Practice management /certified fixed orthodontic courses by Indian dental academy


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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
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Practice management /certified fixed orthodontic courses by Indian dental academy

  1. 1.
  2. 2. INDIAN DENTAL ACADEMY Leader in continuing dental education
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  4. 4. • • • • • Introduction Winds of Change Changing Scenario Management styles in dental practice Orthodontic Office design • Paper less practice • Financial consideration • Physical consideration • • • • • • • • • • • Ethics Patient incentive and motivation Fees & Payments Orthodontic support team and Associate Partnership Relation with general dentist Practice acquisition and transition Preventing loss Retirement Conclusion References
  5. 5. INTRODUCTION • Dentistry :a health care profession • Two fold role : – to provide health care & service – to make profit as a small business. DCNA 1988
  6. 6. WINDS OF CHANGE Metamorphosis of the DENTAL practice TRADITIONAL TO NEW • • • Challenges faced Art and Science to Business New questions and new answers DCNA 1988 & JCO 2002,03,04,06
  7. 7. Challenges posed to today’s dentist When did dentistry seem to become a business first and an art and science second? Why is the practice of dentistry so exquisitely sensitive to every type of fluctuation in the market place? What is responsible for all these changes? DCNA 1988 & JCO 2002,03,04,06
  8. 8. SERVICE v/s BUSINESS • As a health care service: dentistry provides quality care for the patient, following standards of care established by government agencies and the profession itself. • As a business: an enterprise in which one is engaged to achieve a livelihood, be productive & create a profit. DCNA 1988 & JCO 2002,03,04,06
  9. 9. Preferred future through informed choice • Today’s patients will seek optimal services from orthodontists who understands and accommodates their expectations, • Whereas those patients with low expectations will have their requirements satisfied by a provider equipped with to process large nos. of people. DCNA 1988 & JCO 2002,03,04,06
  10. 10. •CAPTAINS of their fate must understand the sociological evolution •If they are to chart an appropriate course for their professional contributions:by accepting that changes are occurring they can prepare themselves and their practices from the segment of the population they choose to serve DCNA 1988 & JCO 2002,03,04,06
  11. 11. CHANGING SCENARIO Up to 1940s:  Solo practice  one-on-one relationship  relatively low key, low pressure, and momentarily rewarding  level of dental sophistication  free to charge 1950 -60 :  consumer demand  Population increases and a greater desire  Technical advances DCNA 1988
  12. 12. 1960-70‟s:  “GOLDEN YEARS” of dentistry  Loss of control on patients  emergence of third party  indemnity insurance concept Mid 1970‟s:  Patients were hard hit  effect of a mini-recession  Manufacturers faced layoffs  excessive no. of graduates  fighting for survival :ERA OF COMPETATION  Closed panel capitation plans DCNA 1988
  13. 13. Late 1970s and Early 1980s:  proliferation of group practices  Department stores and franchise business began Through 1980s and 90’s  Alternate service providers emerged like CPO, prepayment plans and capitation plans  Department of health maintenance organizations (HMO)  Closed panel with staff and group model practice and Individual practice models. The 21st century  change in insurance scheme  advanced technologies  Demanding conscious consumers DCNA 1988
  14. 14. Management styles in dental practices • Leadership: vital to communication. • Authorative management • Free rein management • Participatory management AJODO 2004
  15. 15. Establishing practice goals and objectives • • • • • • Develop a practice philosophy Develop practice objectives Develop procedural policies Develop business principles Develop a practice standard Develop a staff recognition programme AJODO 2004
  16. 16. Desirable characteristics for building relationships: Big Business • • • • • • • • • • Self confidence Genuineness Openness to experience Acceptance of others background and values Enthusiasm Assertiveness Integrity Effective listening Recognition of other needs Sense of turnover AJODO 2004
  17. 17. ORTHODONTIC OFFICE DESIGN • SITE PLANNING: • Office Location • Areas demographics • Price of land and overall cost of the project • Legal restrictions • Landscape and greenery • Type of building • Parking space JCO 2000 & 2002
  18. 18. “TODAYS PRACTICE” - The Paperless Practice • Difficulty in keeping tract of patient files and treatment records. • Demographic (patient information forms) • Diagnostic (health histories, photographs, models, xrays) • Treatment (charts, plans, notes) • Scheduling (appointment book) • Financial (ledger cards) • Increase practice efficiency • computerized practice management program JCO 2000 & 2002
  19. 19. Computer technology and HIPAA • Health Information Privacy and Accountability Act (HIPAA) :influenced the way we gather and maintain patient data on computers and thus have had an impact on the office environment. • Office Designs must now incorporate physical and technical barriers, as well as administrative safeguards, to protect the security of patients personal health JCO 2003 information
  20. 20. • Ancillary tools • • • • • Imaging and cephalometrics insurance – benefits data bases, credit reporting Scanning, Inventory and Electronic ordering, CD-ROM systems for patient education, case presentations, and staff training, prediction, etc JCO 2003
  21. 21. Financial considerations • Investment in hardware and software • The system selected • Size of the practice • Paperless practice should cost 2-5% of gross income • Investment based to increase efficiency alone. JCO 2000 & 2002
  22. 22. Physical considerations • Office Design: • “Work patterns determine the floor plan” • Location and no. of work stations: – Front desk – Financial / business areas – Key areas throughout the operatory – Chair side units – Satellite offices – Doctor’s home • Location of main sever • Record storage: • Storage space JCO 2000 & 2002
  23. 23. Reception Desk • Contemporary style :completely open to the reception room. Helps create a friendly atmosphere. • Open desk with prefabricated fiberglass victratex sound panels on the walls behind it to mute conversations between patients and the secretary. • Computer terminal for appointments, and accounts maintenance. JCO 2001
  24. 24. Examination room • First visit to the orthodontic office • Initial impression is critical to case acceptance • Ambience and design of the examination room • warm atmosphere and décor go a long way toward establishing a comfort zone for both parents and patients. • Set ups • Smaller and newer • Well established • location and design of the exam/consult room JCO 2000 & 2002
  25. 25. Exam/consultation room • designed with enough flexibility • used as an exam room, a treatment coordinator work area, and a consultation room • room in the 150 – square – foot range • imaging system and photography section, impression area, etc • seating for patient and parents JCO 2000 & 2002
  26. 26. Business office/Doctor’s private office • used for education as well as to motivate patients in a semiprivate environment • Payments • Review records of a difficult case on the computer before the patients visit • The doctor to conduct a confidential huddle with the staff about sensitive information during treatment (HIPAA factor) or to meet with the treatment coordinator about a difficult case before the consultation JCO 2000 & 2002
  27. 27. Operatory Design “site of real action” • “Visual Privacy” and preferably sound proof • A rear-delivery cabinet with a mounted computer JCO 2000 & 2002
  28. 28. Chair side cabinetry and delivery system • ambidexterity of the operator • rear-delivery systems to avoid this potential problem • Four hand practice. JCO 2000 & 2002
  29. 29. • Chair side utility centers • Central islands • Sterilization centers :preferable in the most visible part of the clinic : due to public concern STERILIZATION UNIT SINK ULTRASOUND JCO 1988, 2000 & 2002 AUTOCLAVE UV LIGHT
  30. 30. Working Area • Primary work triangle formed by the operator, the assistant and the primary work area (tray) • Secondary work triangle based on the location of sinks, secondary storage, and mixing areas • For easy traffic flow of patients. JCO 2000 & 2002
  31. 31. • “individual non-stress tempos” • At busy times :doctors and assistant can step up their „cadence a notch‟, but it is not desirable or healthy to work that way for extended periods of time. • Experience :the most efficient way to handle the volume of patients DCNA 1988
  32. 32. Arrangement of dental chairs • Save or Waste valuable space in an operatory • Comfort zone where patients feel they have their own territory • Traditional parallel or radial designs • Circular or pinwheel chair arrangements JCO 2000 & 2002
  33. 33. Clinical Time • • • • • • upgrading and rearranging the equipment Procedures and techniques selected. Working position Four hand practice Newer technology Placement of instruments and equipments in the primary working area. JCO 2000 & 2002
  34. 34. • • ETHICS IN ORTHODONTIC PRACTICE Non-payment of treatment fees Breach in Contract or agreement 1. informed verbally as well as in writing about the delinquency of the account / missing appointments/ breakages 2. see the patient at regularly schedule maintenance appointments to monitor the integrity of the braces as well as the oral hygiene 3. removal of the braces, or suggest that they find another practice. JCO 1999
  35. 35. • Offer a limited treatment option – as long as it doesn’t leave the patient in a more compromised relation, but it is unethical to do a limited treatment that could have a detrimental effect – try to convince the patient – Plan for all alternative treatment options along with the level of compromise expected. • Dr. Birdwell – “It is ethical to offer a less-than-ideal treatment because of finances, as long as the limited treatment leaves the patient in better dental health.” JCO 1999
  36. 36. Change in Fees • work, material, time and quality of care, advertising and marketing • “The orthodontist didn’t create the system. He is just trying to survive in it.” –Dr. Schudy JCO 1999
  37. 37. • Charge different fees for the same service ? • If the same work, material, time and quality of care are to be offered it would be taking advantage of the full fee patient to reduce one‟s fee for the managed care patient • Should one Reduce his Fee if treatment finished early ? • Doctor patient relationship? JCO 1999
  38. 38. Getting to your patient: Psychological Motivation “People act to satisfy their own needs and desires, not the needs of other people. People behave to satisfy their real motives, not the motives they should have.” - A N Shoonmaker • When reasons and emotions clash, emotions almost always wins. • In getting a patient to move in the direction of better health, one need to appreciate the powers of emotional appeal and have certain attitudes, values and feelings our self. • Building up a trust that makes it possible to sense our patient‟s real desires.
  39. 39. PATIENT INCENTIVE AND MOTIVATION • Patient behavior through positive reinforcement for decades • Rewards such as T-shirts, stickers, fastfood coupons, and movie passes have been used to recognize good oral hygiene, headgear and elastic wear, and on-time appointment keeping • marketing strategy
  40. 40. • To be effective, motivation must be internalized • Rah-rah speeches usually fall on deaf ears • patient with low self-esteem – the typical noncomplaint patient freedom to choose STIMULUS RESPONSE •Office environment •Monitoring the treatment progress •Nonwww.indiandentalacademy.compatient. cooperative
  41. 41. Positive v/s negative reinforcements • • • • Positive is always better Changing the attitude Office environment and staff concern Parents and peer group
  42. 42. Orthodontic support team / Associates • Doctor and his associates, older patients, parents, etc are its members • Older members are used to motivate the newer members of the same group. • They make reminder calls for headgear wear, elastic wear, removable appliance usage, and oral hygiene. • Advantages include » One-to-one peer contact » Sharing of experiences and practical information » Mutual problem solving » Social interaction
  43. 43. Staff development • maintain staff longevity • continuing education and cross-training • Job satisfaction and level of professionalism of staff members by giving them the opportunity to utilize their intellectual as well as technical skills • better caregiver, communicator, and practice builder.
  44. 44. Staff models •Individual practice: •Doctor, Receptionist/ clerk/ assistant/ technician, etc •Visiting other specialists •Assistant lower qualification doctors • Group Practice: • Multi specialty care center • Many highly qualified doctors working together • Paid Associates and Un-Paid Partners • separate working areas and a bigger set up • Separate Assistants, receptionists, technicians, hygienists, etc
  45. 45. Patient communications • “Communication is the KEY to success.” • The orthodontist can only speak to one patient and parent at a time, • But staff members can greatly expand the distribution of important messages about practice philosophies, procedures, and special features.
  46. 46. Paradigm of Motivation • Primary motivational techniques orthodontists use - for encouraging patients to assist in their treatments • Three main psychological disciplines. • Humanism, existentialism, or Maslow’s Third Force techniques. • Psychoanalytical techniques developed by Freud • Behaviorism » positive reinforces » negative reinforces » punishment.
  47. 47. • Do not expect all patients to do things for your benefit. • Most patients, except for the deranged and totally altruistic, do things that benefit themselves. • So when people do have the skill but not the will to do something, look for the following conditions. – rewarding to perform as desired. – punishing to perform as desired. – simply doesn‟t matter whether performance is as desired. – Identify and remove the obstacles in performance.
  48. 48. Child orthodontic patient • Gives children a first-hand, experiential, and interactive lesson in dentistry and orthodontics. • Involvement in a worth while community service. • Alleviates fears about dental care. • Familiarizes people with the specialty. • Introduces to a great number of potential patients • Allows to market our practice and the services provided in a professional manner. • Newer learning experience
  49. 49. NINE CONGENITAL TEMPERAMENTS THAT MAKE CHILDREN EASY OR DIFFICULT TO MANAGE Trait Easy child Difficult child Activity Low High Distraction Low High Regularity Regular Irregular Approachability Approaches Withdraws Adaptability Good Poor Persistence Low High Mood Positive Negative Sensitivity Insensitivity Sensitive
  50. 50. TURTLES WITHOUT SHELLS • Behaviors associated with non-complaint orthodontic patients : – poor oral hygiene, chronic complaining, easily fatigued jaw muscles, inability to open their mouths wide, copious salivation, frequently broken appliances, refusal to use permissive appliances, easily provoked gag reflexes, chronic mouth ulcers, TMD symptoms, and frequent missed appointments
  51. 51. • Low profile hyper reactive children: – show little inclination to tolerate the demands, discomfort, and inconvenience of orthodontic therapy – broken brackets and bands result from when they touch, tug on, and damage the appliances that are discomforting them . – They cut the wires with nail cutters or wire cutter. – break the offending brackets by biting on a pencil, pen, or block of ice
  52. 52. FEES AND PAYMENTS • Economic success & profitability. • Economic equation : costs and fees • Fixing the fee for service provided. • Cost benefit ratio: INCOME V/S SKILL, EXPERTISE, EQUIPMENTS, TIME
  53. 53. Payment schemes • Direct to doctor • Via insurance company • Patient to doctor and then patient claim from insurance providers. • Free service • Robin hood practice.
  54. 54. • Knowledge and Experience • Cost-per time analysis of the fee-for-service approach • Internal audit of the following variables: – – – – – – Number of dental chairs Hours per week the office is normally open Weeks per year the office is closed Net income forecast Indirect cost factors Percentage of occupation of dental chairs Direct measurement Approximation
  55. 55. How do people choose an orthodontist ? • Referral from their dentist • Recommendations from friends and relatives • Media
  56. 56. Key to patient attraction • Initial phone call – Patients form an immediate impression of the dentist and his practice before ever meeting or seeing the office • Art and Science of the initial phone call: – Art: the way of talking and expressing your gratitude and concern for the patient. – Science: the information to be gathered and information to be imparted • The staff member answering the initial call must have a very pleasing and welcoming voice must sound interesting.
  57. 57. Pre appointment phone call: to Obtain essential information 1. First and last names of the patient and both parents 2. Addresses of the patient 3. Phone numbers 4. Patient’s Date of Birth 5. The dentist or other person who referred the patient
  58. 58. THE PERFECT ASSOCIATE: COLLEAGUE • The doctor usually spends an increasing amount of time at the chair treating patients • Time spent on marketing; with family , vacations etc… gets shorter. • Issues in finding a perfect associate: • differences in treatment philosophies, competition between the doctors, money issues, etc.
  59. 59. OLDER ASSOCIATE • A fresh outlook and avoiding burnout of the practice. • experienced and confident • No Ego hang-ups nor trying to change your practice philosophy, nor leaving to set up a competing practice. • More focused on treatment and provide exceptional patient care. • Better holiday and higher education planning.
  60. 60. PARTNERSHIPS • Importance : • expanding a practice. • making the transition to retirement. • high cost of a bad decision / miss diagnosis.
  61. 61. SUCCESSFUL PARTNERSHIP • A good fit between the personalities of the partners. • Similar values • The ability to be team players • Compatible goals • Mutual trust & understanding
  62. 62. Break Ups ! • The process of dissolution can take months or years and often involves litigation.
  63. 63. RELATION WITH GENERAL DENTIST Relationship :based on referrals • Add new general dentist referral sources or to maintain the loyalty of existing referrers . • Internal marketing efforts • METHODS OF ESTABLISHING RELATIONSHIPS : • lunch meetings, office-to-office events, gifts, set up study groups, memberships to various associations, etc.
  64. 64. PRACTICE ACQUISITION AND TRANSITION • Financing : • Funds • Self funded/Commercial bankers and loans • Partnerships • Fair-market value for the target practice • After-tax cash-flow projections • Debt and living expenses. • Credit-worthiness of the purchaser
  65. 65. Reasons for failure of practice acquisitions 1. legitimate personality conflicts 2. unforeseeable event 3. insufficient planning • Valuation of the practice, cash-flow, taxefficiency, legal, operational, and a myriad of other concerns must be addressed before the parties can proceed with confidence
  66. 66. To sell or not to sell ? • If the practice is of high or moderate income in a highly favorable or favorable location, then the chances of selling are extremely good
  67. 67. Green = Go ! Transition Probability : excellent Yellow = caution ! Transition probability : guarded Red = Alert ! Transition probability : unlikely
  68. 68. Strategy • start looking for an associate / buyer at least seven years prior to retirement • Ample time to choose the best possible buyer. • Higher the income, the better the chances of selling • improve the practice
  69. 69. Every beginner wants to get into profitable existing practice rather than starting a newer one • Less risk. • Guaranteed immediate income. • Continue to build an already thriving practice. • work with a mentor. • benefit from the good will already established within the community by the senior orthodontist. • a high-quality facility that otherwise would not be affordable for years. • practice with a staff. well-trained
  70. 70. PREVENTING LOSS Why do so many orthodontists fall prey to embezzlers ? • Leave the management duties to front-desk staffers • No internal controls or periodic reviews • Shortcut the hiring process
  71. 71. Ten steps to protect the practice when hiring an employee • • • • • • Reclaim any office keys and building passes from the terminated employee. Change the office locks. Revoke the employee‟s computer access, and change passwords. Change the burglar alarm code Revoke any check-writing or other financial authority. Recover any practice credit cards or phone cards.
  72. 72. • • • • Have the employee remove all personal belongings from the office and return all cell phones, pagers, etc If the employee has the power to order supplies by phone, notify suppliers that it is revoked. Finalize all payrolls and benefit details. Give the employee the last pay check. Although a few states have no law governing how quickly doctors must pay employees who quit, most require that an employee receive the final pay check by the next regular payday. If severance pay will be provided, consider having the employee sign a release form to protect your practice from liability
  73. 73. RETIREMENT • 1999 JCO retirement survey : • 92.9% = able to “afford a comfortable retirement” • fewer than 15% of practicing orthodontists will have $4 million or more in assets at retirement NOT PREPARED TO RETIRE. • • • • • Divorce poor investments poor planning limited saving enjoy life today philosophy “Not able to hang up their pliers and ride off into the sunset!”
  74. 74. Strategies  Plan ahead  Seek professional assistance  Monitor your numbers  Maximize peak earning years  Develop both personal and practice budgets  Increase practice income  Reduce practice expenses  Spend less than you make  Determine the investment rate of return needed to reach your goals  Don‟t be greedy  Don‟t make foolish investment mistake  Plan to work longer  Make sure to sell the most valuable asset  Protect the loved ones
  75. 75. • Always know the value of your practice • A practice coverage agreement in case of death or disability • The value of your practice decreases quickly and dramatically if you are unable to operate it • The longer it can be kept running, the better the chances that your loved ones will be able to sell it and reap the benefits of your years of hard work.
  76. 76. • Insurance needs : Protect the loved ones • Life insurance • Liability insurance • Home insurance • Health insurance • Long-term care – Auto insurance • Practice : • Liability (Malpractice) insurance • Office overhead insurance
  77. 77. CONCLUSION • • • • • • • • success in an orthodontic office team effort first, impression is the last impression maintain a good rapport with the patient and associates Right fee for right work is our right. Cost benefit analysis Time for all aspects of life Successful & comfortable retirement
  78. 78. “Managing a practice is an art in itself which everybody has to master it so as to lead a comfortable, satisfied life.”
  79. 79.
  80. 80. REFERENCES 1) 2) 3) 4) 5) 6) 7) Hamula Warren (April 2003) “Orthodontic office design”. Journal of Clinical Orthodontics. Volume XXXVII, Number 4 : Page 213 – 216. Hamula Warren (Oct 2003) “Orthodontic office design”. Journal of Clinical Orthodontics. Volume XXXVII, Number 10 : Page 533 – 540. Iba Howard (July 2003) “Management and Marketing”. “Orthodontic office design”. Journal of Clinical Orthodontics. Volume XXXVII, Number 7 : Page 373 – 375. Iba Howard (Sep 2003) “Management and Marketing”. “Orthodontic office design”. Journal of Clinical Orthodontics. Volume XXXVII, Number 9 : Page 485 – 489. Iba Howard (Dec 2003) “Management and Marketing”. “Orthodontic office design”. Journal of Clinical Orthodontics. Volume XXXVII, Number 12 : Page 659 – 664. Hamula Warren (Jan 2000) “Orthodontic office design”. Journal of Clinical Orthodontics. Volume XXXIV, Number 1 : Page 15 – 18 Gottlieb Eugene (March1999) “Ethics is orthodontic practice”. Journal of Clinical Orthodontics. Volume XXXIII ; Number 3 : page 145 – 150. .
  81. 81. 8. 9. 10. 11. 12. 13. Gottlieb Eugene (April 1999) “Ethics is orthodontic practice”. Journal of Clinical Orthodontics. Volume XXXIII ; Number 4 : page 221 – 223 Mayerson Melvin (March 1997) “Management and Marketing”. “Orthodontic office design”. Journal of Clinical Orthodontics. Volume XXX, Number 12 : Page 153 – 162. Mayerson Melvin (Sept 1997) “Management and Marketing”. “Orthodontic office design”. Journal of Clinical Orthodontics. Volume XXXI, Number 9 : Page 613 – 617. Mayerson Melvin (Dec 1997) “Management and Marketing”. “Orthodontic office design”. Journal of Clinical Orthodontics. Volume XXXI, Number 12 : Page 821 – 825. Mayerson Melvin (Feb 1996) “Management and Marketing”. “Orthodontic office design”. Journal of Clinical Orthodontics. Volume XXX, Number 2 : Page 99 – 105. Mayerson Melvin (June 1996) “Management and Marketing”. Journal of clinical Orthodontics. Volume XXX Number 6 Page 337-341.
  82. 82. 14. Mayerson Melvin (Sept 1996) “Management and Marketing”. Journal of clinical Orthodontics. Volume XXX Number 9 Page 493-497. 15. Mayerson Melvin (Dec 1996) “Management and Marketing”. “Orthodontic office design”. Journal of Clinical Orthodontics. Volume XXX, Number 12 : Page 699 – 702. 16. FinkBeiner Betty, FinkBeiner Charles “Practice Management for the Dental Team”. 17. DCNA 1988 18. Keim RG et al. Jan 2006 practice growth and staff data JCO 40 (1) 17- 26 19. Clark JR facing retirement .JCO 2003 20. O Neil JF Developing , implementing & sustaining marketing plans AJODO 2003 Dec 21. Berning et al. Vision for Orthodontist CEO AJODO 2003 Dec. 22. Gottlieb et al. Manage to Succeed JCO 2003 Nov
  83. 83.