Issue 3 | 2017
CARING FOR AN
UNDERSERVED COMMUNITY Dr. Shaun Rocknak of Cheyenne, Wyoming
CAN MOVING ACROSS THE STREET INCREASE YOUR PRODUCTION BY 20%? Dr. Vic Uhrenholdt’s Profitable Rebuild in Cleveland, Texas
REAL ESTATE: The Second Highest Expense In Your Practice
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FEATURE
TABLE OF CONTENTS
8
20
OFFICE DESIGN
CARING FOR AN UNDERSERVED COMMUNITY
CAN MOVING ACROSS THE STREET INCREASE YOUR PRODUCTION BY 20%?
DR. SHAUN ROCKNAK OF CHEYENNE, WYOMING
BY TINA PETERSON, PHOTOS BY MATTHEW IDLER PHOTOGRAPHY
Dr. Vic Uhrenholdt in Cleveland, Texas BY KIM THOMAS, BURKHART ACCOUNT MANAGER PHOTOS BY STEVE BRACK
PRACTICE MANAGEMENT 4
THE 5-STAR PRACTICE Building your Fee-For-Service Patient Base BY KATHY EDWARDS, RDH, PRACTICE CONSULTANT
7
PRACTICE SUPPORT TEAM FAQS X-Rays, Codes, and Billing
BY KATHY EDWARDS, RDH, MARGARET BOYCE-COOLEY AND DANA MORANO OF THE PRACTICE SUPPORT TEAM
CLINICAL SUCCESS
8
16
VENEERING HEAVILY-WORN DENTITION
BY RHYS SPOOR, DDS, FAGD
TECHNOLOGY
18 KAVO™ INTRODUCES EXPANDED PRODUCT PORTFOLIO
Dr. Uhrenholdt’s beautiful office build
SUBMITTED BY KAVO™
GIVING BACK 28
GETTING PEOPLE OUT OF PAIN
BY UKO ETIM
REAL ESTATE
36
Spending Matters: Tips from one of our financial experts
INDEX OF ADVERTISERS:
32
REAL ESTATE: THE SECOND-HIGHEST EXPENSE IN YOUR PRACTICE
BY NATE TUTTLE, CARR HEALTHCARE REALTY
SUPPLY SAVINGS GUARANTEE 34
MORE PRODUCTIVITY, LESS STRESS
BY JEANA BARDWELL, BURKHART ACCOUNT MANAGER
WEALTH MANAGEMENT 36
SPENDING MATTERS
3M................................... BACK COVER
GENDEX.......................................... 27
A-DEC............................................... 3
KAVO.................................................... 19
ALDRICH ADVISORS......................... 39
NOMAD............................................ 27
BUSINESS OF DENTISTRY
BURKHART....................................... 26
NSK................................................... 6
40
BURKHART EQUIPMENT FINANCE... 31
PLANMECA...........INSIDE FRONT COVER
ARE YOU LEAVING MONEY ON THE TABLE?
DENTAL GROUP LLC......................... 39
REBEC................................................ 6
BY LAUREN COVER AND DOUG FETTIG, CPA, MBA
DIGITAL DOC.................................... 31
VATECH..................INSIDE BACK COVER
BY SAM MARTIN, MBA (TAX), CFP®, CPA
CATALYST MAGAZINE // ISSUE 3, 2017 // 1
SERVING THE DENTAL PROFESSION SINCE 1888
FROM THE
President
B
urkhart is passionate about providing exceptional service for our clients. We aim to identify each client’s unique needs along with their personal and professional goals. We strive to provide helpful information, skilled service, and specific products. We earnestly work in the best interest of others because at the end of the day, that’s what makes our work most satisfying. Passion is not a virtue developed overnight. Since 1888, Burkhart has worked to make sure every service we provide, in some way improves the career or life of our clients. Many of the services we provide help free up our clients from smaller day-to-day tasks and allow them to focus on their top priorities. Some of those services include managing inventory, controlling supply costs, and making sure digital equipment and software work well together. We focus on one central goal, providing the best client experiences. Staying focused is what makes us efficient, knowledgeable, and current in the marketplace.
Lori Burkhart Isbell President
2 // BURKHART DENTAL SUPPLY
At Burkhart we realize our clients are both dental professionals and business owners. It is our goal to help them be successful at both. Catalyst is fully dedicated to that success. The articles in this publication vary from product use and selection to business management topics and provide information and guidance that can lead to a more successful practice. Throughout the publication are stories of Burkhart clients who have succeeded in the areas highlighted. We hope you enjoy!
If you have a request for a topic you would like for us to cover in Catalyst, please contact Sara Wisely at: swisely@burkhartdental.com Catalyst Magazine is published by:
BURKHART DENTAL SUPPLY 2502 South 78 th Street Tacoma, WA 98409 p) 253.474.7761 f) 253.472.4773
DESIGNER Sara Wisely
ADVERTISING
Melissa Gill mgill@burkhartdental.com 253.212.4874 All rights reserved. Reproduction of any part of this publication without written permission from the Publisher is strictly forbidden. Images are not necessarily to scale.
Customer Service:
800.562.8176
Designed to Perform. Made to Inspire. A-dec Inspire Dental Furniture Collection TM
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perform. It’s the pinnacle of efficiency and comfort, blended with a multitude of design options, from unique infills and elegant glass vessel sinks, to ergonomic swing-out shelves. Ergonomic, practical and beautiful, it’s designed for all the things that inspire you.
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Be Inspired at a-dec.com/Inspire.
PRACTICE MANAGEMENT
RELATIONSHIP STRONG
THE
5-STAR
PRACTICE BUILDING YOUR FEE-FOR-SERVICE PATIENT BASE BY KATHY EDWARDS, RDH, PRACTICE CONSULTANT, BURKHART’S PRACTICE SUPPORT TEAM
I
ncreasingly, we find practices are anxious to reduce their managed care participation and provide quality care under their office fee schedules. Attracting fee-forservice patients demands a high-level patient experience, and perhaps a different approach than a model heavily reliant on insurance plans for new patient growth. What does a new patient experience look like, that is designed to impress the elusive fee-for-service patient? It needs to be referral-worthy, an experience designed to solicit additional referrals from friends and family. Look through the list and see how many stars you would rate your own practice.
Greet patients by name. The entire team should know who is on the schedule and welcome patients regardless of who the assigned provider is. Patients should feel they belong there. Office staff can reinforce this by making patients feel the team knows them. Take time to listen. A few minutes at the onset of the appointment to connect with patients solidifies the relationship. Take notes if you need to that will jog your memory the next time you see the patient. Do not let your busy schedule take away from relationship building. It is good for the patient, rewarding for the team, and builds trust that justifies an out-of-pocket expense for patients who value quality over finding an in-network provider.
TECHNOLOGICALLY ADVANCED Expose patients to your high-tech equipment, not only reflecting a standard of care, but the kind of exceptional care they will brag about to their friends. Patients want to be proud of their dentist, the team, and practice in general. Regular use of an intra-oral camera, pano, digital scanner, cone beam, etc. provides the bragging rights they desire. Reinforce the benefit of early diagnosis through the technology you have invested in…and make sure your patients see it in action.
AVAILABLE SCHEDULING Answer the phone—with a smile—obvious to the caller by the third ring. New patients are not likely to leave a message; they do not know how amazing your practice is yet, therefore you have not yet earned their loyalty. Potential new patients diminish in numbers if you don’t answer their calls. When you do get that important inquiry call, make sure the schedule can accommodate the new patient within two weeks. Block enough time in the schedule to support the number of new patients you have as your goal for each month.
4 // BURKHART DENTAL SUPPLY
PRACTICE MANAGEMENT
GREAT SCRIPTING o The hygienists and assistants should utilize an interview technique to understand the patient’s concerns and objectives. Scripted interview questions, woven into protocol, bring consistency to conversations. There is comfort with consistency for both the team and the patient. o No surprise philosophy—provide estimates and financial options prior to treatment. Provide options and honor patients’ decisions. Phase treatment if needed, but do not assume patients are unwilling to have out-of-pocket expenses. Listen to their needs.
H OW ’ D Y P R A CT I C O U R E D O? If a ny of th ea
re a s li sted a re less tha n five s ta rs in you r prac tice, w encou rage e’d you to re ac h o u t to you r Bu A c c ou nt M rk ha rt a n age r a nd Bu rk ha rt ’s P rac tice Support Te a m for help . We have we a lt h of re a sou rces a n d support— we’re just a nd a phone c a ll aw ay at 1
.8 0 0.6 6 5
.5 323
TOP-NOTCH FACILITY Your facility must match your care. Patients want 5-star dental treatment and often judge that based on the facility you create. Evaluating a spectacular crown margin is not in the skill set of most patients; they can evaluate how welcoming, modern, and up-to-date the practice is. Remodeling or implementing cosmetic upgrades are a wise investment. McGill Advisory has found a practice typically grows 10-15% through increased referrals and enhanced case acceptance of higher-end procedures after an “upgrade.”
ONLINE REVIEWS Fee-for-service patients tend to look for dentists by searching multiple sites and comparing reviews. Make sure your reputation is easily accessible by asking patients to post reviews. Research indicates having 10 or more five-star Google reviews has a measurable impact on new patient volume. Your website should be engaging with video links to let potential new patients “meet” the doctor in advance. This will also improve your SEO.
CATALYST MAGAZINE // ISSUE 3, 2017 // 5
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WHAT HAPPENS WHEN YOUR AMALGAM SEPARATOR FILLS UP?
4/27/17 2:54 PM
No problem if you have a Rebec! • Rebec is the only separator company licensed to take back medical waste. • Once each year we send you a postage pre-paid box to return your collector full of waste sludge. (With the other brands, waste disposal is your problem.) • Rebec is the only amalgam separator company that maintains a complete “cradle to grave” record of every disposal for you. (You’ll need those compliance details if your practice gets audited.) Make life easy and save money.* Choose Rebec! The rugged stainless steel separator with the longest warranty and easiest waste disposal program. Why buy anything else?
Get a rebate of $150-$300 direct from the manufacturer with every Rebec model
For more information, ask your Burkhart sales representative. www.RebecEnvironmental.com/rebate 800-569-1088
*ADA Professional Product Review, Volume 7, Issue 2, 2012.
PRACTICE MANAGEMENT
PRACTICE SUPPORT TEAM
FAQS
X-Rays, Codes, and Billing
Burkhart’s Practice Support Team receives hundreds of questions each year; here are a few of the most common questions we’ve received recently: Q: WE ARE NOT MEDICAID PROVIDERS; DO WE REALLY NEED TO LIST ICD-10 CODES? While many insurance plans do not require ICD-10 medical codes to process claims, it will only benefit your patient. This is especially true when health conditions such as diabetes are part of the patient’s health history. Adding the appropriate ICD-10 codes completes your documentation for the patient. In addition, these codes may open up more benefits depending on the patient’s medical condition.
Q: HOW DO I CODE FOR AN EXTRA-ORAL BITEWING TAKEN FROM THE PANO MACHINE? A: D0330 is appropriate. D0251—Extra-oral posterior film can be used for lateral jaw radiograph films and bitewings, if derived from separate images. If the original image was a pano, you must use D0330. This applies even when software cuts out bitewing films from the pano. The code used is always for the original capture taken. The cone-beam code series D0350, D0364-D0368 may also be used—depending on the image captured.
Ext ra-ora l bitewing on a pano? Us e D0330!
Q: WE HAVE GREAT TECHNOLOGY, BUT OUR PATIENTS CAN BE RESISTANT TO LETTING US TAKE X-RAYS AND PANO. ANY SUGGESTIONS? A: It is important to find out why your patients are refusing to have x-rays taken. You must understand the resistance to address the challenge. Use good scripting to discuss the benefits of regular films and let the patient know you will take the minimum necessary to diagnose. Be prepared to have information on radiation exposure to relieve patient fears. Other patients may resist for financial reasons. Discuss the cost benefit of catching issues when they are small, and less expensive to fix, to help them justify any financial outlay for films. Above all, have a protocol in place that makes the doctor comfortable. Perhaps a two-year interval would be reasonable for a patient with no history of decay or incipient lesions—as an example.
How can we help you? Burkhart's Practice Support Team has many years of combined business and dental expertise. Contact us today! practicesupportteam@burkhartdental.com
1.800.665.5323
CATALYST MAGAZINE // ISSUE 3, 2017 // 7
CAN MOVING ACROSS THE STREET INCREASE YOUR PRODUCTION BY
20%?
8 // BURKHART DENTAL SUPPLY
OFFICE DESIGN
BY KIM THOMAS, ACCOUNT MANAGER, BURKHART DENTAL | PHOTOS BY STEVE BRACK
T
hat is exactly what happened when Texas dentist, Dr. Vic Uhrenholdt, built his new practice directly across the street from his existing practice.
Dr. Uhrenholdt began his dental career just northeast of Houston in Cleveland, Texas where he became an associate right out of dental school. Later, he and his young bride decided purchasing the practice was the right opportunity for their family because they liked the small-town atmosphere Cleveland offered. His decision to move his 30-year-old practice into a brand new building across the street has proven to be a great investment—as his production rates have increased by 20 percent. CATALYST MAGAZINE // ISSUE 3, 2017 // 9
OFFICE DESIGN
DR. UHRENHOLDT AND HIS WIFE, MIQUETTE, HAD A VISION TO MAKE THE NEW OFFICE
FEEL LIKE HOME
The office was designed to have a warm, home-like environment. 10 // BURKHART DENTAL SUPPLY
OFFICE DESIGN
INTEGRATING TECHNOLOGY INTO A PERFECTLY DESIGNED SPACE One of Dr. Uhrenholdt's main objectives in building his new facility for Cleveland Family Dentistry was to seamlessly integrate the latest technology into a perfectly designed space that was more practical. "One area of work-flow we really appreciate is in sterilization because it is centrally located and easily accessible to every side of the office," he explains. The Bravo sterilizer and the Hydrim instrument washer - along with the cassettes, ensure the instruments are processed safely and efficiently. Dr. Uhrenholdt added technology at his previous location, but shared, "We installed computers, software, intraoral cameras, and electric handpieces, but I always felt like I was just patching the old office."
INCREASED ACCESSIBILITY WITH INTRAORAL CAMERAS ”Although we had intraoral cameras before, we chose to integrate them into the units so they would be more readily accessible to the staff, which has resulted in more images taken on a consistent basis,” explains Dr. Uhrenholdt. He chose the SoproLife intraoral camera and cavity detection tool for the doctor operatories and the SoproCare with perio mode for the hygiene operatories. Electric handpieces were used at the old office, but he did not like them hanging onto the side of his units. Dr. Uhrenholdt loves his new A-dec units with electric motors built in so they are easy to control. He rarely uses air-driven handpieces now because, “the electric ones are smoother, with less chatter and more torque.”
DESIGN PROCESS MAKES THE OFFICE FEEL LIKE HOME Dr. Uhrenholdt and his wife, Miquette had a vision to make the new office feel like home for their patients. Visitors are greeted with a warm and welcoming ambiance from the stunning stone fireplace, rustic wood beams, and beautiful décor. Charming accents and elegant lighting escort guests down the corridors and throughout every room. The collaborative efforts of Lee Palmer (Burkhart Equipment Specialist), Jonathan Green (Architect/Builder), and Tammie Gandarillas (Interior Designer), helped the Uhrenholdts achieve their dream office.
THERE IS VALUE IN WORKING WITH A BURKHART EQUIPMENT SPECIALIST Dr. Uhrenholdt emphasized the value of collaborating with a Burkhart Equipment Specialist during this endeavor. “Working with Equipment Specialist, Lee Palmer was extremely valuable, because Lee thought of everything I would need.” Dr. Uhrenholdt felt the comprehensive approach of the Burkhart process prevented any unexpected costs at the end of the project.
TOURING A-DEC’S FACILITY EDUCATES AND CREATES CONFIDENCE Dr. Uhrenholdt traveled to Newburg, Oregon to tour the A-dec manufacturing facility where he and his wife could see first-hand how A-dec builds each piece of equipment. He was also able to visit nineteen operatories at the A-dec Education Center, allowing him to understand how each concept would work in a real office setting. Dr. Uhrenholdt said, “The A-dec trip was an amazing experience and gave me confidence in making the right choice for our equipment.”
CATALYST MAGAZINE // ISSUE 3, 2017 // 11
OFFICE DESIGN
A-dec equipment was chosen for the operatories.
MAKING A BIG CHANGE FOR PATIENTS During the project, it was evident Dr. Uhrenholdt was always thinking about his patients— and how they felt. He often asks himself, “If this were my family member, what treatment would I want for them?” His patient-centered focus inspired him to make a big change clinically—so when they enter the operatories, they will not be intimidated by complicated dental equipment. To accomplish this goal, he changed from over-the-patient delivery, to rear delivery for his dental units. He feels patients are more relaxed now when they approach the dental chair because it is simple and inviting instead of cluttered and threatening. This change really goes along with his conservative clinical philosophy where he considers each person's situation as he would his own family.
EQUIPMENT INSTALLATION WAS “MAGICAL” “The equipment installation with Burkhart’s Lead Service Technician, Tom Wells, was just magical. He had such a positive attitude and was very protective of the equipment,” said Dr. Uhrenholdt. The installation was a team effort managed by Tom, along with fellow Burkhart technicians, Steven Rosenlund, Jeremy Tysiachney, and Mark Barbosa. Tom began the process with regular visits to the construction site to confirm proper placement and execution of plumbing and other essentials. At the end of the installation, several hours were spent training Dr. Uhrenholdt’s staff on the new technology. A Burkhart technician was also present for the first morning of treating patients to ensure everything went smoothly.
BRING IN EXPERTS EARLY Dr. Uhrenholdt’s recommendation to a dentist thinking about building a new office is to bring in experts early. “Engage experts that can help you early in the process because you can get to a certain point when it is too late to make changes.” When asked what he would do differently, Dr. Uhrenholdt said, “Absolutely nothing… Burkhart helped me think of everything in advance.”
12 // BURKHART DENTAL SUPPLY
OFFICE DESIGN
“THE A-DEC TRIP WAS AN AMAZING EXPERIENCE AND GAVE ME CONFIDENCE IN
MAKING THE RIGHT CHOICE FOR OUR EQUIPMENT.” –Dr. Uhrenholdt
CATALYST MAGAZINE // ISSUE 3, 2017 // 13
OFFICE DESIGN
14 // BURKHART DENTAL SUPPLY
OFFICE DESIGN
USING THE NEW OFFICE TO GIVE BACK Every year Dr. Uhrenholdt and his staff provide approximately $30,000 in free dental care to their community through Dentistry From the Heart, a non-profit organization that provides dental care worldwide to those in need. This year, the charitable event was held in their new state-of-the-art facility that enabled them to provide an even better experience for the recipients. Each person was seen on a first come, first served basis and was allowed to choose one procedure: a filling, an extraction, or a dental cleaning. Rotary Club provided lunch with others in the community providing music, security, and traffic control to make it a successful and festive event.
The Bravo sterilizer and the Hydrim instrument washer, together with cassettes, ensure the instruments are processed safely and efficiently.
Dr. Vic Uhrenholdt and his wife, Miquette
DREAM BECOMES REALITY AND NEW PATIENT GROWTH INCREASES 30% The new building on one of the main streets in the small town of Cleveland, Texas, seems to have many people in the community excited. With new patient growth up by 30% since the office move, several people have said, “We were waiting for you to open.� Staff members are enthusiastic about their beautiful and technologically advanced work environment. With much planning and dedication, Dr. Vic Uhrenholdt and his wife, Miquette, have made their dream office a reality.
CATALYST MAGAZINE // ISSUE 3, 2017 // 15
CLINICAL SUCCESS
CASE STUDY
VENEERING HEAVILY-WORN DENTITION BY RHYS SPOOR, DDS, FAGD, ACCREDITED MEMBER OF THE AMERICAN ACADEMY OF COSMETIC DENTISTRY
T
his patient had heavily-worn anterior teeth and wanted a nicer smile (figure 1). After doing an examination and obtaining records, we decided to do an indirect intraoral mock-up to determine if the projected size and shade of the final result would aesthetically work. After viewing the mock-up, the patient was enthusiastic about proceeding with treatment.
SLEEP APNEA CONCERNS When viewing the wear pattern, (figures 2, 3, 4, 5, 6 and 7) we observed the majority of the wear was in the anterior area. After further questioning, we agreed sleep apnea might be a contributing factor to this wear pattern and recommended a sleep study. The results of the study were the patient had significant sleep apnea
FIG. 1
01 The wear pattern is a visual history the patient will try to recreate again unless the underlying environment is altered. FIG. 6
and now uses a CPAP at night. This should help reduce the amount of anterior nocturnal bruxing and help preserve our restorative restorations. Aesthetically, the marginal gingiva was V-shaped, wide, and a fairly thick biotype (figure 8). Probing around, the maxillary incisors generally were in the 4 mm range and exhibited generalized gingivitis. Other than a few posterior composite restorations, the dentition was natural (figures 9 and 10).
TWO OPTIONS Our treatment plan was distilled to two options. Both included periodontal therapy, bleaching, and a post-treatment occlusal guard. Option one was 10 maxillary ceramic (Ivoclar eMax) veneers.
FIG. 2
FIG. 3
BEING CONSERVATIVE The goal was to do the most conservative preparation practical, so an overlay from the diagnostic wax-up was placed (figure 11) and depth cuts made through the material (figure 12). When the temporary overlay was removed, only the areas that showed marks needed to be reduced. By starting with the final form as reference, minimal reduction was needed without guesswork.
FIG. 4
FIG. 5
02, 03, 04, 05, 06 AND 07 The teeth were all lingually inclined which can be taken advantage of in conservatively preparing the case.
FIG. 7
FIG. 8
08 There was a wide band of attached gingiva with V-shaped gingival margins.
16 // BURKHART DENTAL SUPPLY
Option two was option one plus additive onlays on the maxillary molars to increase the vertical dimension thereby reducing the overbite and increasing the overjet. The patient chose option one which was the 10 veneers and agreed to reconsider option two's posteriorly addition if the first option did not hold up.
FIG. 9
09 AND 10 Basically sound dentition with very few direct composite restorations in the posterior teeth.
FIG. 10
CLINICAL SUCCESS
A laser gingivectomy was completed and hemostatsis was attained using Hemodent and cotton (figure 13). A polyvinyl impression and bite were taken supplemented by a stick bite, occlusal bite registration, and photographs for the laboratory. Kerr Provisional Connect fiber-reinforced restorations were fabricated directly using B-1 Luxatemp (figures 14 and 15).
SUCCESSFUL RESULTS Four weeks later, the provisionals showed some cracking in the body of the material (figure 16). The Kerr Connect fiber held them together, so no pieces had been lost and the edges were not chipped. As a result, we were confident with the added strength of the final
FIG. 11
11 DMG Luxatemp overlay from the diagnostic wax-up.
FIG. 16
16 Several of the provisionals exhibited cracks after four weeks in function. Kerr Connect fiber reinforcement kept them intact.
restorations, breakage would not be an issue. If the incisal edges had chipped, I would have strongly suggested opening the vertical height.
LONG-TERM SUCCESS Figures 16-19 show the final restorations at one week post-insertion. The smile looked very good and showed no signs of chipping. Results six months later were the same. An occlusal guard was fabricated and delivered. The patient continues to use a CPAP while sleeping.
FIG. 12
12 Depth cuts were made through the overlay, 0.5mm on the facial/buccal and 1.75mm on the incisal. FIG. 17
Dr. Rhys Spoor is a 1983 graduate of the University of Washington where he was an Affiliate Assistant Professor in the Department of Restorative Dentistry for 10 years. He is an Accredited Member of the American Academy of Cosmetic Dentistry, a Fellow of the Academy of General Dentistry, the International Dental Implant Association, and the Pierre Fauchard Society. He is also an Editorial Reviewer for the Journal of Cosmetic Dentistry. Dr. Spoor maintains a private practice in Seattle in aesthetic, implant, and restorative dentistry. Dr. Spoor also is currently offering hands-on, live patient treatment programs in aesthetics through The Center for Exceptional Practices (www.exceptionalpractices.com). He may be contacted at spoordds@msn.com.
FIG. 13
13 Just prior to the final impression, cotton ropes were fashioned soaked in Hemadent to control any bleeding in the areas where laser gingivectomies were preformed.
FIG. 14
FIG. 15
14 AND 15 Directly placed DMG Luxatemp polished, tinted, and glazed provisionals.
FIG. 18
FIG. 19
16, 17, 18 AND 19 The final restorations one week post-cementation.
CATALYST MAGAZINE // ISSUE 3, 2017 // 17
ADVERTORIAL
TECHNOLOGY
KAVO™ INTRODUCES
EXPANDED PRODUCT PORTFOLIO
SUBMITTED BY KAVO ™
F
or more than 100 years, dental excellence has been an ongoing pursuit of the KaVo™ brand. Dentists worldwide associate KaVo with quality and innovation. This year, KaVo is excited to introduce an expanded product portfolio in North America that includes innovative treatment units and advanced imaging solutions, all under the KaVo name.
COMBINING SOREDEX™ AND INSTRUMENTARIUM DENTAL™ BRANDS The imaging portfolio will look familiar to dentists who stay on top of leading-edge innovations and patient-centric solutions. The KaVo imaging portfolio is the result of combining Instrumentarium Dental™ and Soredex™ brands under the KaVo name. These brands have long stood shoulderto-shoulder as part of the KaVo Kerr Group and will be joining forces to provide excellent consolidated service, support, and product development.
COMPREHENSIVE IMAGING PORTFOLIO With over 350 years of combined experience, several million installed imaging products, local skills in over 100 countries, and the expertise of thousands of specialists, KaVo offers a comprehensive portfolio of imaging solutions for everything from routine dental applications to advanced surgical needs.
SIMPLIFIED, MORE EFFICIENT WORKFLOW The goal is not to reinvent the wheel, but to lay the foundation for a simplified, more efficient workflow. Take, for example, the ORTHOPANTOMOGRAPH™ OP 3D Pro—the flagship product of the new KaVo imaging portfolio. Discerning dentists 18 // BURKHART DENTAL SUPPLY
“When I recognize something that provides value for both the patient and my practice, it gets my attention.” –Dr. Terry Work may remember it as Instrumentarium Dental’s ORTHOPANTOMOGRAPH™ OP300 Maxio. All the advanced features and ease-of-use associated with the OP line is carried over to the OP 3D Pro.
3D UNIT PROVIDES VALUE FOR PATIENTS AND PRACTICE “There is a lot of technology available today,” says Dr. Terry Work, a Scottsdale, Arizonabased dentist and OP 300 user, “not all of which makes you a better dentist. Some technologies do, and some are just cool. I can’t jump on every technology bandwagon, but when I recognize something that provides value for both the patient and my practice, it gets my attention.”
major treatment decisions here in our practice. I deal with sales representatives all the time who talk to me about profit centers. This wasn’t about that for me. It has done that, but this 3D system also makes me a better care provider.”
KAVO TO CONTINUE TO SUPPORT INSTALLED PRODUCTS FROM ORIGINAL BRANDS The KaVo imaging merger allows Dr. Work to continue with the sales support and service he’s come to value. All installed products from the original brands will continue to be fully supported by KaVo, including replacement parts, servicing, and warranty claims under the original brands.
3D SYSTEM MAKES ME A BETTER CARE PROVIDER “I chose to invest in a 3D unit,” Dr. Work continues, “in order to provide my patients with a better experience and allow them to feel comfortable making
Proven category leadership takes a new form and wide-ranging expertise continues from a name you trust: KaVo. For more details, go to imagine.kavo.com or call 1.888.ASK.KAVO. Dr. Work is a paid consultant of Kavo Kerr
Imagine more of what matters. KaVo is expanding to offer advanced digital imaging solutions to help you do more of what matters—inside and outside of the operatory. OP 3D Pro offers a full range of modalities to address routine procedures, as well as highly specialized surgical applications. OP 3D Pro provides incredible flexibility to help you do more of
Š 2017 KaVo Dental. All rights reserved. For full terms and conditions, visit: imagine.kavo.com/win100k/terms KV00013/A1.17
what matters.
Experience the new KaVo and enter to win the $100k of KaVo Sweepstakes at imagine.kavo.com/002370
FEATURE
CARING FOR AN
UNDERSERVED COMMUNITY DR. SHAUN ROCKNAK OF CHE YENNE, W YOMING BY TINA PETERSON | PHOTOS BY MATTHEW IDLER PHOTOGRAPHY
D
r. Shaun Rocknak comes from a long line of business owners. He grew up in his father’s hardware store located in Idaho Falls. At the age of 14, his interest in dentistry began when he started working at a local orthodontic office. When pursuing his education in orthodontics, he realized his passion for general dentistry. As a dentist, he is able to serve his community, be a business owner, and provide for his family. Today, he owns the largest dental practice in Cheyenne, WY where he provides general and specialty dental care. Being the first Wyoming dentist to offer IV-sedation, he is also able to treat those with mental health issues and the underserved community. Reaching outside the boundaries of his local community of Cheyenne, his practice attracts about 180 new patients each month, most of them through word of mouth. Dr. Rocknak’s goal is to ensure every treatment plan aligns with his patient’s budget, “The best way I can serve my community is to focus on my patient’s treatment and allow the money to take care of itself.”
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FEATURE: Dr. Shaun Rocknak
Dr. Shaun Rocknak and dental assistant Erika Castinado CATALYST MAGAZINE // ISSUE 3, 2017 // 21
FEATURE
DR. ROCKNAK COULD SEE THE CHANGE OF WHAT GOOD CARE COULD DO FOR SOMEONE
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FEATURE: Dr. Shaun Rocknak
PICTURED: (BACK) Shelly Lewis, Amber Rees, Teresa Pafford (MIDDLE) Erika Castinado, Lisa Grimes, Sierra Sisco, Crystal Koch, Amber Swann, Thora Pino, Danielle Martinez (FRONT) Dr. Christopher Havens, Dr. Shaun Rocknak
During his time in the Air Force at Offutt AFB in Nebraska and Ellsworth AFB in South Dakota, he treated young airmen who had never had physical or financial access to dental services—and realized first-hand, the impact a dentist can have. His wife TeraLyn explains “He could see the change of what good care could do for someone and loved what he did. He was able to see what someone needed without putting a dollar sign on them.” Professionally, the Air Force provided him with the opportunity to practice comprehensive dentistry and grow his specialty skills. When he separated from the military, it was important to him to find a small, family oriented community. He and his family chose to move to Northern Colorado where he became an associate of a practice with two locations in Windsor and Wellington. After two and a half years Dr. Rocknak decided to open his own practice in Wyoming due to a significant number of patients traveling long distances because of the inability to be seen for months in their local areas. Because of his relationship with his Burkhart Account Manager, Brandyn Hohs, he reached out and trusted Brandyn to compile a list of resources necessary to make his dream come true.
AN ASSOCIATE IN SUCCESS Dr. Christopher Havens is a Wyoming native, born and raised in Laramie. He obtained a Bachelor’s degree from the University of Wyoming and a Doctor of Dental Surgeries degree from the University of Michigan School of Dentistry. Dr. Havens further expanded his general and specialty dentistry skills during his residency at the University of Colorado School of Dental Medicine. There he received the Bottone Service Award for his outstanding performance in hospital dentistry. As a Wyoming native, he has a unique understanding of the community and its patients’ needs. His commitment to treating patients in a collaborative and stress-free environment makes him a great fit at Advanced Dental Inc.
Nine months later, Advanced Dental Inc. became a reality and Dr. Rocknak moved into his new building. The practice began with three operatories and four staff members; and in five short years, with the addition of Dr. Christopher Havens, it increased CATALYST MAGAZINE // ISSUE 3, 2017 // 23
FEATURE
Dental hygienist Lisa Grimes and Dr. Christopher Havens to nine operatories and eleven staff members. He strategically built his team based on technical skill, personality, and work ethic. His philosophy is everyone from the front desk to the doctors themselves, should be treated equally. Dr. Shaun Rocknak and the staff of Advanced Dental Inc., are proving a dental practice can cater to the needs of its community and still function as a successful business. His community is known to have limited financial resources and he is committed to putting the needs of his patients above financial gain. To do this and still offer services using modern dental technology is extraordinary.
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Dr. Christopher Havens and Dr. Shaun Rocknak
FEATURE: Dr. Shaun Rocknak
IN
5 SHORT YEARS
DR. ROCKNAK’S PRACTICE WENT FROM
3 TO 9 OPERATORIES AND 4 TO 11 STAFF MEMBERS
Dr. Shaun Rocknak and dental assistant Amber Rees CATALYST MAGAZINE // ISSUE 3, 2017 // 25
You encourage your patients to Team
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GETTING PEOPLE
OUT OF PAIN BY UKO ETIM | PHOTOS SUBMITTED BY DR. FITZPATRICK
A happy patient with Dr. Fitzpatrick in Nicaragua
Have you ever had a toothache? Do you remember the unrelenting pain? Do you recall
and experience agonizing and debilitating tooth pain that feels like nails being hammered into the gums. Because of location or financial burden, these children do not have access to trained dental practitioners. Instead of relief, the child resorts to the only option available, which is: endure the pain.
the type of agony
DEPENDABLE CARE FOR THE UNDER-SERVED
that made you drop
This situation is all too common in developing nations and it has inspired practitioners like San Diego dentist, Thomas Fitzpatrick to take action. He shares, "It is my goal to expand sustainable care locally and globally to underserved communities; getting people out of pain by providing basic necessities in underserved areas that don't have access to dental care."
everything and rush to your dentist? A child in a developing nation— or even a nearby community— might wake up one morning
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VOLUNTEERING IN NICARAGUA While in dental school at Loma Linda University (LLU), Dr. Fitzpatrick joined a group of his peers on volunteer trips to Nicaragua to provide dental care. The group led to the creation of The Foundation of Worldwide Health (FWH) in 2005. FWH consists of dentists and dental students from LLU who team up with local clinicians to provide assistance to underserved areas. In 2006, Dr. Fitzpatrick was informed by Nicaraguan clinicians that the town of Boaco could use their help. While working out the logistics of setting up their mobile units on the coffee plantation where they would
GIVING BACK
HOW DOES IT TASTE? So what was that main hurdle? “Does it taste good?” Dr. Fitzpatrick says with a laugh. “Even if we have a good cause, nobody will want it if it’s poor quality. We performed a roast profile with a local roaster and they confirmed it was of great quality; very smooth and not real acidic.” be providing dental care, Dr. Fitzpatrick saw an opportunity.
SUSTAIN & EXPAND EFFORTS “In the back of my mind, I always thought, how can we actually sustain what we are doing and also expand into other areas?” The answer, generate revenue. “I thought, this is the perfect opportunity. I just needed to figure out how to import coffee from the Nicaraguan community and sell it in the U.S. to help give back to the efforts there."
FAIR SHARE OF HURDLES Running a coffee company when one’s classical training is in dentistry led to its fair share of hurdles; from locating the proper importer and roaster, to identifying distribution channels, and properly setting up the company as a whole. But once one main hurdle was cleared, Dr. Fitzpatrick had more than enough motivation to work through anything.
FROM SAN DIEGO TO GUATEMALA With the success of Cura Coffee, Dr. Fitzpatrick is beginning to expand the FWH’s efforts to the City Heights Neighborhood of San Diego and Nicaragua’s neighbor, Guatemala. He also created a non-profit, Cura Smiles, that caters to donors who would like to contribute to the organization’s expanding efforts worldwide.
Cura Coffee works with loc al Nicara guan roasters to create a quality product
COFFEE IS THE ANSWER That thought led to a general dentist in San Diego to become the CEO of an international coffee company. Cura Coffee, cura meaning care or cure, was born. The same farmers who the FWH provide dental care, sell their beans to Cura at fair trade prices. Cura handles processing and shipping of the harvested product to Southern California. The Nicaraguan coffee is roasted then sold in the U.S. and a portion of the profit goes toward expanding sustainable dental services both locally and globally.
CATALYST MAGAZINE // ISSUE 3, 2017 // 29
GIVING BACK
A MEMORABLE ENCOUNTER One encounter on a Sri Lanka trip, particularly sticks with Dr. Fitzpatrick. He had just finished a long day of providing dental care under humid conditions. As the day came to an end, he removed his sweat-drenched bandana and headed to leave. When he reached their compound, he was greeted by two parents on a motorcycle with a child in tow. “They had followed us all the way home,” Dr. Fitzpatrick recalls. “Their son was in a lot of pain. He had been
T SU P POR E S TH E CAUailable for
e is av Cura Coffe . coffe e.com sale at cura
ant to ers who w k n ri d e e ff Non-co s mission Cura Smile e th rt o p sup ctible a ta x-dedu c a n m a ke nline at donation o .org. curasmile s
30 // BURKHART DENTAL SUPPLY
Dr. Fitzpatrick does a taste profile for Cura Coffee in pain for a very long time. I gave him an injection so I could remove the tooth and he fell asleep. At that point, I was concerned if the boy was okay.”
reminder to Dr. Fitzpatrick of the importance of his programs and why he continues to support them. This boy no longer had to learn how to live with pain.
A WELCOME, PAIN-FREE MOMENT He was. The child had been in pain so long that he hadn’t been able to sleep. The anesthetic gave him his first pain-free moments in a long time. This situation was an important
Dr. Fitzpatrick with patients in Nicaragua
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REAL ESTATE
REAL ESTATE:
THE SECOND-HIGHEST EXPENSE IN YOUR PRACTICE BY NATE TUTTLE, CARR HEALTHCARE REALTY
W
hen it comes to managing expenses in your practice, there are dozens of categories to evaluate: equipment, technology, loan costs, interest rates, marketing, sundries, and so on. Many practice owners are quick to shopout what they believe are the most obvious expenses, but few understand the impact of one of the largest expenses and how it can be dramatically reduced to increase profitability. The highest expense for most practices is payroll, followed by real estate. Real estate encompasses your monthly rent or mortgage payments, along with the property’s operating expenses, maintenance fees, utilities, and janitorial costs.
ONLY ONE OF THE TOP TWO EXPENSES IS REALLY NEGOTIABLE If you consider these top two expenses, payroll and real estate, only one of them is really negotiable. With payroll, you can either pay people their value or they usually find another job that will. You may decide you can cut staff, but if you need people, you need to pay them what they deserve or they will eventually leave.
REAL ESTATE IS 100% NEGOTIABLE Real estate, however, is 100% negotiable. You have the choice of leasing or owning, as well as being in an office building, retail center, a stand-alone building, or large medical complex with many other providers. You can choose the size of
32 // BURKHART DENTAL SUPPLY
your space, the design, and the landlord you want to work with—or to be your own landlord. And if you do own, you get to decide whether to buy an existing building, an office condo, or to develop your own building from the ground-up.
With this many choices to evaluate, and understanding each one affects the final economic outcome, why is it so many practices fail to capitalize on their real estate opportunities? NEGOTIATING LEASE TERMS When negotiating the economic terms of a lease, you get to have a say in the length of the lease, the desired concessions including build-out period, tenant improvement allowance, free rent, lease rates, annual rate increases, and many other provisions.
REAL ESTATE OPTIONS ARE INCREDIBLE OPPORTUNITIES With this many choices to evaluate, and understanding each one affects the final
economic outcome, why is it so many practices fail to capitalize on their real estate opportunities? The short answer is, most practice owners and administrators simply don’t have the knowledge and expertise in commercial real estate to understand how to make the most of these opportunities. They view real estate as a necessary evil instead of an incredible opportunity to improve profitability, reduce expenses, and improve the quality of their patients’ experience. When the correct approach is taken, you may actually look forward to it instead of dreading your real estate negotiation.
THREE WAYS TO MAKE THE MOST OF YOUR REAL ESTATE TRANSACTIONS Let’s look at three key ideas that will help you make the most of your next real estate transaction.
1. TIMING Every type of transaction has an ideal timeframe to start the process. When starting too early or too late, you communicate to the
CLINICAL SUCCESS
landlord or seller you don’t really know what you’re doing. When that message is communicated, it hurts your ability to receive the best possible terms. For example, don’t wait for your landlord to approach you on a lease renewal negotiation. Start by consulting with a professional so you can understand the ideal timeframe to start your transaction; come up with a specific game plan for what you want to achieve; and then approach your landlord with renewal terms.
2. REPRESENTATION Landlords and sellers prey on unrepresented tenants who don’t really know the market or what their options are. If the tenant is a Fortune 500 company, the landlord will likely approach its staff with a high level of respect, expecting they either have a real estate broker hired to represent them or have a team of internal professionals who are well equipped to handle the transaction. In contrast, when a landlord or seller starts speaking with a tenant who isn’t represented, and who probably doesn’t know the market as well as the landlord, that tenant is not going to get the same level of respect through the process. This is because the landlord senses an opportunity to take advantage of a small
tenant who is not an expert; doesn’t have a full complement of real estate knowledge and skills; and who doesn’t have adequate representation. When you understand commissions are paid in commercial real estate just like they are in residential real estate—they are set aside in advance for two parties, not just one—then you understand there aren’t any savings by not having a broker. And if there aren’t any savings by not having a broker, then showing up without one only further detracts from your credibility.
3. LEVERAGE AND POSTURE It is nearly impossible to emerge victorious from a negotiation without leverage and posture, which are created by having multiple options in the market. If you limit yourself to one property, you are at the mercy of that owner. Since most landlords and sellers negotiate
professionally, it is easy for them to know when you don’t have other viable options. Simply telling a landlord you have a proposal from another landlord won’t give you a strong enough posture. Most landlords look at unrepresented tenants and assume they do not know the market, do not understand all their options, and are not really serious about making the landlord compete for their business. Leverage and posture are created when you have the right timing, professional representation, an understanding of all your available options, and a detailed game plan of what you want to accomplish in order to capitalize on the market. These three key ideas are the first of many factors that allow healthcare tenants and buyers to reduce their second highest expense which dramatically impacts profitability and cash flow.
Carr Healthcare Realty (www.carrhr.com) is the nation’s leading provider of commercial real estate services for healthcare tenants and buyers. Every year, hundreds of medical, dental, veterinary, and other healthcare practices trust Carr Healthcare Realty to help them achieve the most favorable terms on their lease and purchase negotiations. By not representing landlords or sellers, Carr Healthcare Realty is able to strongly advocate for healthcare providers and avoid conflicts of interest while saving their clients hundreds of thousands of dollars. Carr Healthcare Realty’s team of experts can assist with all types of real estate transactions, including lease renewals, expansions, relocations, startup offices, purchases, and practice transitions. Seattle Broker Nate Tuttle can be reached at 206.790.9821 or nate.tuttle@carrhr.com.
CATALYST MAGAZINE // ISSUE 3, 2017 // 33
SUPPLY SAVINGS GUARANTEE:
MORE PRODUCTIVITY
LESS STRESS QUALITY CARE PAIRED WITH COST SAVINGS ALLOWS PRIVATE PRACTICE TO FLOURISH THROUGH THE SUPPLY SAVINGS GUARANTEE PROGRAM... ARE YOU READY TO SAVE?
D
rs. Raymund Tanaka and Cynthia Leong (husband and wife team) respectively graduated from Creighton University, Omaha in the early 80's. After initially practicing in the Public Health Services sector, they changed course in 1987 and opened a private practice in Glendale, Arizona. Being committed to providing quality care along with maximizing savings, they teamed up with Jeana Bardwell, their Burkhart Account Manager, for the Supply Savings Guarantee program. Here is their story.
INTERVIEW CONDUCTED BY JEANA BARDWELL, BURKHART ACCOUNT MANAGER
HOW DID YOU GET TO THE OFFICE WHERE YOU ARE PRACTICING NOW? DR. TANAKA: I had a lot of good mentors. It started out with Pankey Institute, the Pride Institute, and then John Kois at the Kois Center, where I am still active. The leaders from these organizations have shown me how to run our practice well. I owned a small practice, 4op/900 sq ft. We had ten people working and it was kind of tight. When Cynthia [Dr. Leong] decided to join the practice in January of 2001, we opened our current location in Glendale, AZ together. An Endodontist we refer to recommended we open a practice near his location. Financially, it was a big jump and Cynthia gave me the push to do it. Once we did, it was busy, but with this much space it felt good, less hectic than the small space I was in. It was less stressful and had a better workflow.
WHAT WAS IT THAT MADE YOU WANT TO WORK WITH BURKHART? DR. TANAKA: I was in between suppliers because we had an issue with some equipment and Jeana Bardwell [Burkhart Account Manager] came in at the right place and the right time. She offered a system we didn’t have in place yet. We like having an employee that we don’t have to put on payroll. Jeana's handson support really eased up time for our
34 // BURKHART DENTAL SUPPLY
assistants because she is familiar with ordering and opportunities for specials and free goods; she's just great at communicating. She is a liaison between us and the individual vendors. We rely on the fact that she knows what other offices are doing and has an unbiased perspective on supplies which is helpful and allows us to focus on dentistry. She takes it upon herself to solve problems for us that would normally take up the teams time. She takes care of us.
WHAT IS MOST APPEALING ABOUT BURKHART'S SUPPLY SAVINGS GUARANTEE (SSG)? DR. LEONG: With honesty and integrity, Burkhart guarantees to lower our cost while having accountability measures in place. We don’t have to ask our team to focus on a number or budget. It would take a lot of additional time and drive our assistants crazy to keep track of the savings percentage; which is definitely not a good use of their time.
WHAT PART OF THE SSG DO YOU FIND MOST VALUABLE TO YOU AND YOUR PRACTICE? DR. TANAKA: Number one, we don’t have to track everything we receive, she does. She also lets us know what free stuff we get and the recommendations of less expensive products. DR. LEONG: Also, the team feels additional security when they know their numbers are in line and when they feel successful, they feel happier. It’s important for the staff.
HOW DOES YOUR BURKHART ACCOUNT MANAGER HELP YOU REACH YOUR GOALS AS A DENTIST AND BUSINESS OWNER? DR. LEONG The more efficient she makes us, the more productive and the less stressful my life is. When she has the materials we need and they work well, we can concentrate on patient care. DR. TANAKA: The assistant used a lot of her time trying to stay on budget. However, the staff did not have the software to track orders past and present like Jeana. Jeana knows what we need and how to keep inventory in line so we do not have cash flow tied up in products that have expiration dates. She takes the pressure off of the assistants following up on orders and its a relief to know that Jeana has set up the system so we do not run short of supplies. Now, our assistants focus on patient care.
WHAT WOULD YOU SAY TO A DOCTOR CONSIDERING THE SSG PROGRAM? DR. TANAKA: Inventory control is a breeze with Jeana. She always follows through, answers all our questions, keeps track of everything and it takes the finger pointing out of the office. She helps the team save time and money!
ANY FINAL THOUGHTS? DR. LEONG: It takes time to build trust. You don't know what you don't know, it's worth it to take a look at your current variable overhead cost percentage and let Jeana/ Burkhart prove what they can do. If any office has further questions, they can contact us about our experience.
Dr. Cynthia Leong and Dr. Raymund Tanaka
“WE LIKE HAVING AN EMPLOYING WE DON'T HAVE TO PUT ON PAYROLL.”
CATALYST MAGAZINE // ISSUE 3, 2017 // 35
WEALTH MANAGEMENT
36 // BURKHART DENTAL SUPPLY
PENDIN
WEALTH MANAGEMENT
MATTERS BY SAM MARTIN, MBA (TAX), CFP ®, CPA
I
magine my reaction, a backwater Registered Investment Advisor, recently coming across this headline in a financial magazine, “Major brokerage firm executive discovers retirement income success is determined more by retirement spending than return on investments1.” Wow, that is what we refer to in our office as a BFO, a “Blinding Flash of the Obvious.” Who would have thought controlling spending to a predetermined amount could be the key to our longterm retirement success? Yikes! ADAMANT ABOUT PLANNING For those of you who read this column in Catalyst, you know I am adamant about planning and typically, most of my emphasis is on becoming a better saver. No matter how good we become at saving, it will not make up for bad spending practices; particularly in retirement.
WHAT PLANNING CAN DO Let’s look at what planning can do for us. It can: 1. Help get our most important goals and concerns in writing, a step that all by itself, can start a positive chain reaction. 2. Bring spouses into alignment, if not immediately, over time.
3. Help us develop steps, if followed, greatly enhance the likelihood for longterm financial success. 4. Bring discipline to current and future spending and saving. 5. Make us much better savers.
GOOD PLANNING BREATHES Planning isn’t just the plan. Good planning lives and breathes. Systematic monitoring, follow-up, and discussion are also keys to long-term success. The monitoring process helps to get you into shape and keeps you on the straight and narrow. It leads to being ready for retirement. The monitoring process also helps give us confidence in the retirement income or cash flow plan we’ve developed.
CATALYST MAGAZINE // ISSUE 3, 2017 // 37
WEALTH MANAGEMENT KNOW WHAT YOU SPEND NOW The first step in preparing a retirement income plan—is to know how much you spend now. It helps to use an online tool or software such as Quicken, but it can also be accomplished manually by capturing three months of your credit card spending and checking account and then adding in expenses that are paid less frequently— such as semi-annual or annual expenses. In particular, identify those items that won’t (or shouldn’t) be there in retirement: 1. Mortgage 2. Children’s education 3. Other debts 4. Certain types of insurance—disability, overhead, life (in some cases) 5. Other work-related expenses—perhaps professional wardrobe and commuting 6. Savings and investing 7. Income and FICA taxes 2 Most of our clients are shocked to realize how little they actually live on! By the time you deduct the items above, it is clear most mid-career dentists’ lifestyles are probably a quarter of what their tax return might otherwise suggest.
TRANSLATING CURRENT INCOME TO RETIREMENT INCOME
Sam Martin is Director of Wealth Management Services and Advanced Tax Planning for the Dental Group, LLC / Martin Boyle PLLC / Dental Wealth Advisors, LLC, a CPA, practice advisory, financial planning and wealth management services group exclusively serving dentists and their practices. Sam is a Certified Public Accountant (CPA), a Certified Financial Planner (CFP), and holds a master’s degree in federal income taxation. Located in Kirkland, Washington, Sam can be reached at 425.216.1612 or Sam@cpa4dds.com.
Once you isolate your current “real” income, it reveals a comfortable retirement income estimate. Of course, additional things will be added, travel is a common example—as is recreation, and perhaps dining out. For some, slight adjustments may be the answer, estimating a similar standard of living for retirement—to what they are currently used to. For others, there may be more work to develop the retirement spending plan.
PLAN TO SPEND MORE THE FIRST TEN YEARS A common approach is to model the first 10 years of retirement at a slightly higher
BENEFITS OF WORKING PART-TIME Once the desired retirement spending goal is determined, we work backward to identify how much additional saving will be required between now and your desired retirement age, to achieve that income goal. We can then work together toward that goal. There are many alternatives to consider in this process. For example, I find more and more clients expect and plan to continue working parttime for a period of years. This can be very beneficial financially and emotionally; even though retirement is no longer being funded, it also prevents retirement assets from being tapped.
PRACTICE ANTICIPATED LEVEL OF RETIREMENT SPENDING As you get closer to retirement, you should begin “practicing” this level of spending and monitoring your results. How well will this work for you? You need to conclude it will work well for you. If you overspend what is feasible to spend, the latter years of your retirement could be quite difficult financially.
SET YOURSELF UP FOR SUCCESS Putting goals in writing and establishing a plan that includes a predetermined level of retirement spending you are confident with will go a long way toward setting yourself up for a financially successful retirement. Practicing and monitoring spending, particularly as retirement approaches, can be extremely valuable and provides the confidence to live comfortably—and enjoy life.
This is a paraphrase of the original quote. Income tax does not go to zero in retirement (although it may for certain dentists in certain years); however, income tax for most dentists will be substantially less than during their careers. For retirement income planning purposes, we use an inflation adjusted “after tax” annual/monthly spending plan—so our clients do not need to plan for income taxes out of their monthly spending, which helps keep life simpler.
1 2
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level of spending than presumed, and estimating the balance of retirement - at a lower level. Studies have shown, when the average retirement is broken into three periods, the first tends to be at the highest spending level; the second, at the lowest level; and the final, at the second highest spending level. Increased primarily by health care costs.
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BUSINESS OF DENTISTRY
• NO INCENTIVE There is not a great incentive to make changes to fees, as long as the practice provides an acceptable income for the dentist.
ARE YOU LEAVING
MONEY ON THE
TABLE? BY LAUREN COVER AND DOUG FETTIG, CPA
M
OST BUSINESSES ROUTINELY EVALUATE THEIR PRODUCT AND SERVICE PRICING, TO MAKE SURE THEY REFLECT THE RIGHT VALUE FOR CUSTOMERS AS WELL AS THE COMPETITIVE LANDSCAPE IN WHICH THEY’RE OPERATING. WHILE DENTISTS ARE PROFESSIONALS CARING FOR THEIR PATIENTS, THEY ARE ALSO BUSINESS OWNERS AND MANY RARELY GIVE THEIR FEE SCHEDULES AN ANNUAL EXAM. SOME OF THE REASONS FEE EVALUATIONS NEVER QUITE MAKES IT ON THE “TO DO LIST” FOR DENTISTS INCLUDE:
• PATIENT CARE OVER BUSINESS The demands of patient care often take priority over evaluating the business side of their practices.
40 // BURKHART DENTAL SUPPLY
• PPO CONTRACTS Many dentists feel constrained by the terms of their PPO contracts and set fees accordingly, without considering the marketplace.
• LACK OF INFORMATION It’s no easy task for dentists to analyze their rates and make the appropriate changes. They don’t have the data available or the knowledge of how to successfully evaluate their fee schedules compared to the competition.
• DISCOMFORT Many dentists feel uncomfortable about asking their patients to pay higher fees for their services. All of these very understandable reasons leave so many dentists in the same predicament—they’re leaving money on the table. That extra revenue can and should compensate for rising labor, materials, and supply costs. It could provide the resources necessary for equipment and technology upgrades which improve the quality of patient care; be used to support continuing education for the dentist and staff, which also bolsters patient care; and could provide the motivation for setting aside sufficient funds annually to prepare for a comfortable retirement. If you’re among the folks who put fee schedule assessment on the back burner, it’s probably time to push through your discomfort and attend to this very important part of your practice. Fortunately, a dental consultant, or a service like Burkhart's Practice Support Team brings the requisite data, analytical skills, and market insights to walk you through the process from end-to-end.
BUSINESS OF DENTISTRY
HOW TO SET THE RIGHT FEE STRUCTURE Most dental practices rely on professional business consultants to help them evaluate if their fees are set appropriately. A practice consultant will begin by downloading the dentist’s billing history for the past year and performing a fee structure assessment. This history provides the number of procedures performed by billing code—as well as the rates charged for those services. Some of those rates will be governed by the allowable reimbursement per the terms of the PPO contracts; others will be associated with patients who pay their fees out of pocket. The latter represents a revenue stream over which the dentist has a clear measure of control. The next step is to collect survey data on dental fees for the zip code in which the dentist operates. This market data provides a distribution of rates charged for each billing code. Thus, for each line item,
the data will demonstrate what dentists who operate in the 90 th percentile charge, what those in the 10 th percentile charge, and everything in between. When the dentist’s actual fee schedule is overlaid against the market data, it is clear where he or she sits in relation to the local peer group. Rankings may vary substantially by billing code. For example, a dentist’s fees may land within the upper quartile for adult prophylaxis, but sit in a lower quartile for a porcelain crown. A dental practice consultant with experience serving hundreds of dental practices around the country, will have the ability to “level set” a practice based on the skills and experience of the practitioners and the technology used in patient care. Clearly, a practice that boasts leading-edge digital technology, high quality materials, and a top-notch team will command higher fees than those without these attributes. That judgment comes into play when crafting the
POTENTIAL REVENUE INCREASES CODE
D1110-Adult Prophy
PERCENTILE
FEES
3,500 UNITS
Current Fee (40 Percentile)
$88
$308,000
Move to 50th Percentile
$91
$318,500
$10,500
th
Move to 60 Percentile
$93
$325,500
$17,500
Move to 70 Percentile
$97
$339,500
$31,500
Move to 80th Percentile
$103
$360,000
$52,500
Move to 90th Percentile
$115
$402,500
$94,500
Move to 95 Percentile
$122
$427,000
$119,000
th
th
th
$ INCREASES
IF YOU’RE AMONG THOSE WHO PUT FEE SCHEDULE ASSESSMENT ON THE BACK BURNER
IT’S PROBABLY TIME TO PUSH THROUGH YOUR DISCOMFORT AND ATTEND TO THIS VERY IMPORTANT PART OF YOUR PRACTICE financial analysis for target procedures. A practice consultant will be able to identify which procedures are priced within tolerance and which ones bear closer examination. Once that analysis is complete, a review of the current volume for targeted billing codes is performed. Then, the upside revenue potential can be assessed, if fees are adjusted to the appropriate market rate. If there is a significant disparity between market rates and PPO reimbursement rates, a practice consultant with contract expertise may take a close look at the affected line items to see if a case could be made for renegotiating reimbursement. The contract may have some “wiggle room” if the practice can demonstrate its tools and technology provide for a superior standard of care. If it has been quite some time since fees were last adjusted, there may be a sizable gap between the current and the target construct. To avoid “sticker shock” and CATALYST MAGAZINE // ISSUE 3, 2017 // 41
BUSINESS OF DENTISTRY
possible alienation of one’s loyal patients, a plan can be put in place to provide for a gradual increase over a 2 to 3 year period.
HOW TO INSTITUTE A NEW FEE STRUCTURE Publishing a new fee schedule and making the requisite changes in the administrative software are relatively straightforward tasks. The real work surrounds the people who’ll be affected by them. First and foremost, the dentist needs to feel confident in the logic behind the decision to adjust the fee schedule. To that end, the market data should relieve concerns about the practice’s competitive positioning in the local market. In fact, that data could be used as a talking point with patients if they raise concerns about the new fees. Beyond that, a fee increase rewards the dentist for investments made for the sake of providing better dental care. With the move to digital technology, the dentist has better information on which to build treatment plans along with the tools to engage patients in that discussion. And, of course, better information leads to fewer mistakes. All of these arguments support charging higher fees.
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42 // BURKHART DENTAL SUPPLY
A PRACTICE CONSULTANT WILL BE ABLE TO IDENTIFY WHICH PROCEDURES ARE PRICED WITHIN TOLERANCE AND WHICH ONES
BEAR CLOSER EXAMINATION Second, the staff needs to be brought into the loop on the proposed changes. As with the dentist, they need to understand how their fees compare to other local practitioners and, therefore, why the adjustments needed to be made. They may also need the gentle reminder of all of the things the practice does to provide the best quality of care. They can feel proud of the work they do and stand behind the rates they charge. Finally, patients need to be aware of the charges for which they will be responsible. Most will anticipate increases based on their general experience in the healthcare arena. When their services extend beyond routine cleaning, the office should provide a treatment plan with all associated fees before the work begins. As it may have been some time since they’ve had such services, staff needs to be prepared to respond to concerns about pricing. A quick tour of the office could highlight the changes in dentistry since that last procedure was performed. However, the focus should shift to providing creative solutions to make the treatment plans work within the patients’ budget.
HOW OFTEN SHOULD FEES BE ADJUSTED? Many dental practices do a fee structure analysis annually. The initial assessment will generally have a one-time set-up fee that is not assessed for routine updates. The typical payback for this service is very fast. Thereafter, an annual evaluation makes sure the practice remains competitive. With the added revenue stream, there will be ample opportunity
to discuss initiatives that could make the practice even better and/or provide a more secure retirement for the dentist. When, and if, the dentist contemplates selling the practice or adding a partner, a fee structure analysis is essential. In such cases, the amount by which the practice could be undervalued could dwarf the relatively small amount of advisory fees to perform the assessment.
Lauren Cover, Manager, Healthcare Business Advisor, Aldrich CPAS + Advisors Lauren joined Aldrich in 2015 as a Healthcare Consultant. She helps businesses with provider health plan contracting, financial analysis and feasibility, benchmarking and other financial reporting, strategic planning, serviceline targeted growth, team coordination, lean/six sigma process improvement and leadership. She received a Bachelor of Science in Business with a concentration in Finance from University of Oregon and a Master of Business Administration in Healthcare Management from Oregon Health & Science University/Portland State University. Doug Fettig, CPA, MBA, Dental Business Consultant, Aldrich CPAS + Advisors Doug has over two decades of experience as a CPA and a finance professional, providing him the unique ability to understand dentists’ needs and help them grow efficient and profitable practices. His insight allows him to effectively communicate business concepts to dental practices while strategically addressing tax, investment, and retirement planning needs. Doug has spoken at numerous dental seminars, academies, study groups, and vendor forums around the country and he is known for his energetic, engaging, and entertaining speaking style. As a dental business advisor, he is adept at collaborating with dental practices and incorporating Aldrich’s expertise to help dentists grow their practices and increase their profitability.
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