Dentistry North Texas
a business and lifestyle magazine for north texas dentists
The Power of Technology
Endodontic Associates of Tarrant County
Smiles in the Spotlight
Dr. Ruben Ovadia Gingival Recession and Treatment
2012 Rite to Smile Golf Classic
Benefits for Patient Referrals
Exclusive Resources Proven to Drive Revenue and Reduce Overhead ProfitMaX changes the playing field for independent dentists and small group practices in the battle against corporate dentistry.
Our production is up 41%! -Dr. B., Dallas, TX
Grow Grow Re Revenue venue
What What is ProfitMaX? ProfitMaX? For the first time ever, ofitMaX pr ovides independent For everr, Pr ProfitMaX provides world-class rresources esources and sservices ervices that that dentists with world-class are proven proven tto o drive drive rrevenue evenue higher and overhead overhead lower. lowerr. are ProfitMaX, yyou ou can no w ccompete ompete he ad-to-head With ProfitMaX, now head-to-head corporate dentistry while pr eserving with corporate preserving
· · · · · · ·
Increase New Flow Incr ease Ne w PPatient atient Flo w Boost Hygiene Production Boo st Hy giene Pr oduction Improve Casee Ac Acceptance Impr ove Cas ceptance Win-Win Establish WinWin Financial Arrangements Arrangements Low-Risk Expand Lo w-Risk PPatient atient Financing Options Revenue Through Maximize Re venue Thr ough FFee ee Optimization Optimization Drivee Daily Suc Success Effective Driv cess With Eff ective Morning Huddles
your independenc e. your independence.
Reducee Overhead Reduc Overhead
up-front ont ffee ee and monthly mon A nominal up-fr ensuree lasting pr profits ofits – sservice ervice fee fee e ensur exceed the ssavings aving vin s alone ex xcceed the fees! fees! e
· · · · · ·
No Risk Guarantee If after 6 months, your net practice profits have not increased enough to pay ffor or the ProfitMaX service ffee, ee, Nexus N will ill refund you
TWICE T WIC CE THE DIFFERENCE
CALL NOW to Learn More!
Reducee Lab Costs Compromising Reduc Costs Without C ompromising Quality Drive Down Costs wn Supply C osts Drive Do Optimize Staff Productivity Productivity Decrease Decrease Bad Debt Enhance Enhance Patient Patient Service Service Measure Monitor or PPerformance erformance Measure and Monit
Gain Financial Freedom Freedom · · · · ·
Estate Estate Planning Wealth We Wealth Ac Accumulation cumulation and Exit Str Strategy ategy Planning Analysis Financial Analysis Accounting Analysis Practice Loan Analysis
““We We ssaved aved 44% 44% on our first supply or der!” order!” - Dr Dr. r.. D D.,., Dallas, TX
Dentistry North Texas
ON THE COVER
COVER Photos: Ray Bryant, Bryant Studios
Endodontic Associates of Tarrant County
ON THE COVER: Neal Horn, DDS, MS, David Gruber, DDS, MS and Gavin Convey, DDS, of Endodontic Associates of Tarrant County
BAYLOR COLLEGE OF DENTISTRY
Grant Opens the Door for New Center for Excellence
Benefits for Patient Referrals Are you violating the anti-kickback and self-referral statutes?
2012 Rite to Smile Golf Classic Join the fun and support a good cause!
SMILES IN THE SPOTLIGHT
Dr. Ruben Ovadia Gingival recession and treatment with subepithelial connective tissue graft
Internet Marketing Initiatives 10 ways to optimize your website’s performance
Do You Have A “Get-Out-Of-Breach Free” Card? Are you prepared if your patient health information is compromised?
Zinfandel: An American Wine Story The evolution of an American favorite
Does Your Culture Create Learned Helplessness? The culture that we create influences every aspect of our organization
The Competitive Advantages of Corporate Dentistry Suggestions for solo practitioners
Transition Planning for a Newly Acquired Practice Financial considerations when buying or selling a practice www.northtexasdentistry.com
NORTH TEXAS DENTISTRY
from the publisher
Dentistry North Texas
Publisher | LuLu Stavinoha Photographer | Ray Bryant, Bryant Studios Contributing Writers | Scott Beard, Tina Cauller, Kim Clarke, Jennifer Fuentes, R. Kirk Huntsman, Dr. Laura Mitchell, Dr. Ruben Ovadia, Neil Rudoff, Dr. Joel T. Small, Sarah Q. Wirskye, David Yandry
The Texas summer is in full swing as our temperatures are soaring well over 100 degrees! I hope you have had an opportunity to escape the heat for a cooler climate.
For this issue North Texas Dentistry visited Endodontic Associates of Tarrant County, the specialty practice of Drs. Yogesh Patel, Neal Horn, David Gruber and Gavin Convey. This dynamic team of doctors uses the latest technology in providing endodontic care.
Periodontist, Dr. Ruben Ovadia presents this issue’s Smiles in the Spotlight. The case presentation showcases a gingival graft using subepithelial connective tissue. If you have an impressive case you would like to present contact North Texas Dentistry for details.
Also inside you will find some great articles. In the column, Benefits for Patient Referrals, attorney Sarah Q. Wirskye answers the question, Are You Violating the Anti-Kickback and Self-Referral Statutes? Dr. Joel Small discusses leadership styles in the article, Does Your Culture Create ‘Learned Helplessness?’ and Money Matters looks at financial transition planning in Scott Beard’s editorial, Transition Planning for a Newly Acquired Practice. Enjoy these and more!
Texas dental community. The SMILE Walk, which raises funds for Community Dental Care, will be held Saturday, October 6 and the Rite to Smile Golf Classic presented by the North Texas Dental Society is Monday, November 12. Have fun and raise money for these great causes.
As the team at North Texas Dentistry wraps up the production of the Special Issue for 2012, it is time to turn our thoughts to the Southwest Dental Conference. North Texas Dentistry is working on the production of the Convention Issue for the 2013 SWDC. Make your plans now to promote your business or service to the North Texas dental community through print advertising, custom profiles and special features. Our team can make your marketing dreams a reality!
WRITING / DESIGN
Thanks to all who support North Texas Dentistry and make its publication possible! Keep smiling and have a great day!
Lulu Stavinoha, RDH Publisher
Make your plans now to participate in two outstanding events that benefit the North
4 NORTH TEXAS DENTISTRY | www.northtexasdentistry.com
Although every effort is made to ensure the accuracy of editorial material published in North Texas Dentistry, articles may contain statements, opinions, and other information subject to interpretation. Accordingly, the publisher, editors and authors and their respective employees are not responsible or liable for inaccurate or misleading data, opinion or other information in material supplied by contributing authors. Copyright 2012. All rights reserved. Reproduction in part or in whole without written permission is prohibited.
Advertise in North Texas Dentistry For more information on advertising in North Texas Dentistry, call LuLu Stavinoha at (214) 629-7110 or email firstname.lastname@example.org. Send written correspondence to: North Texas Dentistry P.O. Box 12623 Dallas, TX 75225
$3.4 million grant
opens the door
for new Center of Excellence
By Jennifer E. Fuentes Center of Excellence to advance diversity in faculty and students at Texas A&M Health Science Center Baylor College of Dentistry has been established through a new $3.4 million grant to the college from the U.S. Department of Health and Human Services’ Centers of Excellence program.
Awarded through the department’s Health Resources and Services Administration, the competitive grant program for health professions schools was developed to strengthen the national capacity to produce a quality health care workforce with racial and ethnic diversity that is representative of the U.S. population.
“I’m delighted by the opportunities that this grant will afford to the students and potential faculty of TAMHSC-BCD,” said Sen. Royce West. “Minorities will be recruited, retained and successfully matriculated through the academic and professional rigors of TAMHSC-BCD, thus increasing the diverse pool of health professionals who will address current and emerging health issues for years to come.”
Starting with first-year funds of nearly $700,000, with recommended renewal for four additional years, TAMHSC-BCD’s fiveyear grant is titled “Bridge to Dentistry: Awareness to Practicing, Teaching and Research” and will be led by Dr. Ernestine Lacy, professor and director of student development in the Office of Student Development and Multicultural Affairs. The Center of Excellence will provide the college with the opportunity to further increase the numbers of underrepresented minority students that it enrolls and faculty that it appoints and retains by providing support that enhances the success of these individuals.
“We are ecstatic about receiving this highly competitive award,” said Dr. Lawrence E. Wolinsky, TAMHSC-BCD dean. “This will give Dr. Lacy and her team the opportunity to lead our college in the significant expansion of an already successful pipeline program. The grant also bolsters the dental school’s ability to serve as a national resource and educational center for diversity and minority health issues.”
The center is a comprehensive program linking the Dallas Independent School District, three undergraduate institutions and community-based entities to provide activities involving Pre-K through dental students and dental faculty. Designed to establish, strengthen and expand programs that enhance the academic performance of minority students attending TAMHSC-BCD, the center also will serve as a catalyst for the college to further institutionalize its commitment to improving access to care for underserved communities.
It will enhance programs that educate TAMHSC-BCD students in providing health care services to a significant number of minorities at off-campus, community-based facilities. It also will strengthen the development of a large competitive applicant pool and establishment of an educational pathway for health professions careers.
The additional funding will enable the college to improve information resources, clinical education, curriculum and cultural competence as they relate to minority health issues and help facilitate faculty and student research in health issues particularly affecting minority groups.
“Although we take great pride in having the nation’s most diverse dental school enrollment, our true success ultimately lies in our ability to establish a replicable model for graduating dental professionals who are committed to improving the oral health of urban and rural underserved communities in Texas and beyond,” said Wolinsky. g
Founded in 1905, Baylor College of Dentistry in Dallas is a college of the Texas A&M Health Science Center. TAMHSC-BCD is a nationally recognized center for oral health sciences education, research, specialized patient care and continuing dental education. The TAMHSC serves the state as a distributed, statewide health science center that is present in communities throughout Texas. Jennifer Eure Fuentes is a communications specialist at Texas A&M Health Science Center Baylor College of Dentistry. A 2006 graduate of Texas Christian University, she has worked in the communications and editorial field for five years.
NORTH TEXAS DENTISTRY
Photos by Ray Bryant, Bryant Studios
The Power of Technology
Endodontic Associates of Tarrant County
GAVIN CONVEY, DDS, DAVID GRUBER, DDS, MS, NEAL HORN, DDS, MS
Tech-savvy practitioners at Endodontic Associates of Tarrant County know that well-chosen technologies benefit the overall patient experience thus making treatment more effective and efficient.
ur world is awash in technology that continues to transform our daily lives in sometimes surprising ways that we probably didn’t imagine even ten short years ago. If you are out of high school, you remember way back when Pluto was still a planet, a blackberry was still a fruit, and “friend” was still a noun. Not very long ago, email was a novelty − today, we Twitter, text and Skype in a constant state of interconnectedness with people, products and services around the globe. We have access to boundless information and we have come to expect that things will continue to get better and better, faster and faster. With few exceptions, our expectations are on the mark.
In dentistry, technology has made treatment better, safer and faster. Tech-savvy practitioners like Neal Horn, DDS, MS, David Gruber, DDS, MS and Gavin Convey, DDS of Endodontic Associates of Irving know that well-chosen technologies benefit the overall patient experience. From the perspective of the dentist, technology makes treatment more effective and efficient. Dr. Horn points out, “Even before the first visit to our office, the
6 NORTH TEXAS DENTISTRY | www.northtexasdentistry.com
patient’s experience is improved by technology. For one thing, our practice is completely paperless. Patients can register online and learn more about the procedure that is planned before the first appointment. We collect a complete medical history before the visit so patients spend less time waiting at their appointment before treatment begins. As a convenient alternative, patients can use a wireless laptop in the reception area to securely provide their information.”
Dr. Gruber adds, “We understand the time constraints that affect our busy patients and we do everything we can not to waste their valuable time. In our first contact on the phone, we find out whether they would prefer treatment that day or prefer to wait until a later time. We can usually perform the diagnostic testing and treatment at the same appointment for maximum convenience.”
“For patients, the top priority is relief from pain and to have a pain-free visit. We assure them that keeping them calm and comfortable is also a priority for us, and that they can expect treatment to be painless. We offer nitrous oxide when necessary, for added reassurance,” Dr. Convey notes.
leagues and establish the groundwork for strong teamwork based in clear, open communication. General dentists can contact the doctors directly at any time by phone. “We consider our general dentists to be an integral part of our team and greatly value their contribution to the treatment plan rather than dictating a specific approach,” notes Dr. Horn. Since all patient charting is digital, a customized report can be securely emailed to the referring office immediately after treatment to keep the general dentist informed, followed with a hard copy for convenience.
Endodontic Associates of Tarrant County is completely paperless. Patients can register online or can use a wireless laptop in the reception to securely provide their information. Referring doctors have the utmost confidence in Endodontic Associates and know that their patients will be in good hands. The doctors take pride in being a resource and asset to the referring dentist’s practice. Dr. Gruber explains, “Our goal is to help dentists find ways to save their patients’ teeth, whether that means consulting with them about a case they are working on or providing specialty care for their patient.”
Dr. Convey adds, “Our referring dentists know that patients will receive quality endodontic treatment in our office. We focus our training on knowing when endodontic therapy is necessary and appropriate, ensuring an accurate diagnosis, and understanding the options for each patient. When the etiology of a painful tooth is elusive, it is critical to look at the problem area at a microscopic level. In the case of retreatment, we determine why the treatment failed and consider how we can optimize the chance of long-term success. Most dentists are surprised at the success rate of retreatment when patients have experienced a problem getting the results they desire.”
Diagnostic accuracy, which is crucial to endodontic success, has been greatly enhanced by sophisticated technology. At Endodontic Associates of Tarrant County, the most advanced, powerful technology helps support the best possible results. Powerful microscopes, sophisticated rotary files, high-tech sealers and filling materials are all part of the advanced technology that has elevated modern endodontic care to a new standard.
Putting this powerful technology in the hands of experienced specialists further enhances the capability of the practice to offer endodontic excellence. Together, Drs. Horn, Gruber and Convey bring more than 30 years of endodontic experience to each and every patient, which is a great advantage in the most difficult cases. They are committed to building personal relationships with referring dentists. Several times a year, they host lunches or other gatherings to get to know their dental col-
The fresh, new facility is crisp and clean, so patients can anticipate the best possible experience. The new office is thoughtfully designed to ensure personal treatment in a relaxed atmosphere. The office interior is serene and calming and features sunny, open spaces appointed with tasteful art and a large-screen television. The four spacious operatories are close to the front, and the floorplan ensures an efficient, comfortable flow.
The experienced office staff makes sure that each patient receives a warm welcome and has a positive experience from the first call through to the follow-up. Each patient has an opportunity to discuss any questions or concerns about treatment beforehand with the doctor and receives a thorough explanation of the scheduled treatment. Dr. Horn notes, “We make sure each patient understands their diagnosis and is wellinformed about the most appropriate options. We encourage them to participate in guiding their treatment plan.”
Prior to the endodontic procedure, Dr. Horn explains the treatment plan and makes sure all of the patient’s questions are answered. Dr. Gruber adds, “Our dental assistants are really the unsung heroes of the practice. They visit with the patient to get their history and help relieve any concerns they might have about treatment.”
The unique blend of clinical expertise, experience and technology at Endodontic Associates of Tarrant County has created a beneficial situation for dentists and patients alike. With three specialists www.northtexasdentistry.com
NORTH TEXAS DENTISTRY
The office environment of Endodontics Associates of Tarrant County supports relaxing, positive emotions and avoids anything that evokes anxiety.
The microscope allows the doctors to visualize the anatomy in great detail.
8 NORTH TEXAS DENTISTRY | www.northtexasdentistry.com
Top: CT scan illustrating a section of the lower left mandible in all three planes. Bottom: CT scan detailing the missed distal-buccal canal.
in the practice, coverage is enhanced so that emergencies can almost always be accommodated immediately. Patient response to Endodontic Associates of Tarrant County has been very affirming, and many refer family and friends for endodontic care based on their own positive experience. Once clinicians see how the latest technology in the hands of experienced, caring specialists can expand their capacity to preserve teeth, most find that it recharges their interest and passion for professional practice. It also leaves their patients with a satisfied smile.
Endodontic Associates of Tarrant County is centrally located at 2201 Martin Drive, Suite 100 in Bedford, Texas. The officeâ€™s location makes it possible to offer scheduled or emergency treatment with maximum convenience. For more information about Endodontic Associates of Tarrant County, send email to: email@example.com or visit eaoftarrantcounty.com. To schedule an appointment, please call (817) 283-5544. g
MEET THE DOCTORS Dr. Gavin J. Convey is an Ireland native and a proud Dubliner. Following high school Dr. Convey enrolled in dental school at Trinity College, Irelandâ€™s oldest university. During this five year period he obtained numerous academic awards, a scholarship from the university and two degrees with honors. Following completion of his training, Dr. Convey was fortunate to be able to combine his passions for international adventure and his dental profession. He has worked in many diverse locations including the Australian outback in the service of The Royal Flying Doctor Service of Australia and the South African veldt via a trainmounted mobile dental clinic. In 2007, after living in Ireland, Australia and the UK, and spending six years as a general dentist, Gavin came to Dallas to pursue specialty training in Endodontics at Baylor College of Dentistry. When not at the office, Gavin and his wife Carrie enjoy hiking, biking and their mutual love of food and cooking. Avid skiers and scuba divers, their favorite getaway spots include the majestic snow-capped Rockies and the innumerable underwater Caribbean coral reefs. The couple live in Las Colinas and are eagerly awaiting the arrival of their first child later this year.
Dr. David Gruber graduated from the University of Michigan School of Pharmacy in 1983, then attended Marquette University Dental School from 1983-1987. He spent another year back at the University of Michigan, completing a hospital based dental residency. From there he moved to the Navajo Indian reservation in Arizona working for the United States Public Health Service. After eight plus years working for the Indian Health Service, he returned to graduate school for Endodontics at Baylor College of Dentistry in Dallas, Texas. Since attaining his M.S. in 1999, Dr. Gruber has worked in private practice. In his spare time, Dr. Gruber enjoys the outdoors, running, cooking, reading and creating mosaic artwork.
Dr. Neal Horn was born in Alexandria, Louisiana. He later moved to Tyler, Texas and went to middle school and high school there. He attended Brigham Young University, where he received his degree in molecular biology. While at BYU, he met and married his wife, Leslie. Following his undergraduate studies, Dr. Horn attended The University of Texas Health Science Center at Houston Dental Branch. Following dental school, he completed a one year General Practice Residency at the University of California at Los Angeles. After completion of his GPR, Dr. Horn was accepted to a residency in Endodontics at UT Houston Dental Branch and he moved back to Houston. He graduated with a Master of Science and a certificate in Endodontics in 2008. Being from North Texas, Dr. Horn was excited to join Endodontic Associates of Tarrant County and move back to the DFW area. Outside of work, Dr. Horn enjoys spending time with Leslie and their three children, Audrey, Parker and Miles. He is an avid baseball fan and enjoys cheering for his sons at Little League games and rooting for the Rangers. He also enjoys tinkering with his saltwater reef aquarium.
NORTH TEXAS DENTISTRY
Dr. Neal Horn with his wife, Leslie
Dr. Gavin Convey with his wife, Connie
Dr. David Gruber
The team at Endodontic Associates of Tarrant County makes it a priority to assure patients that their visit will be calm, comfortable and pain-free. YOGESH PATEL, D.D.S. GAVIN CONVEY, D.D.S. DAVID GRUBER, D.D.S., M.S. NEAL HORN, D.D.S., M.S. 2201 Martin Drive Suite 100 Bedford, TX 76021
(817) 283-5544 (817) 283-5873 fax eaoftarrantcounty.com
10 NORTH TEXAS DENTISTRY | www.northtexasdentistry.com
Benefits for Patient Referrals By Sarah Q. Wirskye
Healthcare fraud is a governmental priority. One area that the government often focuses on in these investigations is potential kickbacks and self-referral arrangements. As one federal publication recently stated “in some industries, it is acceptable to reward those who refer business to you. However, in the federal health care programs, paying for referrals is a crime.”
Also, these are typically easier cases for the government to prove than cases that turn largely on expert testimony regarding complex medical procedures. The government’s concern is that kickbacks and self-referral arrangements can lead to overutilization, increased costs, corruption of medical decision making, patient steering and unfair competition.
The Federal Anti-Kickback Statute (AKS)
The federal anti-kickback statute prohibits knowing and willful conduct involving the solicitation, receipt, offer or payment of any kind of remuneration in return for referring, directly or indirectly, an individual or for recommending or arranging the purchase, lease, or ordering of an item or service that may be wholly or partially paid for by any federal health care program. (42 USC §1320a-7(b)). “Federal healthcare program” not only includes Medicare, but also, Medicaid, Tricare, Veterans Administration and other federally funded programs.
Notably, “knowing and willful conduct” has been very broadly interpreted to mean that a person need not have actual knowledge or specific intent to violate this law. “Remuneration” has been interpreted to include anything of value (tangible or intangible), such as a reduction or discount, direct payment of cash or loans, and free items or services, including transportation. There are also cases stating that if at least part of the payments were intended to induce referrals, the AKS is violated.
12 NORTH TEXAS DENTISTRY | www.northtexasdentistry.com
Are You Violating the Anti-Kickback and Self-Referral Statutes?
Moreover, the government does not need to prove patient harm or financial loss to the program. Finally, there can be a violation of the AKS even if the service was rendered, and the service was medically necessary. A violation of this statute can be the basis for civil or criminal penalties, and collateral consequences such as exclusion and licensure issues.
There are statutory exceptions to the AKS, and voluntary safe harbors are found at 42 CFR 1001.952. Some of the more commonly implicated exceptions and safe harbors applicable in the dental and orthodontic areas involve discounts, certain employer/employee relationships, space and equipment rental, and referral services and arrangements. There are certain rules that must be strictly followed in order to fall within these exceptions and/or safe harbors. If there is a potential issue, it should be examined to ensure there is no violation. The Texas Patient Solicitation Act (“TPSA”)
While the AKS prohibits remuneration for referrals wholly or partially paid for by government funds, what many people do not realize is that the Texas law is much broader and covers non-government pay. The TPSA prohibits a person knowingly offering to pay or agreeing to accept, directly or indirectly, overtly or covertly any remuneration in case or in kind to or from another, for securing or soliciting a patient or patronage for or from a person licensed, certified, or registered by a state health care regulatory agency. (Occupations Code §102.001). Physician Self-Referral Statute (Stark Law)
The Physician Self-Referral Statute, commonly known as the “Stark Law,” limits physician referrals for “designated health services” (“DHS”) when a physician or immediate family member has a financial relationship with the entity, unless an excep-
tion applies. (42 USC §1395nn and 42 CFR 411.350 through 411.389). A financial relationship is defined as either a compensation arrangement (which includes any remuneration) or an ownership or investment interest. A referral includes any direct request for a DHS or a request for a consultation with another doctor who then orders a DHS.
This is a strict liability statute. The individual need not be aware that he or she is referring to an entity with which the provider has a prohibited interest in order to break the law. Penalties include fines and exclusion from Medicare and Medicaid. Unlike the AKS, Stark only applies to Medicare & Medicaid and not all federal healthcare programs.
DHS include (1) clinical laboratory services; (2) physical therapy, occupational therapy, and outpatient speech-language pathology services; (3) radiology and certain other imaging services; (4) radiation therapy services and supplies; (5) durable medical equipment and supplies; (6) parenteral and enteral nutrients, equipment, and supplies; (7) prosthetics, orthotics, and prosthetic devices and supplies; (8) home health services; (9) outpatient prescription drugs; and (10) inpatient and outpatient hospital services. There are nine statutory exceptions and twenty-five regulatory exceptions located at 42 CFR Part 411, Subpart J. There are complex rules governing these exceptions. The complexity of the Stark Law requires a case specific examination when there may be a potential issue.
The Office of Inspector General (“OIG”) also has a voluntary self-disclosure program to resolve Stark and AKS issues. A careful analysis must be performed when and how to do a disclosure. If the government does not feel the disclosure meets the criteria and is not truthful or complete, it does not offer any protection, and it may actually help the government make a case! As of March 2009, the OIG stated that it will no longer accept disclosures that involve only liability under the Stark Law in the absence of a colorable AKS violation. Therefore, the OIG is clearly focusing its resources on the AKS statute.
Because what is generally accepted in many other industries may be illegal in the healthcare industry, it is important to make sure you are in compliance with these rules. Be careful! g
Because there has been much more activity under the federal statutes, the overwhelming majority of the conduct in this section of this article refers to federal violations. Based upon the breadth of the Texas law, however, much of this conduct would very likely be in violation of the TPSA as well. 1
Ms. Wirskye has represented numerous individuals and entities in civil and criminal disputes with federal and state governments. She is currently representing several healthcare providers, including dentists and orthodontists, in investigations by both the state and federal authorities.
Potentially Problematic Conduct
These statutes have a very broad application. If you or your practice is involved in the following conduct, you should probably conduct further investigation in order to ensure you are in compliance with the statutes discussed in this article: (1) waivers of co-pays or deductibles; (2) joint ventures with Medicare/Medicaid pay; (3) arrangements with doctors, such as medical directors, and incentives for recruitment and retention; (4) lab discounts; (5) office rental; (6) gifts to patients, and particularly Medicare/Medicaid beneficiaries; and (7) paying employees based upon production. All of the conduct listed in the previous sentence has been the basis of a violation in certain circumstances. 1 Proactive Measures
In light of the government focus on these provisions, there are a few steps a provider can take to help minimize his/her exposure. A provider should have a written policy regarding gifts. This should include prohibiting and/or limiting both the giving and receiving of gifts to any patient or referral sources. In healthcare fraud investigations, the government usually examines a provider’s marketing practices, and will examine advertising and mailed materials. Providers need to ensure that their marketing professionals know what is appropriate in the healthcare field.
NORTH TEXAS DENTISTRY
Your Personal Invitation
2012 Rite to Smile Golf Classic
at spectacular McKinney Golf at Stonebridge Ranch Selected as one of 2012’s “Top 100 Golf Courses in Texas” by Dallas Morning News
by Dr. Laura Mitchell n behalf of the Board of Directors of the non-profit Rite to Smile Foundation and the North Texas Dental Society, it is my privilege to extend an invitation to you to join us and play in the 2012 Rite to Smile Golf Classic. This annual fundraiser is an excellent way to show your support for community-based dental care for the underprivileged, while enjoying a great afternoon of golf and fellowship with others who share your compassion for those in need. The Rite to Smile Foundation, Inc. is a 509(a)(2) nonprofit charitable organization that is the primary outreach program for the North Texas Dental Society and its member doctors. Now in its twelfth year, it has been a strong advocate for those who are without the means to access essential dental services for their families due to financial constraints. Our efforts have resulted in raising more than $350,000 in funds on their behalf. These resources have been professionally managed and distributed to Texas Scottish Rite Hospital, Community Dental Care, Collin College School of Dental Hygiene, and the NTDS Give Kids a Smile Program. Whether you have helped with the work of the Rite to Smile Foundation in the past or have been recommended as someone who cares about the needs of others, you have an opportunity to be a part of the solution. Please join us in meeting this important need by participating in our annual Rite to Smile Golf Classic.
14 NORTH TEXAS DENTISTRY | www.northtexasdentistry.com
If the drive to improve access to dental care is to succeed, your support of events like Rite to Smile are critical, and every dollar you contribute is magnified by the contributions of volunteers, players, and corporate sponsors.
Sponsorships are available at levels ranging from $1500 to $10,000, and tickets for the Rite to Smile Golf Classic are available in combination packages or separately. Charitable donations are welcome in any amount and are tax deductible. If you prefer to support the event with a gift of your time, it’s not too late to help out at the Rite to Smile Golf Classic. Find a volunteer opportunity that is a good fit for you by emailing firstname.lastname@example.org any time before the event.
The twelfth annual Rite to Smile Golf Classic will take place at Stonebridge Ranch Country Club in McKinney on Monday, November 12th. We need sponsors, players, and volunteers for the event and would be honored if you would join us.
We hope to see you on Monday, November 12th for a fabulous round of golf. For more information, contact:
Dr. John Wise, 972-724-4846 email@example.com
SMILES SPOTLIGHT in the
LEADERS IN NORTH TEXAS DENTISTRY CREATING UNFORGETTABLE SMILES
Pre-op buccal view
A 43 year old African-American healthy male with NKDA presents for evaluation of multiple areas of gingival recession, dental sensitivity and not pleased with his smile.
Clinical evaluation revealed severe gingival recession on multiple teeth with mucogingival deformities, lack of keratinized gingiva and deep pockets with bleeding on probing. Intense dental sensitivity to tactile and thermal stimuli and esthetic disharmony of gingival architecture.
Anchorage of graft 16 NORTH TEXAS DENTISTRY | www.northtexasdentistry.com
Root debridement and scaling
Coronal advanced flap
Oral hygiene instruction with a thorough prophylaxis was given 2 weeks before the procedure to control bacterial plaque accumulation and reduce inflammation and bleeding. Pre-procedural rinse with chlorhexidine was performed for one minute and then local anesthetic was provided. Sulcular incisions were made with a vertical releasing incision on the mesio-buccal on tooth #27. After full thickness flap elevation, subgingival calculus on the root surfaces was noted. Roots were thoroughly scaled and debrided.
A subepithelial connective tissue graft was harvested from the palate. Donor site sutured with 4-0 chromic gut and protected with Barricaid periodontal dressing. The graft was anchored with 5-0 chromic gut suture to protect the roots followed by a coronal advanced flap for closure. Oral and written post-operative instructions were provided.
The patient was followed for multiple post-operative visits and uneventful healing was observed with resolution of the periodontal infection. The patient resumed regular periodontal maintenance and caries control screenings on appropriate intervals with his general dentist. Three years after treatment, all treated areas were clinically stable and healthy without pocket formation. Complete root coverage was obtained and an increase of the keratinized tissue will provide a stronger and more resistant tissue that will help prevent further recession. Thermal and tactile sensitivity are eliminated obtaining a result that is compatible with health, comfort, function and esthetics.
Ruben Ovadia, DDS, MS
Credentials Diplomate of the American Board of Periodontology
Education DDS Technological University of Mexico 2006 GPR National Institute of Perinatology 2007 MS/ Periodontal Certificate - Tufts University School of Dental Medicine 2010 Professional Affiliations Dallas County Dental Society Texas Dental Association American Dental Association American Academy of Periodontology Alpha Omega Dental Fraternity Hispanic Dental Association North Texas Hispanic Dental Association
For more information concerning this case, contact Dr. Ovadia at www.dallasimplant.com or call (214) 503-1000. Post-op three years www.northtexasdentistry.com
NORTH TEXAS DENTISTRY
Internet Marketing Initiatives for Every Dental Practice 1.
Make sure you have a mobile-friendly website.
In 2012, it’s expected that approximately 65% of all local searches will be made on a mobile phone or tablet. Have you checked your site’s appearance on your iPhone? If you can’t conveniently read it and find your office’s phone number and directions, chances are your patients can’t either. It’s becoming increasingly critical for businesses which depend on local traffic to have their websites optimized for mobile search. And speaking of mobile search... 2. Claim your Google+ Local listing and optimize it.
Your Google+ Local listing is important for you in two ways: First, local listings now receive prime space on Google’s results page. Completing your listing is a great way to move into a highvisibility position for your office’s primary search terms. This entails claiming your listing, adding photos, keywords, customizing the description, etc. Not only will your listing rank higher, but patients who visit your local listing will now see photos of your office and smiling staff instead of a generic listing. The other important component of your local listing is its’ role in mobile search. The top local listings receive a prominent place in Google’s mobile search results, and they feature push-tocall and push-for-directions buttons. One other feature of local search may have you wondering about is...
by Neil Rudoff
3. Requesting user reviews, and then monitoring and following up.
You may have noticed user reviews on the Google results page when looking up restaurants, CPA’s, or plumbers. Of course, dental practices have user reviews as well. In fact, there are dozens of review sites on the internet, from Google to Yelp, to FourSquare. Again, there are two key benefits to encouraging user reviews. First, there is strong evidence that a listing receives a significant bump in Google+ Local rankings when it receives five Google reviews (keep in mind that this also helps your visibility on mobile searches). Second, it gives you and your staff the opportunity to strengthen ties with your patients, address issues and concerns, and generally interact with people in your area who are looking for dental services. Another element that Google considers when indexing websites is original, updated content, best delivered by...
A company blog.
Many of us think of blogs as being reserved for fashion, sports, or political commentators. While those are all useful applications, there is a practical reason why your practice benefits from a blog as well. When Google ranks a website, an important factor is how often the site is updated with original content. Gone are the days when a website could be launched and then forgotten. A blog is the perfect tool to deliver dynamic, relevant content to your website. Just remember that your content should be original, not copied or mass-distributed. Informative blogs have an additional benefit: your peers may link to your article, boosting another component of Google’s algorithm, the... 5. Number of quality inbound links to your site.
18 NORTH TEXAS DENTISTRY | www.northtexasdentistry.com
Google’s mission is to promote “authoritative” websites in their results, i.e. pages that are original, trustworthy, high-quality, and generally providing value to the internet audience. One important measure of this is the num-
ber of quality inbound links to your website. What is a “quality” link? The accepted definition is a link that comes from a respected source, like another authoritative website. Inbound links from peers, referrers, dental associations, and even Chambers of Commerce would all be considered quality links. Building your inbound links up over time demonstrates that your website is valued and continues to provide value over the long run. You can further define the most important pages of your website by creating... 6.
Customized title tags.
Title tags are one the most significant factors to search engine rankings. Providing Google with an original title tag for each page often gives an immediate boost to a site’s rankings. It’s easy to tell whether your site’s title tags are customized. Simply hover your mouse over the tab at the top of the page when you are on your website. If every page is “Dallas dentist” or “Dr. ”, then your titles aren’t targeted to bring you the best results. For example, you may have a service page on whitening, one on sedation, and one on implants. The title tag for each page should reflect the subject, much like the title of a magazine article describes the topic. This brings up another key point to improve your website... 7.
Separating out your service pages
Most practices offer numerous services. However, you are doing yourself a disservice if you list all of these on one page with a title like “Services”. The reason? It limits your content and prevents you from implementing original title tags for each service. There is a great deal of difference between a single title tag that simply states “Dallas dental services” and multiple tags reflecting each service that directly correlates to the content of that page, i.e.: “Dallas teeth whitening”, “Dallas dental implants”, etc. Separating out your services provides Google with a focused page, with your title tag and the page content supporting each other. It also gives you more space for original copy and photos. Hopefully, now you’re driving many new visitors to your website. How do you convert them to patients? Provide a...
8. Clear Call to Action and accessible contact information.
Perhaps you offer a free initial exam to bring in new patients, or a certificate for discounted teeth whitening. Make sure that visitors to your website can easily find your promotion and make an appointment from your home page, preferably in the top part of the screen. Whether you have a simple online form to contact your office or a phone number prominently displayed, remember that your website has a purpose; you want to convert visitors to patients. So make it easy for them. Now that your website is optimized for Google’s local and on-page search, you may feel that you’ve done everything you need to. However, you might also choose to consider a...
Pay per Click campaign.
Yes, it does require a monthly investment. However, there are several benefits to a targeted campaign. First, the results are measurable and reliable; you will receive a report detailing the exact results of your advertising. Second, Google devotes a large and prominent space to advertisers, highlighted at the top and the sides of every results page. Third, you can target your ads for any aspect of your practice that you choose to focus on. Finally, pay per click ads are the most effective way to target potential customers in neighboring cities. For example, if your practice is in Garland, but you want patients from Dallas, Richardson and Plano, you can advertise to those areas through pay per click campaigns. Now that you are bringing in more visitors and turning them into patients, how are you measuring your success?
10. Make sure you receive regular site traffic reports and use them.
You may find that you have more new appointments and that your office revenue is improved, but to really get an accurate take on the impact of your website and your online marketing efforts, you need to examine your monthly web traffic reports. You can gather this information from several sources, from simply installing Google Analytics, to receiving a report from your marketing partner. Having this information at your fingertips enables you to not only monitor your progress, but also test the impact of future marketing efforts. g Neil Rudoff is the Senior Account Executive at Bullseye Media in McKinney, TX. He received his B.A. from Tufts University in 1989 and his MBA from UT Austin in 1993, and has been an online marketing and web design consultant since 2003. He can be reached at (214) 491-6166 or send email to: firstname.lastname@example.org.
Do You Have a Get-Out-of-Breach-Free Card? by David Yandry In the game of Monopoly, an unfortunate roll of the dice sometimes lands you face to face with the policeman who ushers you directly to jail. If you haven't secured a get-out-of-jail-free card, you're forced to spend time and energy trying to get out, while everyone else continues to advance around the board.
When it comes to HIPAA compliance, sometimes an unfortunate event can lead to a breach that forces you to spend time and energy (and most likely real-world cash) working with the Department of Health & Human Services (HHS) to determine whether you had established the right policies and procedures for handling Electronic Patient Health Information (ePHI), taken the appropriate precautions to secure your ePHI, and reacted appropriately to the breach once it had occurred. If the HHS determines you made any mistakes along the way, you can expect additional fines and possibly additional time and effort to implement any changes they deem necessary to the way you handle ePHI.
Too bad there isn’t a get-out-breach-free card you could play when it comes to those unforeseen and unintended events that lead to a breach... or is there?
Section 13400(1) of the Act defines ‘‘breach’’ to mean, generally, the unauthorized acquisition, access, use, or disclosure of protected health information which compromises the security or privacy of such information. Two of the most common causes of data breach are loss and theft of a device containing ePHI. Once the device and the data it contains have gone missing, the covered entity is required to report the breach of their patient data to HHS, to their patients, and also to the media if their patient pool is large enough. Unless, that is, the data on the lost or stolen device has been protected by a safeguard called encryption.
Encryption is the process of using an algorithm to transform plaintext information into an unreadable format that can only be accessed by someone possessing the key that was used to enable the encryption in the first place. Without the unique key that’s created at the time of encryption, the data on the lost or stolen device will be completely unreadable.
20 NORTH TEXAS DENTISTRY | www.northtexasdentistry.com
The HITECH Act issues technical guidance on the technologies and methodologies “that render protected health information unusable, unreadable, or indecipherable to unauthorized individuals.” The guidance specifies encryption as an action that renders ePHI unusable if it falls in to the wrong hands. ePHI that is encrypted and whose encryption keys are properly secured would provide a “safe harbor” to covered entities and would not require them to issue data breach notifications.
So, you’re making a flight back from an out-of-town trip, and the checked bag containing your work laptop never comes around the carousel. Or, you show up to work one morning to find someone has kicked in the front door of your office and stolen everything they can get their hands on, including your server. Neither scenario represents a situation where negligence, or even recklessness has compromised the security of ePHI, but without encryption enabled, both set into motion the very painful process of breach notification and resolution.
As an “addressable” standard for ePHI protection, the legislation requires that you either implement it or document why it would not be a reasonable and appropriate standard for your practice to meet. Fortunately, today’s technologies have made data encryption very inexpensive and extremely low-impact on the performance of the device being protected. Considering not only the protection it gives to your patient’s sensitive ePHI, but also to your peace of mind should an unkind roll of the dice come your way, the get-out-of-breach-free nature of encryption is too valuable of a card to leave out of your deck. g David Yandry is the President of Acclaim Networks, an IT service and support provider in Grapevine, TX. Acclaim Networks has been supporting the networking needs of dentists, orthodontists and oral surgeons in Dallas and Fort Worth for the last 10 years. They can be reached at (817) 488-1030 or online at www.acclaimnetworks.com.
Southwest Dental Conference
Make plans NOW to advertise in the North Texas Dentistry Convention Issue
Promote your business and services to the North Texas Dental Community with perfect timing and perfect targeting â€“ before the Southwest Dental Conference
Print Advertisement l Custom Profiles l Special Features Our team can make your marketing dreams a reality!
REQUEST A MEDIA KIT:
Zinfandel an American Wine Story
by Kim Clarke
Zinfandel is my favorite red wine. I know it’s really tough to pick a favorite, but I love everything about a great zinfandel wine. The nose in the glass reminds me of the way blackberry jam smells when you first open a new jar of it. The flavors are almost
decadent – concentrations of dark fruits, a little vanilla from the oak barrel, some mocha, black pepper and spice – all in perfect balance with the tannins to offset the typically higher alcohol levels that come from the ripe grapes. The finish is long and
22 NORTH TEXAS DENTISTRY | www.northtexasdentistry.com
smooth and leaves you begging for more. Zinfandel is fun on its own but goes great with food as well, bringing a different dimension to the taste of grilled steaks, barbeque and pizza. Chocolate and Zinfandel are also fun pairings at the end of a meal.
Zinfandel wine is a uniquely American treasure with a rich past. While the origin of grapes such as Cabernet and Chardonnay were easily traced back to Europe, Zinfandel had no precedent as there were no other Zinfandel-producing areas of the world outside of California. Extensive research into the history of the grape indicates vine cuttings were brought from Vienna, Austria, to Long Island, New York in the 1820’s by a nursery owner named George Gibbs. By the 1840’s, Zinfandel had become a popular table grape in the Northeastern part of the United States. But it wasn’t until the Gold Rush era of 1850’s that Zinfandel made its way to California, where it proved to be a hearty grower and an abundant producer of wine grapes. By the 1880’s, Zinfandel
had become the most widely planted variety during California’s first wine boom.
A survivor of both the late 19th century phylloxera outbreak and the era of Prohibition, Zinfandel continued to play an important part of the California table wine production. But as that state’s wine industry began its move toward becoming one of the world’s premium wine producers, growers were looking to replace the old Zinfandel vines with cabernet and chardonnay. Fortunately for Zinfandel lovers, Sutter Home winery in 1973 “invented” White Zinfandel wine, a lighter and sweeter version that appealed to those who wanted a not-so-dry wine. Beringer Winery joined in and took White Zinfandel to the masses, making it the best-selling wine of all time. The popularity of White Zinfandel saved much of the old Zinfandel vineyards from being pulled out and preserved them until the 1980’s when wineries began to take a fine-wine approach to Zinfandel.
While there are many wineries that produce good Zinfandel, there are three that have been around a long time and specialize in Zinfandel: Ridge, Ravenswood and Rosenblum. Each of these make Zinfandel wines from different regions, vineyards and price levels, and it’s difficult to go wrong with any of them. The Geyserville offering from Ridge is a perennial winner, as is their Lytton Springs wine. Rosenblum makes over 20 different Zinfandel wines from Napa, Sonoma and other parts of California. Ravenswood is the largest Zinfandel producer in the business, with wines ranging from single-vineyard designates to “Vintners Blend” wines that are sourced throughout California.
Other premium Zinfandel producers include Rombauer, Seghesio, Robert Biale, Frank Family and Elyse. Wines from these producers will cost $25 or more, but there are also less expensive Zins that still bring out the characteristics of the varietal. Bargains include wines from Four Vines (Old Vine Cuvee), MichaelDavid (7 Deadly Zins), Cline (Ancient Vines) and Peachy Canyon (Incredible Red). g
Dental Headache Care The Fastest Growing $10B Niche In Dentistry Dentists can now treat force related pain and range of motion dysfunction in the head, neck and jaw.
To learn more:
NORTH TEXAS DENTISTRY
Does Your Culture Create “Learned Helplessness”? by Dr. Joel T. Small
B. F. Skinner, a noted 20th century behavioral psychologist, conducted an intriguing and provocative experiment using laboratory mice. Through an elaborately designed method of behavioral conditioning, he was able to condition one group of mice to believe that through their actions, they were able to determine their fate. Using the same methodology, he also succeeded in conditioning another group of mice to believe that there was nothing they could do to alter their fate. He then placed the first group of mice, the ones that believed that their actions mattered, into a large tub filled with water. As anticipated, this group of mice, when placed in a life-threatening situation, acted instinctively and began to swim to the side of the large water filled tub. Upon reaching the edge of the tub the mice were able to crawl out to safety. The second group of mice, the ones that believed that their actions were meaningless, when placed in the tub of water simply sank to the bottom and drowned. Skinner was able to condition the mice by utilizing controlled environments. In one
environment, the mice were allowed to produce positive stimuli (food) or avoid negative stimuli (electrical shock) through their actions. Conversely, everything that happened to the second group was beyond their control. Their environment was manipulated so that they could neither produce positive stimuli nor avoid negative stimuli through their actions. Eventually this group was immobilized by their inability to alter their state of existence. Appropriately, this lack of responsiveness was termed “learned helplessness.”
“What does this experiment have to do with my practice?” you might ask. In reality, much can be learned from this study. Like Dr. Skinner, we are the ones that create and/or alter the environment (also known as our culture) in which our organizations function. In fact, according to Warren Bennis, an icon of modern leadership thought, the primary function of leadership is to create an organizational culture. The culture that we choose to create will influence every aspect of our organization, and will ultimately determine our practices success or failure.
Value-based leaders understand that power, like organizational beliefs and purpose, is a shared experience. Cultures like
24 NORTH TEXAS DENTISTRY | www.northtexasdentistry.com
these promote abundance and are characterized by collaborative decision making and a profound belief that everyone has influence. The power to alter the course of the organization does not reside with a few, but rather is shared by many. Research studies conducted by the University of Michigan have shown that organizations with a broader sphere of shared influence, had significantly higher performance and productivity, compared to organizations in which power was concentrated at the top.
Believing that our actions and our choices matter is the essential first step to making things happen. What we have come to recognize as good old “self confidence” is in reality a learned competency, and today’s effective leaders must create organizational cultures that promote and teach self confidence to each individual team member. This is accomplished by empowering teams through collaborative decision making and ensuring that each team member has been given the knowledge, skill, support, resources, and appropriate authority to accomplish each task required to meet the shared goal.
Leaders that promote a scarcity philosophy view power as a zero sum game in which power is finite and is coveted and con-
trolled by the few at the top. The resulting organizational culture is characterized by a command and control mentality which is non-collaborative, and places no value on individual contributions to the overall organizational direction. Leaders that create these command and control cultures, when compared to value-based leaders are often lacking in self confidence and are therefore psychologically incapable of sharing power. They also lack trust and utilize excessive control and/or micromanagement as a means of maintaining power. The end result is an organization whose individual members, like Skinner’s laboratory mice, come to believe that their actions are inconsequential and they have no ability to alter their environment or control their future. Eventually they “shut down” and quit trying.
Creative thinking is considered to be one of our highest level cognitive functions and has been found to be a distinguishing characteristic of exceptional organizations. The wise leader understands that their organization is best served by creating a psychologically safe culture that fosters shared power, collaboration, and utilization of the organization’s collective creativity. g
Dr. Joel T. Small is an endodontist, speaker, author, and entrepreneur. He is a co-founder of North Texas Endodontic Associates in Plano,
Texas. His thirty-plus years as an endodontist have been spent in private clinical practice.
Dr. Small speaks nationally on the topics of leadership, practice management, and specialty practice transitions. He co-founded Phase Two Associates, LLC, a dental practice brokerage firm in Dallas, Texas that deals exclusively with practice transitions for the dental specialist.
Dr. Small is the author of the book, Face to Face: A Leadership Guide for Health Care Professionals and Entrepreneurs. For more information, visit www.readfacetoface.com.
A very interesting dynamic develops when the above scenario plays out. Leaders lacking self confidence and the ability to trust believe that their staff is incapable of making meaningful contributions to the overall organization. The staff, being controlled and micromanaged, senses that they are not valued, and finding themselves unable to influence their environment, they shut down like Skinner’s mice. This further validates the leader’s initial thesis that the staff is insignificant, and so begins a destructive downward spiral driven by this self-fulfilling prophecy created in the mind of the leader. Cultures like these tend to implode like a house of cards, because the weakened cultural infrastructure is incapable of withstanding even minor stress.
The shared belief that our efforts affect our destiny is the organizational equivalent of individual self confidence. Knowing that our individual actions will have some effect on our organization’s future will compel us to take action. The goal for effective leaders is to allow all of this to happen in a psychologically safe environment in which our staff need not fear repercussions for their well-intended actions even if the outcome of these actions is less than ideal. By creating psychologically safe cultures, we draw out our organization’s creativity which is often stifled by the psychological repression found in command and control cultures. www.northtexasdentistry.com
NORTH TEXAS DENTISTRY
The Competitive Advantages of Corporate Dentistry – and what you can do about them by R. Kirk Huntsman Many dentists hold strong opinions as to whether or not corporate dentistry is good for the profession or for the American public. Regardless of where you stand, the unrelenting expansion of corporate group practices across the country is creating an entirely new level of competition among providers. As long as private solo practitioners have to coexist and compete with large corporate group practices, there are certain things they should know. Having spent many years in both corporate dentistry and working with private practices, here is my list of the essential things every solo doctor should understand.
First, don’t underestimate the ability of large corporate groups to effectively compete on quality. The old paradigm where large corporate groups could easily be dismissed as low-end, poor-quality hack operations catering primarily to managed care and Medicaid patients is no longer true. Most of the larger groups don’t accept managed care or Medicaid, and their offices are anything but low-end. In fact, they now cater to precisely the same demographics as most traditional solo practices — including yours! Moreover, all of the major players in the corporate dentistry, or Dental Management
26 NORTH TEXAS DENTISTRY | www.northtexasdentistry.com
Services Organization (“DMSO”), arena have highly integrated systems and protocols to ensure consistently high levels of clinical care and customer service. These same companies now have extensive internal continuing education programs where doctors receive world-class training and motivation from many of the leading dentists in the profession.
Second, most DMSO practices generate over 50% greater revenue and operate at 20% lower overhead than their solo counterparts. There are many reasons for this, including the fact that they receive huge discounts on lab and supplies, and often
receive higher negotiated payments from insurance carriers for performing the same treatment. Just remember: Greater revenue and lower overhead means higher profit margins for the corporate groups. In a price war, they have a real advantage over solo doctors.
Third, a large and growing segment of today’s population actually prefers what the DMSO practices are offering, such as acceptance of almost all insurance plans, convenient appointment times (before and after work and Saturdays), same-day treatment options, lower pricing, state-of-theart technology, and flexible “in-house” patient financing programs that make dentistry affordable for almost anyone. Like it or not, you now have some brand new competition going hard after your patients!
Finally, there are other areas where corporate groups have it over on their solo practice competition. These include staff hiring, compensation, benefits, and bonus plans, as well as career advancement opportunities for high-performing staff members.
R. Kirk Huntsman has been active in the dental industry for over 23 years. In 1988, he became the Dallas/Fort Worth licensee for AFTCO Associates, a dental practice brokerage company with over 65 offices nationwide. Within two years, his was the top performing office in the nation. In 1991, he acquired the Houston license and continued to rapidly expand. By 1995, he was ready to begin owning and operating practices, so he launched Dental One as a dental management services organization, or DMSO. Under Mr. Huntsman’s leadership and direction, Dental One (now Dental One Partners) grew from scratch to over 150 offices in 14 states. After leaving Dental One Partners in the spring of 2010, Kirk began working closely with Morgan Stanley Private Equity in their acquisition of ReachOut Healthcare America, the nation’s largest mobile dentistry provider. Mr. Huntsman recently left ReachOut in order to form Nexus Dental Group, a virtual DMSO providing a wide range of DMSO-type resources and services to independent dentists. Mr. Huntsman is a 1981 graduate of Brigham Young University’s Marriott School of Management.
With all of those competitive advantages, it may at first seem as if it will be impossible for solo doctors to compete in the years ahead. That is simply not true. DMSOs have their weaknesses as well. For example, many of them struggle with staff and doctor turnover. In addition, despite their best efforts, many of the providers do not see themselves as anything more than a hired gun. As such, they aren’t always as attentive to things as they might otherwise be in their own offices. At the end of the day, your best and most valuable asset in this battle is what it has always been — your own skills, your own character, your own true professionalism, and your long-term concern for your patients.
You at your best is absolutely requisite, but if you aren’t supported in your efforts, it may not be enough. My strong admonition would be to learn how to run your practice like a business — and quickly. This may mean rethinking your value proposition and doing things you haven’t done before, such as opening up certain appointment slots for early mornings or late afternoons. Learn how to position your practice for suc-
Surround yourself with staff and advisors that can help add value to everything you do. As you do that, you will give yourself the very best chance of winning the battle for market share and ensuring a secure future for you and your family! g
cess by lowering your costs and driving your revenue higher as you serve your patients at a higher level of care. Improve your team at every opportunity. Work hard to maintain a stable team that can offer a consistently great patient experience.
817.988.7842 “We specialize in customer satisfaction..” email@example.com PO Box 325
Canton, TX 75103
P n P n P n
Custom Chair-Side Staining* Pick-Up and Delivery* Simple Acrylic Repairs*
* applies to local accounts only
P n P n P n P n
Full Service Dental Lab All-On-Four Services Implants Digital Capability
Meeting All Your Fixed & Removable Dental Lab Needs www.northtexasdentistry.com
NORTH TEXAS DENTISTRY
Transition planning for a newly acquired practice By Scott Beard, Pacific Continental Bank For dentists who have recently acquired a practice or are interested in acquiring a practice, there are many steps that must be taken in order to ensure a successful transition to new ownership. Once a desired practice is identified and the sale contract is signed, the incoming dentist should implement a transition plan for how the practice will operate under his or her leadership, including the services that will be offered, and communicating the upcoming changes to staff and patients.
Preparing for and implementing a transition plan requires careful examination of all aspects of the practiceâ€™s operations and will often include assistance from outside counsel, such as a financial advisor. When drafting a transition plan, the incoming practitioner may want to consider the following: Determine the role of the selling practitioner
Before the transaction is complete, the acquiring practitioner and selling dentist will need to decide on how the outgoing practitioner will be involved post-sale. The acquiring practitioner should consider the pros and cons of having the outgoing den28 NORTH TEXAS DENTISTRY | www.northtexasdentistry.com
tist work at the practice for a defined period of time. The outgoing dentistâ€™s reputation and long-standing relationships may provide reassurance and stability to current patients.
As the practice begins to operate under new ownership, the transition should be clearly communicated to existing patients and staff. It is important that all parties involved are informed about the changes taking place. Outreach may include a letter to patients or an open house introducing patients to the new practitioner. Assess finances and staffing
The acquiring practitioner will likely have retained a financial advisor or CPA for the purchase of the practice. Post-sale, a financial advisor or CPA can help review the practiceâ€™s finances and set revenue goals and projections. They can also review and assist with employee contracts and non-compete agreements. Additionally, tax considerations, such as write-offs for equipment purchases or property taxes, can be addressed. A review of current staff structure allows the new dentist to
assess whether any changes will need to be made. Potential changes to the staffing structure or internal policies should be carefully evaluated and discussed with employees before implementation. Allowing existing staff to provide feedback regarding policy changes is critical for buy-in and successful implementation. Depending on the size of the practice, the establishment of a management team may be considered to assist in developing new protocol and guiding practice growth. Evaluating practice for growth
If the incoming practitioner intends to grow the practice, existing operations should be evaluated to determine the types of service expansion and additional treatment options that can be offered.The new dentist may specialize in certain services, such as endodontic procedures or oral surgery, which may not have been offered under the outgoing dentist but could be integrated into the practice. It is advisable to establish a plan for growth which includes multiple phases of change over a period of time so patients and staff do not feel overwhelmed. The purchase of new equipment, training for current staff and hiring of additional staff in order to accommodate expansion will also need to be considered.
include letters to all inactive patients, specifically those who have not scheduled an appointment in at least 12 months. Along with current and former patients, there should be plans to engage new patients. To reach potential patients, a letter may be sent to residents within a certain mile radius of the practice and advertisements placed in local publications.The new practitioner may also consider partnering with referral sources to cultivate new patients.
For a purchasing dentist, establishing relationships among existing staff and patients can take time and clear communication. A thorough transition plan allows for a new practitioner to maintain practice culture and service, while establishing leadership and realizing practice potential, for sustained growth and success. g Scott Beard, executive vice president and director of health care banking, is a dental banking expert at Pacific Continental Bank. He can be reached at Scott.Beard@therightbank.com.
Additionally, assessing the current patient base can help the practitioner determine if there is potential for growth. Outreach should be conducted to reactivate former patients. This may
NORTH TEXAS DENTISTRY
Protection is our Business Disability Life Health Long Term Care Malpractice
Our only business is working with TDA Members and their staffs. We are committed exclusively to servicing TDA membership’s needs. Let us review, compare and provide options for your coverage. Bob B b Michaels, Mi h l CLU Local Associate 214-696-5103
AFTCO..................................inside back cover Bob Michaels, CLU.......................................30
Bryant Studios ..............................................11 Bullseye Media ............................................29 Dr. Ravi Doctor .............................................22
J. Houser Construction.................................27
Med+Tech Construction...................back cover Nexus Dental Alliance ...........inside front cover Reliable Dental Laboratory...........................27
SMILE Walk & Run.......................................13 Structures and Interiors ................................25
Tina Cauller ..................................................30 TruDenta.......................................................23
30 NORTH TEXAS DENTISTRY | www.northtexasdentistry.com
Helping dentists buy & sell practices for over 40 years. AFTCO is the oldest and largest dental practice transition consulting firm in the United States. AFTCO assists dentists with associateships, purchasing and selling of practices, and retirement plans. We are there to serve you through all stages of your career.
Victoria E. Ortiz-Parsons, D.D.S. has acquired the practice of
Alan S. Martin, D.D.S. - Dallas, Texas (Baylor College of Dentistry 2003)
Jennifer D. Hedrick, D.D.S. (Baylor College of Dentistry 2010)
has acquired the practice of
Martin Weinberg, D.D.S. - Dallas, Texas (MeHarry Medical College 1973)
AFTCO is pleased to have represented all parties in these transactions.
Call 1-800-232-3826 today for a free practice appraisal, a $2,500 value!