Bulletin, August 2009

The Latest in Area Economic and Technical Trends
Exclusively to Clients and Friends of Advanced Practice Management

The Dental Dow Jones, First Semester 2009:

The mature area practices sampled show an increase in production and collections of 2.3%. Patient flow is almost exactly equal with last year…up less than 1/2 %. New patients are up 6%. Crown and bridge is up 7%. Production per exam is up 2.3%…probably less than fees.


Doctor and Hygiene Down Time was up about 5%. Schedules are a little ligher. About 2/3 of the practices showed mild production increases and 1/3 mild declines.

Delta gets snout rapped in Rhode island

As reported in DrBicuspid.com on July 2nd, a new law in Rhode Island prohibits insurance companies from limiting the fees of dental procedures that they do not cover. Nationally, Delta Dental has been attempting to implement a new feature of its Premier and PPO provider organization contracts that require dentists to honor their contracted fees for services that are not covered by a subscriber’s plan. This includes dental work performed by participating dentists even if not covered because the patient exhausted their annual maximum.
For years now in Minnesota, Doctors have had to take Delta write offs even after the maximum was reached. Fees on non-covered services haven’t been subjected (yet).

None of us like the idea that Delta limits fees for non-covered services (like veneers and bleaching). For one thing, how do you set a fee for such procedures when there can be such a wide range of materials and lab costs?

There are many other states where Doctors can get their full fee (not have to do Delta write offs) once the patient’s maximum has been met. The idea is that the insurance helps cover the first $1,500 or so but after that the patient is responsible. When talking with other management consultants and hearing about their strategies with Doctors in other states, they have been more willing to accept PPO discounts because they can get their full fee once the insurance maximums are reached. I think all of you heard the argument that Delta and other insurance companies should have their maximums increased to $5,000 to have the equivalent coverage of what they had 20 years ago or so. In this context it’s almost good that the maximum hasn’t been moved up.

The Rhode Island legislature voted for this because they felt that it was unfair to patients who didn’t have insurance coverage to in fact subsidize (indirectly) patients who had insurance with big write offs. Also, they felt that could affect access for patients. Rhode Island has neighboring states where the fee schedules are not as low and Delta write-offs are not as much. That gives incentive to new Dentists to not practice in Rhode Island.

Hopefully, this marks a turning point in Delta’s ability to continue to implement these policies nationwide. Maybe some day we can turn it back in Minnesota.

The most difficult subjects in dentistry: money and insurance

Collections Made Comfortable—The Team Approach is coming October 2nd. This has been a perennial favorite. It’s not just about collecting money. It’s about moving patients to treatment. It’s about patient relations. It’s about dealing tactfully with the most difficult areas.

As clients, you are entitled to a $20 per attendee discount. Call our office today to reserve your space. These seminars sell out. We offer this primarily for our clients so get yourself and your team there. You will not be disappointed.

Keeping you informed

When you are an Advanced Practice Management client you are automatically plugged into the data base and experiences of 250 Upper Midwest offices. Our clients tell us the number one reason they hire us is “for an informed third party perspective” and we are very serious about keeping you well informed. So, we continue to add to our website. On it we have data on Fee, Wage, Overhead and Technology surveys as well as our articles and seminars. We are soon going to add an area for “Resources” where we will list vendors that we know to be reliable.

You are going to be spending $50,000+ so don’t blow it!

According to our 2009 survey, as of this year more than 50% of dentists (54%) now have digital x-rays. Bringing computing to the operatories entails considerable expense. Usually as digital x- rays are added, other technologies are added or upgraded too such as intra-oral cameras, patient education software, and digital record keeping. Financially speaking, this often comes out to over $12,000 per treatment room.

The pace of bringing digital technology to the operatories is increasing. Many of you will be making these investments over the next three to four years.

Since we have and will have many clients who will be investing over $50,000, $100,000 and up in this technology, I have two main suggestions to get more bang for your buck:

  1. Get professional help in specs and get bids for the equipment— “cost control”;
  2. Commit to additional training so you get “result control.”

In business, costs are inevitable. A consistent theme of my advice to clients is that you have to have “result control.”

That is, if you buy intra-oral cameras, you want to make sure they’re used. Half of intra-oral cameras are used less than five times per week.

Almost every office with intra-oral cameras struggles with getting them to be part of the hygienists’ routine (and the hygiene department is where they can have the greatest benefit in helping the patients understand their problems and value your solutions).

Lots of offices have the capability to do chartless record keeping but less than 10% are truly chart free. With this technology in the treatment rooms the hygienist (for example) can post charges, set their next appointment, use the intra-oral camera, enter the treatment plan and use the patient education software. However, usually only two or three out of these five things are routinely done. Most dentists have neither the inclination or the time to keep up on computer software and hardware. I have seen many installations where there was no competitive bidding whatsoever. Or, once the equipment was installed it was glitchy… the digital x-rays would go down in one room now and then, the intra-oral cameras wouldn’t work well, there would be server problems, wires and cables in the way, poor monitor placement, etc. With technology the devil is in the details: video cards, cabling, monitors, monitor position, support, warranties, digital x-ray choices, etc.

There are reputable and competent technology installation firms out there, such as Erickson Technologies 651-452-6758 and Sunset Dental Technologies 612-326-8693. However, many clients have used the local “computer guy” or just bought the hardware from the software vendor or supply company.

I recommend you check out Ted Takahashi with T2 Consulting 952-891-5177. Ted does not sell anything and makes no commission or “finder fees” on any technology recommendations. What he does do is draw up the specs so you can get competitive apple to apple bids. He knows what works and he’ll help you pick the right stuff. And, furthermore, you’ll be assured that the installation will be truly functional from day one. He has planned over 750 installations nationally, and he is based out of Eagan, Minnesota.

If you’re about to make a $50,000+ purchase, I strongly recommend you talk to Ted and ask him directly this question: “Why should I hire you?” Anyone that is selling you equipment will tell you that Ted’s services aren’t necessary that they’ll make sure you get a good deal and the specs are right anyway. I’ve had clients save many thousands of dollars by making sure with a new facility or facility upgrade that they had competitive bidding. Don’t let the suppliers take your business for granted! There almost always is some bargaining room if you go through a bidding process. You need someone in your corner who knows the technology.

I’ve made a special partnership arrangement with T2 consulting for an 8% reduced fee for active APM clients. As always, we stand behind our work and guarantee you’ll be satisfied. For more information, go to our website and see Mr. Takahashi’s article, “The Chicken or the Egg…which comes first?”

The $1,000,000 staff is coming to town soon. Be there!

Our good friends, Dr. Joe Steven and Dr. Mark Troilo are coming to Minneapolis to present their popular seminar, The $1,000,000 Staff.

Many of you have seen Joe and Mark in previous seminars and know them to be the gurus of ”bread and butter” dentistry. I’ve arranged a 25% discount for our Advanced Practice Management clients who would like to attend. I highly recommend that you take your entire team to this team-building seminar on Friday, October 30.

Not only is this presentation very entertaining, it is ideal for motivating your entire staff to perform at their highest level in winning over your patients and working together as a team! You’ll see that you can actually enjoy dentistry while becoming more successful. Be sure to tell them you are a client to get your 25% discount!


As you can see, we are working hard on your behalf to arrange for special services, seminars and savings. These are some of the perks of being an APM client. Thank you for your business.