North Texas Dentistry Convention Issue Volume 2 Issue 7 by LuLu Stavinoha

Dentistry North Texas

convention issue VOLUME 2

ISSUE 7

a business and lifestyle magazine for north texas dentists

Smiles in the Spotlight Life After Trauma Sloan Hildebrand, DDS, MS

Profile

Robert Zimbro National Target Mailing/ DentistryPostcards.com

Community News

Perot Museum of Nature and Science Delivers

The Best of Both Worlds

Marshall V. Johnson, DDS, MS & Elizabeth D. Jaynes, DDS, MS

Dental Headache Care The Fastest Growing Niche in Dentistry Dentists can now predictably treat dental force related pain and dysfunction in the head, neck, face and jaw.

Life Changing Dentistry

Booth #1225

100% ROI “I firmly believe I will see well over 100% ROI within the first year. The system works because the patients can see tangible results from the very first appointment. The profitability is limited only to the amount of effort put in by the dentist and team.” - Jodi Danna, DDS, September 2012 The Progressive Dentist

EXCEPTIONAL CARE “Using the TruDenta system, dentists can provide exceptional care by delivering an objective, visually engaging diagnosis and offering scientifically proven, systematic and predictable treatments for patients suffering with the symptoms of dentomandibular sensorimotor dysfunction.” - Ronald Ritsco, DMD, MS, PA, FACE, October 2012 Inside Dentistry

WAITING LIST OF NEW PATIENTS “We’ve experienced professional growth, and I’ve expanded my practice in previously unimaginable ways, all by assessing and treating dental force related conditions and their symptoms. The clinic is flourishing, and within recent weeks, we’ve had 100 patients wait for TruDenta treatment schedule... TruDenta taps into a new market of clients directly benefiting from your services, which helps ensure increased revenue during economically unstable times.” - Robert Harrell, DDS, November Dental Tribune

INNOVATIVE “An innovative diagnostic and treatment technology is now available for dental practices that enable an objective diagnosis of muscle and force dysfunction, as well as pain management through physical rehabilitation of the musculoskeletal physiology, software and therapeutic protocols that have been well developed and tested to provide predictable results through straightforward, conservative care.” - Shane Sykes, DMD, November DentalTown

See dozens of patient, doctor and team member videos at DRSdoctor.com To learn more, call 866-250-5657

Dentistry North Texas

The Best of Both Worlds

ON THE COVER

Dr. Marshall V. Johnson and Dr. Elizabeth D. Jaynes

16 20 22

25 ON THE COVER: Dr. Elizabeth D. Jaynes and Dr. Marshall V. Johnson

BAYLOR COLLEGE OF DENTISTRY

Addressing the Trend in Turnkey Care BCD launches post-graduate surgical implant training program

SWDC BOOTH LISTING

Check out the NTD advertisers Chart your course at the convention and don’t miss a thing!

PROFILE

Robert Zimbro National Target Mailing/DentistryPostcards.com

MONEY MATTERS

Cliff Hangers They make for good movies – but not good portfolio decisions

SMILES IN THE SPOTLIGHT Dr. Sloan Hildebrand Life After Trauma

PRACTICE MANAGEMENT

Financing Success Strategies for the Modern Dental Practice Make your toughest conversations with patients a win-win

PRACTICE TRANSITION

A Deer in the Headlights Don’t panic – take the chaos out of the crisis

PRACTICE MARKETING

Protect Your Rep Patient reviews can make or break your dental practice

LEGAL NEWS

Are You Obstructing Justice Without Realizing It? Tips to avoid actions that could be construed as criminal

WINE CELLAR

Virtual Wineries, Real Good Wines The role of the négociant in getting great wine to your glass

COMMUNITY NEWS

The Perot Museum of Nature and Science Delivers 180,000 square feet inspiring minds through nature and science www.northtexasdentistry.com

NORTH TEXAS DENTISTRY

from the publisher

Dentistry North Texas

Publisher | LuLu Stavinoha Photographer | Ray Bryant, Bryant Studios Contributing Writers | Tina Cauller, Kim Clarke, Carolyn Cox, Marc Fowler, Dru Halverson, John O. Hetzel, Dr. Sloan Hildebrand, Cathy Jameson, Dr. Richard V. Lyschik, Sarah Q. Wirskye

Happy New Year to All!

As 2013 begins, North Texas Dentistry is excited to present the Convention Issue for the Southwest Dental Conference. We look forward to continuing to bring our readers the latest news and information of interest to the North Texas dental community. I hope to see many of you at the Southwest Dental Conference, January 17-19, at the Dallas Convention Center. Please stop by to say hello and tell us about your practice or business. North Texas Dentistry will be in booth #1327.

I believe 2013 will be another fascinating year for readers of North Texas Dentistry. During the coming year we plan to expand our cover features to spotlight several dental industry professionals in addition to leading dental professionals.

For this issue’s cover story, North Texas Dentistry features the periodontal practice of Dr. Marshall Johnson and Dr. Elizabeth Jaynes. Dr. Jaynes is an active member of the Dallas County Dental Society and holds leadership positions with the Southwest Dental Conference, making this feature even more timely. I worked with Drs. Johnson & Jaynes several years ago and their practice continues to have an outstanding team utilizing the latest in equipment & technology.

This issue is packed with lots of great editorials and information. Smiles in the Spotlight features a case by Dr. Sloan Hildebrand that details the restoration of a smile following a traumatic injury. Legal News offers tips to avoid obstructing justice and Money Matters offers suggestions for portfolio management in these uncertain financial times. The Dallas Arts District has a new addition which has received rave reviews, The Perot Museum of Nature and Science. North Texas Dentistry is pleased to share information on what the museum offers along with some fabulous photos. It is well worth a visit in the New Year!

Ray Bryant

PHOTOGRAPHY

Tina Cauller

WRITING / DESIGN

Don’t miss the Southwest Dental Conference Special Booth Listing (pages 6 & 7) for the North Texas Dentistry advertisers who are exhibiting at the conference. Plan to stop by their booths to see the products and services they offer and let them know you appreciate their support of this publication.

Keep smiling and I hope to see you at the 2013 Southwest Dental Conference!

LuLu Stavinoha, RDH Publisher

Remember to “Like” us on Facebook at: http://www.facebook.com/NorthTexasDentistry

4 NORTH TEXAS DENTISTRY | www.northtexasdentistry.com

Although every effort is made to ensure the accuracy of editorial material published in North Texas Dentistry, articles may contain statements, opinions, and other information subject to interpretation. Accordingly, the publisher, editors and authors and their respective employees are not responsible or liable for inaccurate or misleading data, opinion or other information in material supplied by contributing authors. Copyright 2012. All rights reserved. Reproduction in part or in whole without written permission is prohibited.

Advertise in North Texas Dentistry For more information on advertising in North Texas Dentistry, call LuLu Stavinoha at (214) 629-7110 or email lulu@northtexasdentistry.com. Send written correspondence to: North Texas Dentistry P.O. Box 12623 Dallas, TX 75225

turnkey

Addressing the trend in

care

Surgical implant training isn’t just for periodontic and oral surgery residents anymore By Carolyn Cox

Just four months into the new postgraduate surgical implant training program at Baylor College of Dentistry, coordinator Dr. William Nagy is enthusiastic about its progress.

“There’s no other program like it in the country,” says Nagy, professor in restorative sciences and director of the prosthodontic graduate program. “It’s working very well so far.”

Funded by a $100,000 five-year grant from dental device manufacturer Biomet 3i, the initiative serves graduate residents in the areas of prosthodontics and advanced general dentistry. This puts prosthodontic residents ahead of the curve in meeting a new education standard of the Commission on Dental Accreditation: Effective 2014, prosthodontic graduates must place implants.

“There is a big emphasis on prosthodontists placing implants as part of a turnkey effort involving both surgery and restorative care,” Nagy says. “Previously prosthodontic residents placed five to 10 implants in the three-year program; these were placed in the oral surgery clinic with the assistance of oral surgery faculty and residents.

“While our residents participated in treatment planning and assisted the surgeon during placement of all their patients’ implants, most implant surgery was done by periodontic residents and oral surgery residents and faculty. Implant placement already is an integral part of those graduate programs.” Dr. Josh Chapa, a periodontist, was hired as a clinical assistant professor July 1 to supervise the residents in the program and design the course curriculum. Faculty members from the Department of Oral & Maxillofacial Surgery presented a 14-session course this summer for prosthodontic and AEGD residents.

“The summer didactic class encompassed the basic surgical techniques, and Dr. Triplett has given lectures this fall pertaining to treatment planning for implants,” Chapa says. “Previous implant instruction was not geared to single-unit cases like these residents would see in everyday practice. The information they receive now can be applied in the future whether or not they do the actual surgeries.”

As for securing patients, Nagy reports no difficulty identifying implant candidates from the existing pool. “I’d say 75 percent of the AEGD and prosthodontic patients have implant requirements,” he says. “Once the program is going full steam, we estimate residents will place five to 10 implants per year.”

A new dedicated surgical operatory within the sixth-floor AEGD clinic is ideal for the program’s needs. Cabinetry to hold necessary equipment was purchased with grant funds, and a parttime dental assistant will soon join the staff. Biomet 3i also provided $46,000 of products and supplies such as the surgical handpieces, titanium implants and other surgical components, and graft materials used during implant placement. The first surgery took place in early October. “I provide clinical oversight, stand right next to the student and talk them through the procedure,” Chapa says. “In addition, I have started doing case discussions on Fridays with the AEGD residents.

Likewise, I go to the prosthodontic residents and discuss cases with the patient in the dental chair. We talk about things like whether the patient has adequate tissue, if they require bone grafting, and other things a surgeon would look for. We review treatment options with patients, because there is more than one way to approach a case.” Carolyn Cox is publications manager at Texas A&M Health Science Center Baylor College of Dentistry, where she has been employed for 23 years. A 1986 journalism graduate of Texas Christian University, she resides in Lewisville, Texas.

Founded in 1905, Baylor College of Dentistry in Dallas is a college of the Texas A&M Health Science Center. TAMHSC-BCD is a nationally recognized center for oral health sciences education, research, specialized patient care and continuing dental education. The TAMHSC serves the state as a distributed, statewide health science center that is present in communities throughout Texas.

www.northtexasdentistry.com

NORTH TEXAS DENTISTRY

North Texas Dentistry Advertisers 2013 Southwest Dental Conference Booth Listing

Wouldn’t it be nice if you had an advisor guiding you to increased profitability, productivity and stress control? Jameson Management, an Oklahoma-based firm specializing in personalized practice management, marketing and clinical coaching for dentists, can lead you towards this goal.

314

AFTCO is the oldest and largest national dental transition network with over 150 programs customized to meet your needs. AFTCO is truly the nation’s leader in dental practice sales, with 1.5 billion dollars of practices sold to date.

403

Structures and Interiors is a commercial general contractor specializing in dental office construction offering design-build services including new building construction, interior finish out, office improvements and renovations.

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For more than 40 years, Pacific Continental Bank has been providing individually tailored financing solutions to dentists. At Pacific Continental, we strive to understand the needs of dental practices with a personalized level of service that is unique to each client. Our bankers strive to help dental practices and practice owners reach their financial goals by operating efficiently and making the most of opportunities.

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Burkhart Dental has served dental professionals for 125 years. It provides supplies, equipment, office design, practice management consultation, equipment repair and maintenance, and software. Important to its associates are integrity, knowledge and client success.

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Beaird Harris & Co. is a Certified Public Accounting firm providing tax, accounting and business consulting services. Beaird Harris Wealth Management, Inc. is an independent fee-only wealth management firm providing sophisticated financial planning and investment advisory services.

617

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525

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Pact-One As an industry leader, our unique blend of technological expertise represents decades of combined experience exclusively mastering dental networking, 3D imaging and internet technology to enhance the operational management of your practice. Pact-One provides a local presence with live client service representatives waiting to assist you when you call.

724

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AFTCO

306

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Reliable Dental Laboratory is a full service laboratory that prides itself on being able to meet all your fixed, removable and dental implant needs. Working together with our clinicians to provide smiles for our dental community is truly our passion.

735

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J. Houser Construction is a full-service construction company, providing quality construction management for site development, new construction, interior finish-out, remodeling and design-build projects. We have a strong design team consisting of site developers, architects, engineers and interior designers that lend to creating a very functional and appealing dental office.

806

Healthcare Professional Funding (HPFC) is a leading provider of financing programs designed specifically for licensed healthcare professionals. We offer programs designed to grow your practice. We’ll maintain a focus on structuring programs to maximize the value of your asset every step of the way. You take care of your patients. We’ll take care of your financing.

COME VISIT US AT

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RT Edwards & Associates, P.C. is primarily an advisory firm that also provides tax and accounting services to those in the dental industry. In addition, the firm offers compre-hensive, individually tailored, fee-only financial planning, retirement guidance and investment services to its clients.

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Midco Dental is a family owned company with branches in Irving, TX and Oklahoma City, OK. We offer merchandise, service, equipment and office drawing.

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Bullseye Media is a McKinney, Texas based full-service marketing agency that provides turnkey programs for dentists & dental specialists who want to leverage the internet to get high value dental patients.

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Med+Tech Construction is a general contractor which specializes in design, construction and renovation of dental offices across Alabama, Georgia, Florida, Louisiana, Oklahoma, Tennessee, Texas and Washington.

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1327

struction

Wallace Specialty Insurance Group A single source for your insurance needs. We work exclusively for dentists and specialize in malpractice, office, liability, disability, health, life, data breach and EPLI.

1133

LegacyTexas Bank is an independent family-owned bank that has served North Texas for 50 years. Hundreds of dentists and physicians trust our team of specialty bankers to meet their professional and personal financial needs.

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Dental Auxiliary Service has been serving the Dallas dental community since 1979 and has been a leader in employment placement for dental personnel. Dental Auxiliary Service is a full service staffing agency that takes responsibility for paying temporary personnel, minimizing IRS and TWC unemployment issues for its clients.

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TDA Financial Services Insurance Program works with TDA members and their staff in providing life, health, disability income, employee benefits, long term care and malpractice insurance. Bob Michaels, CLU has been an Associate with them for over nine years.

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Dentistry North Texas

TruDenta is a complete system of technology and training which enables dentists to help the estimated 80 million Americans suffering from dentomandibular sensorimotor dysfunction. Symptoms resolved include chronic headache, migraine, tinnitus, TMJ/D and other pains of the head, neck face and jaw. TruDenta is now in use in dental practices in 47 states.

1310

At National Target Mailing / Dentistry Postcards.Com, we create marketing solutions specifically designed to meet the specific needs of dentists and have created and executed effective, customized marketing strategies and materials for hundreds of dental practices all over the country.

www.northtexasdentistry.com

NORTH TEXAS DENTISTRY

Photos by Ray Bryant, Bryant Studios

cover feature

The Best of Both Worlds

A unique blend of technology and personal care

Marshall V. Johnson, DDS, MS AND Elizabeth D. Jaynes, DDS, MS by Tina Cauller

Drs. Johnson and Jaynes have complementary interests and strengths, and share an intense commitment to excellent patient care. They are among a select few periodontists who have gone on to achieve the status of Diplomate in Periodontics, a certification of the American Board of Periodontology.

n a metropolitan area, a patient typically has access to the latest advances in dental care. In a small town, patients are likely to know their dentist personally and enjoy a warm, friendly relationship. Patients choose the practice of Dr. Marshall Johnson and Dr. Elizabeth Jaynes because they have the best of both worlds â&#x20AC;&#x201C; a caring, personal relationship with dental professionals who offer state-of-the-art periodontal care.

Dr. Johnson opened a periodontal practice in Plano 23 years ago, after graduating from Baylor College of Dentistry and earning his M.S.D. at the University of Missouri in Kansas City. In 1997, his colleague, Dr. Elizabeth Jaynes joined the practice. Dr. Jaynes graduated from the University of Tennessee and earned her M.S.D. at Baylor College of Dentistry where she did many advanced cases in cosmetic grafting, oral medicine, and dental implants with some of the best clinicians in these fields. After completing a three-year residency, she practiced in Richardson for two years. She has now been in practice for 17 years and has extensive experience in dental implantology.

Drs. Johnson and Jaynes share an unwavering commitment to 8 NORTH TEXAS DENTISTRY | www.northtexasdentistry.com

excellent patient care, and bring complementary interests and strengths to the patients in their practice. Drs. Jaynes and Johnson provide conventional periodontics, including regenerative therapy, guided tissue regeneration, osseous grafts, as well as cosmetic periodontics including aesthetic crown lengthening, soft tissue grafts/root coverage procedures, ridge and sinus augmentations and dental implants.

Dr. Jaynes is married to a pediatric dentist, and she and Dr. Johnson share a passion for treating orthodontic patients who are referred by their pediatric dentist or orthodontist for canine uncovering, treatment of tooth impaction, microscrews for secure orthodontic anchorage, soft tissue grafting and frenectomies.

Patient comfort is a priority in this thoughtfully designed office. Patients enjoy the homelike environment of the reception area, where they can relax with a bottle of water or cup of coffee. During procedures, patients can snuggle under a cozy blanket, and listen to satellite music to fit almost anyoneâ&#x20AC;&#x2122;s musical taste. For optimal patient relaxation and comfort, the options of oral

sedation and nitrous oxide sedation are available, and an anesthesiologist, when necessary, provides intravenous sedation.

In keeping with their commitment to providing the best possible care for each patient, Drs. Jaynes and Johnson continually learn about and evaluate the latest materials, products, techniques, and procedures. New technologies are incorporated into the practice once they have been proven to enhance patient care.

Over the past decade, technological advances have made dental implants a highly predictable and reliably successful option for tooth replacement. Drs. Johnson and Jaynes are well versed in the complexities of dental implants and have accumulated many hours of experience and continuing education. As Dr. Johnson explains, “The single factor that has most transformed dental implantology is experience – we now know that long-term success depends on restorative-driven implant placement.”

Drs. Johnson and Jaynes rely on sophisticated Dentrix management software to access patient scheduling and information and to improve efficiency and communication between the front desk and their seven operatories. In the early years, dental implants were placed wherever a site was available. Because the placement was not driven by the restorative goal, the longevity of these early implants was sometimes less than ideal. “Now, we work closely with the referring dentist to determine the exact result we want to achieve, and with Cone Beam CT imaging, we can plan and guide the placement of implants with great precision based on the desired result,” notes Dr. Jaynes.

“Being able to accurately visualize the implant area is a critical part of the equation,” notes Dr. Johnson, “but if the bone quality or quantity in the target area is not sufficient to support the replacement tooth, we have exciting new methods of preparing the site to support the implant. Properly prepared bone allows us to be sure the replacement tooth is securely anchored in exactly the right position so it can function correctly. Patients who would not have been candidates for dental implants can now be successfully treated and expect excellent results, both in terms of esthetics and longevity.”

From the front office to the clinical assistants and hygienists to the doctors, each member of the team demonstrates a genuine commitment to patient care.

Besides affecting the long-term success of treatment, suboptimal placement of dental implants can cause irreversible damage to vital anatomical structures, including perforation of the bone or nerve damage. Drs. Jaynes and Johnson use Anatomage software to design computer-generated surgical guides to ensure www.northtexasdentistry.com

NORTH TEXAS DENTISTRY

that vital structures are protected during treatment. This technology also allows the implant to be placed further into the bone, which achieves a more natural-looking result and preserves bone and soft tissue.

Dr. Jaynes describes an arsenal of new products that provide improved treatment options for patients. “Alloderm grafting enables us to treat recession without harvesting tissue from a donor site in the palate, which greatly improves patient comfort and healing time. We also use human growth factors to help regenerate bone. Specialized products like Periosciences antioxidant dental gel help to facilitate post-operative healing.”

In this unique practice, multidisciplinary teamwork is important at every touchpoint in the process of providing care. “We acknowledge the intelligence of our patients and encourage them to be involved in planning their treatment, because their participation is an important component of success,” notes Dr. Johnson. “The restorative dentist is another key player in the team effort that underlies a successful result. Communication is key, so information is tailored to the needs of the restorative dentist, and can be provided either in writing or electronically, depending on the dentist’s preference. We include the restorative dentist at every stage, starting with the initial consultation, which we follow with a detailed case analysis and recommendation for treatment.”

During a preoperative consultation, the doctors take time to explore their patient’s goals, explain their choices, the risks and benefits of each option, and help them define reasonable expectations.

Often, Drs. Johnson and Jaynes meet with the restorative dentist to plan treatment using three-dimensional models, and coordinate comprehensive care between themselves and the referring office. After treatment is completed, a thorough description of the procedure is provided. At follow up,

Drs. Johnson and Jaynes provide conventional periodontics, including regenerative therapy, guided tissue regeneration, osseous and soft tissue grafts, as well as cosmetic periodontics including aesthetic crown lengthening, and dental implants. For optimal patient relaxation and comfort, the options of oral sedation and nitrous oxide sedation are readily available, and intravenous sedation is provided by an anesthesiologist when necessary.

10 NORTH TEXAS DENTISTRY | www.northtexasdentistry.com

Photos by Ray Bryant, Bryant Studios

A talented and experienced hygiene department is important for a successful periodontal practice. Drs. Johnson and Jaynes are proud of their team of hygienists who have been with the practice collectively for 42 years. Pictured from left: Kim, Amy, Ann and Karen. Drs. Jaynes and Johnson reinforce the recommendations of the restorative dentist and set up an alternating cleaning schedule between the two offices.

The staff is an essential part of the team and is integral to creating a positive experience for each patient. From the front office to the hygienists to the doctors, each member of the team demonstrates a genuine commitment to patient care.

Twice a year, Drs. Jaynes and Johnson offer convenient continuing education instruction in hygiene, as well as clinical presentations for dentist colleagues in cosmetic periodontic procedures and implants. They also host a mini-convention vendor show at Gleneagles Country Club. This event has become a popular opportunity to socialize and explore new products and services.

Dr. Johnson and Dr. Jaynes provide pediatric periodontal care, as well as care for adults and seniors. Dr. Jaynes observes that patients generally have three main concerns. â&#x20AC;&#x153;Most patients ask

about their outcome, how much discomfort they can expect to experience during and after treatment, and how they will finance their care. We make sure they are fully informed prior to treatment so there are no surprises. We take time to explore their goals, explain the procedures that are planned, and review the likelihood of success. We explain their choices and the risks of each option, and help them define reasonable expectations. Before their treatment, they understand what to expect in terms of recovery, discomfort, and any post-operative medications that may be required. They also receive complete information about fees and financing options, and our friendly staff helps them maximize their insurance benefits. We find that being well-informed helps put patients at ease.â&#x20AC;?

The office of Drs. Johnson and Jaynes is located at 5800 Coit Road Suite 300 in Plano in the Lone Star Crossing Building, just north of Parker Road on Coit. Additionally, Dr. Jaynes offers expert care in her satellite office at 9191 Kyser Way in Frisco two days a week. For more information or to make an appointment, call (972) 964-8833 or visit www.jjperio.com. n

www.northtexasdentistry.com

NORTH TEXAS DENTISTRY

Elizabeth D. Jaynes, DDS, MS has been honored by her professional peers to be named numerous times in D Magazine as one of the “Best Periodontists in Dallas”. She was named “Young Dentist of the Year” earlier in her career by the Dallas County Dental Society, and now serves on the Board of the Dallas County Dental Society. She is very involved in the Southwest Dental Conference, where she can be found running the host and information booth or registration. Dr. Jaynes is actively involved in numerous professional organizations. She is a member of the National Charity League, and is an associate member of 4th District Dental Society. Dr. Jaynes has taught in the Collin County Hygiene School, and takes more than 50 hours of continuing education each year in cosmetic procedures and implant dentistry. Dr. Jaynes is among the select few periodontists who have gone on to achieve the status of Diplomate in Periodontics, a certification of the American Board of Periodontology. Dr. Jaynes is married to a pediatric dentist and they have a teenage daughter.

Marshall V. Johnson, DDS, MS is a firm believer that a true professional must remain stateof the-art and takes over 50 hours of continuing education each year in implant dentistry, bone regeneration and cosmetic procedures. He was featured in D Magazine as one of the “Best Periodontists in Dallas”.

Dr. Johnson is a dedicated and involved community member. He has served on the staff at Medical Center of Plano, the Board of Directors of Leadership Plano, and is a past chair of the Board of Managers for the Plano YMCA. He is now on the Board of Directors for PISD Education Foundation and Plano Youth Leadership. He is currently a member of the Plano Rotary Club. Dr. Johnson is among the select few periodontists who have gone on to achieve the status of Diplomate in Periodontics, a certification of the American Board of Periodontology. Dr. Johnson has been married for 25 years and he and his wife have three boys, Ryan, Kyle and Travis.

The periodontal practice of Johnson & Jaynes is located in the Lone Star Crossing Building at 5800 Coit Road Suite 300 in Plano.

www.jjperio.com

12 NORTH TEXAS DENTISTRY | www.northtexasdentistry.com

A DEN BO CH T OT STO AN AL H 1 P CE CO 13 BY TO NFE 3 A W RE T T IN N HE A CE NE F W OR IP AD

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MAKE A BETTER CHOICE FOR YOUR PRACTICE When you choose LegacyTexas, you get medical bankers who understand your practice and what it takes to help you operate more efficiently. If all you need is a bank, there are plenty to choose from. But if you’re ready for a real banking relationship with people who work for you and your practice, join hundreds of North Texas dentists and make the better choice.

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Steve Young 972.461.4806

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No purchase necessary. Winner will receive a 1099 for value of prize.

14 NORTH TEXAS DENTISTRY | www.northtexasdentistry.com

Thanks to that remarkable success, we are more than just a printing service or a bulk mail shop. We know the dental industry and understand the subtle but critical distinctions between different types of dental practices. Whether a practice is based primarily on serving families, cosmetic patients, or Medicaid patients, we can implement a plan to create internal marketing, external marketing and internet marketing campaigns that speak directly to potential patients.

Robert Zimbro

National Target Mailing & DentistryPostcards.com 1507 Capital Avenue, Suite 103 Plano, TX 75074 (972) 424-5979 Robert@nationaltargetmailing.com www.nationaltargetmailing.com www.dentistrypostcards.com

Q. Our practice has potential – if only those potential patients out there knew more about it. How do dentists find expert help with marketing?

Robert: At National Target Mailing, we create marketing solutions specifically designed to meet the needs of dentists, and have created and executed effective, customized marketing strategies and materials for hundreds of dental practices all over the country. About six years ago, we started specializing in marketing for dental professionals and today, thanks to referrals from our satisfied clients, dental marketing now constitutes about 90% of our business.

Q &

For some practices, growth is a long-term goal, for others there is a genuine need to see appreciable growth quickly. Starting up a new practice can be challenging and demands a solid marketing plan to ensure that growth happens rapidly enough to sustain the business. A practice that has experienced a shortterm downturn may need to boost productivity in order to be profitable. Or, a practice may need to increase patients to bring on an associate or prepare to sell the practice. Regardless of the specific situation, we can address your needs with a customized plan.

Q. We have been hesitant to get involved with a marketing group. Dentistry is such a unique field, how could a marketing company possibly understand the profession, much less the goals of our unique practice? Robert: We have private practice dental clients with a single office and large dental practices with multiple locations. Through effective marketing, many of our clients have reached their goals to expand their practice. One client who has worked with us for nine years has grown from a single office to seven offices, another from a single location to 27 locations.

There is a saying, “A goal without a plan is just a wish.” We’ll explore your professional goals, and help you outline a plan to get there. For a new practice, we match their goals with an appropriately aggressive marketing campaign. We view our role as a partner in growing your business.

We offer a flexible, dynamic and responsive plan that can adapt easily to accommodate the changing needs of the practice. Whether a client chooses a one-time campaign or a monthly campaign, we never lock them into a rigid plan. If business slows down, we make sure the marketing can respond immediately and, if the office gets too busy, we can adjust the schedule accordingly.

Q. How can we make sure our marketing budget is used wisely?

Robert: We advise dentists to ask questions and become informed when setting out to choose a partner in creating a marketing plan. Too many firms will get a client in the door for a low price and then break the budget with add-ons, or lock clients in to a long-term contract that is carved in stone. Make sure that you are comparing apples to apples when you comparison shop for marketing support.

Our clients enjoy a working relationship with a single team member who provides expert, personal service. Rather than blanketing households with unwanted junk mail created from generic online templates and wasting marketing dollars in the hopes of reaching a few interested individuals, we design custom materials and mailing plans that precisely match the profile of the target audience.

The dental profession is impacted by regulations, laws and conventions that are constantly changing and evolving. Our familiarity with those requirements helps you avoid costly or marketing pitfalls and common mistakes. We help our dental clients establish consistent branding across websites and printed materials. Our approach ensures that every dollar of your marketing budget achieves maximum return. Robert Zimbro has been in marketing for 14 years, and founded National Target Mailing 12 years ago. He recently founded www.DentistryPostcards.com to help dentists easily create mailers that reach clients with high-impact print promotions that get measurable results.

National Target Mailing has experienced tremendous growth for three years in a row, and is perfectly positioned to help dental clients achieve their own goals. With its new 5,200 square foot manufacturing center located in Plano, and stateof-the-art mailing software and addressing equipment that saves time and eliminate production headaches, National Target Mailing is ready to serve dentists more efficiently and cost-effectively than ever before. For more information, call (972) 424-5979 or visit www.nationaltargetmailing.com and www.dentistrypostcards.com.

National Target Mailing/DentistryPostcards.com Robert Zimbro

www.northtexasdentistry.com

NORTH TEXAS DENTISTRY

CLIFF

money matters

HANGERS

Make for Good Movies… Not for Good Portfolio Decisions by John O. Hetzel, CFA, CFP®, AIFA®

“Everything will be fine… just don’t look down!” These are

the words often used to console those dangerously

perched on the side of a mountain, building, or any other

elevated location crumbling below them. We can almost all picture some instance of this particular cliché playing itself

out in our mind’s eye. In the movies, our hero always saves

the day, but will that be the case if we are teetering on the edge of a fiscal cliff?

If you are like most Americans, you probably do not have a lot of confidence in the fairytale ending with a Grand Bargain prior to year end. Fortunately there is still plenty you can do, regardless of what legislation Congress does or does not pass.

Watch your fees. There are going to be a lot of investment managers trading positions with each other as they try and guess what is in store for our country in the near term. Unfortunately, the only known outcome of those trades will be the costs associated with performing them. It is imperative that investors do not get too caught up in trying to guess market direction and lose sight of the overhead associated with all that trading. Generally speaking, you can figure on trading fees of around 1% of the turnover percentage inside mutual funds. These expenses are in addition to the management fees and any marketing costs (12b-1, load, etc.).

16 NORTH TEXAS DENTISTRY | www.northtexasdentistry.com

Diversify. With our growing debt, many are losing faith in the dollar and running to gold. There are far better places to invest your hard earned money if you are concerned about the dollar falling. There is a global market of companies in multiple countries all trying to better themselves. Why not invest in them since they are trying to turn your money into more money? Gold has no ambition and therefore no expected return. Its return is entirely speculative and therefore much riskier than an asset offering a yield (bond), or increased earnings (stock). By holding a well-diversified portfolio of companies from all over the world, you are investing in capitalism and greatly reducing the risk of currency issues.

Remember Taxes. It is almost a foregone conclusion that high income earners are in store for higher taxes in the near term. That increases the need to watch where you hold certain assets to make sure you keep the majority of your gains. For example, hold bonds in your tax-deferred accounts and stocks in taxable or Roth accounts. Also, consider moving to tax efficient share classes of funds you already hold. Many should

look at municipal bonds as their tax-free interest becomes more attractive to higher income earners.

In the end, we have no idea what our hero will look like and when he or she will show up. Fortunately, it does not really matter since there are plenty of things we can do to better position ourselves right now. Just remember to keep your attention focused on what you can control and don’t look down! n

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817.988.7842 “We specialize in customer satisfaction..” jhouser@jhouserconstruction.com PO Box 325

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John O. Hetzel, CFA, CFP®, AIFA® Beaird Harris Wealth Management, Inc. (972) 503-1040 JohnH@bh-co.com www.bh-co.com Beaird Harris Wealth Management, Inc. is an independent fee-only wealth management firm located in Dallas, Texas. Beaird Harris provides objective, fee-only advice to financially established individuals and families, trust funds, retirement plans and non-profit organizations; with a particular emphasis in the healthcare industries. Beaird Harris is dedicated to helping clients maximize their assets, reduce financial stress and realize their personal and financial goals. Please remember that past performance may not be indicative of future results. Different types of investments involve varying degrees of risk, and there can be no assurance that the future performance of any specific investment, investment strategy, or product (including the investments and/or investment strategies recommended or undertaken by Beaird Harris Wealth Management, Inc.), or any non-investment related content, made reference to directly or indirectly in this newsletter will be profitable, equal any corresponding indicated historical performance level(s), be suitable for your portfolio or individual situation, or prove successful. Due to various factors, including changing market conditions and/or applicable laws, the content may no longer be reflective of current opinions or positions. Moreover, you should not assume that any discussion or information contained in this article serves as the receipt of, or as a substitute for, personalized investment advice from Beaird Harris Wealth Management, Inc. To the extent that a reader has any questions regarding the applicability of any specific issue discussed above to his/her individual situation, he/she is encouraged to consult with the professional advisor of his/her choosing. Beaird Harris Wealth Management, Inc. is neither a law firm nor a certified public accounting firm and no portion of the article content should be construed as legal or accounting advice. A copy of the Beaird Harris Wealth Management, Inc.’s current written disclosure statement discussing our advisory services and fees is available for review upon request.

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NORTH TEXAS DENTISTRY

WWW.AFTCO.NET

Helping dentists buy & sell practices for over 40 years.

Come visit us at the Southwest Dental Conference in Booth 314!

AFTCO is the oldest and largest dental practice transition consulting firm in the United States. AFTCO assists dentists with associateships, purchasing and selling of practices, and retirement plans. We are there to serve you through all stages of your career.

David M. Chei, D.M.D. (UMDNJ 1999)

has acquired the practice of

Richard L. Brown, D.D.S. - Dallas, Texas (Baylor College of Dentistry 1971)

Paul R. Searby, D.D.S. (UT Houston 1984)

has acquired the practice of

John W. Scott, D.D.S. - Waco, Texas (UT Houston 1984)

AFTCO is pleased to have represented all parties in these transactions.

Call 1-800-232-3826 today for a free practice appraisal, a $2,500 value!

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Treatment

When implants became a reality for Peggy, Dr. Ron Stukalin elevated the schneiderian membrane and restored the quantity of bone sufficient to place Straumann RP implants in sites #4, 5, 6. Post integration, I fabricated screw retained provisionals with a mesial cantilevered pontic in site #7. This allowed for soft tissue development and to visualize the 3-7mm vertical bone and soft tissue defects present from the ideal gingival zenith. Her low lip line and small buccal corridor aided in the planning of the needed custom gingival colored ceramic.

Life After Trauma

Peggy, one of the first patients I encountered when entering into my fatherâ&#x20AC;&#x2122;s restorative practice, was kicked in the face by a horse at the age of 5 and the damage to her right maxilla was extensive. She lost her primary teeth in this quadrant as well as her budding permanent teeth #4-7. Peggy had no other option than to wear a variety of removable partial dentures for the next two decades. In time, a long-span provisional fixed partial denture was fabricated with a metal substructure, processed acrylic and a rigid precision attachment on the distal of #8, which aided in ease of removal during the preplanned future grafting and implants stage of her rehabilitation.

1. Implants placed in grafted bone. Long span provisional with metal substructure, processed acrylic and rigid precision attachment.

20 NORTH TEXAS DENTISTRY | www.northtexasdentistry.com

2. Custom abutments on Straumann RP implants and prepared teeth for metal ceramic crowns.

Laboratory Expertise

I sought out Gilbert Young of GNS Studio, Inc. to join our team for the laboratory expertise in developing Peggyâ&#x20AC;&#x2122;s final prostheses. Cast custom abutments were fabricated and torqued to 35Ncm to support cement retained crowns and a mesial cantilevered pontic in site #7. Custom gingival colored porcelain was fired onto the cervical contours and embrasures of the crowns in the esthetic zone. Ducera, hydrothermal-1 phase low fusing ceramic, was the material chosen as this ceramic minimizes porosities near the tissue interface allowing for superior cleansability. Ducera has only a matrix phase (no crystalline phase) thus requiring less firing cycles producing less overall distortion. A hydroxyl ion is added to the matrix phase creating an ionic exchange furthering the intraoral compatibility with the saliva and surrounding tissues. These properties were imperative when considering esthetic marginal integrity and cleansability at the gingival ceramic interfaces of #6, the mesial pontic #7 and the distal overhang #8.

“

Sloan W. Hildebrand, D.D.S., M.S.

In life and upon entering into my prosthetic career, my father, Dr. David Hildebrand, taught me to try to ‘Keep it Simple’.

3. Metal ceramic crowns with custom Ducera gingival-colored ceramic, GNS Studio, Inc.

Graduate of Baylor College of Dentistry, Prosthodontics Masters Certificate, M.S., 2005 Graduate of University of Texas Dental School, D.D.S., 2000

4. Intraoral metal ceramic crowns, custom gingival color and marginal integrity of Ducera ceramic.

Sloan Hildebrand, DDS, MS currently practices prosthodontics in Dallas, Texas. Dr. Hildebrand bases his practice on the principles passed down through his father’s legacy in regards to unwavering dedication and excellence bestowed upon each and every patient with no compromise in work ethic, integrity and service. Dr. Hildebrand has a passion for serving those that are seemingly less fortunate around the earth, specifically the geographically and financially isolated villages throughout Africa, South America and Southeast Asia.

Results

5. Peggy's smile, 65 years after her horse-related accident (scar on chin still visible).

Upon delivery of the final crowns, Peggy was thrilled and has been extra diligent with her homecare due to these areas of overhanging porcelain. Over the past four years, her tissue has adapted extremely well and although we know this treatment is far from perfect, we know it is far from where she started with that accident at age five. We never lost sight of trying to “Keep it Simple” and “Keep the End in Mind”.

www.drsloanhildebrand.com

6. Follow up four years post insertion of custom crowns.

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NORTH TEXAS DENTISTRY

practice management

Financing Success Strategies for the Modern Dental Practice By Cathy Jameson and Dru Halverson, RDH

ommunicating with your patients about their financial responsibility and about the options you have available for payment may be one of the most challenging conversations you will have with a patient. If you have done a beautiful presentation, and the patient wants to proceed but indicates that they are not going to do so, more than likely, the reason may be the cost.

Even if the doctor or treatment coordinator gets the go ahead from the patient, donâ&#x20AC;&#x2122;t be too confident. The closing on the clinical aspects of the treatment is the pre-close. The final close comes when the patient agrees to the financial responsibility and schedules that first appointment.

ESTABLISHING FINANCIAL OPTIONS

For patients who need financial assistance, whether for a small case or a major multi-thousand-dollar case, there are ways for them to access financial assistance. However, the dentist does not have to provide the money, only the financing vehicle.

For many years now, I have had the privilege of studying with banking and financing experts and with the people who first originated the concept of patient financing in our industry. It has been exciting to see how this concept has evolved over the years. As dentistry has evolved, so has the patient-financing concept. However, there is still only a small segment of the dental profession that is involved with patient financing, and then once a practice becomes involved, the use of the program is limited. Consider this goal for your practice: to make the financing of your dentistry affordable for the vast majority of your patients without doing the banking yourself. Get out of the banking business, and stay out.

22 NORTH TEXAS DENTISTRY | www.northtexasdentistry.com

FINANCIAL OPTIONS

Consider the following financial strategies. These are the strategies that we, as advisors, have integrated into over 2500 practices throughout the U.S. and other countries around the world. These strategies work to help more people accept your dentistry and keep you out of the banking business. Not only can your production increase significantly, but also your profit margin will do the same thing. Consider the following financial options:

n Five percent accounting reduction for payment in full before treatment begins. (Do this for cases over a designated amount, to be determined by each individual practice.)

n Payment by the appointment. (Take the total investment, divide it by the expected number of appointments, and collect those equal amounts per appointment.) n Bank Cards.

n Healthcare financing programs including revolving payment plans and extended payment programs.

The first option gives the people who can afford to make full payment an incentive to do just that. You will be dollars ahead to get the money in the bank before treatment begins. Any time you have to wait on the money, you begin to lose. The value of the dollar decreases, the chances of the person not completing treatment are increased, the possibility of a person not paying as arranged can be an issue, and the costs of carrying accounts on your own books are prohibitive. In addition, any scheduling coordinator will tell you that if a patient pays for their treatment in advance, they will show up for their appointments. Therefore, do not carry accounts on your own books. You are not a bank, nor are you trained as bankers or loan officers. Stick to what you do best â&#x20AC;&#x201D; dentistry.

The second option, payment by the appointment, is done in a specific way so that the patient’s financial responsibility to you is complete by the time that the treatment is complete. The option payment by the appointment is for cash, check or bankcard.

Bankcards are terrific. Do not be concerned about the service fee you will pay for the use of these financing vehicles. Again, you will be dollars ahead to get payment and not be responsible for statements or collections. The dollars you will save by not running a credit business within your practice will far outweigh any service fees you will pay.

Cathy Jameson founded Jameson Management, Inc., an international dental practice management and marketing firm through which Dru Halverson has advised countless clients over the last two decades. She recently released her third book, entitled “Success Strategies for the Modern Dental Practice”. Learn more about Cathy at www.JamesonManagement.com and plan to attend the March 8, 2013 half-day course Cathy will present at the Waterford Marriott in Oklahoma City. Call (877) 369-5558.

Market bankcards to your patients as a payment option. Believe it or not, people still do not think of using their bankcards for payment of dental services. However, the bankcards are marketing heavily to consumers, encouraging them to consider this option. You can do the same thing right in your practice. Use newsletters, special mailings and verbal skills during financial presentations to get your patients used to handling their payments with a bankcard.

For any long term or extended payments, those patients who want the treatment but need to make monthly payments and spread those payments out over several months, use a healthcare financing program. These programs have the financial wherewithal to loan your patients the monies necessary to receive treatment.

By carefully developing an excellent financial system in your practice and by learning how to maximize the options, you take the lid off your practice productivity. By offering the recommended options, dentists win because they get to do the kind of dentistry they have been so carefully taught to do. Their production goes up significantly when they proactively promote convenient financing.

Patients win because they don’t have to put off needed or desired care if they can’t come up with large amounts of money at one time. That’s what I call win-win. n

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practice marketing

Protect Your Rep How patient reviews can make or break a dental practice

ne of our clients called me this past September with a big problem. After experiencing a strong and steadily increasing new patient flow for quite some time, his new patient flow suddenly slowed down… way down. He was understandably concerned and needed some help. So, my team dug in to do some research. What could possibly cause potential new patients to suddenly decide not to choose him when looking for a dentist? We spent hours on the case and came up empty handed. We could find no reasonable cause of his dramatically decreased patient flow. We were very perplexed so we dug even deeper and finally, we found the culprit. In July, a disgruntled patient left a negative review of her experience with the dentist on a prominent review website. And what do you know… that was exactly when his new patient flow began to decrease. The case was solved and we came to one very strong conclusion. Dentists can’t afford to ignore online patient reviews. Why? Because people read them.

Everybody Googles

Consider this scenario: You are on a business trip in an unfamiliar city. You are taking some colleagues to dinner, so you need a great restaurant choice. You ask around, get a few referrals from the hotel staff, but more than likely, you probably don’t stop there. You do what every other consumer is doing… you head to your smartphone/laptop/tablet and Google the restaurant choices before you decide on your final pick. So, you do a quick search and see that both have websites with great photos of their food and are easily accessible from your hotel. The only visible difference between them is one has a negative review from a disgruntled diner and the other doesn’t. Which restaurant do you choose? If you’re being honest with yourself, you will take your colleagues to the restaurant that doesn’t have a negative review.

by Marc Fowler

This is the way that consumers choose today. They ask around and then they Google. So, if most people go through this much trouble for one meal, do you think they will do the same when choosing a dentist for themselves or their family? Absolutely. Bad Reviews Can Cost You Good Referrals

Our client was in shock that just one dissatisfied patient could impact his practice in such a big way. But he shouldn’t be. Consider these statistics:

n n

One negative review on a social media website can cost a business 30 new customers. (Convergys, March 2012)

84% of Americans say online customer reviews have an influence on their decision to purchase a product or service. (Opinion Research Corporation, April 2009)

The Real Cost (in Actual Dollars) of One Negative Review

Procedure (CDT Code)

Abutment Crown (D6740)

Veneer (D2962)

Dental implant (D6010)

Coronectomy (D7251)

Average Cost

Dollars Lost (30 patients)

$1,620

$48,600

$1,297

$2,297

www.northtexasdentistry.com

$611

$38,910

$68,910

$18,330

NORTH TEXAS DENTISTRY

Today’s customers are conditioned to read reviews before they decide to buy. In other words, your potential patients want to know what others have to say about you before they book a first appointment.

If they read just one negative review, they will likely move on to the next dentist. What’s more is these patients have no point of reference when it comes to the validity of a negative review, they simply have no other choice than to believe what they read on reputable review and recommendations websites like Yelp or CitySearch.

By now you might be thinking, “But most of my patients are referrals from current patients or other doctors”. That’s great, however, a recent HubSpot survey found that 51% of customers find user-generated content (or online customer reviews) more important than the opinions of their friends and family. The bottom line? Whether a potential patient found you through a referral, directory listing or a billboard ad, they are still probably going to Google you before they make an appointment. Protect Your Rep

Leaving your online reputation defenseless is much like leaving the front door to your practice unlocked…it’s just not something you can afford to do. You’ve worked hard to create a thriving dental practice, so why leave your success to chance.

We believe that a great offense is the best defense. A solid reputation management plan is the foundation to any great marketing campaign because without it, any online or offline marketing initiative you invest in will be ineffective if negative online reviews are undermining it.

So what can you do? Here are a few simple steps to “protect your rep”:

n n

Check yourself out. Google yourself and your practice name. Is what you see positive or negative? Getting a good feel for your online presence is the first thing you should do.

Take control. Focus on controlling as much of the content on the first two pages of a Google search as possible. There are definite steps you can take to try to push any negative information down in search rankings. How? By creating positive content through microsites, blog posts, press releases, videos and making sure you have claimed, accurate profiles on all the prominent local listing directories and social media websites.

Think positive. Ask your best patients for positive online reviews. Make it easy for them and have your staff remind your patients to give positive reviews immediately after an appointment. You can do this as they are checking out at the front desk.

26 NORTH TEXAS DENTISTRY | www.northtexasdentistry.com

Turn lemons into lemonade. If you get a negative review, address it! Many businesses ignore negative reviews, so you will set yourself apart by even addressing the issue. In some instances, you can turn a dissatisfied customer into a brand advocate for your practice!

Our team at BullseyeMedia just released our latest eBook on the subject, “The Definitive Guide to Online Reputation Management for Dental Practices”. If you want some instant strategies and specific recommendations on how to proactively protect your online integrity, you can download it for free at www.DDSReputationDefender.com.

Many dentists may not have the time or the staff to consistently monitor their online reputation. Part of what we do is to act as our client’s personal security team…always there to protect anddefend their online integrity. We think Reputation Management is so important, that we’ve been working hard on creating a great offense for our clients. Here is how we can help:

n n n n

Provide 24/7 reputation monitoring so that anytime a client’s name or practice is mentioned anywhere on the web, we’re notified. We then work with the client proactively address any negative reviews.

Customized software monitors the web to identify inaccurate directory listings (incorrect name, address, phone, practice description and hours)

A turnkey patient reviews accelerator program to assist clients with collecting and leveraging positive reviews.

We have developed and tested a multi-step processes to capture more real estate on the first two pages of Google, so when a client’s name is searched, positive content comes up first.

Don’t leave your hard-earned reputation to chance. Implement a proactive approach to protecting your online reputation and take control of your online identity to ensure that prospective patients like what they see when they Google you. n

Marc Fowler is President of Bullseye Media, LLC, a McKinney, Texas based full-service digital marketing agency that specializes in turnkey programs for dentists who want to leverage the internet to get high value dental patients; including Website Optimization, PayPer-Click Online Advertising, Website Design, Mobile Websites, Social Media and Reputation Management. You can contact Bullseye Media at 214-491-6166, info@OnlineDentalMarketing.com or by visiting OnlineDentalMarketing.com.

A DEER

HEADLIGHTS IN THE

practice transitions

by Richard V. Lyschik, DDS, FAGD

There is an old Chinese proverb, “May you live in interesting times” and unfortunately for many dentists today, these times are certainly more interesting than what anyone ever wanted. With high unemployment, most dentists today are seeing a substantial drop in patient revenues. Combine that patient revenue decline with a high fixed overhead, and you have all the makings of a financial crisis almost unheard of in this field of healthcare.

We are all too familiar with the analogy of the “deer in the headlights”. When a crisis arises it creates uncertainty, which often leads to confusion and then panic, and ultimately chaos. Interestingly enough, there are solutions for most financial problems, solutions in which, if pursued in the early stages of development, can prevent those problems from becoming a crisis. However, solutions require decisions, and decisions can be difficult to make when you are in a maelstrom. So, rather than stepping back and approaching a solution logically and early on, many dentists will react like “deer in the headlights” by choosing not to make critical preventive decisions, as the proverbial eighteen wheeler of life bears down on them.

As the saying goes, “How do you eat an elephant?... one spoonful at a time”. When you step back and think about it, most problems can be broken down into manageable increments (or spoonfuls if you may). Most financial problems arise not from an excess of money, but the lack of sufficient funds to pay overhead and make a profit. There is only so much overhead that can be cut in the average dental practice. Sure, supplies and lab fees will drop as production drops, and you could always lay off some staff, but there is a point where you’ve done all the cutting possible and patient revenues continue to drop, so what do you do?

Well, if patient revenues are down, then doing whatever is necessary to increase patient revenues is what makes the most sense. Cutting overhead will not increase patient revenues. Borrowed money is not a fix, if anything, it will make your financial future even more difficult. If the economy takes a long time for recovery, and now you’ve increased your debt, then you’ve increased the need for more money in the future. Borrowing money and/or skipping tax payments is not an answer to any financial crisis.

You increase patient revenues by increasing your patient base. If people put off dentistry during a recession, then you need to increase the size of your patient base. More patients mean more revenue. Advertising during hard times is not going to increase your patient base because there are not a lot of people looking for a new dentist during hard times. However, patients who continue to see a dentist and get their dental care during a financial crisis are the type of patient you are looking for to add to your existing practice. Buying and merging an existing practice allows for economy of scale (two practices in one location cuts overhead by a huge percentage) increases the size of your patient base, and adds more patient revenues. Problem solved. When the going gets tough, the tough get going. The time to act is before your problem becomes a crisis, not after, if at all possible. You might be a candidate to sell and merge, or one to buy and merge, depending on your particular situation. But this is the time to consider practice mergers and/or consolidations which provides economy of scale and increased revenues. No matter how bad you might think things are, there is a solution that is right for you. Don’t get caught in the headlights; improve your practice revenues. n

Richard V. Lyschik, DDS, FAGD is one of AFTCO’s leading innovative Senior Analysts who has helped over 2,900 dentists in associating, buying, expanding, or merging and guided older, disabled and/or “burned out” dentists to sell their practices. Dr. Lyschik’s clients have seen the considerable benefits of incentive programs, pension funding plans and increased productivity through his guidance. There is no substitute for experience in this business. Who better could you choose to talk to about your future transition plans than a seasoned fellow dentist, a recognized premier transition expert, and AFTCO Analyst of the Year Award winner? Check out the impressive AFTCO website at www.AFTCO.net, then call for a free appraisal and a no-obligation consultation with Dr. Lyschik at your office or the AFTCO office in Dallas, TX at (214) 893-0410 or 1-800-232-3826.

www.northtexasdentistry.com

NORTH TEXAS DENTISTRY

legal news

JUSTICE

ARE YOU OBSTRUCTING WITHOUT REALIZING IT? by Sarah Q. Wirskye

he crime of obstruction of justice refers to interfering with the work of police, investigators, regulatory agencies, prosecutors, or other government officials. Obstruction can generally be grouped into the following three categories: (1) statements and actions toward the government; (2) statements and actions toward third parties; and (3) deleting, altering or failing to produce documents. In addition to a term of imprisonment, obstruction can increase a defendant’s sentence under § 3C1.1 of the Federal Sentencing Guidelines.1

Obstruction allegations often arise in health care investigations. These are usually easier for the government to prove rather than explaining complex healthcare fraud schemes to the jury. Obstructive behavior also makes it easier for the government to establish the defendant’s state of mind. Obstructive behavior, particularly relating to documents, also makes it easier for the government to execute a search warrant, which makes it more difficult and more costly for a provider to defend themselves in an investigation. Martha Stewart’s trial is a great example of the force of the obstruction statutes. She was criminally convicted of obstruction for covering up actions that had only civil insider trading consequences and a criminal charge of securities fraud that was dismissed as a matter of law.

The federal obstruction law is located at 18 USC §1501, et. seq.2 This article will discuss some of the provisions more commonly used in healthcare fraud cases. It does not focus on what we would all view as obstruction – for example, bribing a juror – but rather more obscure obstructive conduct. For example, an innocent mis-

statement, adding or removing helpful information in documents or inadvertently failing to produce a responsive document may be viewed as obstruction by the government. This article also contains tips to avoid actions the government may construe as obstruction. THE LAW

The primary federal obstruction statutes used in healthcare fraud cases are 18 USC §§ 1503, 1512, 1516,3 1518 and 1519. The Omnibus Clause - § 1503

Section 1503, titled “Influencing or Injuring Officer or Juror,” contains the Omnibus Obstruction Clause. The penalty for violating this statute, absent a killing or attempted killing, is a fine and up to 10 years imprisonment.

The Omnibus Clause states that a person who “corruptly or by threats of force, or by threatening letter or communication, influences, obstructs, or impedes, or endeavors to influence, obstruct, or impede the due administration of justice” is guilty of obstruction of justice. Federal courts have read this clause expansively to proscribe any conduct that interferes with a judicial process. To obtain a conviction under §1503, the government must prove that there was a pending federal judicial proceeding, the defendant knew of that proceeding, and the defendant had corrupt intent to interfere or attempted to interfere with the proceeding. Cases under this provision include the concealment, alteration or destruction of documents, and the encouraging or rendering of false testimony. Actual obstruction is not an element, however. www.northtexasdentistry.com

NORTH TEXAS DENTISTRY

General Witness Tampering Clause and Documents - § 1512

While certain provisions in §1512 address witness tampering, subsection (c) provides for a fine and up to 20 years of imprisonment when an individual “corruptly (1) alters, destroys, mutilates, or conceals a record or document, or other object or attempts to do so, with the intent to impair the objects integrity or availability for use in an official proceeding; or (2) otherwise obstructs, influences, or impedes any offi-

cial proceeding, or attempts to do so.” This provision is used in document obstruction cases. Obstruction of Investigations of Health Care Offenses - § 1518

In 1996, as a part of HIPAA, congress added a new criminal statute which provides “[w]hoever willfully prevents, obstructs, misleads, delays or attempts to prevent, obstruct, mislead, or delay the communication of information or records relating to a

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violation of a federal health care offense to a criminal investigator shall be fined under this title or imprisoned not more than five years, or both.”

Anticipatory Obstruction of Justice - § 1519

Section 1519, titled “Destruction, Alteration or Falsification of Records in Federal Investigations and Bankruptcy,” was passed under the Sarbanes-Oxley Act. This provision provides that “[w]hoever knowingly alters, destroys, mutilates, conceals, covers up, falsifies, or makes a false entry in any record, document, or tangible object with the intent to impede, obstruct, or influence the investigation or proper administration of any matter within the jurisdiction of any department or agency of the United States…, or in relation to or contemplation of any such matter or case, shall be fined under this title, imprisoned not more than 20 years, or both.” This provision was highly controversial when enacted because it removes certain key proof burdens. Significantly, the government does not have to prove which specific “pending proceeding” the accused attempted to obstruct. Prosecutors charging violations of § 1519 must however, still establish the following: (1) the accused knowingly directed the obstructive act to affect an issue or matter within the jurisdiction of any United States department or agency; and (2) the accused acted at least “in relation to” or “in contemplation” of such issue or matter. HELPFUL HINTS

There are three primary areas in which healthcare providers potentially violate the obstruction statutes. The following discusses those types of actions I have personally seen in my cases and includes things that a provider can do to avoid a potential violation. Government Interviews of the Provider

When speaking to a government employee, it is important that a provider is prepared and knows their facts. While 30 NORTH TEXAS DENTISTRY | www.northtexasdentistry.com

an intentional or blatant lie to an investigator is likely an easy obstruction case for the government to prove (if the other elements of the statute are satisfied), even an innocent misstatement may be construed as obstruction of justice. There was a case in which a healthcare provider represented he had only once ordered from a pharmaceutical supplier who was under investigation. In fact, he had ordered from that supplier twice, but this was several years prior to his questioning and he had merely forgotten. Throughout the investigation, the government agent took the position that the healthcare provider had obstructed justice based upon this innocent misstatement. Government Interviews of Third Parties

Under no circumstances should a healthcare provider instruct a witness not to talk to the government nor suggest what to say. This sometimes occurs when a healthcare provider is under investigation, and he or she tells the employees not to talk about certain topics or not to talk to the government. I have seen cases in which the instruction to not speak to the government may be for the â&#x20AC;&#x153;protection of the employeeâ&#x20AC;? so the employee does not become â&#x20AC;&#x153;scared.â&#x20AC;? Again, these actions were characterized as obstruction by the government.

Ideally, a provider should not discuss the investigation with anyone. Counsel who practice in this area can have a short conversation with the employees and provide them with the ground rules. Alternatively, all a healthcare provider should say to their employees regarding being interviewed by a government investigator is that if they talk to the government, they should tell the truth. Documents

Destroying, altering, or not producing responsive documents could also lead to an obstruction charge. Destroying, failing to produce, or altering incriminating information in documents is a fairly easy obstruction case for the government to prove if the other elements of the statute are satisfied. However, merely â&#x20AC;&#x153;cleaning up the filesâ&#x20AC;? before production may be construed as obstruction of justice. You should never do this. In the event that any additional notes must be made (which I do not recommend), those notes should be dated with the present date so that it is clear this information was added after the document request. Finally, something as simple as deleting an email may also be construed as obstruction. You should have counsel advise you regarding a document preservation procedure if you receive a request for documents from the government.

1 Defendants in the federal system see upward departures for obstruction under Â§ 3C 1.1 more often than any other upward departure.

2 State statutes somewhat similar to the federal obstruction law are found in Chapters 36, 37 and 39 of the Texas Penal Code. These statutes are rarely used in white collar prosecutions and, therefore, are not discussed in this article.

3 This statute is titled Obstruction of a Federal Audit and criminalizes â&#x20AC;&#x153;endeavor[ing] to influence, obstruct, or impede a Federal auditor in the performance of official duties relating to a person, entity, or program receiving in excess of $100,000, directly or indirectly, from the United States in any one year period...â&#x20AC;? This provision is generally inapplicable in the dental and orthodontic context. Ms. Sarah Wirskye has represented numerous individuals and entities in civil and criminal disputes with federal and state governments and private insurers. She is currently representing several healthcare providers, including dentists and orthodontists, in inquiries by both the state and federal authorities. For more information contact Ms. Wirskye at swirskye@meadowscollier.com or call (214) 749-2483.

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Overall, if you are under administrative, civil and certainly a criminal investigation, it is helpful to have counsel to guide you through the process of interacting with the government and potential witnesses so there are no allegations of obstruction. n

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NORTH TEXAS DENTISTRY

Learn how to establish

Dental Sleep Medicine Protocols Please join us

February 1, 2013 8:30 AM - 5:30 PM Nabeel Farah, M.D. Dr. Farah is a graduate of The University of Texas Southwestern Medical School. He completed his residency training in internal medicine at Presbyterian Hospital of Dallas and returned to The University of Texas Southwestern to complete his sleep medicine fellowship. He is board certified in sleep medicine, and he is a member of the American Academy of Sleep Medicine and a diplomat of the American Board of Internal Medicine. He is in private practice, with clinics based in Dallas, Texas. Dr. Farah lectures extensively throughout the United States to the public and his sleep medicine colleagues and also spends time as an advisory consultant to companies in the sleep industry. His research background includes participation in numerous clinical trials in the sleep medicine field. He is a nationally known sleep medicine expert and has appeared in numerous television interviews on news programs on CNN, ABC, CBS, NBC, and FOX as well as radio, newspaper, and magazine articles as an expert on sleep topics.

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Dr. Carstensen earned his DDS from Baylor College of Dentistry in 1983, and is in private practice in Bellevue, WA. Beginning in 1988, he has been a continuous student at the Pankey Institute, was invited to join the visiting faculty in 1996, and serves on the Advisory Board to the L.D. Pankey Foundation. In 1998, he worked with his first dental appliance for sleep apnea, and in the past several years has helped hundreds of sleep apnea patients using oral appliance therapy. In 2006, he was awarded Diplomate status by the American Board of Dental Sleep Medicine. Steve has spent countless hours volunteering in organized dentistry for local and state dental societies; he chaired the ADA’s Annual Session in 2010, and currently is a Director and Secretary/ Treasurer of the American Academy of Dental Sleep Medicine. The Pankey Institute has appointed him Course Director of their new Sleep Course at Pankey.

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wine cellar

Virtual Wineries, Real Good Wines by Kim Clarke

espite marketing hype depicting the wine industry as romantic, refined and prosperous, growing grapes and making wine is hard work. Even more difficult, apparently, is selling wine. The old joke about “how to make a small fortune in the wine business is to start with a large one” is not very humorous to those in the business – it happens quite often. The usual vagaries that come with being a farmer combine with pressures from the economy, competition and shifting consumer tastes to create a roller coaster environment within which to make a profit. When sales are strong and the industry makes money, grape farmers and wineries expand their operations, only to find themselves with excess grapes and winemaking capacity when the next downturn arrives. Coming to the rescue to help span that gap between the wineries, growers and the

marketplace are négociants – merchants who buy, bottle and sell wine under their own label. They don’t own a vineyard or a winery, but a number of them have built strong brands with good quality wines.

Négociants have been a part of the French wine industry for hundreds of years, but they’ve played a big role in the domestic wine scene only within the last couple of decades. Big vineyard expansions in the 90’s flooded the market with product and drove prices down. Growers found themselves with large amounts of grapes leftover after their usual contracts were filled. Independent wine makers, taking advantage of quality wine grapes at bargain prices, found space at wineries or custom crush facilities where they could crush, ferment, age and bottle their wine. www.northtexasdentistry.com

NORTH TEXAS DENTISTRY

One of the more visible and prolific of these California “wineries” is Castle Rock. Started in 1994, the company buys grapes from approximately 40 growers and makes wine at facilities in Napa Valley, Sonoma County, Willamette Valley in Oregon and Washington’s Columbia Valley. With a staff of 11 and virtually no overhead, they focus on producing good wines at reasonable prices. All the wines are made under the guidance of their experienced winemaker, August Briggs (who also makes wines under his own label) and they have several expert growers who spend time in the vineyards to make sure the raw materials measure up. Castle Rock offers more than 10 Pinot Noirs from some of the best West Coast appellations. From some of these same appellations they also make Syrah, Cabernet, Zinfandel, Merlot, Chardonnay, Pinot Grigio, Riesling and Sauvignon Blanc – more than a half-million cases in total. With a price tag of less than $10, a Castle Rock wine always delivers more than you might expect.

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Cameron Hughes is an American negociant whose eponymous company makes, imports and distributes premium wine. Started more than 10 years ago in San Francisco, the company’s wines can now be found in grocery chains, big box stores like Costco and Sam’s as well as in the broad market. Their Lot Series began in 2004 with help from Costco, where Cameron Hughes acted more as a broker, procuring and blending the wine to Costco’s approval. Once approved, Costco issued a purchase order that enabled Cameron Hughes to obtain financing to purchase the wine and bottle it – about 1800 cases. In 2007 the company began buying grapes and making their own wines. In 2012 they crushed 5,000 tons of grapes (about 300,000 cases) and purchased bulk wine of about the same amount. From the original Lot 1 made exclusively for Costco, Cameron Hughes is now at Lot 404 and counting. With wines from all over the world at a number of different

price points, the company offers something for everyone and usually succeeds in making the consumer happy.

Taking advantage of a down economy in 2009 and lackluster sales of wine selling for $20 or more, Ninety Plus Cellars embarked on a plan to help highly rated wineries get rid of their excess inventory without eroding the value of their brand. As partners, the winery would bottle the wine and put a 90+ Cellars label on it. In return, they would be paid promptly and receive complete anonymity. The company’s goal is to “seek out, bottle and deliver fine wine that costs you less money.” Teasing the consumer with a description of the wine and its “Source Price”, the Boston-based company has also managed to secure wines from all parts of the world while keeping the scores high and the price low.

A common theme among these négociants is value – good quality for a fair price. A bargain, so to speak. While an oversupply of grapes and excessive amounts of good wine has helped this formula succeed, the landscape may be changing. According to a June, 2012 Wall Street Journal article, prices for grapes and bulk wine are surging as supplies are failing to keep pace with expanding consumption. The cost of California Cabernet red grapes has doubled in the last year with other wine varietal grapes following suit. The recession put a damper on new vineyard plantings and several strong harvests, such as the one in 2009, further delayed planting. Grapevines have also been pulled up in favor of planting nut trees and vegetables, as prices of those have also doubled.

While the full effects of the price squeeze have yet to be felt, it’s obvious that négociants may have a more difficult time producing the bargains that they have in the past. Get them while you can! n

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Discovering Life Hall

with 180,000 square feet of inspiration for science education

Want to race a T-rex, experience a simulated earthquake, fly like a bird or program a robot? Stirring up buzz from around the globe, the Perot Museum of Nature and Science has welcomed thousands of visitors since its December 1 debut, inspiring people of all ages to explore the many exciting worlds of science offered within the stunning 180,000-square-foot museum.

Located on a 4.7-acre site north of downtown Dallas, the Perot Museum is named in honor of Margot and Ross Perot, the result of a $50 million gift made by their five adult children — Ross Perot, Jr.; Nancy Perot Mulford; Suzanne Perot McGee; Carolyn Perot Rathjen; and Katherine Perot Reeves.

The building was designed by 2005 Pritzker Architecture Prize Laureate Thom Mayne and his California firm, Morphosis Architects.

Photo by Jason Janik

The overall building mass was conceived as a large cube floating over the site’s landscaped plinth (or base). The landscape architecture, which reflects Texas’s indigenous ecosystems and demonstrates a living system that will evolve naturally over time, was created by Dallasbased Talley Associates.

Because its mission is to “inspire minds through nature and science,” the Perot Museum fully embraces both the natural world and the manmade world, focusing on earth and space sciences, life and natural sciences, chemistry, physical sciences and engineering.

The 180,000-square-foot museum features five floors of public space with 11 permanent exhibit halls, including a children’s museum complete with outdoor play space/courtyard, and a state-of-the-art hall designed to host world-class traveling exhibitions. Other highlights www.northtexasdentistry.com

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photo by Mark Knight Photography

T. Boone Pickens Life Then and Now Hall include an expansive glass-enclosed lobby and adjacent rooftop deck; a multi-media 3D cinema with seating for 298; a flexiblespace auditorium; a Café; and a Museum Shop.

The Perot Museum expects to attain three environmental designations – LEED Certification from the U.S. Green Building Council; Green Globes Certification from the Green Building Initiative, (separate from the Green Building Council), which focuses on a wide range of sustainable issues including operations; and the Sustainable Sites Initiative, which emphasizes landscape and site design.

The $185-million fundraising goal – which provided for the site acquisition, exhibition planning and design, construction of the new building, education programs and an endowment – was achieved November 2011, more than a year before the Museum’s scheduled opening.

The Perot Museum is open year round Monday through Saturday from 10 a.m. to 5 p.m. and Sunday from noon to 5 p.m. Please check the website for special holidays, extended hours and unexpected closings.

General admission is $15 for adults (18-64), $12 for students (12-17) and seniors (65+), and $10 for children (2-11). Admission to the theater is $5 (for 30-minute shows) and $8 (for 60-minute shows). For members, general admission is free and theater admission is $5 (for 30-minute shows) and $6 (for 60minute shows). Parking is available under Woodall Rodgers Freeway across from the Museum for $6 when paid onsite, $4 when pre-paid online, and $3 for museum members (when paid onsite or online).

One of the best ways to take advantage of the Perot Museum is through membership. Charter Membership (personal and gift) is $45 for students, $65 for individuals, $80 for dual memberships, $100 for Family, $160 for Family Plus, and $200 for Family Plus Platinum. Patron level memberships also are available for $250 and up. For details, call (214) 756-5751 or go to perotmuseum.org.

The Perot Museum is located at 2201 N. Field Street in Dallas. For more information and to purchase tickets or memberships, visit perotmuseum.org or call (214) 428-5555. n

38 NORTH TEXAS DENTISTRY | www.northtexasdentistry.com

ADVERTISER’S INDEX

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Med-Tech Construction......back cover Midco Dental ...................................38

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