What Kind of Leader are You?

Taking a break from the traditional post this week in the wake of the recent tragedy that happened in California.  During times like this it can be beneficial to look at what lesson is in this?

At times that seems impossible; however, sometimes strength and courage can be a result of something horrible.  The passing of nine innocent lives in a helicopter crash seems like something that is beyond a lesson. Dig deep and look at the words of one of the world's most iconic sports leader.


“The important thing is that your teammates have to know you’re pulling for them and you really want them to be successful”   - Kobe Bryant 

It begs the questions, what kind of leader are you? 

Are you expecting your team to create the results you are looking for? Are you leading them to the results you want to achieve?  Who is standing at the helm of your practice and your life?

Who is taking charge and pulling for the people that are going to be there when you achieve what you are looking to do?

It could be you're practice or a life journey, just know you won’t get there alone.  The lesson to learn here is to make sure your team knows that you want them to be successful.

AMP will continue to pray for the lives that were lost as a result of the tragic helicopter crash in California on January 26, 2020. Always respect what Kobe Bryant did on and off the court in his journey to not only be a tremendous athlete but also a leader of people.

2020 "I thought I'd be further along"

It’s the New Year! Which means, new habit making time. This time of year test to see how long our new habits will secure. We are going to lose weight, stop bad habits, create new habits, do all new stuff with the new year, right? 

JANUARY 10TH HITS

Reality sets in. We have curved off our goals already because we are not getting instant results. The poundage is barely less, the workouts are more, temptation sets in and BOOM, weakness overshadows our newly made dreams.

Do you ever think "I thought I’d be further along by now. How did I get to where I currently am? How can I get to where I want to be?"

Life is the sum of all our decisions. The cumulative effect of all the small decisions define who we are today. All those thousands of decisions we make daily are in front of you right now. But, do you ever ask yourself – How did I really get to where I am today, asking, are the results in my business where I thought they would be?

Do I lead my team with humble strength?

Does my team see me as an effective leader and manager of a business?

If any of those answers are no, this blog may be for you! Accelerate My Practice focuses on incremental growth using small, sustainable changes to provide empowerment within all members of the dental team. ALL. 

SMALl... INCREMENTAL CHANGES.. WITHIN THE ENTIRE TEAM...

Our business mantra is to teach you how to fish, providing tools to accomplish your goals. This may sound cliché , however, ask anyone of our former clients on their sustainable growth rate long after our services are completed. We start with the end in mind, reverse engineer your specific goals, breaking it down to small, manageable change. Once a single new task is mastered, we move to the next, adding tools for your tool belt of success. 

How long do you wish to say, ‘If I did this differently, I would have that’ or ‘I have been doing this for so long, I don’t know where to begin to change.’ If you are new to dentistry and want to carve your business trajectory of sustainable success, now is the time to learn new, small, effective sustainable business habits that not only last a lifetime but allow you to choose to work when your colleagues are mid-career and struggling. 

A Team That Elevates The Business

Everyone is very familiar with the notion that your team can either elevate you to where you want to be or sink an organization.  Having a team of “A Players” is critical if you plan on growing your dental practice. 

What are the different types of players on your team?

The A Player

The B Player

The C Player

If you can work towards having a team of all “A Players” and “B Players” you will see how quickly things can thrive. 

One of the most detrimental things you can do to your practice is.....

As a small business owner you have a very important job in making sure that your business is profitable.  When your practice is small and young, it's very likely that you do not have space to employ people that are not serving the long term mission of your company. 

We hear all the time that it is “hard to fire people” and for many people that do not have experience doing it, we won’t lie, it can be tough. The first step is changing your mindset around the words “firing someone”. 

Can we move into 2020 with the mind set that you are giving them an opportunity to flourish in an environment that serves them better and allowing your company a thrive by building a team that will best serve your goals and mission.

Planning for Q4 Success

Are you strategizing or 2020 in your dental practice yet? Maybe the better question is, have you planned for the last quarter of the year yet? 

Business owners routinely find themselves working in their business and not necessary working on their business.  With that being said, we've provied a framework below that will help in planning appropriately for the last quarter of the year. 

Here are a few things to think about:

If the answer is no to any of these, I would suggest we start talking! 

The first step to pulling all of this together is simply analyzing all of your data thus far for 2019.  You want to get an idea/understanding of the current status of your business goals and if you are on target to meet them. Understanding what needs to happen in the fourth quarter of the year to finish where you wanted to be. 

Every dental office will of course have different goals, but some data to think about could include your net production, collection totals, accounts receivable balances, outstanding Insurance balances, the percent of unscheduled treatment that is on the books or the percent of patient that have been reactivated.  After you have done this you want to analyze and identify where your largest opportunities lie and create a strategic plan for the fourth quarter.  After you have identified what your focus will be make sure that you share the specific goals with your team and track their progress accordingly.

NFL Mindset

How can you apply the NFL Mindset to your dental business?

Sitting here on a Sunday afternoon watching typical Sunday afternoon football. It is amazing how these athletes excel at their craft. This is team play at its best, doing their best for the ultimate win. 

Although the ultimate prize is the super win; Super Bowl, the reality of a team sport is this – play your best, every game every time. Do your best, every game every time OR You are cut or ultimately, traded. Pretty simple concept. 

Quarterback, Tyrod Taylor's first three starts for the Cleveland Browns wasn't an impressive one. Baker Mayfield stepped in to take Taylor's place due to a concussion. Taylor's last appearance for the Browns was in Week 9, and threw for 11 yards. Since Mayfield stepped in, Taylor has been traded to the Los Angeles Chargers

Wide receiver, Kelvin Benjamin he was released by the Bills due to lack of performance.

What would this concept look like in your dental office?

Imagine, your front office not filling the schedule effectively, they're facing a trade. The Hygiene department isn't treating patients to the ADA Standard of Care, they're facing a trade. Imagine any employee during the day using their cell phone or smart watch causing work distraction. Set the performance expectation and your roster will be full of reliable, top performing team members.

How can one bring this type of mindset into the dental office?

Coaching! Coaching challenges and guides athletes to be the best they can be, well beyond their comfort zone. Tough lessons are continually learned to stretch these young athletes, challenging their performance to peak at levels that even surprise them.

Coaching is unlocking a person’s potential to maximize their own performance. It is helping them to learn rather than teaching them.

John Whitmore ; https://www.skillsyouneed.com/learn/coaching.html

Coaching in your dental office can have similar effects on your team. Accelerate My Practice provides mindset opportunity change through consistency, with small incremental steps, creating sustainable growth. 

Here is a Doctor that shares his coaching experience using AMP mindset coaching.

Coaching with Accelerate My Practice changed this man’s life. It challenged and built his leadership within his business he previously felt “deflated.” 

Do you feel like everyday is drill, fill, go home, repeat? Do you feel deflated? Are you willing to be coached to success? Reach out to any of us at AMP.

Coaching matters!

Do I Need a Treatment Coordinator?

Lately we have had many offices discuss if having a dental treatment coordinator is the right thing for their office.  So, let’s break it down!

What is a treatment coordinator? 

A treatment coordinator is someone that essentially works towards having zero patients with incomplete treatment.  They are responsible for “closing” cases and working the unscheduled treatment list in an effort to not have any patients with unscheduled treatment. The treatment coordinator must know how to present treatment. Most importantly, they should be competent and confident when talking to patients (allowing them to establish trust with patients much faster).  

What is the difference between a treatment coordinator and a financial coordinator?

A financial coordinator is someone that manages actions needed to collect money. In short, this may include things like submitting insurance claims, verifying benefits, calculating patient due amounts, working the accounts receivable report as well as the outstanding insurance report, sending statements and collecting over the counter payments.  

A financial coordinator is an administrative position where a treatment coordinator is a sales position (someone responsible for creating revenue).  

How do I know if I need a treatment coordinator?

If the answer is yes to any of these you likely are in a position where case acceptance rates are dropping hence hiring a treatment coordinator may be the right move.

Topical vs. Systemic Fluoride

Topical vs. Systemic Fluoride: What Patients Need to Know

By

 Spring Hatfield, RDH

 -

October 29, 2018

A study published online in Environmental Health Perspective on July 20, 2012, written by Anna Choi, a research scientist in the Department of Environmental Health at Harvard, claimed, “Children in high-fluoride areas had significantly lower IQ scores than those who lived in low fluoride areas.”1 This publication fueled the fire for the anti-fluoride movement.

In March of 2013, another article was published in Environmental Health Perspective questioning the validity of the previously published article. This article stated, “As Choi et al. (2012) pointed out in their conclusion, there is a “possibility of an adverse effect of high fluoride exposure on children’s neurodevelopment.” Such a conclusion can be considered an ecological fallacy, which can easily lead to misinterpretation of the results.”2 Naturally, this article did not go viral on social media, in the same manner as the first article.

I believe patients have a right to refuse treatment, such as fluoride. However, I also believe it is important they make an informed decision. The following are the primary things I like to share with patients in regards to fluoride use and in-office fluoride treatments.

Systemic Fluoride

I encourage patients to research the difference between systemic fluoride and topically applied fluoride. Many patients do not realize there is a difference. The mode of action, as well as the delivery of systemic and topical fluoride, are quite different.

Systemic fluoride’s cariostatic effect is attributed to the reduced solubility of the enamel due to the incorporation of fluoride into the enamel minerals during tooth formation.Systemic fluoride, also referred to as water fluoridation in the U.S. (other countries use fluoridated salt and milk to help reduce caries risk), is often what patients are thinking of when they are concerned about poisoning and neurotoxicity. What patients fail to realize is fluoride occurs naturally in our environment; exposure can occur through dietary intake and respiration.

Just like any other substance, we are exposed to (oxygen, water, table salt), fluoride can be toxic in certain quantities.For comparison’s sake, let’s look at fluoride levels in some everyday foods and drinks:

These are just a few examples; the USDA has a very comprehensive spreadsheet on their website with more information.5,6

Any substance can be lethal at a certain dose, even water. A lethal dose of fluoride for a child is 16 mg per 2.2 lbs of body weight and a lethal dose for an adult is 32 mg per 2.2 lbs of body weight. A toxic dose for children and adults is 5 mg per 2.2 lbs of body weight; with a little math, you can see reaching a toxic or lethal dose would be very difficult.7 For instance, a child weighing 45 pounds would need to ingest 4 tubes of toothpaste to reach a lethal dose. An adult weighing 150 pounds would need to consume 13 tubes of toothpaste to reach a lethal dose. I would like to add, for acute toxicity, or a lethal dose, the fluoride must be consumed in a relatively short period of time. Most cases of toxic or lethal doses of fluoride occur when a child ingests a large quantity of toothpaste or other over the counter dental products.

Another common concern I hear from patients is the fear of fluorosis. Dental fluorosis is generally associated with chronic fluoride toxicity. Enamel fluorosis and primary dentin fluorosis can only occur when teeth are forming. Therefore, fluoride exposure that contributes to fluorosis occurs during childhood. The severity of fluorosis is directly related to the dose, time, and duration of exposure.8,9  

It is important to understand fluoride metabolism. Fluoride metabolism includes absorption, distribution, and excretion, where each step depends on the pH. After ingestion, plasma fluoride reaches a peak within 20–60 minutes, followed by a rapid decline as a result of both uptake in calcified tissues and urine excretion. The small intestine also contributes to fluoride absorption in a pH-independent mechanism. Non-absorbed fluoride is excreted in feces.

From plasma, fluoride is distributed to both hard and soft tissues followed by its renal excretion. A minor portion of absorbed fluoride is found in soft tissues through a steady-state distribution between extracellular and intracellular fluids. However, about 50% of the absorbed fluoride is incorporated in calcified tissues, mainly in bone, where 99% of the fluoride content in the body is found.

Fluoride renal excretion is one of the most important mechanisms for the regulation of fluoride levels in the body. About 60% of the daily ingested fluoride is excreted in urine of healthy adults and children. Many factors can modify fluoride metabolism such as chronic or acute acid-base disturbances, hematocrit, altitude, physical activity, circadian rhythm, hormones, nutritional status, diet, and genetic predisposition.10

Although dental professionals have no control over the amount of systemic fluoride a patient ingests, it is important to understand the mechanism to educate patients better.

Topical Fluoride

The CDC named community water fluoridation one of 10 great public health achievements of the 20th century.11 However, recent studies have determined that fluoride primarily works after teeth have erupted, which indicate adults also benefit from topical fluoride, rather than only children, as previously assumed.4

Applying fluoride gel or varnish containing a high concentration of fluoride to the teeth leaves a temporary layer of calcium-fluoride-like material on the enamel surface. The fluoride in this material is released when the pH drops in the mouth in response to acid production and is then available to remineralize enamel.12

A typical application of fluoride varnish requires 0.2-0.5 mL, resulting in total fluoride ion application of approximately 5-11 mg. Proper application technique reduces the possibility a patient will swallow the varnish during its application, and limits the total amount of fluoride swallowed as the varnish wears off the teeth over a period of hours.13 To reach a toxic dose of fluoride via topical fluoride varnish, a patient weighing 22 lbs (age 1-2 yrs) would have to ingest the entire dose from 5 varnish applications; the amount needed to cause a toxic dose increases as the weight of the patient increases.

A recent study to assess urinary fluoride excretion after topical application of fluoride varnish in preschool children concluded a single topical fluoride varnish treatment did not significantly increase the urinary fluoride excretion compared with placebo.14 As mentioned previously, fluoride is metabolized in the kidneys, making urinalysis a highly reliable test for increased fluoride exposure. This study further supports that minimal fluoride is swallowed, during and after, fluoride varnish application.

A survey was conducted to asses caregivers understanding of fluoride varnish. Of the 140 responses, 22.1 percent of the responses indicated lack of knowledge about fluoride varnish, 23.6 percent stated that it was for teeth, 8.6 percent stated it was something in toothpaste or water, and 45.7 percent stated it is something that helps teeth. About 52.7 percent of responses indicated lack of knowledge, incomplete, or incorrect understanding. At the caregiver-level, 50.4 percent did not know what fluoride varnish was or provided an incorrect or incomplete response. This indicates many caregivers have an incomplete or inaccurate understanding of fluoride varnish.15

Although a lot of attention has been focused on caregiver refusal of vaccines, little attention has highlighted topical fluoride refusal. In the past, it has been reported topical fluoride and vaccine refusal are correlated.16 Findings indicate that correlations between topical fluoride and vaccine-specific concerns are related to disease severity and internet-based, information-seeking behaviors. The clinical relevance of caregivers’ refusal of preventative care has become a problem which leads to greater disease burden for children and peers, potentially higher cost to the health care system, and preventable suffering.17 This, clearly, indicates healthcare providers need to educate patients on the benefits of preventive care.

Preventive care has changed medicine and dentistry over the years. We live in a time that many diseases have been eradicated due to preventive care. Though I believe patients and caregivers have the right to refuse preventive treatment, with the proper education and science-based evidence, I can’t imagine why they would. The amount of misinformation available on the internet will always be an obstacle, but preventive care professionals should not let that discourage them from spreading the facts. Not everyone will believe you or trust the science; however, you can rest easy at night knowing you did your part to help patients make informed decisions about their health and the health of their children.

SEE ALSOFluoride Varnish Shown to Prevent Dental Caries in Young Children

DON’T MISS: The History of Fluoride and Why It’s So Important

References

  1. Anna L Choi, Guifan Sun, Ying Zhang, and Phillippe Grandjean. Develeopmental Fluoride Neurotoxicity: A Systemic Review and Meta-Analysis. Environ Health Perspect. 2012 Oct;120(10):1362-8. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/22820538
  2. Siamak Sabour and Zahra Ghorbani. Development Fluoride Neurotoxocity: Clinical Importance versus Statistical Significance. Environ Health Perspect. 2013 Mar; 121(3): a70. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3621182/
  3. K. Rosin-Grget and I. Lincir Current Concept on the Anticaries Fluoride Mechanism of Action. Coll. Antropol. 25 (2001) 2: 703-712. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/11811302
  4. Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5014a1.htm
  5. Domen Kanduti, Petra Sterbenk, and Barbara Artnik. Fluoride: A Review on Use and Effects on Health. Mater Sociomed 2016 Apr; 28(2). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4851520/
  6. United States Department of Agriculture. Retrieved from https://www.ars.usda.gov/northeast-area/beltsville-md-bhnrc/beltsville-human-nutrition-research-center/nutrient-data-laboratory/docs/usda-national-fluoride-database-of-selected-beverages-and-foods-release-2-2005/
  7. Rizwan Ullah, Muhammad Sohail Zafar, and Nazish Shahani. Potential fluoride toxicity from oral medicaments: A review. Iran J Basic Med Sci. 2017 Aug; 20(8): 841-848. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5651468/
  8. Pamela DenBesten and Wu Li. Chronic Fluoride Toxicity: Dental Fluorosis. Monogr Oral Sci. 2011; 22: 81-96. Retrived from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3433161/
  9. Peres Buzalaf, Camila & Leite, Aline & Buzalaf, Marília. (2015). Fluoride Metabolism. 54-74. Retrieved from https://www.researchgate.net/publication/283794601_Fluoride_Metabolism
  10. 10.Buzalaf MA, and Whitford GM. Fluoride Metabolism. Monogr Oral Sci. 2011; 22:20-36. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/21701189
  11. 11.Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/mmwr/preview/mmwrhtml/mm4850bx.htm
  12. 12.Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5014a1.htm
  13. 13.American Dental Association. Retrieved from https://www.ada.org/en/member-center/oral-health-topics/fluoride-topical-and-systemic-supplements
  14. 14.Twetman S, and Stecksen-Blicks C. Urinary Fluoride Excretion after a Single Application of Fluoride Varnish in Preschool Children. Oral Health Prev Dent. 2018; 16(4):351-354. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/30175333
  15. 15.Chi DL, Richman J, Senturia K, Zahlis E. Caregivers’ understanding of fluoride varnis: implications for Future Clinical Strategies and Research on Preventative Care Decision Making. J Public Health Dent. 2018 Aug 28. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/30152869
  16. 16.Chi DL. Caregivers who refuse preventive care for their children: the relationship between immunization and topical fluoride refusal. Am J Public Health 2014 Jul; 104(7): 1327-33. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/24832428
  17. 17.Richard M. Carpiano and Donald L Chi. Parents’ attitudes towards topical fluoride and vaccines for children: Are these distinct or overlapping phenomena? Prev Med Rep. 2018 Jun; 10: 123-128. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5945909/

Dental Patient Courtesy

In dealing with Insurance companies in the dental offices we serve, there is a cycle, if you would. The last blog went into depth about the Dental Patient Revenue Cycle, if you haven't gotten the chance to read that head on over.

THE STEPS OF THE PROCESS

  1. Treatment plan the patient
  2. Create an insurance billing document
  3. Send the Document, get a response
  4. Response is different than proposal
  5. Send a patient a statement with the balance
  6. Patient is mad they have a balance

WHAT DO YOU DO?

Your front office person gets in the middle of the mucky water, asking the Doc what to do. Often times, the Doc quickly says, just write it off.

For all of you reading this right now, this may sound awkwardly bold; You can not legally excuse a balance when dealing with insurance IF you discount the patient portion after the insurance has paid. The patient balance is fully theirs to pay. Key here – fully. If adjustments or write offs are done after insurance, this is insurance fraud

If this sounds harsh or makes you feel uncomfortable, allow us to be clear. It may be the adage of “everybody does this” and it could be true. We are here to share the rules of the trade. Our intent is for you to understand the responsibility the Doctor has taken to be credentialed to an insurance and to obey by the governing rules. 

WHAT IS RIGHT?

So, what do we do? What is right? The reality of this issue is if you are going to offer a discount to patients attached to insurance, you must do this prior to insurance submission and you must collect the patient portion. You do not have the right to write balances off. 

One way to get around this is to do a service pro bono. This way, there is no insurance involved. Again, to be clear, you can provide free care. You cannot discount patient portions when insurance is involved. 

In numeric terms, discounting insurance can work if done this way. Say the $1000 crown is discounted by you for Suzie before Insurance to $800. Submitted at $800 instead of $1000, the insurance payment of 50% would be $400 not $500 and the same discount to the patient. If this is done prior to filing insurance, this is legal. You must discount the insurance end as well. 

Avoid stripes at all costs! Ask one of our AMP Coaches about this for more information.

Watch Darren Kaberna, AMP CEO go into the in-depth details about the legalities of Patient Courtesy.

https://www.beckersasc.com/pdfs/articles/Ch316896.pdf

https://www.cda.org/news-events/dental-benefits-101-proper-billing-waiving-co-payments

Dental Patient Revenue Cycle!

It can be very eye opening to walk into a dental office, print the dental patient balance totals over 60 days and simply show it to a doctor. This is one area of the practice that is simply easy to maintain and control.

Back to the beginning

How does this get out of control in the first place? Take a look at the Dental Patient Revenue Cycle graphic to the right. This is typically what we see in dental practices when we look at the revenue cycle.

How to control & collect payment

If you can control these factors in your practice you will see that your accounts receivable will likely be more under control. Now, what do we do about those old balances that are sitting out there and need collected?

Old Balances

The answer may seem simple and there are many different approaches. There are many ways to get your accounts receivable under control. Believe it or not there are also ways to make sure it never gets out of control.

Darren Kaberna describes the entire process in the video below.

Perseverance

Do you remember when you were in Dental School training? The excitement of that first cavity prep or the first time you provided anesthesia? Did you sleep the night before your first crown prep, wondering how you were to get the entire procedure done before clinic was over? 

Fast forward where you are today. Do you have sleepless nights wondering how you are going to approach a key team player who’s head in not in the game at work? Ever have thoughts of firing someone who is totally insubordinate, yet you don’t have the guts to do it?

Has the technical side of  dentistry suddenly become really easy?

The Business of Dentistry

Our coaches at Accelerate My Practice are specifically training in the management of people AND the business of dentistry. If a team member’s mind is not in your game, we coach through this. Consultants, on the other hand, tend to be quick to change, fire or pull the trigger without addressing the why of the topic on the table. 

Our CEO, Darren Kaberna, has created a masterpiece of sustainable change (Doc’s -that’s change that continues to provide results long after we are done) through the paradigm of NLP (Neurolinguistic Programming), coaching folks like yourself to understand why you make the decisions you do. We also focus on what drives a business (any business) to success. 

Dentistry is still a profitable business that seems to be driven downhill by PPO’s or late cancellations or even non collection of patient portions, etc. Stress escalates to a 24 hour a day problem, often taking home the stress of the office to your family and sometimes in all you do.

Remember, the bigger the pain, the more potential gain. Muscles grow from resistance and force or pain. Weight is lost from perseverance, or pain and commitment to the process. Are you ready to commit to a process unlike what you have done before? Do you want to go to work singing in your car and dancing when you get there? AND, have your team join you?

What are you willing to commit to and persevere through? Want to love Dentistry again?

Check out our website, AccelerateMyPractice.com. Any of our team members would be happy to chat with you.