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Some Suggestions to Insure Case Presentation Success.

February 21, 2018

Filed under: Uncategorized — Mayer A. Levitt, DMD @ 2:01 am

A week ago I wrote about preparing a patient for a second visit consultation. At that second visit, here are some tips to keep in mind.

1. Treatment presentation is done in a dental operatory and not in a separate consultation room. The patient is seated in the dental chair in the upright position- not lying down in what I would call a defenseless position. Eye to eye contact with the doctor sitting in his/her chair. I like the treatment room as opposed to a consult room because just in case you need to confirm something clinically, you can tilt the patient back to see something – and then return the patient to the upright position for your communication.

2. Your job prior to the consult visit is to design and price out three treatment options – the total cost along with the estimated insurance coverage if applicable for all three choices.

3. Don’t show the patient any x-rays. They have absolutely no idea what they are looking at. It took you two years of dental school to be able to interpret films.

4. Don’t draw squiggly lines on the bracket table cover. I don’t know why so many doctors do this, but it is a very ineffective way to describe or illustrate a procedure.

5. Instead, use photographs of perfectly shaded posterior and anterior crowns along with photographs of poor quality color crowns with gold margins showing in order to illustrate what “your” crowns will look like. When you talk about crowns, patients might have a negative perception based on what they have seen in other peoples mouths.

6. I love using an iPad to show clinical examples. The color is amazing and the experience is very interactive. (link to blog post)

7. Let the patient hold the study casts. Obviously the casts should be properly trimmed and cleaned and polished.

8. Use language that a 10 year old can understand. Do not use clinical words like margins, occlusion, etc. Talk about “cavities” and not “decay”. From the time kids are 3 years old, they know that cavities are a bad thing.

9. Present the three options for treatment. The sequence is to present the best option first – but we don’t call it the best. We say “one way, a second way and a third way.”

Now listen to how I present the three treatment options for a typical scenario of a precipitating event. Tooth #30 had a large amalgam restoration. The precipitating event was that the lingual cusp sheared off. Tooth #31 and tooth #29 are also restored with large amalgam restorations that are suspect but still intact. The patient qualifies for this 2nd visit because there is the possibility or potential to perform 2 or more indirect restorations in the quadrant where the precipitating event has occurred.

click here to listen

In my next blog post I will teach you how to close this case effectively.

Second Visit Treatment Consultations for a Precipitating Event

February 15, 2018

Filed under: Uncategorized — Mayer A. Levitt, DMD @ 3:27 am

There are two kinds of precipitating events that are seen in your practice all the time. The first would be classified as an emergency – a patient calls because something is broken or is painful. The second would be a new or existing patient seen in the Hygiene room and the examination reveals decay or a periodontal problem. In both of these cases, treatment is required. There are negative and significant consequences to not performing treatment. Something must be done.

If the problem is isolated to a single tooth, the diagnosis is made when you see the patient, and the patient will be appointed for treatment. Usually there would be no need for a second visit to present treatment choices. BUT – If there is the possibility or potential for doing two or more indirect restorations within the quadrant or the arch where the precipitating event occurs – I recommend a no charge second visit for the patient to return to the office so that you have the opportunity to present choices. In dollars, that would be a minimum of usually $2500-$3000.

In preparation for that visit, take some diagnostic study casts, necessary x-rays and a few digital pictures – all at no charge – to help you prepare for the treatment choices you offer. You say to the patient “ Mrs. Jones – I want you to come back next week so that I can discuss your treatment options with you.” Now to the patient who has that broken tooth, or decay under an existing filling, they usually say “But Doctor – what are we going to talk about? I need you to fix my tooth.” DON’T say that we are going to discuss fixing those two other heavily restored teeth that are right next to the one that is broken. That NEVER works! And it does not work because the patient is distracted and concerned about only the tooth that is damaged. So they say “no doctor – let’s just fix the one that is broken.We can worry about those others later.”  Because you try to present treatment choices at this initial visit, you fail and you end up being a one tooth at a time dentist – over and over again.

Instead, your answer to the patient when asked “what are we going to talk about”  should be  “you know, I am not sure. I want to study these x-rays and models and photographs to see why this happened – and when you come back, I will know your case by heart.” Those are the magic words! I learned them 25 years ago from the great Dr. Paul Homoly who was masterful at getting patients to say yes to treatment. I promise you those words are just as effective today as they were back then.

The only thing you do at this initial visit is palliative treatment – smooth a rough edge or put in a temporary sedative filling material. Take your photographs and study casts and re-appoint the patient for a 25 to 30 minute visit. Next week, I plan to send you a recording of a typical three choices of treatment presentation for a precipitating event. When you hear this, I hope you will be able to see the many positives of presenting treatment in this fashion.

Increasing Second Visit Treatment Consultations – Strategy #5 for Successful Dental Practices to Grow and Profit in 2018

January 31, 2018

Filed under: Uncategorized — Mayer A. Levitt, DMD @ 3:35 am

People like choices. But people like to buy – they don’t like to be sold. You need to understand this concept when presenting dental treatment.  Too often I see clinicians trying to present complex  treatment at a continuing care examination in the Hygiene room or when a patient is seen for an emergency visit.  We define treatment as being accepted when the patient has scheduled the first visit and has agreed to a payment option. Using this criteria, the results are poor – for many reasons:

• It takes time to analyze, price out, and plan out multiple treatment plans – how could you possibly do that effectively in five or six minutes? You can’t – and when you try, you mess up your schedule, the hygiene schedule,  and you end up frustrated when the patient doesn’t agree or say okay.

• You do not have adequate time to understand or estimate dental insurance benefits that might be available and that might apply or not apply to treatment recommendations.

• You do not have time to review photographs or x-rays or diagnostic casts.

• If you do try to present a fee, the patient may often be overwhelmed with the costs.

So why do doctors act in this fashion?

1. Anxiety over filling an open time slot for treatment rather than investing in a “non-productive” half hour for discussion of treatment options.

2. Trying to strike while the iron is hot. Get the patient appointed quickly for fear that the patient might change his or her mind.

3. Dollar per hour production goals. Especially for associate doctors who are paid as a percentage of adjusted production or collections. When you invite a patient back for a 30 minute visit to explain treatment options, it is usually a no charge visit. Failure to recognize the value of time spent in this fashion is an incredibly penny wise/pound foolish approach.

All second visit treatment consultations are not equal. There are three specific situations and they all need to be handled differently.

1. Emergency treatment when palliative procedures were administered to relieve pain or discomfort.

2. Cosmetic treatments which most of the time are elective procedures.

3. New patient initial exams – either as part of a Hygiene appointment or as a first visit with a doctor.

Over the next few weeks,  I will explain the strategies and details involved for all three situations. In my experience, the absolute best way to gain acceptance for quadrant and arch dentistry is by the utilization of second visit consultations. By definition, more acceptance of those treatment plans will increase growth and profitability in your practice.



Eliminate the Leadership Vacuum – Strategy #4 to Increase Growth and Profitability in 2018

January 24, 2018

Filed under: Uncategorized — Mayer A. Levitt, DMD @ 3:08 am

In my daily telephone calls, physical meetings, or email correspondence, I hear a lot of complaining – both from staff members who are upset with management and doctors who are disappointed with staff behavior. Most of the time these complaints are the result of unrealistic assumptions or promises made but not honored. On further review, the issues can almost always be attributed to inadequate or poor communication between the doctor and the staff. And the larger the practice, the bigger the problem.

A Seth Godin post from a number of years ago has always resonated with me.” If you want to build a vibrant organization, the simple rule is: the rules apply to people in power before they are applied to those without. People might hear what you say, but they always remember what you do.” So understanding that the buck stops here, and that you as the doctor bear the ultimate responsibility for creating a wonderful workplace, what can you do to change the culture in your practice? Or more simply stated, how can you be a more influential and inspirational leader?

• Show up on time to begin the day. The first lesson of accountability is to lead by example. If you are continuously late, it shows disrespect for your patients and diminishes your credibility.

• Show empathy and generosity to your patient population. Patients don’t care how much you know until they know how much you care. We certainly want our staff to act in the same manner.

• Resist the urge to micromanage. Delegate to the extreme. Assign specific tasks and hold people responsible for their actions and the results. Allow people to fail and learn from their mistakes. You can’t do it all yourself – it is way too complex and way too much work.

• Avoid favoritism. When you consistently tolerate inferior performance with no repercussions, it makes you look weak and ineffective.

• Communicate your vision. Compliment and coach every day. Your staff needs to know that you appreciate them. Don’t assume that they know. Assumption is the lowest form of human behavior.

• Allow your staff to be more fully vested in the success of the practice. Try to include them in some of the management decisions in the office. Many times the best source of new ideas come from our staffs.

Above all else, you want to try to be a role model to your staff about how to live an exemplary life outside of the dental practice. I wrote a blog post about seven years ago that talks about imagining life as a game in which you are juggling five balls. The balls are work, family, health, friends, and integrity. You are keeping all of them in the air at the same time. One day you come to understand that work is a rubber ball – if you drop it, it will bounce back. But the other four balls are made of glass, and if you drop any one of these, it will be irrevocably scuffed or even shattered. Once you understand the lesson of the five balls, you will have the beginning of balance in your life. What a wonderful and positive message to share with your staff. That is true leadership.

This is the fourth in a series of five posts about how to create growth and profitability in successful dental practices in 2018. Final post – the need for increasing second visit treatment plan consultation appointments.



Consistent and Creative Internal Marketing – Strategy #3 to Increase Growth and Profitability in 2018

January 17, 2018

Filed under: Uncategorized — Mayer A. Levitt, DMD @ 3:10 am

A key component of growth for successful practices is the acquisition of new patients – patients hopefully who appreciate good clinical dentistry and are happy and willing to pay for it.

This result is not going to happen by joining every PPO plan. It is not going to happen by offering free exams and free consultations to every bargain hunter. It is not going to happen by offering Groupon type programs- those kinds of approaches were an unmitigated disaster. And it is not going to happen by trying to compete on price – someone will always be willing to charge less.

Over the years, I have found the best source of quality new patients is referrals from your existing patient base. Word-of-mouth advertising is by far the most positive and effective and inexpensive way to market your practice. So how do you create the WOW experience that compels people to rave about you?

• An extraordinary customer service experience at every level with every interaction with every person in the office. This is easier said than done. The effort to achieve this needs to be continuous and consistent. Something that always gets people talking at cocktail parties is when they have received post treatment telephone calls by doctors and hygienists following difficult procedures.

• Rewarding patients for referrals. The greatest management principle in the world says that if you reward good behavior, you will get more of that behavior. So you certainly want to thank patients in meaningful and creative ways for the referrals of friends and family.

• Informing patients of how much you care.  Every day we hear through the patient grapevine about someone in the practice who has suffered a tragedy – a parent, spouse or relative dying; someone who may be gravely ill; someone who perhaps lost a job. We also hear wonderful success stories – kids getting into the college of their choice, job promotions, or new business achievements. The magic of a short personalized handwritten note from the DOCTOR will bring a smile to the face of your patient. In the mind of the public, such behavior from a busy doctor’s office is unheard of. You will forever be marked “special”.

There is an old saying that relates to fee sensitivity. “Why pay the difference if you can’t tell the difference?”  Accept the challenge to make it very obvious to your patients that your office is indeed different. Take every opportunity to let your patients know that you care.

It is impossible in a 500 word post to give all of the details and all of the specifics and innuendos of how to implement an effective Internal Marketing program. Please contact me if you are seeking more information.

This is the third in a series of five posts about how to create growth and profitability in successful dental practices in 2018. Next post –improving leadership skills.

Staying on Time – Strategy #2 to Increase Growth and Profitability in 2018

January 10, 2018

Filed under: Uncategorized — Mayer A. Levitt, DMD @ 3:18 am

I firmly believe that the doctor is ultimately responsible for staying on time. No matter how perfectly crafted a schedule might be at the start of a day, it can all go to hell in a handbag if the doctor does not stick with the program. At the core, it becomes simply an issue of respect – an agreement and an understanding that the patient’s time and the patient’s life is just as important as yours. And I do find that people/patients will respect your time in direct proportion to the way you respect theirs. It has to become a major part of the DNA of the practice–we will stay on time!

So what can a doctor do to consistently maintain an on –time schedule?

• Do not perform definitive therapy for emergency patients. While I strongly advocate that emergencies should be seen on the day of the call, the main goal should be to relieve pain or anxiety. Diagnose the problem. Get them comfortable, of course. And then reschedule for definitive therapy.

• Resist the temptation to present elaborate treatment plans in the hygiene room. This creates delays in both the hygiene schedule and the doctor schedule.

• Stop taking personal calls during business hours –from your stockbroker or a golf buddy. Totally unacceptable. And please don’t think that patients in treatment rooms are not aware of what is going on. When some-one is reclined in the dental chair and hears the doctor gabbing instead of paying attention to them, it is very aggravating.

• Do not agree to or allow a treatment schedule that you know is unsustainable or unrealistic. I could spend six hours discussing proper scheduling, but this is obviously not the place to do that. However the two most common scheduling errors that I observe are related to unbridled optimism: an inadequate time allowance for a known procedure, and an inadequate time allowance for a patient put in the schedule for an unknown procedure like a toothache or broken filling. Both of these situations almost guarantee that the doctor will fall behind.

• Be aware of the implications of bad judgment calls. This typically happens when a scheduled procedure is not progressing well. Maybe the patient was late, maybe an impression has to be repeated because the tissue was bleeding. There are a million examples. It’s important to know when to punt. Don’t mess up an entire morning or afternoon by stubborn determination to finish a procedure.

Insist on a morning huddle. I find that practices that consistently use a huddle significantly increase productivity, reduce stress, and are way better at staying on time throughout the day.

There will be, of course, situations where despite your best efforts, you get behind schedule. If you can anticipate this, it is always a good idea to call a patient to let them know you are running late. This beats their sitting in your reception room waiting – and waiting – staring at the front desk person and looking at their watch. When you keep someone waiting more than fifteen minutes, they start mentally counting up all your faults! In this day and age where new patient flow is so key to success, be aware that it is unlikely that a patient will feel compelled to refer friends and family to your office when that patient is kept waiting. “Why further compound my problem and make this doctor even busier when he doesn’t even have time to see me!”

Above all else, take the stress out of your life. Stay on time. Everyone will be much happier.

This is the second of five posts on how successful dental practices can increase their growth and profitability in 2018. Next week’s topic – consistent Internal Marketing.




Overcoming Front Desk Overload – Strategy #One to Increase Growth and Profitability in 2018

January 3, 2018

Filed under: Uncategorized — Mayer A. Levitt, DMD @ 1:56 am

The front desk of a dental practice, as I like to say, could often be described as the busiest place on the planet. Answering the telephone, scheduling appointments, changing appointments, making financial arrangements, treatment plan coordination, insurance coordination, billing, collection calls, payroll, etc. The list of administrative responsibilities goes on and on and it is virtually endless. There are constant interruptions. There are always tasks to do with not enough hours in the work day to finish them. And that list is only for daily responsibilities. There is also a need to set aside blocks of time for specific projects like HR management, HIPAA and OSHA compliance, marketing initiatives, and website maintenance.

Yet while all of these tasks need to be accomplished, they  must always be sublimated or set aside in order to consistently be able to offer an exquisite customer service experience, where every patient feels special and important and recognized. That is the constant dilemma – how can you organize your time to be able to accomplish your tasks but still give the feeling to every patient that they have your undivided attention?

There is no “one size fits all” solution. Depending on the size of the practice, the staffing requirements will be completely different. The challenges of the smaller office can often be even greater than the larger one. In my opinion, for every practice, there needs to be a conscious attempt to upgrade systems that will allow the front desk to operate more efficiently. These include but are not limited to on-line appointment scheduling, appointment confirmation, on-line payments, daily deposits from the comfort of your office, and electronic tablets to input patient data.

There are other behavioral changes that do not need new technology that can be a huge help to your administrative staff.

• Practice management software training at least once per year.

• Support from clinical staff – especially Hygiene – to schedule future appointments from the treatment room.

• The doctor understanding the work flow at the front and not requesting “stuff” to be done unless it is urgent or really important.

• Cross training for front desk personnel  in order to mitigate the impact of vacations and sick days.

I hope that these suggestions will stimulate you to develop an action plan to retool the workings of your front desk. This is not an overnight fix. This will take time and creativity. Schedule a number of meetings with your staff this month. Listen to their input. Get consensus. And then start to create some momentum. Continuing to do what you’ve always done and expecting  better results – I don’t think so! It’s a New Year – how about a New You.

This is the first of five posts on how successful dental practices can increase their growth and profitability in 2018. Next week’s topic  – staying on time.

Important New Information About Google

December 20, 2017

Filed under: Uncategorized — Mayer A. Levitt, DMD @ 3:25 am

Starting in October 2017, Google Chrome will begin showing large red colored “NOT SECURE” warnings when users try to complete a form on a website that doesn’t have secure SSL encryption set up. SSL stands for Secure Sockets Layer. It is used for establishing a secure link between a browser (like Chrome) and a web server that hosts a website like jodena.com. SSL is an industry standard used by more and more websites these days to protect online transactions with visitors. The insecure designation will show up in some way for all browsers but at the moment will be most visible in Chrome.

An SSL certificate can be added to your website by your webmaster or hosting company that verifies authenticity of a website and shows up as a “locked” or secure site once installed. Secure sites have https in front of the domain rather than http – and the S is a big deal.

SSL is a ranking factor. Research now shows that https sites typically rank higher than their http counterparts. This means that if two websites are equally relevant in all other factors, the https or secure site will rank better in many cases. SSL also leads to increased trust with visitors to your site. Seeing that prominent NOT SECURE next to your website address is not a real confidence booster to patients visiting your site for the first time. And SSL is safer for your visitors as https protects user data and ensures that you are connecting to an authentic site and not a fake one.

My site is now secure. You can see the picture of the lock next to my url. And if you click on the url you can see that it is now https. A good certificate for a dental website is not expensive – probably shouldn’t cost you more than $10 per month.

One last point – and a very important one. There is a significant amount of work involved to make this changeover for sites that are optimized for search. You can’t simply add the SSL lock without suffering catastrophic failure of top search results. Http to https is like changing your domain. You must create a roadmap (.htaccess file) that tells search engines that everything that used to be http is now https. If you forget this step you will lose rank big time. So you need to hire a professional to do this for you. I would heartily endorse and recommend my friends at TNT Dental. You can give Tim Healy a call at 214-680-1270.

Year End Pressures

December 4, 2017

Filed under: Uncategorized — Mayer A. Levitt, DMD @ 9:23 am

In the blink of an eye, the New Year will be here. December is usually a very very busy month. Patients trying to maximize their yearly insurance benefits makes for a hectic schedule. A good problem to have, but one that creates an inordinate amount of pressure on everyone. And the holidays in general, with shopping, and parties, and family gatherings and kids out of school, are quite stressful. Certainly not the best environment to be able to sit down and take the time to carefully plan for 2018 and develop strategies on how to improve the performance of your dental practice.

From my vantage point as a coach working with many successful dental practices seeking ways to become more successful, I get to see first hand on a daily basis the good and the bad, the elation and the frustration, what works well and what doesn’t. Here is a list of five common problems – in no particular order – that I repeatedly observe. Finding a fix will go a long way towards creating growth and increasing your profitability.

• Front desk overload.

• Inability to consistently stay on time.

• Inconsistent and/or schizophrenic Internal Marketing.

• Lack of leadership and poor communication with staff by the doctor.

• Not enough second visit treatment plan consultation appointments.

My plan is to write a weekly blog post – rather than my normal every other week – and attempt to address each of these five topics with as much detail as possible. Hopefully these posts and the suggestions they contain will be good source material for some January staff meetings.

So go ahead and enjoy this Holiday Season, but please be prepared to set aside the necessary time as 2018 unfolds  to introduce some system changes in your office that will give you the maximum opportunity to make  2018 your best year ever.



A Thanksgiving Message

November 20, 2017

Filed under: Uncategorized — Mayer A. Levitt, DMD @ 9:25 am

Thanksgiving is far and away my best day of the year. Family, friends, great food and drink, and plenty of football. What could be better? The older I get, the more appreciative I am for all of my many blessings.

We, as most families have, for many years, continued a tradition of having everyone around the table articulate what they are most thankful for. It was always interesting to hear the comments, especially from the kids. “I am grateful for my family even though I sometimes fight with my sister”. “I am grateful that we can all be here today together to celebrate.” “I am grateful that I don’t have to go to school until Monday!”

How times have changed. Now we are grateful for:

• A month without a mass shooting.

• A week without an act of terrorism being perpetrated on innocent civilians.

• A day without political partisanship and the spewings of the extremists on both the left and the right.

• A day without another exposé of sexual harassment that is so demeaning.

• A day without the politicization of sports.

• A day when I can actually get back to being able to believe as truth what I read in the newspaper or see on TV.

Next Thursday my plan is to take a complete break from email and social media. I will turn off the computer and my iPhone. I will decompress and enjoy the day and the company.

America is still the greatest country on Earth. The eternal optimist in me believes that normalcy and respect and goodness to others will return. And for that we will happily give thanks.

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