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Meeting the challenges of the THE ADVANCED PRACTICE

Dec. 1, 2003
This four-part series examines the problems —and solutions! — that are unique to the advanced practice. Part two reveals how the innovative technology of CEREC and transform your practice.

by Jim Pride, DDS, and Amy Morgan

This four-part series examines the problems —and solutions! — that are unique to the advanced practice. Part two reveals how the innovative technology of CEREC and transform your practice.

In our last article, we established the benchmarks that make a dental practice advanced. They include:

• Staff members running the systems in self-directed work teams,
• Systems pro-actively moving the practice toward its goals,
• Cash flow meeting the business's needs and also funding the dentist's lifestyle and retirement goals.

We introduced you to Dr. Bryan Shanahan, a Pride dentist with a thriving, high-technology practice in Flagstaff, Arizona. We chronicled Dr. Shanahan and his team in their successful implementation of a paperless charting system. Utilizing all of their sophisticated tools, they created a more customer-service oriented, efficient, and profitable charting model. Continuous improvement and innovation is a must for any practice to stay ahead of the bell curve. Therefore, once their new charting system was in place, Dr. Shanahan and his team were ready for their next challenge: integrating CEREC 3.

With the help of his Pride consultant, Dr. Shanahan implemented this new technology, and the results far exceeded his expectations. His staff and patients fully embraced the innovation, and he realized a return on his investment within 18 months.

Are you thinking of purchasing CEREC and wondering whether you'll recoup your investment? Are you worried about whether your staff and patients will accept the innovation and what it will do to your office systems and routine? Based on our experience helping many dentists introduce CEREC and other innovations, we have identified the following guidelines. These guidelines helped Dr. Shanahan achieve phenomenal results, and they can do the same for you.

Determine if CEREC is right for your office

Before making any change, determine if the innovation personifies your values, aligns your systems, furthers your goals, and promotes the vision for your practice. One of the biggest mistakes that dentists make is introducing changes without a compelling reason why and a specific strategy for success. The questions that you and your team must answer are:

• What do I hope to gain from this change?
• Will it benefit my staff?
• Will it be compatible with my existing patient base?
• Will it take me one step closer to achieving my vision?
• Will it allow me to target a new market of patients and ones who will align with my philosophy of care and service?

"If you market to the 'masses'," says Dr. Shanahan, "don't be surprised when the 'masses' walk through your door and you're unhappy because you're not getting the patients you want." Before introducing CEREC, Dr. Shanahan determined the kind of dentistry that he wanted to do and the patients who needed it. "Our target patient," explains Dr. Shanahan, "is 40 to 65 years old. This patient needs the comprehensive care that we do more than someone under 40. When we researched CEREC, we found it to be strong in posterior porcelain restorations, which fit our targeted patients' needs." Dr. Shanahan determined before purchasing CEREC that it would support his practice's vision and goals.

Get your systems and staff ready for CEREC

Advances in the practice rest on having the basics in place to support innovation. This is our motto at Pride, because we know that the basics are the foundation of all practice growth. Once you have established that CEREC will meet your practice goals, be sure your office systems and staff are poised to support it. Here are key areas to examine:

1 Do you have a marketing plan that attracts targeted patients who appreciate and embrace innovations in dental care?

Before introducing any innovation, be sure you have a marketing plan established to attract those patients who will support it. Many of Dr. Shanahan's patients are working professionals. The time savings with CEREC was an important benefit to them. "As employers are cutting back and requiring more efficient work places, it's getting more difficult for our patients to take time off from work for their treatment," says Dr. Shanahan. "We knew they'd appreciate the convenience of having only one appointment for their crowns."

Dr. Shanahan announced his innovation through a letter campaign to his patient base and through his Web site. He tied the new technology to his vision and elicited his patients' excitement through tying their motivators to the technology's benefits. Here's an excerpt from his announcement:

Our goal is to make sure that our patients are comfortable, well informed, and happy, so they feel their needs are sensed, served, and satisfied. To that end, we are very excited to introduce our newest addition to our office: CEREC. CEREC is the latest in dental technology, and we are pleased to be the first office in Flagstaff to have it ... CEREC is a great addition for our time-conscious and anxious patients because everything is done in one visit.

Once Dr. Shanahan's patients began receiving the benefits of CEREC restorations, the team then focused on an internal referral campaign, which increased new patients by 5 percent.

2 Do you have a scheduling system that is productive and profitable and that provides a quality experience for your patients?

CEREC requires a major shift in scheduling. Prior to Dr. Shanahan's implementing this technology, his staff was already skilled in using Pride's scheduling system. Therefore, the staff had the mechanics and verbal skills to apply to scheduling CEREC. Getting your schedule in order to implement CEREC or any other innovation means ensuring that your scheduling basics are in place. "Prior to CEREC, after I prepped a traditional crown and took an impression, the dental assistant would prepare the custom temporary before I then adjusted, polished, and cemented it, which gave me time to check a hygiene patient or to administer anesthetic to the next patient," says Dr. Shanahan. "With CEREC, I was in the room the entire time, so the staff couldn't overlap my schedule as they had before. Also, the CEREC restorations didn't require a crown-seat appointment. This was another major scheduling shift because we used to pre-block crown-seat appointments so the patient wouldn't have to wait long to get one. With CEREC, my staff had to figure out what to do with that extra time in the schedule."

Dr. Shanahan and his staff weathered the initial period of adjustment. "We continually reviewed how CEREC was changing the schedule, and we solved the problems," says Dr. Shanahan. "When an innovation is brand new, the dentist has to be 100 percent committed. You can't leave it for the staff to do by themselves. I had to constantly reinforce why we were introducing CEREC and encourage my staff during the frustrating times. I tried to make the change exciting, telling the staff how happy they and the patients were going to be with it."

"The frustrating part of CEREC was the scheduling," recalls Stephanie James of the front office staff, "because Dr. Shanahan is very capable of working out of all three of his chairs. It was a challenge trying to figure out how much time the procedures took, what could go where, what could overlap, and what couldn't. I would think I did it right, then go to the huddle the next morning and hear the others say that the schedule didn't work. I'd say, 'Gee, I thought it was perfect.' They were all very supportive and understanding, and they always explained why something was wrong. The staff meetings also helped us come together as a team and iron out problems."

Because Dr. Shanahan already had established avenues of safe communication, he and his staff were able to discuss and fix problems. "It took a while to come up with an ideal schedule to integrate CEREC into the practice," recalls Dr. Shanahan. "However, we made up the extra time it initially took by not having to seat crowns or make adjustments in temporaries. Now we've reached a point where the CEREC appointment actually takes less time than a regular crown prep formerly took, so there's a real time savings. This translates into higher production per hour and more time spent building patient relationships.

3 Have you developed methods for case-presentation that collaborate with patients, educate them, and enlist their enthusiasm for their long-term oral health?

If you have qualms about looking a patient in the eye and recommending costly treatment, you'll need to resolve them before implementing this new technology. Since Dr. Shanahan and his staff have already honed the verbal skills for building trusting relationships and gaining patients' acceptance of treatment, they could apply these skills to making CEREC a success. "I'm involved in patient education," says hygienist Rita Ortiz. "When I have patients in my chair, I explain to them how CEREC works." Prior to CEREC, Ortiz already supported restorative treatment from the hygiene chair, so she could transfer those skills to the new procedure.

4 Do you have financial arrangements established for patients to invest in their care in as financially stress-free a way as possible while still being profitable for the practice?

If you expect payment in full at the completion of treatment, you'll need to reevaluate your financial policies. Since CEREC restorations take only one appointment, the patient will have to pay the full amount all at once. "With CEREC restorations taking only one appointment," says Dr. Shanahan, "we had to find new avenues of financing for patients receiving multiple quadrants of this treatment. We selected new outside sources that could meet our patients' needs, and we also created other options internally. Our outside sources have been so effective, flexible, and accommodating that our patients are happily choosing that option, which has considerably lessened our follow-up efforts on receivables. So, CEREC has actually helped our accounts receivables."

Whether you choose to offer an internal payment plan or outside sources of credit or both to your patients, make sure that your financial arrangements give viable options for patients to accept the new treatment. Remember, the vision for effective financial arrangements includes making sure that your system: a) Is win-win for your practice and your patients; b) Increases patient commitment; c) Increases productivity and cash flow; d) Reduces delays in treatment significantly.

5 Have you led your staff in a way that fosters their enthusiasm and commitment to new technology?

As with any advancement in the practice, your leadership is the key to making it successful. Dr. Shanahan had already developed leadership skills to inspire his staff to embrace growth and innovation, which was vital when introducing CEREC. Hygienist Rita Ortiz says, "If we didn't have Dr. Shanahan being enthusiastic about everything, we'd probably be in a rut. He is like a kid in a candy shop when there's something new to try. He gets so excited about it, and he gets us excited to try it, too." Dr. Shanahan's enthusiasm was essential in gaining his staff's commitment to CEREC.

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Dr. Shanahan invested in training his staff on the new technology, which was also essential to its success. "Dr. Shanahan had someone come in to explain CEREC to us," says dental assistant Marlena Berry. "He also took me and another staff member to a seminar on CEREC. We shared the information with the others when we got back. Then our staff came up with ideas on how to tell patients about CEREC and how to schedule it. This was very helpful."

This highly positive staff response to CEREC is a result of Dr. Shanahan's leadership skills. "Never assume that just by saying you want to do something, it'll get done," says Dr. Shanahan. "You have to explain to the staff why you're going into it and constantly use and reinforce it. Address the issue daily with the staff. Ask: How are we doing? What do we need to do differently? Catch your staff doing something right and praise them. Quickly and in a positive way, correct them when their actions are not right. Otherwise, the innovation will not get implemented."

Determine the return on your investment (ROI)

Before purchasing something new, define the ROI that you want from it and how you will measure it. Any innovation must bring a return, be it a financial return or another benefit.

Let's say your purchase will be $80,000 and you expect a full financial return on it in five years. Let's also say that you will take out a loan to pay for it at eight percent interest for five years, with monthly payments of $1,813. You'll need to produce enough over and above your current production to pay for the new equipment. Table 1 shows the ROI formula that Dr. Shanahan and his consultant used.

Working 32 clinical hours per week, you'll need to generate $928 in additional production per week. You can break this figure down into the number of units of the new procedure you'll have to perform each week and month over your normal production to obtain the production increase. Without targeting an increase in production, incorporating it into daily goals, and focusing on achieving it, chances are it will not be accomplished. With no increase in production, guess where the money comes from to buy the new equipment? Your compensation.

The results

With your basics in place to implement CEREC, you may obtain a return on your investment much sooner than projected, as Dr. Shanahan did. "In 18 months, we've done about 600 to 700 restorations with CEREC, many more than we anticipated, and gotten a full return on our investment," he says. "This is because our patients are accepting more posterior porcelain treatment than before, thanks to the convenience of CEREC."

With a targeted patient that needs and wants CEREC, a marketing system to attract the ideal patient, an effective scheduling system to accommodate CEREC, a case-presentation model to gain the patient's acceptance of the new treatment, financial arrangements to facilitate payment, and a staff motivated and trained to embrace the new procedure, Dr. Shanahan was overwhelmingly successful in implementing CEREC. With the basics firmly in place to support practice growth and innovation, you too can implement CEREC to the fullest, realize a return on your investment, generate extra profits, excitement among your staff, and rave reviews from your patients. It's all possible, with practice management playing a leading role in the show!

Meet the authors and profit from their insights on developing an ideal practice. They are instructors who conduct Pride's popular seminars on practice management and leadership. For more information on cities and dates, as well as on how to get your systems and staff ready for innovation, call Pride Institute at (800) 925-2600.

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