embrace your surroundings - Burkhart Dental · No matter where you are in the organization, there...

A MAGAZINE DEDICATED TO THE SUCCESS OF DENTISTRY ISSUE 4 2008A MAGAZINE DEDICATED TO THE SUCCESS OF DENTISTRYA MAGAZINE DEDICATED TO THE SUCCESS OF DENTISTRY ISSUE 1, 2011

The Ultimate Goal

Offi ce DesignInnovations in Dental Chairs and Cabinets

Practice ManagementWhy and When do you Need a Coach?

Dr. Scott Kido & Dr. Lori Lovelace

on Combining Their Practice

With Their Community

Veraviewepocs 3De Affordable 3D/Pan/Ceph for All Your Imaging Needs

Thinking ahead. Focused on life.

For more information, contact your Burkhart representative

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Catalyst M

agazine B

urkhart Dental —

Issue 1, 2

011

Burkhart Dental Account Manager,

embrace your surroundings...Your intuition and hard work have gotten you this far. Ours will

take your practice to the next level. Indulge your senses with

the perfect combination of our Spirit family of dental chairs &

delivery units, Helios LED dental lights, Renaissance Collection

of dental cabinetry and genuine KaVo handpieces. Surround

yourself in a dental environment unlike any other.

www.pelton.net www.kavousa.com

Contents

The Ultimate Goal Dr. Kido and Dr. Lovelace ............................................. 22Contributing Writer: Paige Mead, Assistant to the PresidentContributing Photographer: Cheryl Bennett

Practice Management Everyone Else is Doing It…Why Don’t We? ...................4Contributing Writer: Margaret Boyce-Cooley, MS Director, Practice Leadership, Burkhart Consulting

Why and When Does Your Practice Need a Coach? ......8Contributing Writer: Margaret Boyce-Cooley, MS Director, Practice Leadership, Burkhart Consulting

Burkhart Office Manager Superstar............................ 10

Office Design Innovations in Dental Chairs and Cabinets ................ 12Contributing Writer: Lee Palmer, Burkhart Equipment Specialist

Assistant Success Burkhart Assistant Superstar ...................................... 15

Supply Savings Guarantee: A No Lose Situation ........ 16Contributing Writer: Greg Biersack, Vice President of Operations

Clinical Aesthetic and Functional Replacement of a Mandibular First Molar ............................................. 18Contributing Writer: Rhys Spoor, DDS, FAGD, FADIA, Accredited Member of the American Academy of Cosmetic Dentistry

Technology PCI Compliance Standards Changes and How They Affect Your Dental Practice as a Level 4 Merchant ......................28Contributing Writer: Dawn Christodoulou, President, PEB/XLDent

The Risky Business of Referrals .................................. 32Contributing Writers: Linda J. Hay, J.D. and Anne M. Oldenburg, J.D.

Business of Dentistry After All, It’s Just Your Money ...................................... 35Contributing Writer: Bob Creamer, CPA

Wealth Management 2011 Back to Basics — Long-Term Investing ................38Contributing Writer: Sam Martin, CPA, CFP®

Cover Photo: Dr. Kido and Dr. Lovelace — Dentistry and community combine in Boise, Idaho. Photo by Cheryl Bennett.

Index of Advertisers: A-dec: Ease .......................................................................................2

Air Techniques, Inc.: Spectra™ .................................................31

Burkhart: Nitrile Gloves ..............................................................42

Burkhart: Supply Savings Guarantee ........................................17

Creamer & Associates: Powerful Tax & Business Solutions ...........................................................................36

DentalGroup LLC: Is Your CPA a Dental Specialist? .............40

DDSWeblink™ ..............................................................................33

EMS: The New Piezon ....................................................................11

Ivoclar Vivadent: bluephase® 20i. .........................................37

J. Morita: Veraviewepocs 3De. ............................... Back Cover

Midmark: Elevance™ ...................................Inside Front Cover

Oral Health America: Seal Two Million by 2020..................14

Pelton & Crane: Embrace Your Surroundings. ........................Inside Back Cover

Planmeca: ProMax® 3D. .............................................................21

Practice Leadership, Burkhart Consulting: Practice Leadership & Achievement Seminar ..................................6

SciCan Dental: STATIS Handpieces .............................................20

Summit Dental Study Group ..............................................34

Wells Fargo Practice Finance ...........................................27

XLDent™: Bringing Your Whole Practice Together .....................29

CATALYST MAGAZINE Issue 1 2011 1.

In This Issue:

EaseEvery detail matters. It’s why you can expect outstanding

patient comfort, unsurpassed operator access, and

seamlessly integrated technology to create a level of

ease you never thought possible.

In a world that demands versatility, the A-dec 500® gives

you a complete solution without a single compromise.

© 2010 A-dec Inc. All rights reserved.

Contact A-dec at 1.800.547.1883 or visit a-dec.com to learn more.

ChairsDelivery SystemsLightsMonitor MountsCabinetsHandpiecesMaintenance

InTouch


Burkhart takes a tremendous amount

of pride in the high level of service

that we provide to our customers. It

is an important piece of our long history. It is

a key part of our culture. It is our reputation

and the main reason why our clients select us.

Recently, Burkhart was selected by the

Customer Service Institute of America as

the Small Business of the Year (for our overall

approach to understanding and serving our

clients). It is wonderful to be recognized for

something that means so much to us.

With that said, all businesses, regardless of

how successful, should always spend time

looking for ways to improve. We should

always be looking for companies that shed

new light on how to elevate the customer

experience. Well, I didn’t have to go far from

home to find new inspiration. In fact, it was

right under my nose as I held my grande,

non-fat, hazelnut mocha from Starbucks.

But the real inspiration came from reading

the book Tribal Knowledge by John Moore

about the Starbucks experience and brand.

The book is all about the importance of the

customer experience, and in my mind helped

me to celebrate many of the things that we

are doing, and challenged me to think about

how we can be even better. I also think that

the book is relevant for our customers and can

provide inspiration for you.

Some of the key points from the book that

apply to Burkhart and that I think can apply

to your office are:

1. There is important space for

companies that provides an

enhanced customer experience.

2. The client experience is our primary

marketing tool — Spend money to

enhance the customer experience

rather than on an ad campaign.

3. Communicate passion by telling

your story in a meaningful

and genuine manner.

4. Growth is a by-product

of being the best.

5. In a customer experience,

EVERYTHING matters.

6. Focus on the employee experience.

They create connections with

customers — provide care, reward

and development for them.

7. People create brands. It’s the

people that matter most —

genuineness, conscientiousness,

knowledge, involvement.

8. Hire passion over experience. Passionate

people find ways to say “yes.”

9. No matter where you are in the

organization, there is a direct line

connecting you to the customer.

10. Know your customer’s

expectations and exceed them

So even if you think you are doing a great job

in customer service, (even if you are doing an

award-winning job) there is always room for

improvement, especially if you are continually

seeking new inspiration. I hope you find yours.

Yours in Customer Service,

Greg Biersack, VP of Operations

GREG BIERSACK, Burkhart Vice President of Operations

Serving the DentalProfession since 1888...

Customer Service:

800.562.8176

At Burkhart we realize that our clients are both dental professionals and business owners. It is our goal to help them be successful at both aspects o f the i r careers . Catalyst is fully dedicated to that success. The articles in this publication vary from product use and selection to business management topics and provide information and guidance that can lead to a more successful practice. Throughout the publication are stories of Burkhart clients who have succeeded in the areas that are highlighted. We hope tha t you en joy.

If you have a request for a topic that you would like for us to cover in Catalyst, p l e a s e c o n t a c t H o l l y Ke a n a t :

[email protected]

CATALYST MAGAZINE is published by Burkhart Dental Supply2502 South 78th StreetTacoma, WA 98409

TEL. 253.474.7761FAX 253.472.4773

PublisherGreg Biersack

Principal EditorHolly Kean

Graphic DesignersBrittany StatenSara Wisely

AdvertisingMelissa FlansburgSarah Gill

All rights reserved. Reproduction of any part of this publication without written permission from the Publisher is strictly forbidden. Images are not necessarily to scale.

4. Issue 1 2011 CATALYST MAGAZINE

As the “contractions” persist in our current economy,

we continue to hear from practices that financial

arrangements are a challenge. How do we get

people to pay for the treatment we know they need? The

roots of accepting treatment and financial arrangements

are established in the clinic. In order for the treatment to

blossom into reality, strong systems must be in place. In

this instance, there are several “best dental practices” for

offices after which to pattern their financial arrangements.

However, there are best practices from outside the dental

office that may be beneficial to borrow, as well. Sometimes,

we can make financial arrangements so complicated in our

own minds that it is difficult to convey information to our

patients clearly and confidently. Let’s

start with a few fundamentals taken

from outside of our industry.

BEST PRACTICE #1 — Al l t eam

members, the owner of the business

included, should be expected to follow

the business’s financial policy. Establish

a system that spells out how financial

arrangements will be handled. Every

successful business, no matter what

amount of revenue they are generating

or where they are located, must institute and follow clear

financial guidelines. That’s why whether it’s your doctor,

your roofer or your health club, the business has written

financial policies that you are required to read and sign. No

one departs from these on the team; no one hand-writes

in changes to the financial arrangements. They are what

they are, and everyone abides by them. If you are like some

practices we’ve seen recently that have large, 90 to 120

day-old amounts in their accounts receivables, you’ll want

to stick to the financial arrangements of the practice in the

future to ensure healthier ARs and continued profitability.

As we mentioned, the effectiveness of financial arrangements

starts in the clinic. While we are not recommending

the doctor make the financial arrangements, we would

recommend that doctors start a financial conversation

that gets transitioned to, and continued with, the financial

coordinator. The doctor gives a “ball park” figure in the

clinic area and the patient receives details and options from

the financial coordinator in order to schedule treatment.

With recare patients not needing to schedule restorative

treatment, the hygienist escorts the patient to the front office.

On the way, the hygienist mentions that the scheduling

coordinator will schedule the next recare appointment, and

collect any patient portion due. This same method applies to

the patients who are in your practice for a series of restorative

appointments. The financial arrangements should have been

made prior to the patient scheduling any treatment so that

the patient is verifying their next appointment and paying

the previously arranged investment.

BEST PRACTICE #2 — When you visit

a car repair shop, they will call you to

complete work on the car which exceeds

their estimate or exceeds the amount

you have pre-authorized. Wouldn’t you

be upset if they didn’t? Patients should

expect to clearly understand the fee for

treatment as well. This is best handled

by a staff member — not the doctor —

who will provide information on the

available payment options. Practices

that provide care with no mention of the patient’s financial

obligation often find things can turn ugly rather quickly.

Chances are, you have had more patients leave your practice

because proper financial arrangements weren’t made in the

past, than you’ll ever have leave in the future, if you promise

yourself that your practice will discuss finances for dental

treatment openly and honestly ahead of time. You know your

mechanic won’t begin work until financial arrangements are

made, and neither should you.

BEST PRACTICE #3 — Staff should be expected to request

payments according to a well-prepared, well-rehearsed script.

“Susan, your estimated patient portion for the services we

provided today is $168. How would you like to take care of

that, cash, check or charge?” Listen in the next time you are

in any business where services are provided. You will rarely,

if ever, hear the provider say they’ll just mail them a bill.

Customers are prepared to pay for services rendered. We

In order for the treatment to blossom into reality, strong systems must be in place.

By Margaret Boyce-Cooley, MSDirector, Practice Leadership, Burkhart Consulting

Everyone Else is Doing It…Why Don’t We?

Practice Management


need to ask for payment. Let’s take another example: the

financial coordinator tells the patient that the cost of the

crown is $1,100. She goes on to give the patient two options,

designed to benefit both the doctor and the practice. “If you

would like, you can pay for the cost of the crown today, or

at the next appointment when we start the procedure.” If

the patient asks to make smaller payments, the front desk

person responds, “Mrs. Jones, we could take the total and

divide it into two investments: $550 today or when we start

the process and the remainder when we place the crown.”

BEST PRACTICE #4 — On the heels of #3, the practice

should be expected to provide additional payment options

that encourage patients to pursue treatment and enable

them to manage the financial obligation. While being

escorted to meet with the scheduling coordinator, patients

can begin an internal dialogue. Wanting the treatment, they

will try to figure out how to pay for it. Before arriving in

the consultation room, the patient has already determined

what amount will fit into their monthly budget. Haven’t we

all done this when purchasing an item or service we’ll need

to make payments on? For example, if the patient says, “I

can make payments of $100 per month.” The front desk

person says, “Mrs. Jones, we would be unable to accept $100

monthly payments because it would take eleven months to

pay for your crown. Being a small business, we are unable

to extend interest-free loans to our patients for that time.

However, we do have a relationship with CareCredit, which

will provide an interest-free loan for this period of time. It’s

just a matter of providing me with a little more information.”

When the patient is seated in a private area for consultation,

the financial arrangement discussion may sound like this:

Suzie: “I understand that Dr. Jones has recommended three

crowns, along with two restorations to replace some existing

fillings. Did you have any questions about the treatment that

weren’t answered?”

Mr. Smith: “No, I would like to know how much of the

amount will be covered by my insurance, though.”

Suzie: “That’s a great question, Mr. Smith. I have some

good news. Dr. Jones has recommended treatment with a

total investment of $4,497. I believe that’s less than doctor

originally quoted you. I have verified your remaining

benefits, which come to a total of $1,258. That means that

if your benefit plan pays according to plan, your estimated

patient portion will be $3,239.” At this point, Suzie says

nothing until Mr. Smith responds.

Mr. Smith: “Oh ... that’s a lot of money. Do I have to pay

that all at once?”

Suzie: “Only if it would be comfortable. Otherwise, I can arrange

monthly investments to fit your budget. We have several options

available to you to make your dentistry affordable for you. I’d

like to review those options with you. Would that be alright?

(Wait for consent). One choice is to make your investment in

three installments of $938.00. Another choice would be an

outside funding option on approved credit. It is interest-free for

12 months as long as you make regular payments and the balance

is paid in full prior to the end of the 12th month. Which option

works best for your current situation?”

Mr. Smith: “The $938 would stretch things for my family a

bit, so probably the second option.”

Suzie: “That would be just fine, Mr. Smith. What monthly

investment would be affordable for you? Would you mind

sharing that with me?”

Mr. Smith: “I was thinking that $300 per month would fit

into our budget. Can we make that work?”

Suzie: “Of course. In order to assist our patients to get

the dentistry they want, Dr. Jones has established several

resources for our patients. Some of them, as I mentioned,

are even interest-free for certain time periods.”

Mr. Smith: “Do you need any information from me to get

things started?”

Suzie: “Yes, Mr. Smith. I will have you fill in the requested

information on this form while I look for an appointment

time for you. Is there a day of the week you would prefer?”

ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry. Credits for courses off ered by ADA CERP nationally recognized providers are accepted by the AGD towards that organization’s fellowship and mastery awards.

DOCTOR AND BUSINESS PARTNER ARE INVITEDTO JOIN OUR ROUNDTABLE OF EXPERTS!

www.practiceleadership.comR 12/10

Practi ce Leadership’s professional consultants will guide you through systems that create lasting practice success. This conference is sponsored by Burkhart, the region’s premier dental resource company.

Hours CE Lecture Credit

• Increase focus on principles of eff ectiveness that will improve your business now.

• Elevate team performance to new levels.

• Enhance and refi ne your leadership skills.

• Increase profi tability.

• Avoid costly litigation.

PRACTICELEADERSHIP

DEVELOP GREATER DIRECTION AND FOCUS IN YOUR PRACTICE

ACHIEVEMENT SEMINAR&

To register, contactShannon at 800.665.5323A full refund will be provided with a 72 hour cancellation notice.

January 21 8:30 am – 4:30 pm

February 25 8:30 am – 4:30 pm

March 25 8:30 am – 4:30 pm

April 22 8:30 am – 4:30 pm

May 20 8:30 am – 4:30 pm

June 8:30 am – 4:30 pm

Practice Leadership Training Center11879 NE Glenn Widing Drive

Portland, Oregon 97220

$349 per DoctorTuition Grant for Bravo Platinum Clients

14Tuiti on grant for Bravo Plati num Clients!Ask your Burkhart Account Manager to fi nd out how you can take advantage of this benefi t!

Practice Management


This option gives both the practice and the patient a

reasonable and cost-effective alternative. Offering payment

options for patients not only allows the dentist to collect

what they produce, but production will go up. An additional

benefit is that you seldom have a short notice cancel or

no-show from a patient that has pre-paid for their treatment.

BEST PRACTICE #5 — Employees discussing payment

options should be expected to understand the patient

financing process. Few things will kill a treatment plan

quicker than the employee who is poorly educated on

financing options. Too often, the staff member will

halfheartedly mention the availability of a dental credit card.

When the patient seeks additional information, such as the

interest rate on the card, the staff member either doesn’t have

it or fills in with a comment such as, “It’s kind of high.”

Kiss that treatment plan goodbye! Dentists who choose not

to use a finance company but still want to allow patients

to make payments could consider having the patient make

the installments before the procedure begins. When the

procedure is paid for, begin the treatment.

If you plan to change long established procedures, educate

existing patients individually. Avoid mailings, which often

come across as impersonal. Rather, talk to each patient

individually when they come in for their regularly scheduled

appointment. Most patients will understand and respect the

fact that their dentist is running a business and must operate

it according to sound business practices, like they experience

in other areas as consumers.

BEST PRACTICE #6 — Make financial arrangements in a

private area. More than ever, in our contracted economy,

this is critical. Almost everywhere you go lately, a separate

private area or semi-private areas have been set up in

businesses to discuss finances. Just recently, when I bought

a washer and dryer, I was led to a semi-private area of the

store where I could sit down and talk with the associate about

the investment I was making and how I could pay for it. I

can’t tell you how much better I felt being able to candidly

discuss my options. Arrangements made in the operatory

while the patient is in the dental chair won’t be as successful,

even though there may be privacy. The patient is still in a

vulnerable position, not having made the mental transition

from dental care to finances, often with a dental assistant

prepping the room for the next patient around them.

While you may feel that the reason you’re moved to a private

area at the car lot is so they can high pressure you into the sale,

car dealers have found what we have found over time. Privacy

allows the purchaser to candidly discuss what they can afford,

and more sales are the result. In fact, Practice Leadership

continues to see similar results to those published in Dental

Economics magazine: 60% of patients are unable to accept

treatment presented due to financial constraints; however,

half of these accept treatment if financial arrangements are

made in a private area. This can have a significant impact

on your patients’ accepting the treatment they need, and on

your bottom line!

An additional benefit to having clear financial arrangements

made in a private area is a significant decrease in cancellations.

We generally find that when presented with a financial

request in the reception area, your patients will not want to

tell you or your financial coordinator they can’t afford to pay

for the treatment. Most often, patients will agree, make the

appointment and then call within a few days with a “conflict”.

They usually will not reschedule, but promise non-specifically

to call back. The responsibility to reschedule the treatment

then falls to the scheduling coordinator. When your patients

know you and your team care enough to make treatment

affordable for them and to discuss this privately, they are

more committed to receiving their recommended treatment.

As we continue to work through the current economy with

our patients, dental practices would be well served to make

sure best practices are in place in their businesses. One key

element is effective financial arrangements. The Six Best

Practices outlined here can go a long way to enhancing the

patient experience, and ultimately, enhancing your bottom

line. If you’d like more information regarding how to

implement these strategies in your practice, we encourage you

to call Practice Leadership, Burkhart’s Consulting division,

for additional support, information and training.

Practice Leadership, Burkhart Consulting, is a full-service consulting team specializing in developing leaders and teams in dentistry. For more than a decade, Practice Leadership has helped hundreds of practices achieve new levels of success. Contact your Burkhart Account Manager or Practice Leadership directly at 800.665.5323 for more information.

Practice Management


With football season in full swing, I continue to

notice what separates successful teams from the

rest of the pack. Not only do they have great

players, they usually have another key element that makes

the players play even better: a coach. Then, as I snack while

watching these football games, my thoughts also go to how

several associates I work with have been able to change poor

eating and exercise habits, and as a result, have lost weight and

improved their overall health. That same key element exists:

a coach. Coaches offer new ideas, expertise in a given area,

motivation, and perhaps most important — accountability.

Now, as a business owner, you might be saying, “how does this

relate to me?” This relates to you because the best have a coach,

that’s how. Do you have a coach? If you don’t, you’re selling

yourself short. CEOs often have a board of directors, sports

stars have personal trainers and coaches, government leaders

have a cabinet, and so forth. If you hire the right coach, you will

be guided to higher levels of success. In a recent training, one

of Burkhart’s Account Managers had an insightful comment.

As he reviewed the practices he supports, he noticed some are

doing better than others in the present economy. Guess which

ones? You guessed it: the one’s using a coach.

Years ago, it was possible to own a profitable dental practice

without too many business management skills. You could show

up each day at your office and perform dental procedures on

the patients who were scheduled that day; usually, at the end of

the month there would be money left over after the bills were

paid. This may not be the case in your practice anymore. Staff

challenges may be causing you stress; open hours and a decrease

in new patients may add to that stress. Top that off with a

decrease in case acceptance and collections, and you have all

the symptoms of needing to call in a coach.

What about other times that a coach may be necessary? When

you first start a new hobby or interest, when you begin to enter

into an area where you have no experience, when life knocks

you sideways for a bit — you call in a coach. We count on the

coaches in our lives to support us in areas where we’re not an

expert (nor do we want to be!) A person who wants to learn to

pilot a plane, play tennis, or needs to start a job search after 20

years at the same company will call in a coach to create a greater

chance of success. The coach’s knowledge, insight, motivation

and accountability help insure this. These times occur in your

practice, as well. Whether you are starting a practice, adding an

associate, or getting ready to transition your practice, a coach

increases your chance of success.

To decide if your practice needs help from a coach, take this

two-minute test.

Practice Leadership, Burkhart Consulting, is a full-service consulting team specializing in developing leaders and teams in dentistry. For more than a decade, Practice Leadership has helped hundreds of practices achieve new levels of success. Contact your Burkhart Account Manager or Practice Leadership directly at 800.665.5323 for more information.

Why and When Does Your Practice Need a Coach?Margaret Boyce-Cooley, M.S. Director — Practice Leadership, Burkhart Consulting


78 ― 85 TOTALYou appear to have a Superstar practice! Consider a coach to

fine-tune specific areas.

68 ― 77 TOTALYour practice is above average and if you keep your eye on the ball,

you will be fine. Consider a coach to take the practice to the next

level through enhanced accountability and perfecting systems.

51 ― 67 TOTALYour practice appears to be satisfactory in some areas. Without

improvement in the economy, your practice may decline. Consider

a coach to maximize the opportunities available to you in dentistry

through improved systems, leadership, and teamwork.

34 ― 50 TOTALYour practice may be in decline and not satisfying to you or the

team. Use a coach to help turn the practice around and move

it in a positive direction. You have invested too much in your

education and your practice to let it decline further.

1 2 3 4 5 Reducing stress

1 2 3 4 5 Increasing Doctor’s production

1 2 3 4 5 Gaining accounts receivable control

1 2 3 4 5 Scheduling for greater profitability

1 2 3 4 5 Transforming staff into a team

1 2 3 4 5 Increasing new patients (marketing)

1 2 3 4 5 Improving leadership skills

1 2 3 4 5 Improving case presentation and case acceptance

1 2 3 4 5 Clarifying practice and personal goals

1 2 3 4 5 Hiring, training and keeping good staff

1 2 3 4 5 More time for myself and to enjoy family

1 2 3 4 5 Reducing numbers of days worked in the practice each week/year

1 2 3 4 5 Increasing numbers of days worked in the practice each week/year

1 2 3 4 5 Reducing dependency on insurance

1 2 3 4 5 Getting control over cancellation and no-show appointments

1 2 3 4 5 Lowering overhead costs

1 2 3 4 5 Increasing hygiene production

Rate each of the areas below you would like to improve in your practice. Please circle the appropriate number for each variable.

1 Most important 2 Very important 3 Important 4 Not very important 5 Not needed/All’s well

ADD THE NUMBERS FROM YOUR SCORES ABOVE TO GET YOUR ANSWER:

Practice Management

TOTAL


Hobbies:

What I like about my job:

My Greatest challenge is:

Success at our office means:

What Burkhart means to me:

Going to the beach, enjoying the outdoors with my husband and twin boys, exercising and shopping.

The satisfaction of seeing patients' self-esteem and confidence bloom after we have given them a whole new smile. I love knowing I was a part of that, whether it was in making them feel welcomed when they came in the door or working out financial arrangements.

Like every woman — finding the perfect balance in the many hats we wear and being successful in all of it!

Exceeding our patients' expectations in dentistry and customer service.

A dependable ally who has taken very good care of our office and contributed to our success for many years! Thank you!.

Office Manager, Stephens and Gatewood Dentistry ― Spring, Texas

Kimberly Swan

Superstar

Office Manager


hat are the latest innovations in terms

of ergonomics, efficiency and equipment

integration in the delivery system of

chairs and dental units?

The integration of electric handpieces, piezo electric scalers,

high speed curing lights and intra-oral cameras into the

delivery system all working off one foot control and/or touch

pad control is a common approach for most leading equipment

manufacturers. Most manufacturers have now offered monitor

mounts that either mount on the chair or light post or mount

from the ceiling or wall to make viewing intra-oral photographs

and radiographs easier for both operator and patient.

Many have also integrated the operatory exam light into the

programming of the dental chair, so the light goes on/off with

the positioning of the chair and dismissal of the patient. Exam

lights have also gone LED and many exam lights now have

‘composite’ settings that either decrease light when working

on composite or filtering out the wavelength that activate the

photoactivators. Most delivery systems have put all these features

into right/left convertible packages making it equally as efficient

for a left handed doctor/hygienist as a right handed one. Double

articulating headrests are now standard on almost all dental

chairs and this increases operator access to the oral cavity.

Treatment room equipment is now centered as much around

the efficiency of the assistant as the operator. New rear mounted

assistant platforms allow assistants a quickly convertible right/

left handed platform for holding instrument trays/cassettes,

procedure material tubs, vacuum accessories and syringe as well

as a mixing and working surface that can easily be positioned

above the assistant’s legs and allow her to sit up higher above the

operator for better visibility. Many of these also incorporate the

operator delivery system into them to remove it from the chair

and allow the assistant to manage the dynamic instrumentation

as well. Many intraoral dental x-ray units now allow the digital

sensors to plug into them directly eliminating the USB cables or

other cables previously strung across the room to reach the chair.

What benefits do these innovations offer dentists and

their staffs? What about patients?

Relative to the dentists and their staffs, all of the mentioned

technologies allow for more ergonomic and efficient delivery. This

reduces physiological problems long associated with performing

dentistry, hygiene and dental assisting. The efficiency of these

advances frequently allows more time, which is a most sought after

return, but the real benefit is lower stress to the team.

Relative to the patients, all the integration allows for quicker

visits and in my career in this field the quicker the patient can

get in and out of the dental chair the happier they are! The

double articulating headrest if used properly can also greatly

reduce neck strain during treatment.

What are the most compelling reasons a dentist

would consider renovating either an operatory or an

entire office?

Many dentists do not realize how dated their offices are. When

they do, there’s a lot of motivation to change.

Another key motivating factor is great deals due to the slow

economy, low interest rates and a huge tax break by replacing

capital equipment.

Unfortunately the least used approach is probably what it will

do for their health, stress relief and overall efficiency, but this

can be a huge motivating factor for many dentists especially

those with bad necks or backs.

What do you consider as the two most significant

innovations in chairs and why?

The first would be ultra-thin backrests combined with double

articulating headrests to improve overall access to the oral

cavity for the dentist or hygienist.

Second would be position programming and control via

touch pads vs. backrest mounted switches or foot controls.

The pre-programmed positioning allows an operator to always

position the patient in the correct orientation for working on

the maxilla or the mandible and to dismiss the patient in a

comfortable position for entering/exiting the chair. The touch

pads can be chair mounted, unit mounted or even mounted in

multiple visible locations not hidden when the chair is reclined

like backrest mounted switches or foot controls.

On the subject of cabinets, which recent innovations

help improve ergonomics, efficiency and productivity?

Modular dental cabinetry has made huge advances from its

early days and now offers nearly the same audible and visual

privacy as a walled room concept without closable doors. The

cabinetry is taller between rooms and can be closed to the

ceiling with glass or a soffit for total division of spaces.

Innovations in Dental Chairs and CabinetsBy Lee Palmer, Burkhart Equipment Specialist

Office Design


Modular dental furniture integrates the computer CPU,

monitors, keyboard, mouse and a multitude of ancillary pieces

of dental equipment into ergonomically selected storage and

usage position without making the treatment room cluttered.

This furniture is made to take the physical demands of

dentistry, disinfection and materials storage into account.

Dental furniture eliminates a substantial amount of traditional

tenant improvement costs by mounting the intra-oral x-ray in

a storage cabinet between rooms, mounting operating lights

off the top to provide excellent positioning while eliminating

involvement with an already crowded ceiling in the treatment

room. Usually it integrates the sinks, trash, sharps management,

cup/towel/glove dispensing into a seamless and efficient

delivery system that looks neat and professional to the patient.

As dentistry moves towards more asepsis and the use of

instrument cassettes and procedure material tub delivery,

this furniture is designed to store and deliver these elements

efficiently to increase team productivity. 95% of what goes into

a dentist’s hands passes through their assistant’s hands first. If

they don’t make the assistant efficient, then they have very little

chance of improving their efficiency or lowering stress. To this

end most furniture is designed around this aspect.

Do the latest cabinet systems facilitate infection control

efforts, and/or a practice’s ability to deliver more

consistent outcomes? If so, Why?

Infection control has become a significant reality in dentistry

and all surfaces must be either barriered or disinfected. Modular

equipment is designed for easy application of barriers and the

rigors of disinfectant wipe-downs. Drawers are usually easier to

clean and all cabinet shelves are laminated or glass and easily

removable for cleaning. Doors and drawers are either push to

release and close without handles or have aseptically designed

handles. One manufacturer has an optional storage tank and

outlets to allow an assistant to easily and automatically rinse

and disinfect the vacuum

hoses and valves in the

treatment room versus

doing it manually.

Delivering more efficient and consistent

outcome comes from being able to focus on the

dentistry and not busy tasks. A properly laid out modular

treatment room using instrument cassettes and procedure

materials tubs and supplemented by strategically placed

drawers and cabinets/dispensers can increase productivity

by 20-25%. Anytime the work flows smoothly

the overall stress on the staff decreases and the

patients pick up on that as well.

Have recent developments in cabinets and chairs

created opportunities to better utilize floor space —

for example, the ability to enlarge or increase the

number of operatories within a given footprint?

In existing facilities it really cannot do much to increase the

number of treatment rooms, but it can open up more space

within each room over traditional shop built cabinets.

In new facilities it can be a significant space saver by

eliminating 21 square feet for every two treatment rooms by

using a modular central wall. This may not add any more

treatment rooms, but it frees up space for other uses which are

just as important.

What about image: How might upgrading affect

patient and staff perceptions about the practice?

Unfortunately a dentist is perceived as competent and “up-to-

date” far more by their surroundings than their clinical skills.

Patients do not have the ability or knowledge to discern the

difference in a dentists skill level, but they know when the

facility is clean, bright and modern looking! This does not

mean you have to go over the top in spending, just involve

professionals in the interior design, color selection and lighting

and you can create a remarkable difference even without

necessarily building a new office.

If a staff member is not proud of the office they work in

appearance-wise, then I propose they are less likely to recruit

patients for the practice or even propose optional treatment.

I think staff members also judge their

employer’s concern for them and their

well being by how well they maintain

the physical practice image and

invest in technologies to make

the whole team more efficient or

more ergonomic.

Office Design


SEAL TWO MILLION BY 2020Ten years ago, Oral Health America made a commitment to

America’s Promise Alliance, founded by Colin and Alma

Powell, to contribute to their “Get a Healthy Start” initiative by

promising to provide one million sealants to at least 225,000

children by 2010.

Thanks to the generosity of our supporters and sponsors,

we surpassed that goal, and are now doubling our original

commitment to America’s Promise. We are promising to

provide two million more sealants to 500,000 at-risk children

by 2020.

Oral Health America is grateful for the significant number of

donated dental sealants provided by DENTSPLY International,

3M ESPE, Pulpdent Corporation, Harry J. Bosworth Company,

and Ivoclar Vivadent. These companies enabled us to provide

dental sealant materials to 900 non-profit community-based

treatment partners in 27 states.

Our Seal Two Million promise is about helping at-risk kids.

This campaign will take all Oral Health America programs

to a new level in connecting communities with the resources

they need to promote healthy mouths for healthy lives.

Please join us today.

Founded in 1955, Oral Health America (OHA) is the nation’s

leading non-profit oral health organization. Our mission is to

change lives by connecting communities with resources to

increase access to care, education and advocacy for all

Americans, particularly those most vulnerable.

Oral Health America is setting a goal to seal 2,000,000 teeth by 2020

To find out more about the Seal Two Million campaign and make a pledge

visit www.oralhealthamerica.org or call (312) 836-9900

Join Our Seal Two Million Campaign Today

Burkhart is a proud Gold Level Sponsor of Oral Health America.

Assistant Success

Hobbies:

What I like

about my job:

My greatest

challenge is:

Success at our

office means:

What Burkhart

means to me:

Dental Assistant, Southwest Dental Group — Duncan, Oklahoma

Sheley Womack

SuperstarAssistant

Mostly spending time with my family. Enjoying the outdoors and visiting our state parks.

I like helping our patients achieve healthy smiles, and I get to do this daily with a great team.

trying to not allow myself to take on too much at one time.

that at the end of the day we all still like each other, we look forward to the next day and we have a wonderful feeling of fulfillment.

Peace of mind, even when we needed something yesterday TODAY! I feel like they are truly there to help your office and this makes everything a lot less stressful. I am very thankful that we have a rep like Chris Luksa, he has always gone that extra mile for our office.


Dr. Daren Evans runs a successful practice in the

thriving city of Austin, Texas. He grew up in Austin,

the son of an Orthodontist. After completing his

undergraduate studies at the University of Texas in Austin, he

went to University of Texas, Houston Dental School, where

he graduated in 1992. In 1994, he bought his current practice

from a retiring dentist. He has been working with Burkhart

since 2008 and we are proud to serve him. Michael Zuelke is

his Burkhart Account Manager and has been serving the doctor

with the Supply Savings Guarantee Program since he started

with Burkhart. I had the opportunity to ask him a few questions

regarding the program’s effectiveness.

What was it about the Supply Savings Guarantee that

made you decide to go on the program?

I had been jumping around using

two other supply companies. Each

would say that they had a better deal.

But when it came down to it nothing

seemed to get better. I always felt baited.

I wanted someone to look out for my

bottom line. Michael presented that

the program would reduce the costs

of my supplies. That it would address

my bottom line. I was skeptical that it

would work but thought that I didn’t

have anything to lose.

What impact has the program had

on your bottom line?

We have saved a lot of money and every year we get better. Every

year we get more efficient, even with my production going up.

In the first year on the program for Dr. Evans his supply

percentage was lowered from 5.98% to 5.4%. This saved him

more than $7,800. In the second full year on the program his

supply percentage was 5%. This saved him more than $14,000

compared to his original supply percentage.

What thoughts would you share with other dentists

considering this program?

At first, I had fears that Burkhart was not big enough to meet

my needs. But this has not been the case. They have got me

everything I need and in a number of situations my friends that

are using larger suppliers have had to come and borrow from

me because I was able to get something that they were not. I

would also tell them that they do not have a whole lot to lose.

Try it out for a year. I found that we were more efficient and

organized. We were way better off.

How has Michael worked with your accountant on this

part of your business?

I am not a numbers guy. At the end of the day, I want to go

home and spend time with my family. Michael has done a great

job preparing quarterly statements and does the numbers for

us. He hands these off to my book keeper. It is really easy for

me. I don’t have to worry about it. I just save the money.

How has the change to Burkhart and

the SSG program helped your staff?

At first, they were a little resistant to

change. But now, that they have had

a chance to work with the systems

and tags they are the biggest fans of

Burkhart. It is great all around.

How has Michael and Burkhart

helped your practice?

Michael is like an unpaid employee

on my staff that looks out for our

supplies. I know that he could do

things and try to sell things to make more money but he

is more interested in making things better for my practice.

I would talk with my friends at my study club about all

the products that we bought that would go unused and

expire. With Michael helping me to make good decisions I

don’t have that problem anymore. I don’t have superfluous

supplies in my practice. Additionally, he has offered to help

with a practice analysis and provided good advice regarding

digital technology. He is helpful in a lot of ways and does

not disturb our flow. He makes things better for my practice.

Congratulations, Dr Evans for your success with the Supply

Savings Guarantee! Thanks for selecting Burkhart to be your

business partner.

Try it out for a year. I found that we were more efficient and organized. We were way better off.

By Greg Biersack, Burkhart Vice President of Operations

Supply Savings Guarantee — A No Lose Situation


Let Burkhart show you how our unique Supply Savings Guarantee can help you keep your supply overhead low!

Do you need to control

SUPPLY overhead in your practice?

Your Burkhart Account Manager can:

> Allow your staff to focus on patient care — not spend time researching or ordering supplies

> Identify & recommend products that deliver the best value

> Carefully manage inventory

> Take advantage of manufacturer coupons & specials

800.562.8176www.burkhartdental.com

Contact your Burkhart Account Manager to learn more today!

Replacement of missing posterior teeth can be done

in a healthy, functional and aesthetic manner. This

case reviews principles and techniques to replace

a mandibular first molar with an implant-retained crown.

Planning for the final result before the time of the loss of the

existing natural tooth gives the largest number of options to

attain an excellent result.

Tooth #19 had a gold onlay placed 20 years ago; approximately

one year ago, it became sensitive to biting pressure. Endodontic

therapy was completed with the aid of a microscope and the

distal buccal root showed a vertical fracture line that was also

evident coronally (Figure 1). The symptoms were lessened but

did not abate. After waiting for several months, the patient

decided that he was ready to extract the tooth and place an

implant-retained crown. The patient also expressed a desire to

have a more natural looking replacement than the gold onlay.

Using local anesthesia, the tooth was atraumatically extracted by

surgically separating the mesial and distal roots to preserve all of

the remaining alveolar bone. The socket was curetted to remove

any granulation tissue and the walls perforated in multiple sites

to create bleeding points to aid in healing. A peptide enhanced

synthetic bone graft material that is biomimetic of autogenous

bone, was placed in the extraction site. This accelerates natural

bone regeneration by enhancing the healing cascade that leads to

cell proliferation, cell differentiation and the formation of new

bone. A collagen membrane was placed over the extraction site

and sutured with 6-0 Polylactic acid mattress suture (Figure 2).

Primary closure is always preferred but not easily attainable in

this case, so a well-stabilized collagen membrane secured the site

to allow for primary healing (Figure 3).

Six months healing time was allowed for the graft to mature into

enough viable bone for implant placement (Figure 4). A decision

was made not to do an immediate placement of the implant at

the time of the extraction because of the granulation tissue that

was present around the root fracture; due to the extraction voids,

better implant positioning and angulation could be attained by

placing the implant into a solid bone mass.

In lieu of a surgical stent, an interproximal implant guidance

system (Innovative Implant Technologies) (Figure 5) was used

to center the implant between the adjacent teeth with 3mm of

clearance. A 2mm pilot hole was drilled 8mm deep, and the

surface gingiva was punched with a 4.3mm soft tissue punch

(Figure 6). After cutting down to the level of the bone with the

punch, the soft tissue was easily removed with a surgical curette

(Figure 7). A radiopaque alignment pin was placed (Figure 8) and

radiographed (Figure 9), and the succeeding osteotomies were

adjusted to create the preferred alignment to parallel the roots of

the adjacent teeth. A 4.3mm X 10mm tapered Implant Direct

Replant implant was placed and torqued to 35Ncm (Figure

10). Because of the initial high stability, a polyvinyl impression

was taken with Kerr Take One at the time of placement using a

closed tray impression coping (Figure 11). A distinct advantage

of this technique was after the 4-month healing period, the

next appointment for the patient was the delivery of the final

restoration. A radiograph was taken to confirm proper positioning

of the implant fixture and intimate mating of the coping and the

fixture (Figure 12). The impression coping was then removed

and matched with the implant analog, tightened to 20Ncm and

seated in the impression with the exact orientation in which the

impression was taken (Figure 13). This is an important step to

gain maximum accuracy of the final impression. A 3mm healing

collar was placed on the implant fixture and radiograph taken

for the integrative phase of four months (Figures 14 and 15). A

shade was taken and instructions sent to the dental laboratory for

the fabrication of a porcelain fused to gold crown over a cast gold

abutment. This design allowed for a very fine marginal interface

between the crown and the abutment. A cement-retained crown

was fabricated and the gingival margin of the crown was within

1mm of the gingival crest. Designing the margin placement within

a 1mm depth facilitates cement removal after cementation.

A cast gold abutment was designed and fabricated along with a

porcelain fused to gold crown. An acrylic verification matrix was

made on the model that could be used to verify the orientation

and position of the analog in the model (Figure 16) was the exact

duplicate of the fixture in the mouth (Figure 17). The impression

coping should fit exactly to place on the fixture when using the

matrix. The cast gold abutment was placed and torqued to 35Ncm

(a similar acrylic seating matrix can be used to aid in proper

orientation) (Figure 18). A radiograph was taken as perpendicular

to the abutment fixture interface as possible to verify complete

seating (Figure 19). Retorquing the abutment screw one last time

was done to assure the correct abutment torqued.

The final crown was adjusted and seated with 3M Relyx Luting

Cement. Margin placement was just below the marginal

Aesthetic and Functional Replacement of a Mandibular First MolarRhys Spoor, DDS, FAGD, FADIAAccredited Member of the American Academy of Cosmetic Dentistry

Clinical Success


Rhys Spoor, DDS, has a private practice in aesthetic, restorative and implant dentistry, and is a 1983 graduate of the University of Washington School of Dentistry. He is an Accredited Member of the American Academy of Cosmetic Dentistry, and a Fellow of the Academy of General Dentistry, the American

Dental Implant Association and the Pierre Fauchard Society. He welcomes comments or questions at [email protected].

1

5

9 10 11 12

13

17

21 22

14

18

15

19

16

20

2

6

3

7

4

8

01 Tooth #19 with a distal buccal vertical root fracture. 02 Atraumatic extraction with

bone graft and collagen membrane. 03 Post extraction healing at two weeks. 04 Healing

at 6 months. 05 Implant Guidance System pilot drill position. 06 4.3mm tissue punch. 07

Removal of punched tissue with a surgical curette. 08 Radiopaque metal guide pin. 09

Position of pilot hole too far mesially inclined. 10 Torquing fixture to 35Ncm. 11 Implant

impression coping ready for final impression at time of implant placement. 12 Radiograph

verifying coping fixture fit. 13 Placing implant impression coping and analog into impression.

14 Healing cap in place at implant placement. 15 Radiograph of implant at time of

placement. 16 Acrylic verification matrix on model. 17 Acrylic verification matrix in the

mouth. 18 Cast gold abutment in place. 19 Radiograph of seated cast abutment on fixture.

20 Occlusal view of porcelain fused to gold crown. 21 Buccal view of final crown. 22 Final

radiograph of seated restoration exhibiting complete excess cement removal.

gingiva, so complete post cementation cement removal was

easily accomplished. Because of the relatively narrow diameter

of the implant compared to the natural root it replaced, the most

coronal aspect of the fixture should be at the crest of the bone and

approximately 3mm subgingival. In this particular case, the tissue

thickness was only 2mm, so the emergence profile needed to be

relatively flat to allow for broad interproximal contacts between

the implant retained crown and the adjacent teeth (Figure 20). By

reducing the size of the interproximal gingival embrasures, food

impaction problems in the gingival embrasures that are common

with many posterior implants retained crowns are reduced

(Figure 21). A final radiograph was taken to confirm complete

seating and complete cement removal (Figure 22).

The final result in this case is aesthetic, replaces the full function

of the missing natural tooth and will have predictable longevity.

Implant retained restorations are an excellent option but

requires attention to detail from start to finish.

Clinical Success


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Dr. Kido and Dr. Lovelace combine their love for their community and their practiceBY PAIGE MEADPHOTOS BY CHERYL BENNETT

ULTIMATEthe

Goal


There are simple and straightforward reasons

why Drs. Lovelace and Kido are well-known

and respected in the Idaho community where

they practice dentistry together. They place

a tangible priority on building authentic relationships,

and they do their best for the people who trust them. Dr.

Scott Kido would appear to possess a high degree of self-

confidence as he applied to only one dental school and took

only the Idaho State Board exam. Before he took his exam,

he stopped in Boise and signed the papers to lease his office

space and buy his equipment. Interest rates were at 18%,

the economy was headed into a recession, and he was going

to start his practice from scratch. Recalls Dr. Kido, “That

wasn’t confidence! I was scared to death. I had no options

because I was absolutely broke. That was all I could afford

to do. Looking back, I was an idiot.”

Dr. Lori Lovelace was the first female dentist practicing in

Canyon County, a very conservative, largely agricultural region

in Idaho. She was a Catholic girl taking over the established

practice of a prominent LDS dentist. Drs. Lovelace and Kido

started in very challenging circumstances, and came from very

humble beginnings. Neither of them tends to demur from

challenges, by nature. Both are grounded in traditional values

— and let’s not forget, in humor. The story of their success as

partners in dentistry is a unique one because although they stay

focused on the goal, their collective goal, as a husband-wife

team, has never been “success in the most traditional sense.”

I had been told, prior to this interview with Drs. Lovelace

and Kido, that it might be difficult to get them to talk about

themselves in terms of their professional success in practice.

They aren’t given to discussing their professional lives under

that particular microscope. When I asked them the nature

of their greatest accomplishment, one might think the

mention of Dr. Kido’s Lifetime Achievement Award would

have come up, for instance; or the fact that Dr. Lovelace

was the pioneering female dentist in Canyon County, a

community largely known at the time as agricultural and

less-than-liberal. They have a list of accomplishments. Yet,

because their joint focus has been trained on the goal of

building relationships, the items on their “list” are probably

not what some would imagine them to be. In fact, in answer

to my question, they were both momentarily stumped; after

a pause, they answered identically, “It hasn’t happened yet.”

Dr. Lovelace added, “But it would have to be something

having to do with [our] kids.” As I reflect on the interview

experience with them, I believe it was hard to get them

to say a lot about their success, in the traditional terms

and markers of success in business. Nonetheless, once I

understood what they consider to be highly valued and

most important, what I heard, and what you’ll read, is solid

advice for success in practice.

“I’ll tell you the secret to our success if you like,” said Dr. Kido,

as the laughter subsided at our dinner table, “Get REALLY

involved in your community.”

“When I first moved to Boise, I really didn’t have any friends. I

was young, single, bored ... so I got involved in service clubs.”

Though the plan wasn’t complex, Dr. Kido knows that it has

had long-range, lasting impact on the growth of his practice.

When asked by Derek Johnson, Burkhart’s Branch Manager

in Boise, whether or not he knew his community involvement

would lead to new patient growth in his practice, Dr. Kido

replied directly, “Sure I did. But I didn’t think of it as business

strategy, I just wanted to meet people my own age, make

friends, and enjoy my life! Many of the friends I made then

became my patients, and they still are today.”

I’ve seen him hug his patients; they are friends. The friendship

didn’t cease to be real when they became patients because

turning them into patients was never the goal of the friendship.

The goal was friendship. Community involvement doesn’t

simply mean showing up to events. He and Lori didn’t just

become members of clubs and organizations, they fully

committed themselves. They put their best efforts towards

making each project successful and worthwhile. They became

leaders. Their involvement in the community service clubs

was a matter-of-fact approach to becoming an active part of

the living community. Explained Dr. Kido, “When the roots

start sinking in, and you fall in love with your community,

your practice starts to become much more than a business; it

becomes part of your family.”

As a married team, the doctors are a pretty formidable duo,

both excellent practitioners. They have learned how to

beautifully blend their strengths in the business partnership,

as well as in the practice. Scott loves the science and technical

aspects of dentistry; Lori loves all the wonderful personal

interactions with her patients. Scott likes to look at the big

picture; Lori sees all the details. Their ability to combine their

individual areas of expertise has served them well. They joined

their once-separate practices after marriage, in 1990. Said Dr.

Kido, “Initially, the main reason we joined practices was to

make it easier when we started our family. I could cover Lori’s

patients while she was taking maternity leave. It has worked

out great. Our overhead expenses are much lower than if we

had separate practices, and it gives us a lot of flexibility to

handle all the twists and turns of having four kids.”

For some, there might have been dueling egos, or a wrestling

match of patients. Should the names on the shingle read Kido &

Lovelace, or Lovelace & Kido? “(Ahem,) It’s Lovelace & Kido,”

said Dr. Lovelace, tongue-in-cheek. Still, for the doctors, again,

the goals came into focus, and the relationships at stake — theirs

and the ones they had with patients and staff — became the

Feature


priority. What became apparent as my interview with them

progressed was that Drs. Lori and Scott are partners everywhere

it matters, and that fact is essential to their success, as well.

They found a lot of similarities in their values; their personal

upbringing; their goals for future and family; and in their sense

of what is fun, funny and important in life. Love can complicate

matters in business for some, certainly; but mutual respect and

admiration, common interests and compatible strengths, in this

case, resulted in an excellent pairing.

When their children were born, their focus shifted to activities

involving the kids. Their kids all enjoyed sports, so youth

sports became a big part of their lives. Scott coached baseball,

basketball, wrestling and football. Lori was a standout Team

Mom. “I’d never coached before and I was worried I didn’t

know enough about the sports to even be a coach. So I read a lot

of books on the sports. I went to coaching clinics, and I spent a

lot of time with real coaches. I did everything I could to make

myself a good coach,” said Scott. Lori organized everything to

make every member of the team feel special and appreciated.

They put a lot of effort into making sure their teams had fun.

“It didn’t take long to realize what a positive impact we could

have for so many kids that might not otherwise ever have such

an opportunity,” said Dr. Lovelace. “What started off as just a

way to spend more time with our own kids, we began to see,

was a great way to reach and help a whole bunch of kids! The

parents sure appreciated what we were doing.”

According to Dr. Kido, they have a shrewd marketing plan:

no marketing. “But we support the community. Donate $800

bucks to sponsor a little league team, and you’ll get so much

more out of that than a yellow page ad. We have so many

Lovelace & Kido uniforms and hats running around!” Their

motivation for community involvement is to give back. The

results have translated into a practice full of patients that

already have a great relationship with the doctors. They aren’t

there because they can get a bargain or discount, and they

usually don’t become collection problems. It’s all about friends

taking care of friends. That’s the simple truth.

NO MARKETING PLAN, IN THE TRADITIONAL SENSEThey don’t run ads or targeted campaigns. But their presence in

their community is tangible and speaks volumes — so much so

that for a stretch of about ten years, from 2000 through 2009,

they had to close their practice to new patients. Driven purely

by word-of-mouth referrals, they were seeing upwards of 100

new patients a month, and had to start turning them away. It

had reached a point where they felt they could not give their

patients — their friends — the care they wanted to give them

because they didn’t have enough time. Throughout this time,

their community involvement never stopped.

There have been challenges along the way for both doctors: for

instance, the challenges inherent in starting individual practices

in communities that didn’t at first recognize them. Dr. Lovelace

recalled, “A few people questioned my decision to go to Canyon

County ... But I was raised in the Wilder/Parma area until I

was in the eighth grade. These were some of my favorite years

growing up. I knew I wanted this kind of life for my future

family. Those first few years were hard. I knew some people left

my practice because I was a woman. But for those that have

stuck with me, I am eternally grateful. Today my patients often

reminisce about when I first started, before Scott, before kids.

One female patient said just a few months ago, ‘I am sure glad I

stuck it out with you.’ I believe in the end we attract people like

ourselves with common goals and common values.”

So what about the challenge of blending professional lives with

private ones? In this case, you have a husband/wife team whose

practice is succeeding for a lot of the same reasons, perhaps, that

their personal relationship does: equitable partnership born of

mutual respect and admiration, complimentary strengths, and

common values and goals. Dr. Kido reflected, “One would think

that practicing with your wife would be a big challenge, but it

really hasn’t been ... or maybe we have just learned to overcome

that challenge. We have our moments, but that is all they are —

moments. We are different and we see things differently, but as

long as I eventually do things her way, we get along great. Actually,

there has to be a conflict resolution plan; and there is. I think we

both just try to agree on the best idea, regardless of who had it.”

PICTURED ABOVE: Dr. Lovelace consults with a patient.

Feature


“My career was well on its way when I met Scott,” said Dr.

Lovelace. “It seemed silly to change my name after we married.

We merged our lives and practices together but I still had my

own identity. I really never correct anyone that calls me by a

wrong name. I get called Dr. Lovelace, Mrs. Kido, or Charlie-

Grant-Jon or Maura’s Mom, and that is great by me. I really

don’t like being called Mrs. Lovelace though — she is my Mom.”

Earning patient trust is another thing they are passionate

about. Preserving that trust is a challenge the whole profession

faces, according to Dr. Scott. Drs. Lovelace & Kido don’t have

monthly production goals. “We just don’t want our patients or

staff to ever feel that we are somehow motivated by money,”

said Dr. Kido. “It’s probably weird, but it works for us.” One

of the things clear about both the doctors is that they are

unwavering about doing the right thing for their patients. He

told me plainly, “I worry our profession is beginning to develop

a reputation of being self-serving and greedy.”

He challenges what doesn’t seem right to him, and is willing

to rock the boat in his profession when it counts. Neither Dr.

Kido nor Dr. Lovelace has anything against profit. In fact,

WHAT ADVICE WOULD YOU GIVE TO SOMEONE THAT IS THINKING ABOUT APPLYING TO DENTAL SCHOOL?The same advice I’m giving to my sons who are planning to apply to dental school: you need excellent grades, so learn excellent study habits. About half the dentists are over 55 years old, and there isn’t the capacity at the dental schools to replace them all when they retire, so there will be a shortage of dentists in the near future. That will make being a dentist a good thing. If you are in high school, take as many science and chemistry classes as you can, so when you take them again in college, you will already be familiar with the concepts. Seek out scholarships for college. Make this a very high priority. You’d be surprised how many scholarship opportunities there are, but you have to dig around — not just your first year, but for every year. You will be borrowing a lot more money for dental school and there aren’t many scholarships available for that. You need to do everything you can to keep your debt load as low as possible. It is not easy paying your education loans back the same time you are starting your practice. If you are going to be buying an existing practice, you will be paying for that at the same time … and maybe you will be starting a family. Just try to keep the loans down. They are easy to get but they add up fast and because of the time they come due, they can be difficult to pay back.

PICTURED ABOVE: Dr. Kido and Dr. Lovelace value their staff tremendously. “The most

frequent compliment we hear about our office is how good our staff is.”

Feature


profit is important, but only as a means to an end. For them,

that means being able to continue taking care of their family

and friends by doing what they love to do.

WHEN WE LOOK TO HIRE SOMEONE, THE FIRST THING WE LOOK FOR IS CHARACTERWhen you consider the individuals who round out their team

in the practice, you find more of the same great synergy of

skills, strengths, and core values. As a group collectively, the

Practice Team approaches treatment with whole-hearted

devotion to providing the best possible care for the patients

who trust them with their dental health. There is team

cohesion, clarity and dedication to high-quality care. Dr. Kido

shared, “Our staff is great and they all have been with us for a

long time. The most frequent compliment we hear about our

office is how good our staff is. They all have different strengths,

and are not reluctant to bring them to the office ... If someone

shows an interest in something, we spend the time to train

them to do it exceptionally well. Every one of our staff has

things that they do exceptionally well, and they know it. Of

course, they all have to do stuff they aren’t all that excited

about, and they do those things with a great positive attitude.

It’s amazing. Our staff has the perfect blend of self-confidence

and a wonderful consideration for everyone’s feelings. They

are all so nice, fun and enthusiastic, plus are able to genuinely

admire their co-workers’ skills without feeling threatened

themselves.” Dr. Lovelace concurs, “I view our staff like I do

PICTURED ABOVE: BACK ROW (LEFT TO RIGHT): Jennifer Strong, Sally Ray, Tina Miles,

Sierra Maxwell, Judy Lynn Solberg, Nicole Guray, Nancy Ward. FRONT ROW (LEFT TO

RIGHT): Tammy Torrey, Kayti Bauer, Dr. Lovelace, Dr. Scott Kido, Becky McCormick,

Kristen Krause

ADVICE TO A FOURTH YEAR DENTAL STUDENT• Do everything you can to make sure your clinical

skills are very good and you are proud of your work, even if there no longer is a clinical instructor in the room grading you.

• Do the right thing. You know what it is. Make it easy on yourself and keep it simple; just always do the right thing.

• Be careful not to turn important things around. If your GOALS are to do good work, be honest, ethical and treat everyone as if they were your mother. The RESULT is you will eventually have an above average income.

• Don’t make having a high income as your ultimate goal. It can mess up #2. Your patients do not want to feel like you are just using them to reach your ultimate goal, they want to feel like their good care IS your ultimate goal. And it should be.

• You probably won’t get rich being a dentist. You can, however, get rich if you are smart with the money you make as a dentist. Live below your means and invest what you save. Eventually, you will be rich.

• For the most part, dentistry has been self-regulated. That is, dentists, either through the ADA or the State Boards, are the ones that set our practice rules and regulations. This is because the government has been able to trust us to regulate ourselves. Should enough dentists become so self-serving they destroy that trust, the government will have no choice but to take away our ability to self-regulate. That would be bad.

Feature


my family. I really feel they are a true extension of our family.

There just isn’t anything I wouldn’t do for them. They accept

my shortcomings, understand when I am intense, and often

help me learn to laugh at myself. We are eager to share with

each other at so many levels, joys and sadness. The women we

work with are very amazing people.”

After two years building his small practice in Boise, Dr. Kido had

the opportunity to purchase an established practice in Nampa.

He went for it and then “sold” his Boise practice to a friend

just finishing dental school. As he tells the story, he traded his

practice for a hunting dog and some art work. “It wasn’t worth

much, but it was a good start for my friend.” Amid laughter

around the table during our interview, he says, “I think what

you’ll find is that I don’t really care about money ... but I love

dogs!” A few more laughs, and Dr. Lovelace says, “And art!”

They really don’t care about money, but their practice is

financially successful. What they care about is community:

family, friends, and authentic relationships. They possess a

peace about them that stems from knowing together what their

priorities are and should be, in their personal and professional

lives, and keeping those priorities firmly in place. The message

they have to share with those who would listen is that in

practice, as well as in one’s personal life, resources are a means

to an end, not the end itself. In other very specific terms, they

have pressure on the door because of what they have poured of

themselves into their community, not the other way around.

While our name has changed, the value and service you expect from us has not. We remain committed to helping you achieve your practice goals, and are still the only practice lender endorsed by ADA Business ResourcesSM .

Contact us at 888.937.2321 or wellsfargo.com/practicefinance and let’s talk about how we can support you.

Matsco is now Wells Fargo Practice Finance

© 2010 Wells Fargo Bank, N.A. All rights reserved. Wells Fargo Practice Finance is a division of Wells Fargo Bank, N.A.

ADA® is a registered trademark of the American Dental Association. ADA Business ResourcesSM is a service mark of the American Dental Association. ADA Business Resources is a program brought to you by ADA Business Enterprises, Inc., a wholly owned subsidiary of the American Dental Association.

DR. LOVELACE AND DR. KIDODr. Lori Lovelace graduated from the University of Southern California Dental School in 1987; Dr. Scott Kido graduated from Oregon Health Science University in 1982. Both began in private practice in Idaho soon after graduation — Dr. Kido in Boise and Dr. Lovelace in Nampa. Dr. Kido also worked as a part-time associate in Nampa and when that dentist retired, he bought the practice and moved to Nampa full-time. The two met at a dental meeting in Caldwell. In 1990, they were married at St. John’s Cathedral in Boise. They have been married twenty years and have four children; Charlie (18), Grant (14), Jon (12) and Maura (9).

Feature


Technology

If you accept credit card payments, the Payment Card

Industry standards changes published October of last

year will affect you in the 2011 implementation

year. Be alert to notices you may receive in your

Merchant statements, as the industry addresses

and attempts to put these standards in place. In

addition, be aware that many Merchant Service

Vendors may try to win your business on the guise

of these new compliance requirements.

The PCI Data Security Standard is designed

to ensure that secure environments exist for all

merchants that process, store or transmit credit or

debit card information. The latest revision of the

compliance plan requires that all merchants (dental

practices included) now follow these requirements

to be considered compliant. Previously,

compliance and adoption of the

standard stopped with the Merchant

Service Vendor and did not trickle

down to the merchant level.

While the process of attaining the status

of “PCI Compliant” at the merchant level

is Merchant Service Vendor directed, it will be

Merchant paced during this period of standards adoption.

How long the adoption period will last is uncertain,

but compliance will be a prerequisite at some time in the

future. Eighty-five percent of data security breaches occur

in Level 4 businesses, so smaller merchants must take more

accountability for policing themselves. Given the threat of

potential security breaches that exists today, I think everyone

in the dental industry would agree that it just makes good

business sense to take the measures necessary to protect

patient card data.

As part of the movement to engage merchants in the process

of becoming PCI DSS compliant, many Merchant Service

Providers are offering their merchants access to Compliance

Services as part of their card processing solution. The compliance

standard indicates that merchants must complete a Self-

Assessment Questionnaire annually and that they also

complete a quarterly Network Scan, as specified by their

Service Provider. At present, participation is voluntary (self-

paced), but the associated fee to administer the service is

not. As an added incentive to complete the Self-Assessment

Questionnaire (SAQ), some Service Providers may discount

this PCI Compliance fee. If your Merchant Service Provider

does not offer these services, you would need to contract

with a Compliance Service Provider directly and navigate the

process independently to attain the status of “PCI Compliant.”

ControlScan, for example, offers a PCI Compliance Solutions

package for $249.00 per year. Obtaining this service through

a Service Provider such as TransFirst will reduce that cost to

about $75.00–$115.00 per year.

by Dawn Christodoulou, PEB XLDent President

PCI Compliance Standards Changes and How they Affect Your Dental Practice as a Level 4 Merchant

Eighty-five percent of data security breaches occur in Level 4 businesses, so smaller merchants must take more accountability for policing themselves.


1.800.328.2925 or visit www.xldent.com

™

Windows is a registered trademark of Microsoft Corporation in the United States and other countries.

Technology

1. Install and maintain a firewall configuration to protect cardholder data

2. Do not use vendor-supplied defaults for system passwords and other security parameters. Under HIPAA, you are responsible for maintaining the privacy and security of PHI, so network security should already be a top priority in your office. Reputable Network Service Providers routinely address these elements as part of their offering.

3. Protect stored cardholder data.

4. Encrypt transmission of cardholder data across open, public networks. If your solution is integrated with your Practice Management software, it is likely that strict security guidelines were followed during the development process to ensure protection of this data. For example, XLDent’s integrated XLCharge solution does not store any card data and completes the entire transaction within a secure payment gateway.

5. Use and regularly update anti-virus software

6. Develop and maintain secure systems and applications

7. Restrict access to cardholder data by business need-to-know

8. Assign a unique ID to each person with computer access

9. Restrict physical access to cardholder data

10. Track and monitor all access to network resources and cardholder data

11. Regularly test security systems and processes

12. Maintain a policy that addresses information security

*12 requirements and complete PCI DSS Compliance information available at www.pcisecuritystandards.org

As a HIPAA covered entity, you must comply with the

HITECH Act, so in all likelihood you are already doing most

of this. All you have to do to achieve PCI Compliance is extend

your security protocols to include cardholder data.

In the end, whether self-paced or industry directed,

common sense practices just make good business practices.

PCI Compliance can help you reduce your risk of security

breaches and the potential of fines.

At first glance, the PCI compliance process seems daunting; but really, it

just boils down to 12 requirements.* They are:


all configuration to protect

defaults for system passwords ers. Under HIPAA, you are responsible nd security of PHI, so network security should

daunting; but really, it

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Spectra™. For caries detection, nothing else measures up.

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www.airtechniques.com

Technology

When a general dentist refers a patient to another

specialist, the general dentist takes on some

responsibility to make a proper referral. The risk

of a malpractice case involving the failure to make a proper

referral can be avoided by good documentation of the referral

process, systematic follow up to assure patient compliance,

and ongoing communication with the specialist. These

guidelines can help a general dentist avoid and manage the

risks associated with referrals. Web based systems, such as

www.ddsweblink.com can streamline compliance with these

guidelines in a simple manner and securely maintain storage

of referral documents by patient case.

1. Always refer to a specialist in written form. Send the

original with the patient to the specialist; keep a copy in the

general dentist’s chart.

2. The written referral form

should include the date of

referral and latest date

the referral may take

place. Timeliness can

be a key component

in a claim.

3. If the referral is accompanied by a phone conversation to

the specialist, the practitioner details in the chart, including

the phone call’s date, time and topic in the chart. If there is

a dispute about the recommendations of the general dentist

and specialist, document the dispute. Typically, a specialist’s

recommendation trumps a general dentist’s, but coming to a

mutual agreement is optimal.

4. If a referral form is faxed or sent by other electronic means,

keep a copy of the fax and confirmation receipt in the general

dentist’s chart.

5. If a general dentist recommends an immediate referral

appointment, advise the patient and document it in the

referral form and chart. Adhere to the patient follow-up

process and document follow-up details. Web based referral

systems that link practitioners and specialists electronically

can help in this regard immensely.

6. The general dentist should receive communication from

the specialist in writing or by phone to confirm that the

problem is being handled by the specialist, and to keep the

general dentist updated on the status of the referred care. If

that communication is via phone, document the details of the

call in the chart. Never release original records or radiographs

to a patient, but make copies available.

7. The referral form should indicate that records,

films, models or other information are available to

the specialist if needed. Important records or films

should be sent as copies, and it should only be in

the most unusual circumstance that originals are

sent. If so, great care and a clear chain of possession

with signed receipts, must accompany any originals.

8. If the general dentist is aware that a patient has

not followed up with the referral, the dentist should

communicate with the patient by either a documented

discussion concerning lack of compliance or a written

letter detailing the need to follow up with the referral.

Patient fault or lack of compliance can be a strong

defense. Again, web based referral systems that link

practitioners can accomplish this with reminders

and exchange of ongoing information between

practitioner and specialist.

9. Communications concerning the referral

and follow-up process should be committed to a

regular protocol.

The Risky Business of ReferralsLinda J. Hay, J.D.Anne M. Oldenburg, J.D.

www.ddsweblink.com can streamline compliance with these

guidelines in a simple manner and securely maintain storage

of referral documents by patient case.

1. Always refer to a specialist in written form. Send the

original with the patient to the specialist; keep a copy in the

general dentist’s chart.

2. The written referral form

should include the date of

referral and latest date

the referral may take

place. Timeliness can

be a key component

in a claim.

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Technology10. Never assume that a patient has followed up on a referral,

especially if the patient’s need for a referral was urgent. Many

referring dentists assume that once a referral has been made, it

is no longer their responsibility. Dental negligence law does not

necessarily absolve a referring dentist from liability because he

or she told a patient to see a specialist. If the patient ends up

with serious problems related to that referral, the lack of detailed

documentation makes it difficult to prove that the patient was

fully aware of the reason, need, and timeliness for the referral,

or seriousness of the potential condition. Clear communications

between the general dentist and specialist regarding evidence of

the patient’s condition help to delineate responsibilities.

11. Be cognizant of issues related to confidentiality in the

referral process. Compliance with HIPAA/HITECH Act

insures insure the privacy and security of patient personal

information. In February 2010, new and stricter federal and

state requirements were imposed for the protection of patient

information. The HITECH Act changes HIPAA requirements

and further imposes steeper penalties for violations. The

HITECH Act additionally requires the Federal Government

to be more rigorous in enforcing the law. Both civil monetary

penalties and criminal sanctions have increased. In addition,

enforcement activities have been enhanced. Periodic audits of

Covered Entities by the Department of Health and Human

Services will soon commence. The Department of Health and

Human Services will formally investigate all complaints and

imposed penalties where violations due to willful neglect are

established. In order to protect yourself and your practice,

you must have a HIPAA compliance program in place. That

program must include a number of key elements including:

training program for workforce members; sanctions for HIPAA

violations; a written risk assessment; written policies and

procedures that address compliance with HIPAA Privacy; and

HIPAA Security and HIPAA Breach Notification. The ADA

provides guidance in establishing a compliance program.

Often, referrals are not well-documented and communication

is informal. The practitioner needs to set a regular protocol

for documentation of referrals, compliance with follow

up and monitoring the patient’s care with the specialist.

Electronic systems that link practitioners with specialists go far

in accomplishing many of these goals and reducing the risk

associated with referrals. If a patient develops a problem that

the specialist did not realize was urgent or the general dentist

assumed was handled, then the general dentist has exposed

herself to a potential claim that the standard of care required

follow-up by the general dentist to assure timely diagnosis and

treatment. Without the clarity of these communications and

details, referrals can be fraught with risk.


Join Us!

Summit Dental Study Groupis an ADA CERP Recognized Provider

A LLeegaacy of EExccellenncce

Summmiit Dennttal Study GGrouup is deediicated too eenhaanciinng aand iimproovving the prracticce of ddentistry byy oofferringg g

qquaalitty connttinuiing eduucatiionn proogrrams oonn ppertinnennt annd reelevannt topiics, dellivereedd by rreccognizedd leeadeers in deenttal educattion.. It is oour ggoal to mmeet annd exxceed tthhe

neeedss aand exxppectaations of ouurr partticiipant bbyy ddevelloping coourrses thatt aaddrress theeir cuurrrent cliinical anndd bussineess cooncerrns inn ppracttice, and pproovidee a forumm tto netwworrk

aandd sharre infoormatioon wwitth thheirr colleaagguees inn a rrelaaxed, cconsttructivve and posittivve enviiroonmmennt.

Dr. David Garber“Resolving Controversies in Your

Clinical Implant Practice”

San Diego, CA - January 28, 2011

Dr. John Flucke“Day to Day Technology that can Improve

Your Practice”

San Diego, CA - April 14, 2011

Dr. Peter Jacobsen“Drugs, Bugs and Dentistry:

What to Prescribe!”

Seattle, WA - May 19, 2011

Dr. Norm Ickert“Adjacent Implants in the Aesthetic Zone:

Truth of Consequences”

Seattle, WA - March 10, 2011

Dr. Marc Geissberger“Quarterbacking Difficult Cases in

Restorative Dentistry”

Seattle, WA - April 14, 2011

Dr. Michael Simmons“Sleep Disordered Breathing: Why

Dentistry? Why Now?”

San Diego - March 7, 2011

Mr. Rolfe Carawan“Winning Together: The Key to Building

Unified Teams”

Tulsa, OK - March 24, 2011

Jan Hargrave“Let Me See Your Body Talk: People

Reading Through Understanding

Nonverbal Communication & Personality

Differences”

Yakima, WA - February 25, 2011

Dr. Michael Miyasaki “Principle-Based Dentistry to Achieve

Clinical Success”

Tulsa, OK - February 17, 2011

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Programs are supported by educational grants from:

Ask your Burkhart account manager about the exciting continuing

education opportunities near you!

www.summitdds.com1-800-765-7277

You have paid your team. Your supply and equipment

specialists have been paid. You have written checks

to your taxing partners, lawyer, CPA, and banker.

The bills have been paid to keep the lights on and the water

running. But what about you, the doctor; did you get your full

pay check? Do you sometimes feel there is nothing left for you

to take home at the end of the month?

Dentists are amazing people and wonderful caregivers.

Sometimes you are so busy taking care of the needs of others

that you forget there is a business side of the dental practice

that also needs care and personal attention. There can be

some substantial consequences if the business side of your

practice is ignored.

This past year, I have spent considerable time speaking to

groups of dentists across the country. I have met privately with

many of these dentists, some have voiced concern that they

don’t feel they are adequately being rewarded for the level of

care they give and the liabilities and responsibilities they carry.

I often ask the question, “Doctor, can you tell me within a

few thousand dollars the balance of your Accounts Receivable

(A/R)?” Likewise, in the seminars I teach, I ask the dentists

to raise their hand if the can tell me with reasonable accuracy

what their A/R balance is today. I typically see some spouses

elbow the doctor as chuckles circle the room. Seldom do I get

more than three or four raised hands in groups of 60 to 80

dentists. That concerns me and is no laughing matter. I then

explain to them that if they don’t care enough to know, no one

else in the office cares either.

During these seminars, I teach the dentists that they run their

practices based on the “Cash” method of accounting. Simply

put, you collect money for services provided to patients and

then you use that money to pay for practice expenses. After

you write checks for all the fixed and variable expenses of the

practice, it is often the doctor who is not fully compensated.

Where is your share of the pie? It is all too often tied up

in your Accounts Receivable (A/R). Frequently, I hear the

acceptable level of A/R for a general dentist is one month

to one and one-half month’s production. While one month

is acceptable, I find my best practices can maintain a figure

closer to seven-tenths of one month’s production. But for

the moment, let’s accept the one month benchmark. Let’s

also accept the average general dentist has a 30 percent

profit margin. If you and your dental team are producing on

average $50,000 per month, then the acceptable A/R could

be $50,000. If no one is focused on actively collecting the

A/R, it will soon grow older and the balance can quickly

increase to maybe $75,000. Let’s say $45,000 of the new

$75,000 balance is expected insurance reimbursements,

which leave $30,000 of aging patient A/R. Since it is now

aging and not current, we can assume all the expenses

associated with its production have been paid. Therefore, by

collecting these dollars, it represents your profit. Based on

the aforementioned 30 percent practice profitability figure,

you needed to produce $100,000 of patient production, in

order to pay $70,000 in overhead costs, to have the remaining

$30,000 left now aging in A/R.

When you and your team fail to pay close attention to the

management aspect of the practice, it is easy to see why cash

flow issues arise. More importantly, that can also explain why

many of you feel like you are not profiting at a level you should.

How does the dentist solve this problem? It is all about effective

and frequent communications. Develop a policy of having

patients pay for treatment at the time they receive care. Patients

already understand when they go to the grocery store they must

pay for their items before they leave the store. The same is true

when they pull up to the gas pump to fill up their vehicle. It is

clearly understood that they must pay before they leave the gas

station. Why is it that some dentists allow this well-founded,

payment procedure to change when these same people show up

at their dental practice to receive treatment? Why should they

walk out the door thinking they don’t have to pay?

The policy of being paid for services at the time of treatment

must be well understood and accepted by all team members.

In addition, patients need to be fully aware of the expectation

to pay at the time of service. If you train your team and they

effectively communicate the treatment plan to meet a patient’s

needs and the related investment of such treatment, why not

expect the patient to pay for treatment when completed? With

the whole team on board with the practice collection policy

and learned word scripts communicated with the patients prior

to treatment, there should be little problem collecting what you

deserve. If financial arrangements are needed, the policies for

such arrangements should clearly be in place and presented to

patients who need those options.

To assure maximum collections and to maintain the lowest

A/R possible, communications between the dentist and the

team member responsible for collecting payment is an absolute

must. The easiest way to accomplish this is to schedule regular

After All, It’s Just Your MoneyBy Bob Creamer, CPA

Business of Dentistry


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monthly meetings. This meeting should be calendared for the

same day and time each month, for example, the first Monday

of the month at 4 p.m. No more than 60 minutes a month are

needed for this meeting to be highly successful.

At this monthly meeting, the dentist and team member will

concentrate on the oldest A/R balances and work backwards

to the most recent A/R balance. The team member will

report on the actions they have already taken and what they

plan to do to collect the remaining outstanding amounts.

The dentist will provide oversight and approval for the

collection actions to be taken.

After suggesting this A/R collection concept to my dental

clients, as well as to those doctors I am privileged to teach

in my seminars, I ask them to call me to let me know if the

plan didn’t work. To date, I have not received a negative

call from a doctor who has followed the plan. Many have

called to report the amazing results. After a few months of

success, one doctor discontinued the meetings, thinking the

A/R was now under control. Only when he failed to hold

the monthly meetings did the A/R start to climb again. This

monthly meeting must be continued to be successful.

It’s up to you! The first step is to find out just how much

money you have sitting in your A/R balance. Be prepared for

that figure to be alarming. Make a decision to do something

about it. Create and implement a payment policy for your

practice and get your team trained and on board. Then, schedule

regular monthly meetings with the team member who is

responsible for collecting A/R.

You can drift along, or you can collect what you deserve.

The choice is yours. Clear financial policies and proper

communication will allow you to be paid timely for the valuable

and caring services you render to your patients. After all, it’s just

good business and it’s just your money!


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Although Wall Street and the financial media seem

to find it in their best interest to make investing

seem complicated, in reality, successful long-term

investing is quite simple — not necessarily easy, but simple.

Over the past almost 60 years academia has done substantial

research into how investment portfolios behave and why.

There are but a few key fundamentals.

Fundamental number one is that how you allocate amongst

asset classes — (Equities (stocks) versus Fixed Income (bonds),

Domestic Equities vs. International

Equities, Large Company Equities

vs. Small Company Equities, Growth

Companies vs. Value Companies) is

the number one factor in explaining

the investment returns of a portfolio. A

study that has been peer reviewed and

replicated many times demonstrates

that as much as 93.6% of the influence

on the outcome (good or ill) of a given

portfolio comes from the allocation

amongst asset classes. Market Timing

and Security Selection (stock picking)

add some minor influence; however,

those activities also add expenses which

detract from any gains. One might wonder, if stock picking

and market timing only provide minor influence, why does

Wall Street work so hard to pedal these concepts?

Foundational Principal Number One: Building your

portfolio on the principal of Asset Allocation provides the

best opportunity to access market returns and avoids the costs

associated with Market Timing and Stock Picking.

A second foundational principal is the concept of lack of

correlation within the Asset Allocation. Assets (or Asset Classes)

that are highly correlated tend to move together. High correlation

does not help to lower the volatility of the portfolio. Alternatively,

Asset Classes that are less correlated or even negatively correlated

to each tend to reduce the volatility of the portfolio and increase

the long term annualized (compound) return.

I think we all inherently “get” the concept of diversification in

terms of not putting all of our eggs in one basket. That is part

of the concept of Asset Allocation; however the sublime aspect

of Asset Allocation is strategic allocation amongst Asset Classes

in such a way as to minimize risk at a particular expected rate of

return. If we can lower the risk without giving up our expected

return we should — anything else would be foolish.

Foundational Principal Number Two: Strategic Asset

Allocation strives to provide lower risk at a given expected return.

Risk and reward. It occurs to me that

virtually everything in life is a series of

risks and rewards. No risk, no reward (or

perhaps very little reward). Relationships

are a risk, starting or buying a practice

is a risk and although we don’t think

about it much or at all, going out the

door every morning is a risk. Investing

is no different — there is not much

reward to be had without taking risk

— which leaves those of us who are risk-

conservative or adverse with a daunting

task when it comes to investing. To

overcome this problem, we examine the

three dimensions of risk that apply to each investor: Your

willingness, ability and need to take risk.

Willingness is your (honest) emotional response to risk. If

your portfolio is down 20% are you willing to sit still? How

about 30%? How about 50%? We know that humans are wired

backwards when it comes to investing. We tend to jump on

the bandwagon when markets are going great guns (greed,

exuberance). However; when markets fall, we tend to pull the

plug — but not until after suffering significant losses (fear).

This “Buy High — Sell Low” phenomenon is rampant among

individual investors. We also know that successful long-term

investors buck these emotional tendencies and hold-tight and

rebalance in the face of down markets as well as up markets.

Consequently, one extremely key element of long-term

investment success is to make sure that you do not take on

By Sam Martin, MBA (tax), CFP®, CPA

2011 Back to Basics — Long Term Investing

93.6% of the influence on the outcome (good or ill) of a given portfolio comes from the allocation amongst asset classes.


more risk that you are really willing to experience. Set yourself

up in an overly risky (for you) portfolio and sooner or later

the “risk” will show up — you will pull the plug — but not

until after suffering tremendous losses. Then what will you do?

There is no “all clear” sign as to when to get back into the

market — so more than likely you will miss most if not all of

the inevitable up swing that follows the down market.

Risk dimension number two is the ability to take risk. Ability

to take risk is about the security of your income and number

of years left in your work life. For most practice owning

dentists — the income stream is pretty secure and predictable

(compared to other lines of work) — so age (and health) are

typically the primary issues in terms of ability to take risk. I

think we all understand that the closer we are to wanting to

retire (define that however you like) the less time and therefore

the less ability to recover from heavy losses.

The third, and most overlooked dimension of risk, is the need

to take risk. If you think about it, you will understand that

there is no good reason to take risk unnecessarily. Further, the

more risk you “take of the table” the more likely your expected

results will be obtained. At a lower level of risk your expected

return may be less but your outcome has a higher probability

of success. Smart investors take no more risk than necessary to

achieve the goal.

Foundational Principal Number Three: Be very deliberate and

honest in exploring the three dimensions of risk. Take no

more risk than you need or are willing to live through

and you are on your way to long-term success. When

the risk shows up — you will be prepared: You will

hopefully say to yourself “we knew from the outset that

we had to live through market time periods such as this.

We are a lot better off than we would have been had we not

thought through and adjusted our investment allocation and

we are certainly better off than the neighbor, the colleague, the

brother-in-law who are down two or three times as much

as we are. Until the markets eventually turn upward,

we will leave our statements unopened and tune out

the financial as well as the rest of the media.” These are

the thoughts of the successful long-term investor.

Foundational Principal Number Four: Regardless of your

investment strategy the single biggest influence on your long-

term success is your rate of savings. Creating savings is simple;

establish and maintain a lifestyle that is well below your means.

How far below your means? This is unique to each individual

and therefore the answer should be found in your written

financial plan (see below). As a rule of thumb, save 10% of

pretax income during the early years when you have practice

debt, perhaps 20% through mid-career when your practice is

likely debt free but you are servicing a personal mortgage and

possibly paying for college educations and maybe 30% or more

in the later stage of your career when you are hopefully debt

free and higher education costs have been completed.

Your practice is your most important investment. Its ultimate

sale value is important to your overall plan — but of much

greater importance is the annual income it generates —

assuming that you invest a significant percentage into your

long term portfolio. As a business owner, you have the

advantage over most in that you can make decisions about

your profitability and therefore influence your savings not only

by appropriately limiting your lifestyle but also by increasing

your income should you so choose. If you don’t have a written

business plan — you should create one. This would include

an estimated schedule of investments in your practice — such

as updating, modernizing and acquiring the equipment and

the tools to continue to expand profitability and/or quality of

life. Consult with your dental CPA and your Burkhart Account

Manager as well as other members of your professional team of

experts as needed. Once your business plan has been written

then work with your dental CPA to establish an effective

and automated process for monitoring the plan

and adjusting as necessary.

Foundation Principal Number Five: Your long-term

investments are just one piece of a comprehensive financial plan.

The vast majority of investment professionals are investment

centric. They may give lip service to financial planning; but at

the end of the day, they are all about the investments.

We believe that your long-term investments are highly

important — but really, no more important than the rest of

Wealth Management


(425) 216-1612

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your financial plan. For example, you can walk out the planner’s

door with the perfect investment plan — but if you wrap your

car around a tree on the way home, the investment plan is

worthless. Your personal plan for long-term investing should

be an outcome of a comprehensive plan that addresses who

and what is most important to you and your spouse. Estate

planning, risk management, education funding, advanced

tax planning strategies, etc. are all integral to your, and your

family’s, long-term success.

CONCLUSIONSuccessful long-term investing should not be complicated

although (emotionally) it is not necessarily easy. Your

Investment Plan or Policy Statement should be in writing

and it should be the result of a comprehensive financial plan

that addresses all of who and what is most important to

you and your family. Your investment plan should also take

advantage of Asset Allocation and the massive body of peer

reviewed academic research on the subject — buy and hold and

rebalance as per your written plan.

Your investment platform should be low cost and tax-efficient.

Should you use an advisor, make certain that advisor has your

best interest at the forefront of the entire relationship. As part

of your written contract request that the advisor document his

or her fiduciary responsibility to you. You may be surprised, but

the vast majority of brokers and other financial providers are

not fiduciaries and will not agree to become one. Why so many

people trust their hard earned money to those who do not and

are not required to put the interests of the client (investor) above

their own is a mystery I think I will never understand.

SOURCE: Gary Source: Gary P. Brinson, L. Randolph Hood and Gilbert L. Beebower,

Determinants of Portfolio Performance. Financial Analysts Journal, Jan/Feb 1995.

Information from sources deemed reliable, but its accuracy cannot be guaranteed.

Performance is historical and does not guarantee future results. Differences caused by

market timing and security selection may be either positive or negative.

Sam Martin is Director of Wealth Management Services and Advanced Tax Planning for the Dental Group, LLC / Martin Boyle PLLC / Dental Wealth Advisors, LLC, a CPA, practice advisory, f inancial planning and Wealth Management services group exclusively serving dentists and their practices. Sam is a Certified Public Accountant (CPA), a Certified

Financial Planner (CFP), and holds a Masters Degree in Federal Income Taxation. Located in Kirkland, WA—Sam can be reached at 425.216.1612 or [email protected].

Wealth Management


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