Equal and opposite reaction

Jan. 1, 2000
Case Profile: In the shadow of the Abraham Lincoln legacy, this Springfield, Ill., practice is a stone`s throw from the Capitol steps. Although the majority of patients work in state offices, bureaucracy is not theirs alone and has helped bring about a serious reversal of fortunes for a man called "Judge."

Sally McKenzie, CMC

Case Profile: In the shadow of the Abraham Lincoln legacy, this Springfield, Ill., practice is a stone`s throw from the Capitol steps. Although the majority of patients work in state offices, bureaucracy is not theirs alone and has helped bring about a serious reversal of fortunes for a man called "Judge."

Symptoms: Productivity is off by 29 percent from last year. Patients are leaving left and right. Those who are staying are baffled. The staff is distraught. The doctor is dazed and discouraged.

Observations: Our doctor is well-liked by just about everybody in town. They call him "Judge" because his consultation room occupies a former judge`s office, and because the name fits him. As the nickname suggests, Judge reads all the time - too much in fact. He also attends too many CE courses and even more seminars, embracing more than his share of fashionable theories. Last year, with more patients than time, plus a whopping $150,000 in accounts receivable - for which he blamed insurance bureaucracy alone - Judge was ripe for a change. It was then that he started paying attention to some pretty prominent "experts" who were espousing the "stop accepting insurance" ideology of dental practice management. In their zeal for fee-for-service and cash, these experts professed that enough cosmetic and implant procedures would literally keep practices in the pink and swarming with patients. Well, that may be true, but where and how does one suddenly pick up enough of these high-ticket procedures to stay in the pink? Our doctor sure didn`t know and, after losing one-third of his patients, he`s now in the red! I can tell you candidly that he`s not alone either.

Discussion and Recommend-ations: Because of the mammoth amount of accounts receivable, Judge was convinced that he needed to stop accepting assignment. So he stopped just like that. Although such an abrupt move may work in quantum physics, an equal and opposite reaction can take its toll on a dental practice. It did. It`s understandable that the doctor had "had it" with insurance company bureaucracy, but if he wanted to end up "insurance-free," here`s what he could have done over the course of time.

To begin, he might have commissioned some demographic studies to determine the socioeconomic level of his patients and exactly how many insurance patients he was dealing with. If more than 50 percent of his patient base was on insurance, he`d be shooting himself in the foot to stop accepting it, especially without any warning.

He might have started to wean patients off by not accepting insurance for recall and/or by no longer accepting assignment. He might have determined which HMOs and PPOs had the worst fee schedules and, each time he saw a patient on one of those plans, he might have personally explained why it was impossible to continue to accept such plans, and offered a compelling pitch as to why the patient might want to remain with the practice on a fee-for-service basis. Even if the patient was bound and determined to leave, he might have suggested that if the patient ever became dissatisfied with what his/her insurance plan allowed, he would welcome the patient back. Finally, before closing the lid on insurance, he might have had in place a marketing plan designed to appeal to those patients who might be willing to handle fee-for-service for the right reasons. Or he might consider the possibility that pulling the plug on insurance might have been the wrong decision for his patients and his practice.

Sally Says: On this visit to Lincoln`s home, I was reintroduced to the plain-spoken wisdom of the great president. Two of his insights seem particularly fitting here.

"It is best not to swap horses while crossing the river."

"We shall sooner have the fowl by hatching the egg than by smashing it."

Sally McKenzie is a Certified Management Consultant, nationally known lecturer, and author with more than 32 years in the dental profession. Her sole proprietorship, McKenzie Management and Associates, provides in-office systems` analysis of the business, clinical, and hygiene department; staff training; and offers a full line of educational-management books, audiotapes, and videos. McKenzie`s dental clients span 40 states over 20 years. She is a consultant to the Council on Dental Practice of the ADA. Call her at (877) 777-6151, or e-mail: [email protected], or visit her Web site at www.mckenziemgmt.com.

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