lists layout 1 7/28/11 1:34 pm page 94 lto what you should ...€¦ · you never knew you always...

the list

August 2011 » dentaltown.com94

Lists keep things simple. And we’re fans of lists at Dentaltown.Herein, we’ve collected and written lists for your entertainment and easy reference.From out-of-context quotes from the Dentaltown message boards (just for fun), to what you should have in your emergency kit (seriously!) – we’ve got a list for you.LLISTS

Here’s Our List of Lists...

Watching your practice’s numbers is just as important as the dentistry you do

We all remember “P. Sherman 42 Wallaby Way, Sydney”…here are 22 additional dentists on our TV screens

Things about Dentaltown and Dentaltown.com you never knew you always wanted to know

Be prepared for the 72 hours following a disaster with this emergency kit for the office

Townies present hypothetical to-do lists for each other; a snapshot of the camaraderie of Dentaltown.com

To prevent quarterly and annual practice maintenancefrom falling by the wayside

Insider strategies from Keating Dental Lab

ADS answers your 10 most frequently asked questions about practice transitions

Curve Dental debunks your excusesregarding cloud computing

p. 95 Numbers You Should Know

p. 96 In the Media

p. 98 Dentaltown

p. 99 Emergency Kit

p. 100 Townie To-Do Lists

p. 102 Maintenance

p. 103 5 Ways Dentists Can Saveon Their Lab Bill

p. 104 Top 10 Questions Dentists Ask When Buying or Selling a Practice

p. 106 Excuses Dentists Give forNot Converting to the Cloud

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NYou Should Know by Douglas Carlsen, DDS

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Your Payment ScheduleEach day, meet with your financial coordinatorto check each patient who was scheduled tomake a payment above a certain amount, say$200. This is either from patients who had pro-cedures that day, were scheduled for a treatmentplan with possible payment or were to make anelectronic or check payment. Did that patientmake the proper payment? If yes, good; if no,have the financial coordinator provide the reasonand both the doctor and the coordinator shoulddecide on a course of action.

Total Accounts PayableHave your financial manager or accountantnotify you of whether all accounts payable arecurrent. Actually, this is not a “number,” just ayes or no. This includes practice loans, staffsalaries, lab and supply bills, taxes… everything.If you are not current, find out why, pronto.

Office Checkbook BalanceThis is the real barometer of your practice. Yourcollections minus your expenses – your profit –is inherent here. Each month find the low pointfor the last four months, not the high points,the low points. Are the numbers increasing,decreasing or about the same?

Total Accounts Receivable Each month compare the last four months on the same day each month.Pick a day when there are less insurance payments posted, as that can skewthe numbers. The last Wednesday was always a good day for us. Otheraccounts receivable numbers are equally valid, yet this number is the mostcommonly used and easiest to find. Are the numbers going up or down?

Amount of Refunds and Write-offs Each month, compare the last four months. This is a new addition to thelist as the explosion of HMOs, PPOs and office embezzlement has taken atoll on collections.

What to do when something is off: What doesone do if the numbers aren’t heading in the rightdirection? Go to the source directly involvedwith the errant number. This sounds a bit vague,but it works. If the checkbook is steadily wither-ing, ask the staff person who pays office bills andthe staff person who collects and posts pay-ments. If accounts receivable are up, go to theinsurance and billing coordinators. The personwho works directly with the number in questionwill usually have an intuitive monitor to assessthe reason for the change.

dentaltown.com « August 2011 95

Number of New Patients Each month compare the last four months. Arethe numbers going up or going down? Whatmarketing strategies are most effective for gettingnew patients? Keep track of what works and whatdoes not work in your area, for your practice.

Total production, total expense and overhead percentage have beenleft off this list on purpose. I want to emphasize the importance ofthe office checkbook in evaluation. Production and overhead are notnecessarily the holy grail of modern dentistry.


MAugust 2011 » dentaltown.com

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96

In Dr. Nicholas “Oz” Oseransky (Matthew Perry) in

The Whole Nine Yards – 2000

n Dr. Orin Scrivello (Steve Martin) in Little Shop of Horrors – 1986

n Dr. Frank Sangster (Steve Martin) in Novocaine – 2001

n Dr. Christian Szell (Laurence Olivier) in Marathon Man – 1976

n Dr. Sheldon Kornpett (Alan Arkin) in The In-Laws – 1979

n Dr. Doug Madsen (Tim Allen) in Wild Hogs – 2007

n Dr. Theodore “Ted” Brooks (Cuba Gooding Jr.) inSnow Dogs – 2002

n Dr. Phillip Sherman or better known as “P.Sherman 42 Wallaby Way, Sydney” (voice of BillHunter) in Finding Nemo – 2003

n Dr. Bertram Pincus (Ricky Gervais) in Ghost Town – 2008

n Drs. Steve and Ben Jessup (Phill Lewis and BillHenderson, respectively) in City Slickers – 1991

n Dr. Julia Harris (Jennifer Aniston) in Horrible Bosses – 2011

For Women: n Julia Roberts

n Angelina Jolie

n Halle Berry

For Men:n Tom Cruise

n Tiger Woodsn Brad Pitt

n Barack ObamaSource: Chicago Dental Society

Midwinter Meeting Survey, 2010

IN THE MEDIA

From Seinfeld to The Simpsons, dentists are present throughoutpop culture. Do you remember seeing these?

Most RequestedCelebrity Smiles

In The Movies


EDIAdentaltown.com « August 2011

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Famous &Fictitious

Dr. Tim Whatley (Bryan Cranston) of Seinfeld Dr. Wolfe (voice of

Hank Azaria) of The Simpsons Dr. Wilbur Wonka (Christopher Lee) of

Charlie and the Chocolate Factory Dr. Bernard Nadler (Sam Anderson) of

Lost Dr. Barry Farber (Mitchell Whitfield) of Friends Dr. Jerry

Robinson of The Bob Newhart Show Captain Walter Koskiusko “Painless

Pole” Waldowski (John Schuck) of M.A.S.H. Dr. Orson Hodge (Kyle

MacLachlan) of Desperate Housewives Dr. Glenn Martin of Glenn Martin,

DDS Dr. Bob Fish of Bob and Margaret Dr. Carl Howell (John

Stamos) of Glee Doc Holliday Dr. Barney Clark, the first recipient

of the Jarvik-7, the first implantable artificial heart


August 2011 » dentaltown.com

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continued from page 79

DDENT

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United StatesCanadaIndiaUnited KingdomEgypt

AustraliaRomaniaNew ZealandSaudi ArabiaChina

DavidJohnMichaelRobertJames

MarkRichardWilliamJenniferThomas

Locating the Elusive Root Canal – Dennis Brave,

DDS and Kenneth Koch, DMD

Practical Oral Surgery for the General Dentist:

Surgical Extractions – Jay B. Reznick, DMD, MD

Precision Based Endodontics – Dennis Brave, DDS

and Kenneth Koch, DMD

dentaltownpasswordpass123tooth123[lastname, birthday]*Actually, we just made this up. Dentaltown’sOnline Community Manager Kerrie wouldn’t helpus out with this list. But if we hit the nail on thehead, you should probably go swap out your tiredpassword with something not containing the actualword “password.”

We won’t tell you who said it or on which thread, but these are all verbatimquotes from the message boards of Dentaltown.com.

“My pits and palms are getting sweaty just thinking about it.”“I’ve considered doing dentistry with my shirt off now.” “After all, if you want to catch a kangaroo, you need to think like a kangaroo.” “Hair straighteners, curling wands and refillable lighters.” “If they get blind drunk on Saturday, they are always fine on Monday.”“I love me some Gator.”“Tetley tea is also the official tea of the Harold Radford Society.”“Congratulations on your new chins.”“Usually the aliens are more careful about where they leave their probes.”“How can you go wrong with an inflatable pig?”“It would have to be a really smart monkey.”“I got a reindeer that poops root beer jellybeans...”“The Ferris Wheel won’t fit.”“Just ’cause Tiger Woods would have put it next to the pin does not make me wrong.”

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Things about Dentaltown you never knew you always wanted to know.

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EMERGENCY KITIn just the last few years we’ve seen plenty of disasters

strike – for some it’s been devastating, for others it’s been

too close for comfort. From Hurricane Katrina, to the

flooding of the Mississippi; from tornadoes in the

Midwest to the California earthquakes, we all have to be

prepared. Disaster preparedness organizations through-

out the country insist having 72 hours worth of emer-

gency supplies on hand is essential. Many of us have

emergency kits at home, but what about at the office?

Here’s what should be in your “Go Bag”:

Water – enough for each person to have one gallon per day. First aid kit including

essential medications. Non-perishable food (don’t forget the can opener!).

Blankets. A flashlight with extra batteries. Cash, in small denominations. A battery-

powered radio. Matches and candles. Duct tape. Utility knife. Extra clothing.

Personal hygiene items. Addresses and phone numbers. Pen and paper.



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TPart of the appeal of Dentaltown.com is the camaraderie among friends and colleagues – a professionally cen-tered Web site with a casual feel. To show this spirit, we asked some of our most active-posting Townies towrite hypothetical to-do lists for each other. We’ve certainly got some characters roaming the message boardsof Dentaltown.com! [Editor’s Note: Each list has been pre-approved by the person about whom it was written.]

TO-DO LISTS

Kerrie “kerriek” Kruse’s To-Do List(List written by Howard Goldstein)

q Wake up 15 minutes early to make decision onwhether to go curly or straight this day.

q Make sign that anyone who touches hair dies.q Get to office and show Ken Scott (I.T. Director) how

to turn the Dentaltown server on.q Check the new registrations to Dentaltown and

delete all bogus ones.q Ban “Seymour Butts” for the thousandth time.q Edit HoGo’s postings from the night before.q Decide she made the wrong decision on the hair.q Change title from “Online Community Manager” to

“Queen of All Media.”q Challenge every male at Dentaltown headquarters to

an arm wrestling contest.q Collect winnings.q Go home and look in mirror. Decide she made the

correct decision on her hair after all.

Phil “philzelmanow” Zelmanow’s To-Do List (List written by Bradi Boyce)

q Wake from restless slumber.q Remember not to go to work.q Take kids to school.q Take pictures of butt in jeans, post pictures on Dentaltown.q Count days until retirement.q Shop for watch that costs more than most cars.q Take pictures of shoes and socks, post on Dentaltown.q Mourn about having to work in three days.q Browse current trends in ladies shoes and handbags;

must stay current.q Look for excuse to take more time off.q Check 401(k) to see if retirement day can be moved up.q Night cap with the Yankees.q Celebrate one day closer to retirement.

Bradi “sfddds1” Boyce’s To-Do List (List written by Phil Zelmanow)

q Wake up to kid crying.q Log on to Facebook and Dentaltown,

simultaneously.q Grab breakfast and Diet Coke; eat on the

way to work.q Running late; miss morning huddle.q Work though lunch; grab Diet Coke.q Leave work early to see kid’s show.q Back to work for eight more patients; grab

Diet Coke to power up for home stretch.q Grab dinner on way to fundraising event.

Running late; grab Diet Coke.q Exercise on elliptical machine.q Log on to Dentaltown and Facebook,

simultaneously… while on elliptical.q Say hello and goodnight to husband.q Rinse and repeat.

Howard “howardmgm3” Goldstein’s To-Do List(List written by Kerrie Kruse)

q Wake up.q Check scotch supply to make sure there is enough

for later.q Style mustache with little comb and mustache wax.q Log in to Dentaltown. Edit post. Edit post.q Go back to first edited post to make sure edits

were grammatically correct.q Double-check scotch supply.q Log in to Dentaltown on office computer.q Fill cavity. Supervise new associate.q Get home. Pour scotch.q Log onto Dentaltown. Edit post.q Pour another scotch for night side table.q Go to bed. Dream of scotch and Dentaltown.



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Gary “garyshooter” Torres’ To-Do List(List written by Jason Luchtefeld)

q Open eyes; flex eyelids.q Evaluate biceps in mirror on ceiling.q Power jump out of bed.q Log on to Dentaltown; check p90x thread.q Bottle sweat to be used later in coffee.q Post workout update.q Shower.q Check Dentaltown for comments of video.q Arrive at work for morning huddle

(aka, pushups and wall squats).q Place implant in plank position.q Do agility drills through office.q Drive home.q Flex in mirror while getting ready for dinner.q Post on p90x thread about dinner.

Armen “nemrA” Mirzayan’s To-Do List (List written by Rich Rosenblatt)

q Wake up late and rush to get to Scottsdale Center.q Blast Justin Beiber to get pumped up for the day.q Log on to Dentaltown. q Ignore all spell check corrections in posts.q Make a post to create mass controversy.q Log in to Sirona beta testing forum. Post joke that

does not translate well, offending European testers.q Ignore e-mail reminders about overdue blog post

on CerecDoctors.com.q Log on to Dentaltown. Stir pot once more before

calling it a night.q E-mail HoGo requesting no editing be done to

controversial post.

Rich “rgrosen” Rosenblatt’s To-Do List (List written by Armen Mirzayan)

q Climb out of bed; hit snooze button.q Curse Tolkien for writing The Silmarillion

as part of daily ritual.q Pull out step ladder. Open fridge. Reach

into bottom shelf to get juice.q Head to work. Have driver’s license handy

for when pulled over for potential under-age driving.

q Start planning for gift wrapping overChristmas at double-secret location inNorth Pole.

q Open image sent by Armen via MMS of aKeebler delivery truck driving by.

q Prepare for onslaught of “little” jokes thathave filled inbox over night.

q Log on to Dentaltown. Check messageboard regarding how to answer patientswho ask “Are you old enough to practice?”

q Remind staff to only stock small gloves.

Jason “jasonl” Luchtefeld’s To-Do List(List written by Gary Torres)

q Wake up.q Take Vibram five finger shoes out of

washing machine to air dry.q Oil bike chain.q Review endorsement contract from

Hammer Nutrition.q Post workout on Dentaltown.q Check Facebook… and abs in mirror.q Forget shaving; need to look primal at work.q Put on office five finger shoes, helmet and ride

bike to office.q Sell some implants.q Ride bike home like bat out of hell. Pretend it is

race day.q Put on Vibram five finger slippers.q Contemplate meaning of life and post single-word

status updates on Facebook. Wait for replies.q Go to bed with dreams of five finger shoes and

Hammer Nutrition Invitational.



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MAINTENANCEThe daily and weekly maintenance tasks are delegated out to your staff and are part of the rou-tine that keeps your office running smoothly. However, the things that need to be handled quar-terly or annually can easily fall by the wayside. Here’s a checklist to help you stay on track!

n Clean computer equipmentn Wipe and oil furnituren Clean windows and window coveringsn Shampoo the carpetn Organize storage spacen Update displaysn Check plumbing for leaksn Test security systemn Apply pest control systemn Test smoke detectors and carbon monoxide detectors

(and replace the batteries)n Service heating and air conditioningn Check fire extinguishern Repaint parking stripes n Clean or update signagen Check for practice management program updatesn Update computer anti-virusn Re-evaluate phone and Internet contractsn Check your first aid kit for expired medicationsn Check that the “Go Bag” is ready and up-to-date (see page 99)n Lubricate door and window hingesn Get your teeth cleaned!n Get a new door matn Take a walk around to see outside repairsn Replace burned out light bulbsn Conduct yearly evaluations for staffn Re-evaluate insurance policies



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5

5. Choose restorativematerials wisely. With the continued increase in alloycosts, your laboratory bill could be rising without any change in your tech-nique. Consider consulting with your lab-oratory on metal-free options. Many zir-conia products are just as strong and ver-satile as metal, but more aesthetic andless expensive.

1. Work with a lab withwhom you communicateeffectively. When doctors have a good working rela-tionship with their laboratory, mistakesare less likely to happen. Effective com-munication will increase consistency andpredictability and save money for yourpractice in the long run.

2. Give your lab a perfect impression.Use a high quality tray and impressionmaterial. Whenever possible, use thedouble retraction cord technique. Theclearer and more precise the marginis, the less likely the case will need tobe remade. This saves on seating timeand overall fabrication time.

4. Work with an implantsurgeon you trust. Since implants are some of the mostexpensive products on the market,remakes can be especially costly.Implants which are placed in less-than-optimum locations can lead tocases requiring more custom fabrica-tion cost and lab time.

3. Learn to make ahigh quality provisional.It is the blueprint for the final restoration(high quality temporaries with properinterproximal and occlusal contacts willsignificantly decrease your seating time).High quality temporaries will help youavoid “rush” case fees from your lab.

Dentists Can Saveon Their Lab Bill

WA

YS

Provided by Keating Dental Arts Contact:You can find more information about KeatingDental Arts at www.keatingdentalarts.com.

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Questions Dentists Ask When Buying or Selling a Practice

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The value of a properly appraised practice is a function of two

factors: risk and net income. The greater the risk is, the lower

the interest is from buyers. Higher risk translates to lower

practice value. Valuing a practice involves the review of three

years of financial information and other practice management

reports. While value is heavily influenced by the most current

year of cash flow, to properly assess risk, a full analysis must

be conducted. Value simply cannot be based on one or two

points of data or rules of thumb, or be made “on the spot”

without careful review.

What can increase ordecrease value?

Fewer specialty services (in a general practice), less

discounted fees or insurance (especially HMO/capi-

tation), more stability, higher gross and higher net

income yields higher value. Aesthetically, the more

visibly appealing a practice is, the more a practice

will sell for. Note, this will not necessarily affect the

appraised value, but might affect the sale price.

Importantly, some procedural and nearly all finan-

cial modifications to increase value might necessitate

longer range planning (three to five years out) to

provide a return. Major equipment or aesthetic

changes most likely will not yield a justifiable return

in the immediate short term.

Can you provide an overview of thetransition process?

What’s the value of adental practice?

Provided by ADS (with Greg Auerbach – transition specialist with ADS Florida and a financial analyst for Pride Institute)Contact: You can find more about ADS at www.adstransitions.com and ADS Florida at www.adsflorida.com.

After finding a practice, the purchaser makes an

offer which the seller can accept, decline or count-

er. The offer should establish the general framework

(price, anticipated closing date, restrictive covenant

terms, whether there will be a transfer of real estate)

for the purchase agreement that will be developed.

Once the offer is accepted, the purchaser applies

for financing (if applicable) and completes the in-

office due diligence. Concurrently, purchase agree-

ments (and lease, if applicable) are developed and

reviewed by seller and purchaser’s counsel. Once

documentation is finalized and financing is

secured, a closing date is set and the staff notified.

Many steps, if done incorrectly, can adversely affect

future steps and jeopardize the sale, so it is impor-

tant to consult with an expert.

The restrictive covenant establishes a time and geographic area

within which the selling doctor agrees to not practice or partic-

ipate in another practice after a sale. The seller is also usually

restricted from soliciting patients or staff. The area for the

covenant is unique to each practice and location, and is usually

correlated to the service area of the practice (where most of the

patients live/work) taking into account local and regional fac-

tors. Time limits are often established by state law or jurisdic-

tional court rulings and can be months (if at all) to a number

of years.

What is a covenant notto compete/restrictivecovenant?4


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6When properly developed and reasonable in its terms (distance and/or time),

covenants are enforceable in most areas. The specifics of the covenant are very

important and defined by local laws. Since a restrictive covenant is vital to

almost every transition, it is important to consult with a local transitions

expert and legal counsel to verify the statutes and ensure legality of a

covenant. That said, in all states but Alabama (others do not allow them for

employees), restrictive covenant contracts are enforceable and care should be

exercised when drafting them.

Are restrictive covenantsenforceable?

The staff typically are as worried about keeping

their jobs as the purchaser is about keeping

them. If they leave, they have to start working

for a new doctor and with a new team with a

new set of expectations, benefits and a reset on

their seniority. This amount of change sets a

high incentive to stay. With a proper transition

strategy, the staff should stay in place unless the

purchaser lets somebody go or somebody was

already set to retire. In the case that he or she is

ready to retire, this should be disclosed through-

out the due diligence process.

Will the staff stay in a transition?

The patients of the practice will accept a new doctor if the

introduction and transition are handled the right way. The

seller’s endorsement, coupled with staff acceptance and

enthusiasm, is key but the purchaser’s participation in cre-

ating a steady environment over a period of time will

enhance acceptance significantly. Generally speaking, we

see that patient retention is in the mid to high 90 percent

range knowing that those who travel from out of the area

and some others might not return. The vast majority will

return and give the new doctor a chance if the transition is

handled correctly.

Will the seller’s patientsaccept a new dentist?

No valuation is made on one year’s data alone, and metrics such

as percent of gross or multiple of net are not accurate appraisal val-

ues. A true appraisal process includes evaluation of several differ-

ent methods of correlating value to residual net income of a prac-

tice after reasonable expenses, including all those to produce the

dentistry are deducted from the gross income. There are methods

that are generally accepted in the business valuation profession,

legal community and banking industry that can be applied to

valuing a practice. Appraisals should have detailed documentation

that review the methodologies examined to determine final value.

How do you appraise orvalue a practice?

Does my dental practiceneed to be a certain size toaccommodate an associate?

There are generally recognized minimal requirements for a full-

time associate which include office size (square footage and

operatories), production levels, available staffing, new patient

flow and overall transition plans. That list is just the beginning

and a careful evaluation is really necessary to ensure whether a

need or opportunity is really there and, if so, to make sure the

addition of another doctor goes smoothly. If you are contem-

plating this in the near term, we suggest that you contact a tran-

sition specialist to determine your needs.

Dual representation is the practice of representing both

the seller and purchaser in a brokered transaction and

being paid by both. In many states, this practice is ille-

gal. Not only is it illegal, it is unethical. Transactional

brokerage is the practice of representing neither party,

but rather, the transaction itself. This usually provides

shelter for a broker whereby he or she minimizes the

responsibility for accuracy and disclosure.

What is dual repre-sentation and trans-actional brokerage?

dentaltown.com « August 2011 105



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10TOP Excuses Dentists Give for Not Converting to the Cloud

Provided by Curve Dental Contact: You can find more about Curve at www.curvedental.com.

What if the Internet goes down?

We hear this every day. When you take a minute to identify exactly

how many times this has happened in your practice you might discover

that your hardware or server crashes far more often. Using the cloud

doesn’t need expensive hardware and servers. Stuff happens, and if

Internet service in your neighborhood is interrupted, trucks are

rolling to fix it, just like any other utilities. But if your server crashes,

no one cares but you.

What if someone hacks my data?

When was the last time the media reported that a dentist’s database was

hacked by a nerdy kid or by a really bored terrorist organization? The

truth of the matter is that it rarely happens because, quite simply, your

patient data doesn’t offer a motherlode of information. Stored on your

server in your office, your data is more suceptible to hacking. On the

cloud your data is protected by the same technology used by banks and

other large corporations and organizations.

My dealer rep said I shouldn’t convert.

Your rep is likely someone you trust. But ask yourself – is your rep a

cloud computing expert? Stick to the experts on this one, at least until

your dealer is selling a cloud-based system.

What would I do with my broom closet?

Most practices were not designed to incorporate a server. As a result,

you’ll find the server in the strangest places, like the broom closet.

Cloud computing does not require a server. So think of the additional

space you’ll have to store more brooms.

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I need to have my data in my office.

If you won’t put your money in the bank, then you probably won’t put your

data on the cloud. This is actually an emotional response rather than a log-

ical one. Why? Because actually your data is safer on the cloud than it is

sitting on your server in the broom closet (which might be crashing regu-

larly). Your practice is more susceptible to theft, fire or natural disaster than

the cloud. When you consider the amount of security, professional man-

agement, backup and redundancy in use by the cloud, the typical practice

can’t afford to replicate it.

I don’t want to hurt my IT pro.

Typically, cloud computing requires less attention and maintenance at the

hands of a capable IT pro. A good IT pro will help you move to the cloud

by making sure your connectivity and other processes are reliable and stable.

Cloud computing does not require expensive servers, monster hardware, and

hours and hours of continual tweaking and configuration.

Al Gore didn’t think of everything.

You might not agree with his politics and his claim to the Internet. But one

thing’s for sure: Al was smart to claim the cloud as his own.

The Internet hasn’t come to my community.

With a little research and asking around you’ll quickly discover that there

might be several Internet service providers in your community that you

didn’t know about. Also look into satellite-based Internet access.

I don’t want my staff Facebooking all day.

How your staff utilizes the cloud is a valid concern, but it is more of a staff

management challenge than a reason for not moving to the cloud.

I don’t want to get a computer virus.

Your computers can stay quite healthy if you use anti-virus software, keep your

anti-virus software updated and make sure you and your staff stay clear of

strange messages from Nigeria and Russia. Your IT guy can help, too.

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