Dental Practice
CANADA’S LEADING BUSINESS & LIFESTYLE MAGAZINE FOR DENTISTS
WINTER 2012
MANAGEMENT MANAGEMENT
GREEN Technology Dentists and technology; going chartless
Can Non-Dentists
OWN DENTAL
PRACTICES? w w w.oralhealthgroup.com Canada Post Product Agreement No. 40069240 ISSN 0827-1305 (PRINT)
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LET’S TALK
BUSINESS. We’re helping make successful practices more successful. Find out how our programs are paying off for other practices at HealthyPracticeNow.ca.
Dr. Eric Rouah D.M.D.
Dr. Eric Rouah has not been compensated to appear in this ad.
We mean business.
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Dental Practice
MANAGEMENT
Winter 2012
18
Features OFFICE TECHNOLOGY
10 Green I/T Technology Craig Wilson
FINANCE
18 Is Committing Insurance Fraud
Helping or Harming Your Patients? Sandie Baillargeon
42 Dentists & Technology David Chong Yen, CFP, CA
PRACTICE MANAGEMENT
26 Six Steps to a Chartless Practice
26
Lorne Lavine, DMD
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LEGAL MATTERS
34 Can Non-dentists Own Dental Practices?
34
Michael Carabash, BA, LLB, JD, CDPM
Departments 4
News Briefs IDS 2013, ACD meeting
5
Editorial A new year, a new look
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Dental Marketplace
Dental Practice Management
Winter 2012
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News Briefs A BUSINESS INFORMATION GROUP PUBLICATION Editorial Director: Catherine Wilson 416-510-6785 cwilson@oralhealthgroup.com Art Direction: Andrea M. Smith
IDS 2013 on horizon Cologne—All signs indicate that the upcoming 35th International Dental Show (IDS, held in Cologne, Germany March 12th to 16th 2013) will be an impressive success. More than 1,900 exhibitors, from over 50 countries, will greet approximately 118,000 visitors in the 150,000 square metres of exhibit space. Approximately 66 percent of the exhibiting companies will come to Germany from abroad. IDS is held every two years and is the most successful and comprehensive presentation arena and global venue for all market participants from the fields of dentistry, dental technology, the dental trade and industry. For more information, visit www.ids-cologne.de
ACD President’s Dinner held during ADA San Francisco—The American College of Dentists was founded in 1920, with a mission to advance excellence, ethics, professionalism and leadership in dentistry. The College is recognized by its peers as the “conscience of dentistry”. Membership is by invitation only and at the recent meeting in San Francisco (October 17th19th 2012), Dr. Jordan Soll was one of the new members inducted into the College, joining over 7400 Fellows. Approximately 3.5% of dentists are Fellows of the American College of Dentists. On Thursday, October 18th, members came together to celebrate at the Presidents Dinner.
Production Manager: Phyllis Wright Circulation: Cindi Holder Advertising Services: Karen Samuels 416-510-5190 karens@bizinfogroup.ca Consumer Ad Sales: Barb Lebo 905-709-2272 barblebo@rogers.com Classified Advertising: Karen Shaw 416-510-6770 kshaw@oralhealthgroup.com Dental Group Assistant: Kahaliah Richards 416-510-6777 krichards@oralhealthgroup.com Account Manager: Tony Burgaretta 416-510-6852 tburgaretta@oralhealthgroup.com Associate Publisher: Hasina Ahmed 416-510-6765 hahmed@oralhealthgroup.com Senior Publisher: Melissa Summerfield 416-510-6781 msummerfield@oralhealthgroup.com Vice President/ Canadian Publishing: Alex Papanou President/ Business Information Group: Bruce Creighton OFFICES Head Office: 80 Valleybrook Drive, Toronto, ON M3B 2S9. Telephone 416-442-5600, Fax 416-510-5140.
Drs. Brian Chapnick, Jordan Soll and Aldo Boccia Drs. Aldo Boccia, Rollin Matsui and Jordan Soll (seated)
Dental Practice Management is printed twice in 2012 and is designed to provide the entire dental team with business management information to make practices more successful. Articles dealing with investment planning, personal finances, scheduling and collection procedures, in addition to lifestyle issues, are geared to all practicing Canadian dentists, hygienists, dental assistants and office managers. Please address all submissions to: The Editor, Dental Practice Management, 80 Valleybrook Drive, Toronto, ON M3B 2S9. Dental Practice Management (ISSN 0827-1305) is published quarterly, 80 Valleybrook Drive,Toronto, ON M3B 2S9. Subscription rates: Canada $28.95 for 1 year; $43.95 for 2 years; USA $31.95 for 1 year; Foreign $49.95 for 1 year; Single copy $19.00. Printed in Canada. All rights reserved. The contents of this publication may not be reproduced either in part or in full without the written consent of the copyright owner. From time to time we make our subscription list available to select companies and organizations whose product or service may interest you. If you do not wish your contact information to be made available, please contact us via one of the following methods: Phone: 1-800-668-2374; Fax: 416-442-2191; E-mail: privacyofficer@businessinformationgroup.ca; Mail to: Privacy Officer, Business Information Group, 80 Valleybrook Drive, Toronto, ON M3B 2S9. Canada Post product agreement No. 40069240. Dental Practice Management is published quarterly by Business Information Group, a leading Canadian information campany with interests in daily and community newspapers and business-to-business information services. ISSN 0827-1305 (PRINT) ISSN 1923-3450 (ONLINE)
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Editorial
A Message from the Publisher
Melissa Summerfield Senior Group Publisher
www.oralhealthgroup.com
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A NEW YEAR… A NEW LOOK!
It all began just over 100 years ago. In 2011, Oral Health celebrated its 100 th anniversary of publishing Canada’s leading clinical journal; we launched a new publication, Oral Hygiene and we created a new banner, the Oral Health Group of magazines. Our expansion is a direct outcome of our desire to be the best vehicle to meet the information needs of all sectors in the dental profession. Our growth is also a testament to the support we receive from both readers and advertisers and for this we are deeply grateful. Under the auspices of Oral Health Group, our newest venture, the premiere issue of Oral Health Labs will be coming out this November polybagged with Oral Health. And now as part of our commitment to continued improvement, we have a new name and new look for DPM and we are proud to announce that in 2013, you’ll be seeing the newly rebranded and redesigned Oral Health Office! When we started Dental Practice Management back in the mid 1980s, it was intended as the perfect complement to Oral Health. Where Oral Health spoke to dentists
as clinicians, DPM would speak to them as business owners and managers, addressing their concerns with building and running their practices, improving business and financial skills, and increasing practice productivity and profitability. That will remain our editorial goal and focus, but now under a new name that better reflects the overall editorial mandate of all the publications in the Oral Health Group. Our primary focus, as always, will continue to be to serve the needs of our readers: dentists, dental labs, dental students and the dental industry (manufacturers and dealers) right across Canada. Our commitment to editorial excellence remains unchanged as does our dedication to ensuring that all articles contain timely, relevant content that will help dentists and their team members achieve optimal performance in their offices and for their patients. This group of magazines, including Oral Health, Oral Hygiene, Oral Health Labs and Oral Health Office will deliver a total of 20 issues next year, delivering total market coverage, timed throughout the year, with informative editorial content that will be of interest to all readers. So we welcome you to the group! We hope you’ll enjoy the new look of Oral Health Office when it is unveiled in the spring of 2013. We welcome your feedback, comments and suggestions on all our publications, they’re written for you! DPM
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Dr. Eric Rouah D.M.D.
Dr. Eric Rouah has not been compensated to appear in this ad.
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PATIENTS FIRST. PRACTICE FIRST. WIN. WIN. We’re helping make successful practices more successful. Find out how our programs are paying off for other practices at HealthyPracticeNow.ca.
We mean business.
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ADVERTORIAL
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Dental Practice Management
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ADVERTORIAL
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Office Technology
Green
I/T
Technology Craig Wilson
10 Winter 2012 Dental Practice Management
www.oralhealthgroup.com
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‘G
oing green’ means using resources efficiently and maximizing return from those resources. Typically, changes made to become more ‘green’ have positive environmental consequences, but also save money, improve efficiency and productivity, and may even provide additional business benefits. The I/T and technology infrastructure in a dental practice, by virtue of the fact that it is already in a constant state of change, is often an easy place to make ‘green’ improvements. If improved efficiency and cost savings are not incentive enough to undertake ‘green’ initiatives, consider that the dental practice’s record and
Office Technology
commitment to the environment is becoming an important marketing and patient retention consideration. Harris Interactive, a market research company in N.Y., conducted a survey, which found that 82 percent of American adults claim to be well informed about companies and brands with a strong track record for sustainability. In addition, 80 percent of those consumers let that knowledge guide their purchasing decisions. Patients have many reasons to choose one dental practice over another, but sustainability and ‘green’ practices represent an important and growing part of their decisions.
Reduce/Reuse
Whenever possible, make use of I/T equipment such as workstations, servers and monitors for as long as possible, within productivity limits. This can sometimes be as long as four years depending on changing requirements and software updates. Replacing I/T equipment is not only expensive, but the disposal of old equipment has a very negative impact on the environment. Make sure that all data is removed from old hardware and then try to find a way for equipment to be reused through either donation to a charity, or as a gift to a staff member. When disposal is required, make sure that equipment is recycled in the appropriate manner. Most communities have a process for handling the recycling of electronic items. Many I/T service organizations have a way to handle this responsibly for you. When purchasing new equipment, give some thought to the energy requirements of the new devices. Electricity costs involved in powering hardware over its lifetime can often approach or exceed the cost of the device itself. Avoid overpowered power supplies and graphic cards when possible. Power consumption by a high-end graphic card can be a significant part of the total power usage of a workstation. If high-end graphics are not required at a particular machine, don’t invest in the high-end card and avoid the ongoing electricity costs.
Power Management
The easiest way to reduce the energy consumed by I/T and other equipment is to switch it off. Many IT devices are left on 24/7 to avoid the annoying delay involved with booting the machine when needed. This wastes unnecessary electricity, and also generates heat, which introduces additional cooling costs depending on the season. In addition, electronic devices wear faster when powered on, which in turn increases device replacement costs. To avoid these unnecessary costs, power down I/T equipment that is not in use. If users find this to be inconvenient, have your I/T service people create a scheduled shutdown and startup schedule, which mimics your practice schedule. One hour after the last patient leaves, the workstations can shutdown automatically, only to start-up again one half hour before the first staff member arrives in the morning. Cost savings result and staff members are not inconvenienced.
All modern computers have some method for varying power consumption depending on usage and computing requirements. Mechanisms include putting the machine in lower power, sleep, or hibernation modes after a period of inactivity, or simply reducing the voltage to the processor when less power is required. Access to power management settings is available conveniently through the operating system settings. Navigate through the power settings and make appropriate choices. If this is confusing, have your I/T service providers configure systems to balance usage and speed when required with aggressive power savings during periods of inactivity or reduced computing load. Screen savers don’t reduce the power consumed by a device. A better option is to setup power management services that power off a display after a period of inactivity. Most new monitors will power on with little to no delay at the end of an inactive period. Estimates abound regarding the dollar savings available through judicious use of power management. Depending on various factors, savings range from dozens to hundreds of dollars per year. Multiply this by the number of workstations in the practice and the savings can be significant.
Phantom Power
Most of us are familiar by now with the concept that many devices consume power even when they’re not in use. The power supplies and/or stand-by electronics in many devices draw power from the wall even when not fully powered on and result in a reduced but detectable power usage at all times. What many of us don’t realize is that this combined ‘phantom power’ wasted by a collection of electronic devices over months and years can be significant. Nokia, the cell phone manufacturer, estimates that if their approximately one billion users worldwide unplugged their Nokia phones’ battery chargers when not in use, the combined energy savings would power 100,000 European homes. The easiest way to reduce phantom power usage is to either unplug cords from the wall or use power bars to turn off devices. Alternatively, ‘smart’ power bars are available which will shutdown power to devices completely when they’re not operational. Additional options, especially in new practices, might include a central ‘lights out’ power switch to shutdown power to all non-essential outlets and lights at the end of the day. If that isn’t possible or practical, shutting down the appropriate circuit breakers at night will accomplish the same thing.
Track Usage
The old management adage that you can’t manage what you don’t measure applies to power usage as well. Come up with a time efficient method to track key ‘green’ metrics such as electricity consumption, cooling costs, paper usage, toner usage, etc. This not only shines the spotlight on avoidable costs and creates an environment for
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Dental Practice Management Winter 2012 11
Office Technology
The majority of patients are sufficiently knowledgeable to recognize that dental practices have digital options, and the ongoing use of film is something that they question, even if they don’t do it out loud goal setting and forecasting, but it gets the rest of the staff involved as well. Adecco USA, a N.Y.-based human resources firm, surveyed 2,000 workers and found that 52 percent felt that their employers should be taking more steps to reduce and become ‘greener’. When everyone is involved with energy reduction, reducing paper usage, and generally being more ‘green’, results will follow.
Solid State Drives
Traditional hard drives use spinning platters driven by electric motors to store and retrieve data. During normal use these spinning platters rotate continuously and consume electricity while producing heat and noise. Newer solid state drives are built using semiconductor technology similar to the familiar ‘USB keys’ that are used to transport and backup data. Solid state drives consume far less energy, produce less heat, generate no noise, are potentially less failure prone, and store and retrieve data much faster than traditional hard drives. Reduced energy consumption and heat generation have obvious ‘green’ advantages and produce immediate cost savings, but speed improvement is the best and ‘greenest’ reason to buy these devices. Workstations built with solid state drives boot up much faster than traditional units, and during normal use applications open much faster as well. First time solid state drive users are pleasantly surprised by the increased speed. Solid state drives boot so fast that it is convenient to shut down workstations at night and boot them again in the morning. In fact, it is not uncommon for solid state drive users to power down at lunch or during breaks. The boot process is quick enough on these workstations that a user can comfortably power on the machine when needed, rather than leave it on indefinitely to avoid a lengthy boot-up.
Paperless Offices
Paper production is still one of the inevitable side effects of computer usage. Although electronic documents are
12 Winter 2012 Dental Practice Management
increasingly common, printing to paper is not going to disappear completely in the near future. However, most dental offices could dramatically reduce their paper usage. Paperless charting, electronic medical questionnaires, digital imaging, and various other types of electronic record keeping reduce paper use, and also benefit the practice in other important ways. Improved productivity, reduced storage space requirements, and enhanced patient care are only a few of the most obvious advantages. Besides, printing is a grossly inefficient way of handling records that begin in an electronic format. Reducing printing whenever possible results in cost savings, but also produces a tangible ‘green’ outcome that patients understand and appreciate.
Digital Radiography
The advantages of digital radiography and digital imaging are many, and this is unquestionably one of the ‘greenest’ improvements that a practice can make. Reduced radiation exposure to patients has obvious ‘green’ implications. Likewise, eliminating chemicals and lead-backed film use is great for the environment. Patients recognize these changes in a practice and understand the ‘green’ advantages of digital radiography immediately. In fact, the majority of patients are sufficiently knowledgeable to recognize that dental practices have digital options, and the ongoing use of film is something that they question, even if they don’t do it out loud. As with most other ‘green’ improvements, the advantages of digital radiography far exceed the environmental benefits. Improved efficiency, better record keeping, improved patient communication, and improved patient care are only a few of the most obvious reasons to use digital instead of film based imaging. Most dental practices could make simple changes and become more ‘green’ in the process. Start with the I/T infrastructure. Once the goal of becoming ‘greener’ is established and staff members are engaged, other opportunities will be obvious. Lighting and heating/cooling systems are places where great improvements are possible, many which will pay for themselves or even positively impact the bottom line. Water usage is another especially important area to focus on in a dental practice. For most, ‘green’ initiatives won’t be enormous projects but will be simple changes which make the practice more efficient and better able to provide great patient care. Start small and involve everyone. Patients will notice, staff members will notice, and the environment will notice. Working to ‘green’ the dental practice is not only good business, it’s also win-win-win. DPM
Craig Wilson is president of Compudent Systems Inc., an organization that provides custom computer, networking, imaging and technology solutions to dentists and the dental industry.
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ADVERTORIAL
Don't Believe Most of What You Read
About Fraud
As the CEO of a company specializing in investigating dental
I have seen many cases where an embezzler adapts their
embezzlements, I have spent considerable time reading
methodology (sometimes repeatedly) to overcome new
articles on this topic, many written by well-intended authors,
controls implemented by practice owners. Adaptation is
including some of the stars of dental consulting. However,
facilitated because the embezzler is fully aware of the systems
I disagree with the central premise of most of the articles.
in place. I’ll also say that I don’t think that fraud-proof dental software exists, although some software is better at retaining
The articles to which I refer have enticing titles, like “How to
information that facilitates discovery and investigation.
Prevent Fraud in Your Dental Office,” and outline internal control measures designed to stop fraud in your office.
So if controls don’t work, what does? My first suggestion is to change your focus from prevention to early detection. The
I have been investigating dental office fraud for over two
welcome news for dentists is that, regardless of the method-
decades and I will confess that for the first 15 years, I also
ology being used, embezzlers exhibit predictable behavior at
believed that fraud could be prevented if an office would just
work. A questionnaire designed to quickly and reliably capture
implement enough controls. My company even considered
employee telltale behaviors is available by emailing
offering a type of internal controls remediation service at one
fraudnews@prosperident.com.
point. I have since seen the flaw in the “controls prevent fraud” hypothesis.
Early detection is crucial to preventing further losses and this is facilitated more efficiently when practice software permanent-
Controls work when a thief has several possible targets – a
ly retains all transactions, including deleted ones. My investiga-
burglar alarm is quite effective at convincing a casual thief to
tors like Eaglesoft because of its built-in security that retains
rob someone else’s house instead of yours. Since the pressure
ALL transactions and patient information forever. In addition,
causing the stealing behavior won’t disappear when the thief
the format and structure of that information makes our job far
realizes your house is protected, they will simply rob someone
easier, and can translate into more recovery for fraud victims.
else. For this reason, burglar alarms have no impact on the crime rate in the community, even though they are quite
Over 50% of dentists will be fraud victims. I hope that you
effective at protecting a single house.
aren’t one of them. If you are, I hope that you catch it early and that your software retains all data needed for investigation.
In this analogy, the dental practice is really the community, and the controls simply channel the thief to another embezzle-
David Harris, MBA, CMA is CEO of Prosperident, a
ment pathway within the practice. Given that embezzlers are
Halifax-based company that is the world leader
clever and have many possible “houses” to rob, stopping fraud
in investigation of embezzlement against dentists.
with controls in a dental practice is almost impossible.
Prosperident’s website is www.prosperident.com. The phone number is 902-423-6624.
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Winter 2012
Dental Practice Management
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ADVERTORIAL
Dentistry is your Expertise. Dental Software is ours. From Dental Student to Professional Every dental graduate from British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, and the Maritimes will have used Exan’s software at some point during their education. In fact, 75% of all dental academic institutions in North America use Exan’s products. Not only does this enable a shorter learning curve for newly hired clinical staff, but features in our dental educational software are analogous to our private practice software (and vice versa) allowing for a truly unified experience.
Clinical to Administrative Exan’s Power Practice Px is the software of choice for several Canadian Hygiene schools, CDA courses and Dental Reception courses. With a strong focus on transactions, insurance and scheduling, it is no coincidence that so many of the dental reception and hygiene courses use Power Practice Px as the basis of their education.
Embracing Technology Tablets like the iPad have changed the face of personal computing and are fast becoming the choice of the medical and dental industry. As a result, Exan is launching the touch-optimized Px Form system which allows you to easily build your forms in your Power Practice Px system and have your patients fill out these forms with a
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Winter 2012
Dental Practice Management
tablet device. The information the patient enters is transferred directly into the Power Practice system. No need for duplicate data entry, no need for scanning and no mistakes. Px Forms can be used to enter patient demographics, health care information, medical alerts and patient preferences. Although optimized for the iPad, Px Forms can be used on any tablet device including Android, Blackberry and HP devices.
Increasing Patient Care With Power Practice Px, Dentists can now create custom treatment proposals directly from the charting module. This makes it much easier to build multiple, complex or multi stage treatments. Once created, the proposals are automatically transferred to the office manager or treatment coordinator to be presented with full Optio animated educational materials for consideration and approval by the patient.
Power Practice Px: The perfect complement to your practice. Power Practice Px is an easy to use, efficient dental management system designed with patient care in mind. Wether if you’re a single practitioner or a multi operatory dental group, Power Practice Px can help you achieve your goals. It is the perfect complement to your dental practice.
Finance
B
ased on the calls that I receive from doctors, as well as analysis of my current and past client base, I have discovered that approximately 50% of dentists who have contacted me have experienced, or are currently experiencing, some level of fraud or embezzlement in their offices. The alarming statistic leads me to wonder how many dental offices are experiencing this at some level and either don’t know what is happening or may be aware that something is wrong but don’t want to take action due to the fear of repercussions from the fallout. It’s important to note that in all cases, the offices accepted assignment of benefits. This explains why I don’t always get a warm fuzzy welcome from some staff members when I am hired as a consultant to analyze the practice. If an employee is hiding something, she does not want a ‘consultant’ snooping around and asking her questions. Although I am never looking specifically to find fraud, it always rears its ugly head when I ask questions about obvious discrepancies in the management reports. In one case, it was the reaction of the manager that provided me with a clue that I might have stumbled onto something. She became very agitated and red in the face when I asked her a very benign question. Judging by her bizarre behaviour, I decided to do a little more digging before I reported my findings to the practice owner. It’s no wonder why she didn’t want a consultant coming into the practice. She was hiding a lot and committing outright fraud.
The Robin Hood Syndrome There is a saying that the road to hell is paved with good intentions. The person responsible for the actions was a long-standing employee who may not have started out to commit fraud. She may have been thinking that she was doing something good to help the patient receive his/her full benefit entitlement. By changing the codes to help the office or the patient receive 100% of the fees and not to have to deal with the copayments, she felt she was doing something good for the patient. Now the perpetrator has become the ‘heroine’ to the patient, because the patient did not have to pay the insurance copayment. There is also a sense of unfairness or entitlement whereby the perpetrator will justify her actions because, in her mind, the patient needed the treatment and it should have been covered.
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Winter 2012 Dental Practice Management
Is
Committi Insuranc
Fraud helping or your
How does she do it? It may seem counterintuitive to describe how easily fraud can be committed, but the intent of this article is not to help the perpetrator, because she already knows how to do it and has been getting away with it. The following examples are intended to help you, the dentist, know what to look for if you suspect something is going on and then know what actions you should take. Here are some examples based on actual cases:
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Finance
patient’s insurance company. The result was that the doctor had to reimburse the insurance company $16,000 and write a letter of apology, even though he had no knowledge of these claims being submitted. In the eyes of the insurance company, the dentist is responsible for all claim submissions.
Changing Codes
Sandie Baillargeon
ing e
A receptionist was changing the codes on the insurance submissions. For example, if the patient had coverage for 3 units of scaling and the hygienist only coded for 2, she would change the code so that more money is received at the practice. She would also add an extra surface to a filling or code for procedures that were never performed. The submissions for procedures that were never done were all for soft tissue procedures like perio surgery because insurance companies do not request x-rays for soft tissue procedures and she knew it. She made improvements to the practice production and received a nice healthy bonus, but at what cost to the dentist. The doctor in this case had to pay back in excess of $20,000 to several insurance companies. Changing procedure codes is one of the most serious crimes that can be committed. The chart is a legal document and it must contain an accurate and complete record of the treatment that was performed. Changing codes may lead to the doctor and the hygienist losing their licenses.
Professional Courtesies and Write Offs
harming patients? Over Billing
A client was contacted by an insurance company to verify the payments that were made for an orthodontic case. The former office manager, who had been terminated from the practice, was creating invoices for the insurance company for double the amount of the treatment because the patient only had 50% coverage for ortho. Long after the patient had completed the treatment, the manager continued to submit claims for ortho and other false claims to the
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In this case, the perpetrator would enter write offs to correct procedural errors instead of following the appropriate steps to make adjustments to accounts accompanied by full explanations as to why the account needed to be adjusted. Some of the dental software programs make it difficult to correct an entry, so following the path of least resistance, it may be easier to write it off or delete a transaction. The perpetrator did not want you to know how many mistakes she is making which would make her look incompetent. The danger of this scenario is that it may be tempting to write off a transaction that was cash-based and won’t be missed. When a staff member is facing her own personal financial crisis, it may be too tempting to put her hand in the cookie jar to get herself out of an immediate situation. If the employee’s hand is in and out of the cookie jar too often, eventually she will help herself to a cookie. It may only be a small amount at first, but if it is easy to
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ADVERTORIAL
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A “Whiter” Paradigm
Philips has made Zoom better than ever with the introduction of the Philips Zoom WhiteSpeed Light-Activated Whitening System that combines a light with advanced, new LED light technology and variable intensity settings with the now familiar Philips Zoom Chairside Light-Activated 25% hydrogen peroxide bleaching gel to provide easier chairside whitening. The gel works in combination with the Philips Zoom WhiteSpeed technology. The gel is dispensed from a patented, dual-barrel syringe that auto-mixes a 32% hydrogen peroxide gel with a high pH booster gel, producing a 25% hydrogen peroxide gel. Backed by new marketing and training support — a worldwide public relations campaign to drive patients to dental professionals and new programs to help you quickly and easily integrate Philips Zoom into your practice — Philips Zoom WhiteSpeed delivers on the promise of professional teeth whitening and profitable practice building.
To Light or Not to Light?
Light activation of bleaching gels has long been debated. Some studies with other chairside whitening units have demonstrated minimal, if any, noticeable differences in whitening when comparing teeth treated with the same bleaching gel without a chairside light. The new, improved Philips Zoom WhiteSpeed is clinically proven to whiten teeth up to 8 shades in 45 minutes. That’s 40% better than comparable non-light activated systems.1 The new LED light technology emits at the optimal light spectrum with 100% greater light intensity than the closest competitive lamp.2 The light then activates a photo catalyst within Philips Zoom Chairside Light-Activated Gel to greatly accelerate and enhance whitening results and deliver the dramatic results your patients will love.
Solving the Sensitivity Issue
Another drawback to chairside whitening is sensitivity as teeth rehydrate. Some patients demonstrate increased sensitivity after chairside whitening, especially those who have sensitivity before the procedure or have root exposure and enamel wear. With adjustable settings of low, medium, and high, the Zoom WhiteSpeed System now allows to customize the intensity for sensitive patients to ensure each patient receives a more comfortable treatment and a more pleasant experience. The Philips Zoom WhiteSpeed System also uses a sensitivity protocol to further maximize patient comfort. This includes the application
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of Philip’s Relief ACP Oral Care Gel, which acts as a desensitizing agent that can be applied in trays or with a toothbrush.
CLINICAL TIPS Successful Chairside Whitening with Philips Zoom WhiteSpeed System
1. Isolation is critical because chairside whitening solutions typically use highly potent hydrogen peroxide bleaching gel, which can cause soft-tissue damage if it comes in contact with the gingiva or lips. Lip and tongue retractors, such as Philips Zoom’s IsoPrep Retractor and Liquidam light-curable dam, can completely isolate the soft tissue from contact with the bleaching gel and exposure to the chairside whitening light. 2. The whitening gel should be applied in a 1-mm to 2-mm thick layer over all tooth surfaces that will be whitened to ensure that adequate bleaching gel is present to whiten teeth when the light is applied. To avoid spreading the bleaching gel onto the soft tissue or under the isolation, remove the gel from the teeth using a surgical suction tip (now included in the redesigned Philips Zoom Chairside Light-Activated kit) after each 15-minute session. Avoid using the air/water syringe because this can dislodge the isolation and push bleaching gel onto the soft tissue. Any remaining gel can be removed with moist gauze. 3. Tooth sensitivity can be addressed by using the variable intensity settings of the light and by having the patient use a desensitizing agent. The Philips Zoom Chairside LightActivated procedure includes a unique Patient Post Care & Maintenance Kit complete with a syringe of Relief ACP. The Relief ACP gel can be administered in either a take-home tray or applied with a toothbrush daily for 10 to 30 minutes. 4. Application of vitamin E oil to the lips before beginning whitening will minimize irritation. 5. Patients also should be advised that consuming coffee, tea, or red wine or smoking during the first 2 hours after chairside whitening can lead to staining and darkening of the teeth. It will take about two hours for a pellicle to reform on the enamel surface. 6. To maintain and further enhance the chairside whitening results, it is advisable to make take-home trays to be worn by the patient for 30 minutes weekly. The Philips Zoom WhiteSpeed System provides whitening maintenance with either Philips Zoom NiteWhite or DayWhite take-home whitening gels, also conveniently found in the Patient Post Care & Maintenance kit. 1. Compared to Dash 2. Compared to Beyond™ Polus®
The #1 patient-requested professional whitening system* is now better than ever. New Philips Zoom offers advanced light technology that gives you more control and your patients the same great results. It’s clinically proven to whiten up to 8 shades in 45 minutes—that’s 40% better results than a professional non-light whitening system.1 With these great results and a fully supported marketing and training program, you’ll have the answer to the confident, beautiful smile your patients are asking for. Ask about the new Philips Zoom WhiteSpeed today. Call 800-278-8282 or visit philipsoralhealthcare.com. * In the United States 1 Compared to Philips Dash (same duration and product category) Philips is a registered trademark of Koninklijke Philips Electronics N.V. ©2011 Discus Dental, LLC. All rights reserved. To be dispensed by or on the order of a dental professional only.
Finance
Using Someone Else’s Insurance Benefits
In this case, the perpetrator knew that ‘Patient A’ had not used all of his/her benefits, and ‘Patient B’ needed treatment, so ‘Patient A’s insurance company was billed. The perpetrator would know that the claim would be covered and not challenged by the insurance company. It’s important to note that both patients were members of the same family and ‘Patient B’ did not have insurance benefits.
Who Are the Victims of Insurance Fraud? Victim #1 — The Patient
The patient is victimized by his/her insurance benefits sometimes being maxed out. If a patient realizes that something is wrong with their insurance benefit entitlement and it is the result of what is happening at your office, they will blame you, because you are the dentist. The victim will not know, or care, that you have had a dishonest employee working for you who did these acts without your knowledge or consent. Over-utilization of insurance benefits will result in employers not purchasing dental benefits for their employees. Dental insurance is the most costly component of a group insurance benefits plan. If the costs for the premiums rise due to the inflated utilization rate that was created by false claims, employers are likely to drop dental benefits from their employee benefits packages. When employers are faced with economic stresses, paying premiums for dental benefits become too cost prohibitive to sustain. The patient is now victimized a second time because they lose their employer paid benefit.
Victim #2 — The Doctor
If insurance companies launch an investigation and the doctor is aware of some problems that exist, but does not act on them, he/she is considered the prime suspect. In other words, the insurance company will assume that the doctor is responsible and his hands are dirty. Some insurance companies can, and will, deny any future claims that come from your office. You are considered guilty until proven innocent and even then, you are still guilty. The doctor will also be expected to pay the insurance company back all payments that were received from fraudulent claims. That can become an administrative nightmare to sort out which claims were legitimate and which were not , costing the doctor both time and money. 22
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Watch the observable behaviour of your employees In some cases the doctor may have his/her license suspended or revoked if they knowingly allowed insurance fraud to occur and did nothing about it after it was discovered. You are responsible for the actions of your employees because it is assumed that they work under your direction and control.
Victims #3 — Collateral Damage
If the doctor and/or hygienist loses their licenses, who will treat the patients? Also, the jobs for the remaining staff are in jeopardy making them victims as well. A lot of honest, hard-working people can become the collateral damage of the perpetrator’s misguided actions and the doctor’s career can be ruined. What should you do if you suspect or detect fraudulent activity? The most important advice that you can receive is get professional help — don’t try to do it all yourself. Follow these steps: 1. Contact a forensic investigator to begin an investigation without the knowledge of any of your employees. If the investigation shows that fraud has occurred he will guide you through to let you know what your next actions should be. If no fraud is detected, that would be good news. An experienced fraud investigation service that I recommend is Prosperident. 2. Perform a complete backup on your computer system immediately. Offsite backups are best and most dental software companies provide this service. 3. C ontact an employment lawyer who specializes in employment law. I recommend Mariana Bracic from MBCLegal.ca who made the following comments.. Employment law in Canada is risky business at the best of times. In situations involving allegations of employee fraud or embezzlement, it is particularly important to act carefully and with the benefit of experienced employment law advice. You will likely wish to take action against the employee before you have received the results of a forensic audit but you need to appreciate that the level of proof required for the satisfaction of a Court to justify a termination based on criminal or quasi-criminal behaviour is extremely high. If you www.oralhealthgroup.com
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do and she gets away with it, this could lead to finding ways to take larger amounts and bigger cookies. Account write offs must require authorization by the dentist accompanied by an explanation about why the account is written off. Typically account write offs are only done once per year.
Finance
act to discipline or terminate the employee without that high level of proof, it may come back to bite you really badly. If you have proper contracts and policies in place, you will have much greater rights to deal with the employee and this is another of the dozens of reasons every dentist should have proper contracts and policies in place. It is interesting to note that every office in these examples accepted assignment of benefits, which is another good reason for becoming a non-assignment practice. Within the next few years, insurance companies will force the issue because they only want to deal with their subscribers to the insurance. If your practice is assignment based and insurance driven, your practice is at risk. It’s important to treat the patient according to their clinical needs and not their insurance benefits. If you suspect that fraud is happening in your office, don’t wait, take action quickly and get professional advice. The consequences of not taking action far outweigh any disruptions that may occur. Perform frequent and random checks to ensure that the services
you are actually performing are the same services that are being billed. Watch the observable behaviour of your employees. In every case presented, it was the unusual or overly defensive behaviour of the employee that tipped off the dentist that something was wrong. Remember, that writing off copayments, providing professional courtesies to cover copayments, overbilling and changing codes is not helping the patients, it’s hurting them. Fraud is fraud. DPM
Sandie Baillargeon is author of two text books, Dental Office Administration and The Canadian Dental Office Administrator, published by Nelson Canada. Sandie is the owner and operator of Dental Office Consulting Services, which specializes in dental business planning, staff development, consulting and continuing education seminars. Visit her website at www.dentalofficeconsulting.com or contact her directly at (905) 336-7624. Special thank you to Mariana Bracic from mbclegal.ca. She may be reached by telephone at 905-825-2268 or by email at mbracic@mbclegal.ca.
@cusimanopc professionals since 1984
www.oralhealthgroup.com
Dental Practice Management Winter 2012
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ADVERTORIAL
Get In Touch with a More Profitable Practice – Dentrix G4 With DENTRIX Practice Management Software, you can make sure every patient receives the best possible service and care from the moment they walk through your door. Because DENTRIX offers the latest practice management technology and creates a completely digital practice, your staff will have all the tools and resources they need to achieve new levels of efficiency and professionalism. From your front office to your operatories, DENTRIX offers solutions that create a seamless workflow to enhance patient care and increase your practice’s profitability. So, what makes DENTRIX the best choice for your practice? We’ve been a leader in dental practice management for more than 20 years. More than 30,000 dental practices across North America depend on our solutions and services every day. Old-fashioned paperwork is expensive and inefficient — DENTRIX makes it easy, practical and affordable to move toward a more paperless practice. DENTRIX also offers a complete management solution, providing tight integration with powerful electronic services which automate timeconsuming tasks and improve patient communication. It integrates with leading dental equipment, such as DEXIS, giving the entire team a complete view of the patient’s records and makes the digital dental practice a reality. Back in late 2011 we announced the Canadian launch of DENTRIX G4 which provides our customers with new features on a more frequent basis. These new features are bundled in Productivity Packs, which are delivered conveniently via the internet and provide added efficiencies to your practice. Here are just a few of the most significant feature updates;
Practice Advisor DENTRIX Practice Advisor is a unique feature that quickly compiles your practice data into concise, easy-to-read reports that help you stay on top of your practice’s financial health. This new feature analyzes your office performance and helps you gain a better understanding of your practice’s strengths, weaknesses and opportunities. The Practice Advisor also includes benchmarks and suggestions to improve your office operations that were developed by top practice management consultants. For example, the DENTRIX Practice Advisor can help you analyze your Accounts Receivables (AR). If your AR-to-production ratio is too high, the DENTRIX Practice Advisor will flag it and offer recommendations, such as
reviewing your aging reports, insurance aging reports and payment agreement reports to see possible opportunities. The Practice Advisor offers other recommendations like determining whether it is time to start the collections process on some accounts, or seeing whether patients on payment agreements are making payments. The DENTRIX Practice Advisor provides an effective way to instantly transform your practice data into actionable information that will help your practice become more efficient and profitable.
Daily Huddle In the fast-paced, complex world of modern dentistry, it’s difficult to keep everyone focused on the same patient care priorities and long-term business objectives. The new Daily Huddle feature addresses this challenge by bringing all the critical information your staff needs together into one easy-toread view. Daily Huddle starts with a set of reports that makes it easy to organize daily activities, measure daily performance against long-term performance metrics, and unify your team around a common set of goals and processes. The Daily Huddle production schedule even includes automatic alerts and reminders to help team members identify potential problems early, prepare for patient visits, and stay focused on the most important daily tasks. When you make the move to DENTRIX, you’re in good hands while you and your staff make the transition. Effective, live training delivered by an experienced instructor will give you the confidence that translates directly into a more efficient, productive and profitable practice. DENTRIX offers a complete range of training options to meet your specific requirements whether it’s right in your office, at one of our many seminars across Canada, or live over the internet. We’ll give you the customized training you want to turn you and your staff into experts. With DENTRIX, your office staff can focus more on patient care and their needs while the technology takes care of some of the important, but mundane, tasks. It can be almost like having another employee working for you. A practice that operates smoothly and efficiently can get patients’ attention too, and reflects the quality of care they receive. If your goal is high-quality dentistry, an efficient practice management system like DENTRIX is absolutely essential.
Why not contact one of our Henry Schein Canada sales consultants today at 1-800-561-2983 to arrange a demo and put you in touch with a more profitable practice.
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Practice Management
6
steps TO A CHARTLESS PRACTICE
T
here is no doubt that the modern dental practice has changed rapidly over the past 10 years. Dentists have come to realize that with new technology, they can create a practice that is more efficient, costs less to run, and allows for decentralization of the front office. Records that were primarily paper and film-based are being replaced by digital radiography, electronic records, and a move towards a paperless, or at the very least, chartless practice. Most offices realize that there will always be paper in a dental practice. Whether it’s walkout statements, insurance forms, or printed copies of images, paper will forever be part of the dental practice. That being said, there are a number of practices that
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LORNE LAVINE, DMD have truly eliminated their paper charts. While the process is easier for a start-up practice, with proper planning, existing practices can achieve this goal as well. The challenge for most offices is to develop the best plan on how to evaluate their current and future purchases to ensure that all the systems will integrate properly together. While many dentists are visually oriented and thus tend to focus on the criteria that they can actually see and touch, some of the most important decisions are related to more abstract standards. I have therefore developed a six-point checklist that I feel is mandatory for any dentist who is adding new technologies to their office, and I recommend that each step be completed in order: www.oralhealthgroup.com
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Practice Management
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Practice Management Software
It all starts with the administrative software that is running the practice. To develop a chartless practice, this software must be capable of some very basic functions. For offices that want to eliminate the paper, you’ll need to consider every paper component of the dental chart and try to find a digital alternative. For example, entering, charting, treatment plans, handling insurance estimation and processing with e-claims, ongoing patient retention and recall activation, scheduling, and dozens of other functions that are used on a daily basis. Many older programs do not have these features and if an office wants to move forward, they will have to look at more modern practice software. It’s also important to understand that as much as we would all prefer that our practice management software programs can handle all of these functions, most fall short of this. Fortunately, there are a number of third-party programs that can provide functionality where the practice management programs cannot. We’ll explore many of these programs and services in a future issue, such as programs that allows you to digitize forms that require patient signatures and programs that can reduce the process of entering progress notes down to a few mouse clicks.
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Image Management Software
This is probably the most challenging decision for any office. Most of the practice management programs will offer an image management module: Eaglesoft has Advanced Imaging, Dentrix Dexis, Kodak has Kodak Dental Imaging, and so on. These modules are tightly integrated with the practice management software and will tend to work best with digital systems sold by the company. For example, having an integrated image module makes it very easy to attach images to e-claims with few mouse clicks. However, there are also many third-party image programs that will bridge very easily to the practice management software and offer more flexibility and choices, although with slightly less integration. There is www.oralhealthgroup.com
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no perfect system…it really boils down to paying a premium for tighter integration or paying less for more flexibility. Some of the better known third-party image programs include Apteryx XRayVision, XDR, and Tigerview.
3
Operatory Design
4
Computer Hardware
The days of a single intraoral camera and a TV in the upper corner are being replaced by more modern systems. The majority of offices are placing two monitors in the operatories, one for the patient to view images or patient education or entertainment, and one for the dentist and staff to use for charting and treatment planning and any sensitive information, such as the daily schedule or other information that you would prefer that the patient not see. Windows has built-in abilities to allow you to control exactly what appears on each screen. There are numerous ergonomic issues that must be addressed when placing the monitors, keyboards, and mice. For example, a keyboard that is placed in a position that requires the dentist to twist his or her back around will cause problems, as will a monitor that is improperly positioned. Another important decision for the office will involve deciding whether you prefer the patient to see the monitor when they are completely reclined in the chair. If this is the case, then the options are a bit more limited for monitor placement. There are some very high-tech monitor systems that not only allow the patient to see the screen, but create a more relaxing environment for patients who are considering long procedures.
After the software has been chosen and the operatories designed, it’s time to add the computers. Most offices will require a dedicated server in order to protect their data as well as having the necessary horsepower to run the network. The server is the lifeblood of any network, and it’s important to design a server Continued on page 39
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12-10-23 11:04 AM
ADVERTORIAL
Some ‘Work Smart Rants’ for you to think about… You’re in your office going about your daily routine and everything is okay, but do you ever ask yourself why you do the things the way you do? Do you listen to what your instincts are saying or are you just following the recommendations of others? We think you should question everything. Our ‘Work Smart Rants’ started so we could challenge traditional “in the box” thinking. It’s not important you agree with the points we’re making. It is important you think about the points we’re making and figure out what's working for you and what isn't. Our ‘Work Smart Rants’ are an ongoing series of articles highlighting different points of views and opinions about various topics that can be found on our website.
Why Do You Chart the Way You Do? According to record keeping guidelines of governing bodies: “Dental Records should provide an accurate picture of the patient’s oral/dental status.” So how can you get more accurate than an actual photograph and/or digital x-ray? This is the basis of The Bridge Network’s ‘Visual Charting’ which has revolutionized traditional charting methods and goes beyond just simply computerizing charts. Enhance your patient’s dental records easily and more efficiently without relying on cumbersome ‘bridges’ between different modules or programs.
Faster than Speech Recognition
Possibly the Most Inefficient Tool in an Operatory... the Intraoral Camera
Fact vs Fiction: The Truth about Digital X-Rays
It’s quite common place to see intraoral cameras in a dental office. While there are certain scenarios where an intraoral camera is a useful tool, most offices are not using this tool efficiently. With the advancements made to digital photography as well as imaging software, taking better quality images can be much faster and easier when staff (preferably not the doctor) uses a simple point-and-shoot camera rather than an Intraoral Camera. With a point-and-shoot camera and the aid of a standard occlusal mirror, you can take better quality images of a patient’s arch and easily zoom in on an individual tooth.
Why Spend More Than You Have to for an Intraoral Camera? Intraoral cameras do however have their place in the operatory, such as when a dentist is in the middle of a procedure. But how much should you be paying for an intraoral camera that won’t be used that often? With falling electronic prices, you might think there would be more reasonably priced intraoral cameras. There is: The Bridge Network offers two intraoral cameras for $500 and $1250 and we challenge you to compare both cameras to ones that are five times their cost. Want proof? Actual photos taken from these two cameras are on our Website.
With more computing power, Voice Recognition and Voice Dictation have now become very reliable and quite useful. Many think Voice Dictation is the answer for you to do your notes quickly and efficiently. This is not always true. In the majority of cases, paragraphs of information can be quickly created using welldesigned electronic forms where you simply pick from a list of common entries. It’s what we call ‘Smart Phrases’ and we have videos to prove why it’s often faster than using Voice Recognition.
Digital radiography is now the norm in a modern dental office, yet there are still many myths that exist. Myths such as: a Digital x-ray systems work best with the software sold by the digital x-ray rep; using a ‘Bridge’ with a 3rd party imaging software will make that imaging software ‘compatible’ with your practice management system; only the Dental Supply company can support your imaging software; and that ‘bigger is better’. Challenge these myths!
Are You Still Using Paper To Stay In Touch? Offices have indicated a growing concern when it comes to the privacy of their patients while using electronic communications between providers. Tracker, together with iTRANS clinical document service, is the smart and efficient way to deal with this issue. Technology used smartly can streamline the referral process and help offices communicate more efficiently and effectively.
Efficient Image Acquisition – Wireless & Instant Imagine being able to take a picture, seconds later it appears on your screen and is automatically saved to your imaging software. No more downloading ‘when you get around to it.’ We’ve worked with dentists to make this a reality in order to make the digital imaging experience as effective and as easy as possible.
If you enjoyed reading these abbreviated ‘Rants’, full versions accompanied by videos and images, are available on our website at www.bridge-network.com.
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DPM Wint12 p28-29 Bridge Ntwrk Advert.indd 28
12-10-24 3:27 PM
o ur is g
n e d s, lof e
et y p; at nt g
e ns nt e. d
Our commitment in offering innovative Our commitment in offering innovative
n o h g
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12-10-24 3:27 PM
ADVERTORIAL
Canada's Dental Software Leader ABELDent Inc.'s mission is to provide dental professionals with the highest return on their investment in dental software for as long as they practice dentistry. Feature-rich and user-friendly, our ABELDent program is backed by a team with a 28-year track record of delivering innovative, high quality software and services to Canadian dentists. ABELDent Portal and ABELDent Mobile build on that tradition - offering you new and better ways to provide services to your patients.
ABELDent
ABELDent Portal
ABELDent Mobile
Comprehensive software that adapts to your needs.
Keep your patients and practice in sync.
Stay in touch while you are on the go.
ABELDent clinical and practice management software provides an exceptional solution for offices - large and small. Developed in collaboration with thousands of daily users, ABELDent offers an exceptional balance of ease of use and the flexibility to grow and change with the needs of its users.
ABELDent Portal improves your communication with patients while dramatically reducing time spent on telephone confirmation and similar tasks. Portal sends appointment reminders and confirmation requests that patients can respond to from any computer or mobile device.
ABELDent Mobile allows you to access selected ABELDent data from your smart phone or other mobile device.
Support for the paperless practice. Secure electronic charts and forms, storage for externally created documents, integration with imaging systems, secure offsite backs – these tools and more allow you to retire your paper-based charts. Selective use of standard technology in ABELDent allows you a degree of customization while remaining within constraints of secure electronic recordkeeping. A solid, stable SQL database provides a reliable platform for your data and Authorization Manager allows you to control and, where desirable, constrain access to both software and data.
Patients can inform you of changes in their demographic information, view their financial balance, request unscheduled appointments or update their medical history before their visit.
Freedom of choice. As an independent company, ABEL provides integration with many digital radiography systems so that you can select the system that best meets your needs.
ABELDent Portal even makes it easy for patients to refer you to their friends - something they’ll be happy to do once they see the service that the Portal helps you provide.
ABELDent Portal provides much greater integration with ABELDent than other patient communication systems. If an opening appears in your schedule, you can let patients that want to book an appointment know about it instantly. When a patient confirms an appointment, ABELDent reflects the change immediately.
You can view your upcoming appointments and drill down when you need additional information about a patient. You can also contact patients and the dentists that you refer patients to (or those that refer patients to you). ABELDent Mobile accesses data securely and in real time so you always have access to the most current information. Practice data is never stored on your mobile device so your practice remains protected if your device is lost or stolen. ABELDent Mobile is a webbased application so it can run on any device with a browser including all of the most popular tablets and smartphones. ABELDent Mobile is your practice on the go.
ABELDent Inc. - Your best choice today and for as long as you practice dentistry. Call 800-267-ABEL (2235) ext. 1 today or visit www.abeldent.com/dpm for more information. 30
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DPM Wint12 p30-31 Abelsoft Advert.indd 30
Dental Practice Management
12-10-25 9:18 AM
I love this! “My dentist emails our appointment reminders and I can confirm with a click of a button. I can even go online to check our account and provide information.”
Better Communication Less Effort Great Service The difference is in the integration. ABELDent clinical and practice management software and ABELDent Portal provide a seamless solution that works for today's busy patients and for your practice. As a special offer, you can receive both ABELDent and ABELDent Portal for a price that is comparable to what some companies charge for their patient communication systems. Call 800-267-ABEL (2235) ext. 1 today or visit www.abeldent.com/dpm for more information. www.ABELDent.com 800-267-ABEL (2235)
DPM Wint12 p30-31 Abelsoft Advert.indd 31
12-10-25 9:44 AM
ADVERTORIAL
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12-10-24 3:28 PM
DPM Wint12 p32-33 Community Lend Advert.indd 33
12-10-24 3:29 PM
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Legal Matters
CAN NONDENTISTS OWN DENTAL PRACTICES? MICHAEL CARABASH, BA, LLB, JD, CDPM
practically anyone. But what about patient charts, lists and records (Dental Records)? That is where the true value of a dental practice lies. So what exactly are Dental Records? Who owns them? And can they be sold to and owned by non-dentists?
What are Dental Records?
I
know what you’re thinking: non-dentists cannot own a dental practice. But is that true? What exactly is a dental practice and what do Ontario’s laws say about who can own it? Are we heading towards non-dentists becoming involved in owning and operating dental practices — like in the U.S. or Australia? And is
34
it a good idea? If you’re intrigued, just keep reading…
What is a Dental Practice?
A dental practice is made up of assets — such as equipment, furniture, fixtures, supplies, and computer hardware and software. Generally all of those types of assets can be bought and sold by
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DPM Wint12 p34-38 Carabash.indd 34
Dental Records are information about a patient’s dental care that are created and maintained by a dental professional or dental practice. At a minimum, this information includes general patient information (e.g. name, contact information, date of birth, etc.). The Royal College of Dental Surgeons (RCDSO) has said in its Dental Record keeping Guide-
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S?
Legal Matters
lines that dental records must also include things like a patient’s medical and dental history, diagnosis and treatment plans, and even financial records.
Who owns Dental Records?
Over the years, Canadian courts have consistently held that the physical or electronic dental records of patients are owned by the dental professional who compiles them; patients do not have a right to possess or own the records, but have an interest in the personal information contained therein and can access them [see for example: Lamothe v. Mokleby, [1979] S.J. No. 354 (Saskatchewan Court of Queen’s Bench); Peters v. Palmer et al., [1985] N.J. No. 278 (Newfoundland District Court Judicial Centre of St. John’s); McInerney v. MacDonald [1992] 2 S.C.R. 138 (Supreme Court of Canada); Axelrod (Re), 1994 P.J. No. 2277 (Ontario Court of Appeal); and Lodwig v. Mather [1995] A.J. No. 382 (Alberta Court of Queen’s Bench)].
Can Dental Records be bought and sold?
When it comes to buying and selling Dental Records, there is nothing wrong with dentists selling them as part of a practice sale to another dentist. As long as dentists follow their legal, professional and ethical duties concerning the transfer of Dental Records, such sales are fine. But can Dental Records be sold to and owned by non-dentists? There are many different (and seemingly conflicting) laws that could govern this situation (for example, property law, contract law, privacy law, and the professional and ethical laws governing dentists); however, at the present time, these laws do not appear to come to a single conclusion about whether Dental Records can be sold
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to and owned by non-dentists. So where does that leave us? Two words: clever arguments. There’s a strong argument out there that Dental Records cannot be sold to or owned by non-dentists. This seems to be the position that the RCDSO has taken. For example, in a Februar y / March 2012 article by in Dispatch Magazine (at page 28), an RCDSO Practice Advisor responded as follows to the question of whether dentists can leave their dental practice (including Dental Records) to their spouse in their Will: “No. While non-dentists can own dental office premises, supplies and equipment, non-dentists cannot own dental records….” In support of this position, there are other laws that come into play — most of them dealing with patient privacy and practicing dentistry generally. And they all point towards (although not saying it unequivocally) the conclusion that Dental Records can only be owned by dentists and those working under their authority. But there’s also a strong argument out t here t h at D ent a l Records, like other types of property, can be sold to and owned by non-dentists — so long as those non-dentists do not possess or access them. This view finds support in Ontario court decisions. For example, in Axelrod (Re), 1994 P.J. No. 2277 (Ontario Court of Appeal), a dentist had signed a general security agreement with a non-dentist and pledged patient lists and files as collateral in case the dentist defaulted on the loan. When the dentist defaulted, the non-dentist sought to seize those lists and files and transfer them to another dentist. The dentist argued that those assets could not be pledged as security because of their confidential nature and because of the fiduciary relationship that exist-
ed between a dentist and patient. The Ontario Court of Appeal ultimately ruled in favour of the nondentist and wrote: “I see no difference between a dentist’s entitlement to sell his or her practice, and a dentist’s entitlement to pledge records [to a non-dentist]. Both can be accomplished in a manner compatible with a dentist’s professional responsibilities, as long as the dentist acts with the utmost good faith and loyalty in protecting the patient’s confidence. The doctor may use the records to pursue his or her self-interest, so long as it does not conflict with the duty to act in the patient’s best interests.… When a dentist sells or pledges his patient list, as the [dentist] did in this case, I think that he or she should be held to have parted with his or her own interest in the patient list, subject to his or her patients’ rights to confidentiality and access.” More recently, in Smilecorp v. Pesin, 2012 ONSC 1966 (Ontario Superior Court of Justice), a dentist had signed a management agreement with a non-dentist (denturist) to provide dental services at the non-dentist’s dental care facility. That management agreement included a non-solicitation clause. When the dentist left and took a patient list, the non-dentist sought to enforce the non-solicitation clause. The Ontario Superior Court of Justice held that the nondentist had established sufficient goodwill in their facility (which included client lists) that was worthy of protection in the form of a non-solicitation. The Court stated that the agreement between the dentist and the non-dentist “does and can prohibit solicitation of the goodwill built up in ready made dental practice that [the non-den-
Dental Practice Management Winter 2012
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12-10-23 11:46 AM
ADVERTORIAL
Protecting Patients & Staff from Infection Cleankeys helps reduce transmission risk in dental facilities
Preventing infection transmission is a critical component of providing quality oral healthcare, but can be challenging. Dental practices provide multiple high-touch surfaces that are potential microbial reservoirs and dental procedures can spread contamination over a wider area than previously recognized.1 One often over-looked high-touch surface ubiquitous in the healthcare environment is the computer keyboard. The proliferation of computer equipment poses a significant risk for cross-contamination in clinical settings. Several studies have revealed that keyboards in dental practices are highly contaminated and are a vector for pathogens,2-5 including multi-drug resistant organisms. In the US, the Centers for Disease Control and Prevention have set out guidelines for infection control in dental health-care settings.6 In addition to patient-contact devices/items, the CDC also identifies two categories of surfaces in dental offices to address in your infection prevention strategy: clinical contact surfaces and housekeeping surfaces. Clinical contact surfaces are those that, though they do not contact patients directly, are in close proximity to the patient. These surfaces are therefore at risk for contamination through spatter or spray, or through hand-transfer during a dental procedure. In their guidelines, the CDC lists chair-side computer equipment as a clinical contact surface. To prevent contamination of such surfaces, the CDC Guidelines recommend using barriers such as plastic wrap, or similar materials. It is also recommended that these protective barriers be replaced between patients and that the clinical surface be examined “to make sure it did not become soiled inadvertently”; a challenge, given that microbes are not visible.6 The guidelines further require de-gloving, hand sanitizing, and re-gloving before replacing the barrier protection on these surfaces; this can be a time-consuming and imperfect process. Data suggest that using covers does not afford 100% protection.3 Likely, this failure is due to coverings that rip or tear, forgotten or removed coverings, or transfer of contamination during the changing of coverings. The design of conventional keyboards makes them difficult and timeconsuming to clean and disinfect thoroughly. Cleankeys Inc. (www. cleankeys.com) has developed a medical grade keyboard that has a flat, touch-sensor surface, which is easy to clean and disinfect
because there are no raised keys. The keyboard is fully sealed to withstand liquids; and the surface is glass or polycarbonate, which can withstand repeated treatment with standard clinical disinfectants. These difficult to manage surfaces pose a significant challenge for running a safe and efficient dental practice. Cleaning compliance of both surfaces and hands in dental practices may be poor.5 To address this, the CDC recommends that part of a successful infection control program in dental facilities includes continual evaluation and assessment. It’s important to be regularly assessing the efficacy of infection prevention procedures and the compliance with your policies. Tracking compliance presents an additional challenge as staff have numerous activities to conduct and patients are the priority. Dental practices are busy workplaces and with so many activities to keep up with, “smart” surfaces can help keep activities on track. Having a keyboard that IS cleanable is one thing, but having a keyboard that actually GETS cleaned is a more powerful tool in the battle to reducing contamination. However, just making a keyboard surface readily cleanable isn’t enough to mitigate the risks. Monitoring and prompting healthcare workers into action has been shown to drastically improve compliance.7,8 In addition to the easiest to clean typing surface, Cleankeys boasts features developed specifically to improve infection prevention activities in clinical facilities. The new Cleankeys keyboard is more than a keyboard – it is also a monitoring, reporting, and alerting system. The Cleankeys keyboard monitor allows the keyboard to communicate cleaning events and reports this information. In this way, both front-line staff and those overseeing infection prevention activities can easily monitor whether or not the keyboard cleaning is actually being done. Cleankeys keyboards have been in use in dental operatories since 2008. “Infection control has always been a priority, but not all products make it easy. Keyboards in general are magnets for contamination. Prior to Cleankeys we were using rubber keyboards. Cleankeys is by far easier and quicker to clean than those were. We replaced all six with Cleankeys.” Dr. Ronn Gibb, DDS (North American Dentist). Using keyboards that are infection control tools is a valuable first step toward a healthier environment for patients and staff.
For more information, please contact: Bill Meeks, Sales Manager, Cleankeys Inc.4423 97th Street, Edmonton, Alberta, Canada T6E 6W6 T: 780-702-1473, ext. 2 • sales@cleankeys.com REFERENCES 1. Rautemaa, R., et al., Bacterial aerosols in dental practice — a potential hospital infection problem? J Hosp Infect, 2006. 64(1): p. 76-81. 2. Anjumn, M.S.R., P.P.; Abbas, I.; Monica, M.; Rao, Y., Microbial contamination of laptop/ keyboards in dental settings. International Journal of Public Health Dentistry, 2011. 2(2): p. 4-5. 3. Hughes, E.A.P., C.J., Microbial Contamination of Computer Keyboards and Mice, in OSAP 2012 ANNUAL SYMPOSIUM, A.a.P.O. Organization for Safety, Editor 2012.
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Winter 2012
4. Patel, S., K. Porter, and R.L. Sammons, Are computer keyboards a cross-infection risk in a dental clinic? Journal of Infection Prevention, 2010. 11(6): p. 206-211. 5. Stambaugh, R.V.E., L., Contaminated Surfaces — a look at multidrug resistant organisms and computer keyboards/mouse devices in the dental office. Dimensions of Dental Hygiene, 2009. 7(6): p. 42-45. 6. Kohn, W.G., et al., Guidelines for infection control in dental health-care settings — 2003. MMWR Recomm Rep, 2003. 52(RR-17): p.1-61.
7. Weiss, C.H., et al., Prompting physicians to address a daily checklist and process of care and clinical outcomes: a single-site study. Am J Respir Crit Care Med, 2011. 184(6): p. 680-6. 8. Armellino, D.H., E.; Schilling, M.E.; Senicola, W.; Eichorn, A.; Dlugacz, Y.; Farber, B.F., Using HighTechnology to Enforce Low-Technology Safety Measures: The Use of Third-party Remote Video Auditing and Real-time Feedback in Healthcare. Clinical Infectious Diseases, 2012. 54(1): p. 1-7.
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Legal Matters
tist] established, inclusive of the list of patients and related material that [the dentist] inherited and for which [the dentist] has no right of possession.” As in Axelrod (Re), the non-dentist was permitted to transfer the Dental Records to another dentist. So the argument goes that ownership of Dental Records has realizable economic benefits which can in certain circumstances be owned by non-dentists, but only possessed and accessed by dentists and those working under their authority. This ensures that patient privacy is not violated and that the dentist has met his or her duty of good faith towards patients. Both are very good arguments. But the law does not exist in a vacuum. It needs context. And that context comes in the form of a legal dispute. If there is no dispute, then parties can do as they please with little or no repercussions. So trying to figure out whether a non-dentist can legally buy and own Dental Records and therefore a dental practice will remain in the ‘grey’ area of the law until a legal dispute arises. Will it be a contractual dispute for the Courts to decide or a professional misconduct matter for the RCDSO to deal with? Interestingly enough, in Smilecorp v. Pesin, the Court rejected the dentist’s attempt to have professional misconduct matters affect the contractual dispute. The dentist in that case argued that the non-dentist should not be allowed to enforce a non-solicitation clause because the non-dentist had engaged in fee splitting — something that dentists are prohibited from doing; but the Court held that any prohibition on fee splitting “is a problem for [the dentist], not for [the non-dentist]”. The Court essentially kept the two legal con-
texts — contractual dispute vs. professional misconduct — separate.
So, is it a good idea?
Whether it’s a good idea to have non-dentists involved in owning and operating dental practices is open to debate. Non-dentists argue that they can provide better access to quality dental care. While dentistry is a professional services business, not all dentists make for good business owners / operators. Non-dentists can enhance patient care by allowing dentists to focus on providing dental services while leaving the
for example, non-dentist organizations backed by private equity firms in the U.S. have been heavily criticized for, among other things, overtreating patients and engaging in predatory third-party financing practices to gouge patients’ pocketbooks (sources: “Dollars and Dentists” (26 June 2012) PBS Frontline; Sarah Childress, “America’s Dental Care Crisis” (19 June 2012) PBS Frontline; and David Heath and Jill Rosenbaum, “Patients, Pressure and Profits at Aspen Dental” (26 June 2012) PBS Frontline).
Are we already there?
Trying to figure out whether a non-dentist can legally buy and own Dental Records and therefore a dental practice will remain in the ‘grey’ area of the law until
38
a legal dispute arises administrative tasks of running a dental practice to them. Furthermore, non-dentists with financial resources can leverage technology and economies of scale to help deliver cost-effective, comprehensive and consistent dental services for the general public. Others (including many dentists), however, respond by arguing that dentistry is more of a profession than a business. Non-dentists know little about dentistry and should not be telling dentists what to do. Non-dentists are also not governed by regulatory bodies charged with protecting the public (such as the RCDSO); their involvement in providing dental services could jeopardize patient care as the pressure for profits leaves patients at risk. In recent PBS Frontline stories,
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While the topic of non-dentists owning a dental practice is a theoretically interesting one, we may already be there. T hat’s right: I’m talking about Dental Corporation (an Australian-based non-dentist organization backed by private equity firms which partners up with dentists). In Australia, Dental Corporation is the largest provider of dental services. In 2011, it owned 172 practices in Australia with annualized revenue exceeding $300-million. And this year, Dental Corporation entered the Canadian marketplace and has already partnered up with dentists to operate 17 practices (Source: Bite Magazine, February 2012, page 16). Is this the beginning of a dramatic shift in the dental industry? And is it for the better? Time will tell… DPM Michael Carabash is a dental lawyer and holds a Certificate in Dental Practice Management. He has his own dental law firm, DMC Law (www.dentistlawyers.ca), and can be reached at 647-680-9530 or michael@dentistlawyers.ca. Disclaimer: This article does not offer legal advice. If you need legal advice, you should consult a lawyer.
www.oralhealthgroup.com
12-10-25 10:30 AM
Practice Management
Online backup is now a reality and a very viable option
cameras are still an excellent addition to any office since they allow patients to see the things that typically only a practitioner could see.
6
Continued from page 27
that is both bulletproof, has redundancy built-in for the rare times that a hard drive might crash, and can easily be restored. The workstations must be configured to handle the higher graphical needs of the office, especially if the office is considering digital imaging. The computers placed in the operatories are often different from the front desk computers in many ways: they’ll have dual display capabilities, better video cards to handle digital imaging, smaller cases to fit inside the cabinets, and wireless keyboards and mice. Most dental software programs will work on the Windows 7 operating system (I recommend Windows 7 Professional in the office), and even for ones that don’t, Windows 7 ships with an “XP Mode”, allowing older programs to be tricked into thinking they are running in XP.
5
Digital Systems
The choice of image software will dictate which systems are compatible. Digital radiography is the hot technology at this time, due to many factors. For those that can afford it, cone beam 3D systems are all the rage. Dentists who have digital radiography report more efficiency by having the ability to take and view images more rapidly, better diagnostics, cost savings by the elimination of film and chemicals, and higher case acceptance through patient co-diagnosis of their dental needs. All systems have pros and cons and dentists will have to evaluate each system based on a set of standards that are important to that practice. For some dentists, it might be image quality. For others, it may be the cost of the systems, the warranty of the sensor, the company’s reputation, or the compatibility of the sensors with their existing image management software. Keep in mind that intraoral
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DPM Wint12 p26,27,39 Lavine.indd 39
Data Protection
With a chartless practice, protecting the data is absolutely crucial to prevent data loss due to malware or user errors. Every office, at a minimum, should be using antivirus software to protect against the multitude of known viruses and worms, a firewall to protect against hackers who try to infiltrate the network, and have an easy-to-verify backup protocol in place to be able to recover from any disaster. The different backup protocols are as varied as the number of offices, but it is crucial that the backup is taken offsite daily and can be restored in a quick manner. Online backup is now a reality and a very viable option for many practices that want a true set-it-and-forget-it system for their daily backup. For offices that wish to be chartless or paperless, it’s crucial to evaluate all the systems that need to be replaced with a digital counterpart, and to take a systematic approach to adding these new systems to the practice. Most offices would be well advised to replace one system at a time, and get comfortable with this new system before adding new technologies to the practice. The typical practice will take 6-18 months to transition from a paper-based office to a chartless one, but the journey will be well worth the DPM reward at the end.
Dr. Lorne Lavine is founder and president of Dental Technology Consultants. Born and raised in Toronto, Canada, he is a graduate of USC. He earned his DMD from Boston University and completed his residency at the Eastman Dental Center in Rochester, NY. He is a CompTia Certified A+ Computer Repair Technician, CompTia Network+ certified and will soon be a Microsoft Certified Systems Administrator. thedigitaldentist.com 866-204-3398.
Dental Practice Management Winter 2012
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12-10-23 11:04 AM
ADVERTORIAL
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Winter 2012
Dental Practice Management
DPM Wint12 p40-41 AGNeovo Advert.indd 40
12-10-25 8:55 AM
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12-10-25 8:55 AM
Finance
Dentists Technology
&
D
eciding if, when and how to acquire new equipment for your practice is seldom a straight-forward decision, so, many careful dentists will research before investing in technology. Your decision whether to invest should be driven by the needs of your practice, but once that point is reached, good managers will consider the tax dimensions before making the final decision. This summary considers some of the most challenging decisions, and how a good decision can be made better by proper tax planning: • Should I buy or lease equipment? • What are the tax deductions available if I buy versus lease? • What are the HST implications of acquiring new technology? • Should I buy new equipment just before selling my practice? Buying versus leasing is often not a clear-cut choice,
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Winter 2012 Dental Practice Management
DPM Wint12 p42-44 Chong Yen.indd 42
and many factors must be weighed. For example, if you buy new equipment and finance it with a bank loan, your interest will be tax deductible. However, leases have implicit interest rates, since the leasing company is itself financing the equipment, so you should determine from the leasing company what interest rate has been built into the lease so you can compare it with the rate available through a bank. On the other hand, many new dentists who are already carrying a bank loan to buy their practice may not want to add to their debt load, or may be prevented by bank covenants from doing so, and leasing may be a viable option. Leasing may also be preferable for dentists who intend to “trade up” their technology in the short term, rather than buy equipment to hold for the long term. Leasing may be beneficial when the item will likely be obsolete very quickly. This could be so even if the dentist can buy the equipment outright for cash — buying rather than leasing is usually preferable for dentists with ready cash, but not always. If financing is available, be sure to compare the monthly payments
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12-10-23 11:43 AM
thinkstockphotos.ca
Finance
DAVID CHONG YEN, CFP, CA of principal and interest under the financing option, to monthly lease payments. Leasing companies usually stress that lease payments are 100% tax deductible. This lease payment ties together three components — the expense of the equipment itself, the built-in interest, and the leasing company’s own costs. If you buy instead, you can deduct the interest on your loan, and you can also deduct the cost of the equipment over time. How quickly you can deduct the expenditure TYPE OF EXPENSE/EXPENDITURE Leasehold improvements Dental & medical equipment >$500 Dental & medical equipment <$500 Furniture Computer Software Repairs www.oralhealthgroup.com
DPM Wint12 p42-44 Chong Yen.indd 43
depends on how you have structured your purchase, by allocating the purchase price to the various categories. For example, some of the purchase may be considered “training” costs, which is 100% deductible at once. Software is deductible over two years. Hardware can be written off 27% in the first year, 40% in the second year, and 18% in the third year (the remaining 15% over the next several years). Equipment can only be written off 10% in the first year, 18% in the second year, and 14% in the third year (the remaining 58% over the next several years). It is important for the dentist to negotiate not just the purchase price, but also the allocation of the purchase price among various categories (training, software, hardware, equipment, etc.). The optimization of the purchase price allocation will reduce the after tax cost of the purchase. Where a purchase price allocation results in a very fast tax write off, buying may be better than leasing. The following outlines common items purchased by a dentist and their corresponding deduction rates permitted by the tax department (see table). Leasing can have non-tax drawbacks which must also be taken into consideration. For example, when you decide to sell your practice, potential buyers may not want to assume or take over the equipment leases, or may even be prevented from doing so in certain situations. In that case, the vendor usually has to pay a penalty to the leasing company in order to free himself from the lease commitment. This can involve penalties/payments. You should review the lease agreement before signing it to be sure you are satisfied with the lease opt-out penalty provisions. Proper timing can also make the buy decision more tax-effective. The tax rules give you the same amount of write-off regardless of when in your tax year you buy the equipment. This applies whether you operate through a professional corporation (PC) or as an unincorporated dentist. Therefore, if your PC has a November 30 yearend, if you buy your equipment and put it into service even on November 30, 2012, you will get the tax benefit in your 2012 tax year. But if you delayed even one day to buy the equipment on December 1, 2012, you will have to wait until you file your 2013 tax return, one entire year later, before getting the first-year tax write-off for the equipment. Buy equipment or other fixed assets just before your year end. ANNUAL DEDUCTION Expensed over the length of the lease plus one renewal option — a minimum of five years 20% 100% 20% 55% 30% / 100% 100%
Dental Practice Management Winter 2012
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12-10-23 11:44 AM
Finance
Many careful dentists will research before investing in technology replace the old technology. However, the old technology may still perform reliably, safely and effectively. Technological obsolescence should not be confused with functional obsolescence — when equipment no longer serves its intended function in a safe, reliable and effective manner. Instead, focus your spending on what benefits you, your patients and your practice the most when taking the following into account: 1) The clinical aspects of the purchase 2) The after tax cost of the expenditure 3) The revenues generated from the expenditure: how long will it take you to recover the cost of the equipment? DPM David Chong Yen, CFP, CA of DCY Professional Corporation Chartered Accountants is a tax specialist and has been advising dentists for decades. Additional information can be obtained by phone (416) 510-8888, fax (416) 510-2699, or e-mail david@dcy.ca. www.dcy.ca. This article is intended to present tax saving and planning ideas and is not intended to replace professional advice.
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Winter 2012 Dental Practice Management
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When you buy dental equipment, you are required to pay Harmonized Sales Tax (‘HST’), even if you import it from outside Canada. This extra 13% cost is deductible over the term of lease if you are leasing, and becomes part of the cost of the equipment if you purchase it and write it off over the next several years. The only exception is for those dentists who have registered for HST and are in a position to claim all or part of the HST. When dentists are considering selling their practice, they may decide to upgrade their equipment. As we mentioned earlier, it seldom makes sense to enter into a leasing agreement at this point in the name of the company, since buyers may want to make their own arrangements for new equipment, and the seller will be left to pay cancellation penalties. If you still decide to go ahead with the purchase, it should if possible be timed before the end of a fiscal year, with the sale in the next fiscal year. In a vendor’s market, where there are more buyers of dental practices than sellers, it may not be prudent to invest in upgrading your office’s technology just before selling your practice, except when the equipment is functionally obsolete. In many dental practices, a substantial portion (70% or more) of practice’s value is represented by goodwill. Often, equipment or other fixed assets will be discounted significantly due to technological obsolescence. Buyers will pay you much less for the “new” equipment since they know that better and more current equipment is available or will be in the near future. There are many issues that make acquiring new technology a complex decision-making process. Tax considerations should not drive this professional decision, but once you have decided to go ahead, you should review the tax implications to be sure your decision is as taxeffective as possible. Although it may be prudent to have new technology, it is not necessarily wise to keep up with the Joneses. Obsolescence does not always mean useless. Technological obsolescence means that newer technology is available to
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Dental Practice Management
PROFESSIONAL SERVICES – page 1
Winter 2012
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12-10-22 2:46 PM
Dental Marketplace Professional Services
Practices & Offices
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Let’s talk about how the assets of your Professional Corporation can be productively invested in our
We are a progressive office in mid-town Toronto that is able to accommodate your existing practice 2-4 days per week. All aspects of practice management looked after. This is an ideal opportunity for someone facing lease termination due to sale and demolition, or simply wants to practice without additional stress. Our practice offers comprehensive care with a strong preventive model and on-site periodontist. Dreaming of an easier 9-5? Consider joining our high profile practice that is quality centered. Serious Inquiries Only: info@aestheticsindentistry.com
Practices & Offices
PRACTICE WANTED
OWEN SOUND — COLLINGWOOD AREA, ON Experienced dentist looking to purchase practice in the Owen Sound-Collingwood area. Non invasive management style. Cash buyer and welcomes selling dds to stay on as associate. Large practice preferred but will look at all opportunities. Confidentiality expected and assured. Please reply to DPM Box 009 – e-mail: kshaw@oralhealthgroup.com
RICHMOND HILL, ON
1,331sq ft for rent in retail plaza anchored by Future Shop, NoFrills, 3 Major Banks, new tenant being added — Hakim Optical and Deserres. Space is adjacent to a Family Medical Practice on site for 10 yrs. approximately 3,000 patient per month foot traffic. Located at 16th Avenue and Yonge Street in Richmond Hill. Long terms lease structure. Please contact: Moe Jiwan, Uptown Health Management Inc. T: 416 709 8876 or e-mail: mjiwan@uptownhealthcentre.com
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VANCOUVER PERIODONTAL PRACTICE FOR SALE
Excellent staff trained in periodontal procedures. Beautiful office in great location. Price reduced to $199,000. Very profitable practice netting over $500,000 per year. Annual gross billing over $900,000 on 3.5 days per week. Extremely motivated Periodontist wishes to sell this lucrative practice in the next month. Excellent opportunity — this will sell very quickly. Contact Henry Doyle for more information: Phone 1-866-638-6194 Cell 604-724-1964
AURORA, ON
PRACTICE WANTED IN ONTARIO AND/OR ALBERTA
Looking to purchase multi-associate practice grossing 1 million and above. Confidentiality respected. Please email: practicedds@gmail.com
EAST CENTRAL ALBERTA
Thriving, well-established, 4 operatories practice for sale; 548K gross; located in a busy Medical Center; oilfield town. Contact Dr. Maria Tarcu at 780 753 6242 or 403 918 3334 after 9 pm or email: mctarcu@gmail.com
THORNHILL, ON
Dental practice for sale or cost sharing partnership. Thornhill central location. BRAND NEW just opened. Store front Chabad Gate Plaza. Top of the line equipment with 3 operatories. Contact: esp@smilejob.com
Careers IMPLANTS AND PERIODONTICS: SPECIALIST AVAILABLE
Certified periodontist, UWO graduate, available for periodontics and implantology in a general practice or specialty setting. Email torontoperio@gmail.com or call 416-617-0520 for complete resume.
Associateships CALGARY, AB
Practice for Sale in Aurora. 1650 sq/ft, 2 working ops, plumbed for 5 ops in prime plaza in Aurora. Asking $500k. For inquires please email to: aurorapracticeforsale@hotmail.com.
Part-time associate position available in recently renovated, well-established, family practice. We have an experienced team and provide all aspects of dental care. Please email resume in confidence to dental_team@yahoo.ca.
BRAMPTON, ON
BOLTON AND AJAX, ON PEDODONTIST REQUIRED
A new dental office for sale in Brampton, located in a busy plaza anchored by grocery store, banks and medical office. Private sale. E-mail: gtadentalofficeforsale@gmail.com
Dental Practice Management
Pedodontist required part time for 1 or 2 days/week. Busy family practices with a large number of young children. Inquire at tel: 416-464-9217.
www.oralhealthgroup.com
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tal practice with extremely high ASSOCIATE OPPORTUNITY IN THE a 50% split. Be mentored by the COMOX VALLEY ON VANCOUVER ISLAND, B.C. whose practice is limited excluWe are looking for an associate dentist to join our team in a permanent, full-time position, 3-4 days per week. ntology. Our office has an established patient base of 3000+ ly by faxing CV or resume to: patients currently being serviced by just one dentist. We Implant Smile Center, have a brand new facility with all new equipment, digital x-rays and electronic charting. Our practice is system 349-2626 (Attn: Anita), or based, offering comprehensive care with a strong preAssociateships il to drleigh@telus.net. ventive model. The Comox Valley is the recreation capital of B.C., ies: 1-888-877-0737 (toll free). LLOYDMINSTER, AB MISSISSAUGA, ON offering a mild climate and affordable living. ww.albertadentalimplants.com Full-time, quality minded, detail and patientNeeded for a busy office www.riverwaydental.com oriented Associate required for busy practice. w.implantsmilecenter.com in Mississauga: www.discovercomoxvalley.com State-of-the-art – digital, offering implants and PleasePaid send ortho. Well established, growing practice. on PRODUCTION! New grads welcome. Please email: azhrdental@gmail.com.
090335
FT/PT ASSOCIATES
ULY 09
, ALBERTA
d for progressive, practice located in , Alberta. mail CV to @telus.net o 403-276-3664
INTER 09
E REQUIRED TORONTO
-time associate ailable immediwell established, practice. Unique a self-motivated, who performs all stry. Conveniently s north of Toronto. n confidence to 722-8271 or ss@bellnet.ca
ed Ads
FEB 2011
— Twice a month. CV to:Periodontist riverwaydental@shaw.ca
Interested please forward email to DentalResource@Rogers.com
ASSOCIATES EAST OF GTA
FT/PT Associates required for very busy offices in Mississauga, Barrie and Scarborough. Please email: Dentaldreams@live.com. Please specify which location you are applying for.
Starting Part-Time leading to Full-Time. New Grads Welcome. Please contact Dr. Alex Rhee at 905-706-7665 or alexrheedds@gmail.com
ALBERTA – 2 hrs from Edmonton
ST. JOHN’S, NEWFOUNDLAND
Looking for a motivated full time associate in small townJULY Alberta –09 2 hours from 090325 Edmonton. No weekends, no evenings, above average earnings. ON OTTAWA, Please email or inqiries to to Denture clinicresume seeking dentist dhrdds@hotmail.com
assume workload from current dentist transitioning out of practice. REGION, Clinic NIAGARA has been in businessON for over Associate required for a busy family ori25 years in the Ottawa area. Great entated, progressive practice in Thorold. opportunity start taking patients All aspects of to dentistry. Excellent opportunity to workNew with graduates a great team in a wonright away. welcome. derful atmosphere. Call 613-749-4055 Please samlima10@aol.com email a resume to: or e-mail: thoroldassociate@gmail.com
Busy east-end St. John’s dental practice has immediate opening for a fulltime associate in our newly expanded and renovated office. We are a hightech practice utilizing soft tissue laser, Cerec technology and digital radiography. We experience very low staff turnover and enjoy a loyal, growing patient base. Interested applicants may contact Dr. Janet Lawlor at: janetlawlordds@gmail.com.
Dental Marketplace
GUELPH / MILTON, ON
P/T Associate needed to replace one leaving. New associate will be taking over an existing patient load. Please specify days available. E-mail resumes to guelphdentist@rogers.com for Guelph and miltondentist@rogers.com for Milton.
GREAT OPPORTUNITY! Ontario-Midland: Small town charm on Georgian Bay, ideal for outdoor enthusiasts. Currently seeking associate with the potential for future ownership. Practice all aspects of dentistry, including sedation and implantology in a well-established, modernly equipped office. Interested applicants please fax resumes to 705-527-7775 or email: allison@lifestylesmidland.com.
OSHAWA AREA
Part time associate required for a very successful, large group practice. E-mail: kathleen@healthcentredental.com or tel: 905-438-9977.
Grundy Family Dental Care in Hanover and Lucknow Ontario We are looking for an Associate with strong clinical and interpersonal skills to assume an established associate ASSOCIATESHIPS page position–in our52 busy practice. CREE NATION TRIBAL HEALTH CENTRE INC. We are a state of the art general dentistry practice known for exceeding patient expectations and providing a full THE PAS, MANITOBA range of dental services in office including sedation. New REQUIRES A GENERAL DENTIST Associates immediately leverage our market presence, The Cree Nation Tribal Health Centre invites applications established patient pool, terrific facilities, professional for the position of a general dentist. This is a full time posisystems and support teams to deliver excellent and tion located on Opaskwayak Cree Nation, MB. The dental comprehensive dental care. program provides services to the communities of Opaskwayak, Mosakahiken, Chemawawin, Misipawistik, SapoOur Associates earn above average compensation, and taweyak and Wuskwi Sipihk First Nation members. those wanting professional development opportunities The current salary is dependent on years of experience have consistently increased their competence, scope and service. and earnings within our established general dentistry, Applicants must be eligible for dental license in Manisedation and implant practice. toba with OR time expected at local hospital for applicants Work full-time or part-time, in a rewarding professional with GPR training. environment, have a great quality of life in a lovely area For further information contact Noreen Singh, Finance of Ontario with very affordable housing and nature at Manager at 204-627-1505. your door. All with Toronto and Pearson Airport just Closing date November 16/12 2 hours away. Please send cover letter and resume with three references to: Check out our website at Noreen Singh, Finance Manager www.grundyfamilydentalcare.com nsingh@tribalhealth.ca Please send your resume via email to Box 2760 laurieg@grundyfamilydentalcare.com The Pas, MB R9A 1M5 Or call us at 1-519-378-7425 www.oralhealthgroup.com
DPM Wint12 p45-49 classifieds.indd 47
Dental Practice Management
Winter 2012
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Dental Marketplace ASSOCIATES FOR HAMILTON & WATERLOO, ON
Associates required, for TWO VERY busy and modern practices with VERY strong new patient flow. E-mail: associatedentist@ymail.com Fax CV: 888-880-4024
ASSOCIATE POSITION KITCHENER-WATERLOO AREA Replacing Associate who billed $4050,000 per month. Income is 45% of collections. Schedule is 5 days per week with no weekends. We require experience and commitment. Email your resume to: kwdentalgroup@gmail.com
CAMPBELLFORD, ON
Endodontist needed for a Burlington dental practice. 3 – 4 days/month to start. Please email CV to excellenceinpractise@gmail.com
KITCHENER-WATERLOO, ON
ASSOCIATES FOR DOWNTOWN TORONTO
Full or Part time associate wanted to join busy well established family dental practice in Kitchener-Waterloo. Experience preferred but not necessary for the right determined individual. Existing patient base and regular new patient growth. Partnership opportunity available! Please fax resume to 519-664-3782 or email: kapasi2000@rogers.com
CORNWALL AND OTTAWA WEST, ON Looking for full time associates for 2 busy locations. Minimum 1 year exp. required. Long term commitment required. To apply for this excellent opportunity please email: rsandhu@sandhudental.ca
PICKERING, ON
Associate position available immediately 3-4 days a week in a well established Family Practice with a busy patient load. Must be fluent in English with minimum 2 yrs experience. Email: brockington@polardental.com
TORONTO, ON
Associates wanted for Toronto indoor mall retail location opening in December. New grads welcome. E-mail resume to: pa291@nyu.edu CAMBRIDGE, STRATFORD, ORANGEVILLE, ON. Cambridge, ON (right off the 401) Stratford, ON (between Kitchener and London) Orangeville, ON (just north of Brampton) Full time or part time. Busy and established offices. Fully paperless/digital, new equipment and leading edge technologies (cerec, lasers, implants, ortho...). Restorative hygienist available to associates. Potential for buyout or partnership for the right person. Email resume to: dentalgroupswo@gmail.com
NORTH YORK, ON
Busy, progressive practice in North York has a PT position available for proven GP associate dentist. Opportunity to grow within. Fall 2012 start up. For more info please email resume: bvdhiring@gmail.com
HAMILTON AREA
Busy, family practice with multiple locations looking for long-term associate dentist with experience. Saturdays and some evenings. Large patient base. Email resume to: dentalhiring@hotmail.ca
BRANTFORD, ON
Immediate Part-Time Associate Position Available Modern, progressive, growing practice in multi operatory office offering advanced dental concepts and procedures including; oral surgery, prosthetics, endodontics, implants and oral medicine. Successful candidate will have at least five years experience in general dentistry. Flexible hours available Monday to Friday. This is an ideal position for a Dentist who has recently relinquished ownership and still wishes to practice. Interviews will be arranged by emailing your resume and contact information to Cheryl; ddpc2008@live.ca
WILLIAMS LAKE, BRITISH COLUMBIA DENTAL ASSOCIATE POSITION
Full Time Dental Associate needed for large multidisciplinary family dental practice. Whether you’re someone who’s just starting off in your dental career or a seasoned provider we would welcome you to join our team. We are a digital and paperless practice, newly renovated with the latest technology (including CBCT). Come and work in an office where you can experience a variety of dental cases, work with the latest technology and be supported by our highly trained and skilled team. We have a very successful clinic that is a great place to practice dentistry! This is an excellent environment to gain experience and earn a six figure income while enjoying a healthy lifestyle. Position Available July 2013. Call Perry @ 250-398-0532 Vitoratos@shaw.ca and visit us at www.cariboodentalclinic.com
DPM Wint12 p45-49 classifieds.indd 48
BURLINGTON, ON
Associate to begin 2 days a week with possibility of full time. High income potential. 8 operatory practice. Comprehensive general family dentistry. Excellent opportunity. Please e-mail resume to: chrisadams@persona.ca or fax to 705-653-5662.
Looking for an experienced associate for a very busy high end office. Good hours and relaxed environment. Commitment for 3-5 years required. E-mail: dentalpositions4u@gmail.com
PICTON OR BRACEBRIDGE, ON
Full time associateship available immediately for a busy Dental office. Two locations, Picton or Bracebridge, ON. Guaranteed production, No late hours, No weekends. Please email resume to: connect_dental@yahoo.ca
THOMPSON, MB
Full-time, energetic, detail oriented associate needed for established, busy family practice with income potential up to $30,000 per month. Experience preferred. Excellent opportunity. New grads welcome. Mentorship provided. E-mail cv : thompsondental@hotmail.ca
ORILLIA, ON
Part time associate required 1-2 days per week for busy general family practice. Please forward resume to dental_2010@live.ca
NORTHERN BRITISH COLUMBIA
Full-time or part-time associate needed for established, busy family practice in Burns Lake with high income potential. The clinic features high quality full time hygienists, dental assistants, Cerec and friendly, hard working staff. Contact Curtis: cklmanagement@gmail.com or 801-376-0976.
OTTAWA VALLEY, ON
DENTIST required for our well established practice in the beautiful Ottawa Valley. The area is a paradise for boating, fishing, hunting, and the outdoor enthusiast. Self-motivated, caring individual with the highest quality of all aspects of family dentistry in mind. This is an excellent opportunity to work with a great team that thrives in providing exceptional and comprehensive patient care. Looking for a career oriented dentist with the possibility of future buy-in. This is an incredible opportunity for the right candidate. Please send resume to ottawavalleydental@gmail.com
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Dental Marketplace GUELPH AND OSHAWA AREA, ON
OTTAWA/SASKATOON/HALIFAX
Associate wanted for practices in both Guelph and Oshawa area. Minimum 3 years experience required. Please send your resume to resumes@dawsondental.ca or fax it to 1-877-482-4320.
Associates wanted both full and part-time in established practices. Ottawa, Saskatoon, Halifax locations. Email: info@finetouchdental.com or phone Andy 888-526-3535.
ORANGEVILLE, ON
Part-Time position available leading to full-time. Full service office offering high quality dentistry to all ages. Including Lasers, Digital, and Implant dentistry. Please send resume to info@creditcreekdental.com
KITCHENER-WATERLOO, ON FULL TIME ASSOCIATE WANTED IMMEDIATELY
Great opportunity in the growing high tech community of Kitchener-Waterloo. Two experienced practitioners with large seven chair practice, undergoing an expansion, require a motivated self starter to come join our team Contact Monica at tel: 519-742-8303 or e-mail: dr.hoediono@rogers.com
TRENTON, ON We are looking for a caring, motivated and enthusiastic doctor to join our team. Part time leading to full time for experienced doctor or new grad. This is a great opportunity for someone who wants to treat people with great income potential and great working conditions. We have an excellent supporting staff and state of the art facility providing full range of dental services.
ASSOCIATE â&#x20AC;&#x201D; EAST GTA THOROLD, ONTARIO Established dental practice in Thorold, ON requires an associate 2-3 days per week. Full range of dentistry offered. New graduates welcome. Please fax resume to (905)227-5358.
BRAMPTON, ON
URGENTLY NEEDED: PEDODONTIST
City of Guelph, population 100,000 has only one Pedodontist and needs one more. 1700 sq. feet available in a facility with lots of parking zoned for Dental. Full General Anaesthesia available. Please call Dr. Cooperband (519)767-2886.
KINGSTON, ON
Leading Dental Group looking for an associate for an established family practice. Must have at least 5 years experience. Contact Trish: at trishc_9@hotmail.com
ST. ALBERT, ALBERTA P/T 2 or 3 days per week or F/T Associate required immediately for modern, busy office in excellent demographic area. High new patient flow. New grads welcome. Call (780) 458-7040, fax (780) 458-6669 or e-mail resume to: drbeau@shaw.ca
SUDBURY, ON
I have a very unique full time position available for an associate in a busy, well established practice located in Sudbury, just 3.5 hours north of Toronto. We are looking for a self-motivated, caring individual proficient in all aspects of dentistry. Full time, no weekends. The successful applicant would be the only dentist in the practice. He or she would have the ability to work on their own without all the headaches that come with owning your practice. The staff consists of a receptionist, an assistant, a floater, a full time hygienist and a part time hygienist. Please e-mail: krista123@bellnet.ca
DPM Wint12 p45-49 classifieds.indd 49
www.oralhealthgroup.com
A) Orthodontic dentist required at very busy practice in Brampton; open for all options. B) Associate required in a very busy practice in Brampton. Part time postion leads to full time permanent position effective Dec. 1st, 2012. Please contact Cell: 647 216 4110 or email: jb_khawaja@yahoo.com
HAMILTON, ON Busy group practice in Hamilton is seeking a self motivated and team player dentist to replace a departing associate of 4 years. Full time or part time (Mondays, Fridays) with two Saturdays a month. Experience with molar endo and oral surgery preferred. E-mail: hamilton.associate@hotmail.com
Please send your resume by email to ryounes@sympatico.ca
ST. THOMAS, ON
Leading Dental Group looking for an associate for an established family practice. Must have at least 5 years experience. Contact Trish: at trishc_9@hotmail.com
EAR FALLS, ON
Locum dentist needed for mature practice 1-2 weeks per month, minimum one year commitment, accomodation provided, location â&#x20AC;&#x201C; Ear Falls, Ontario, pristine wilderness, 400km from Winnipeg, 45% of gross billings. Send resume to Dr. Matthew Walkiewicz at e-mail: mattjw@kmts.ca
East GTA practice seeking to compliment our team with a new Associate. Our facility is open 7 days a week providing dentistry to our regular patient base along with the emergency needs for some of the community dentists. e/o Saturday & e/o Sunday are our primary concern however we are able to compliment these two shifts with Wednesdays & Thursdays for a suitable candidate. This opportunity will appeal to an individual who can maintain a high level of professionalism & is interested in building a long term business relationship. We offer state of the art equipment and a team of professionals to work alongside. Please forward your resume to DPM Box 10 e-mail: kshaw@oralhealthgroup.com
Equipment
GO DIGITAL! Scanx with Pan system Pan Instrumentarium OP200 , 2006 model retails new $36000.00. Air Techniques Scanx ILE retails new $24000.00. To be sold together ONLY $20,000.00. E-mail: fletchersmeadows@gmail.com or tel: 905-846-7645.
Highspeed Handpiece Rebuilds Starting as low as $99.99. Call for details. All Makes and Models. 1-800-465-8442 Selmar Dental (Barrie) since 1984 Your Handpiece Specialists.
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50
Winter 2012
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Dental Practice Management
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