal with the question with honesty and integrity.

Pull cousin Mary's chart and tell your patient the truth. "You're right; we did do Mary's crown for $580. Mary works for ABC Electric Company, which provides her dental insurance through the DLT company. By contract, we have registered a special set of fees with DLT. If you had your insurance through DLT, we could offer you the same rate."

People are used to special discounts for different classes of patients. Most doctors give 5%-10% off for the elderly. Many give up to 8% off to patients who pay cash. In our example, Mary received a reduced rate because she is insured through the DLT company.

The ethical question is not as easily answered. With two fee structures, your "usual and customary" fee patients are actually subsidizing your DLT insurance patients. This a question which each doctor must wrestle with individually.

Remember that quality treatment must be supported by fees that allow you to maintain your staff, facilities and continuing education at the highest levels of which you are capable. If fees are restricted by one class of insurance patient, do you cut back on the quality you provide, or raise fees for your usual and customary patients?

There is no easy answer. We welcome your comments.

October 02, 2007

Celebrity Cosmetic Dentists: Dental Survey Results

Most Dentists Think Celeb Docs Are Good for Dentistry

Dental Survey In our most recent survey, we asked dentists if they think celebrity cosmetic dentists are good for the profession. Two out of three dentists say TV dentists are good for dentistry, and media exposure only makes the public more aware of what cosmetic dentistry can offer. The remaining 38% feel that these docs are pushing appearance over health, and it's not making dentists look good. "It's all about the money and prestige... What ever happened to the best interest of the patient?" asked a Georgia dentist. "There is so much we can do for people by improving their smiles!" exclaimed an Oklahoma dentist.

Read the complete celebrity cosmetic dentistry survey results.

September 30, 2007

Dentist Collects Candy for Troops in Iraq

Dental SurveyCincinnati dentist Dr. Larry Hagen is putting a new spin on a classic dental ploy. As many dental practitioners do this time of year, he's offering to buy back kids' Halloween candy for a dollar a pound. However, he's not just doing it to get the sugary treats out of the hands of children!

The doctor plans to send his candy collection to American troops stationed in Iraq. It's an idea that occurred to him as he packaged up sweets to send to his stepson, now in his second tour of duty. As Dr. Hagen points out, troops overseas have more to worry about than cavities. If his candy donations bring them some small joy, then bless the doctor for having done his part.

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Note: This web site is for the purpose of disseminating information for educational purposes, free of charge, for the benefit of all visitors. We take great care to provide quality information. However, we do not guarantee, and accept no legal liability whatsoever arising from or connected to, the accuracy, reliability, currency or completeness of any material contained on this web site or on any linked site. Copyright 2007. Du Molin and Du Molin, Inc. All rights reserved.