Join the Dark (Insurance) Side, or not?

Those who know me, know that I’ve been “insurance-free” for my whole career.  My practice has been truly FFS (fee for service) for its entire history.  I can tell you, that it has NOT been easy.  But, when I observed the struggles of my insurance-based colleagues, it hasn’t been easy for them, either. 

My friends deal with the vagaries of deeply discounted fees, rejected claims, lost claims, delayed payments, denied payments, down-coding, and demanding patients who expect them to know the intricacies of dozens or hundreds of plans, and so on.

My challenge has been to attract patients who choose to come to my office because of the level of the service we provide rather than where their “insurance booklet” tells them to go.

Maybe I’m an idiot?

But, times have been tough.  I have a lot of empty chair time.  While my goal has never been to simply “be busy,” it’s natural to get worried when things are slow.  And, as time has gone on, it seems people (patients) care less and less about quality of service and more about low cost and “does my insurance cover this?”  There have been times where I doubt myself and think, “maybe I’m an idiot and should join some plans?”

OK, maybe I should look into it?

Last month I decided to at least look into it.  I figured I’d at least get some information from one or two insurance companies about their PPOs.  I started with Cigna.  I had my office manager give them a call and ask for some information to be emailed to me.  They promptly accommodated that request and emailed me a fee schedule. 

I exported my fee schedule from my practice management software into an Excel spreadsheet.  Then I took Cigna’s fee schedule home with me and had my wife dictate the fees to every single code to me, as I input them into another column in the spreadsheet.  I then created another column with a formula to calculate the percentage discount for each fee. 

You can click on the spreadsheet image below Continue reading

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Posted in Practice Management | Tagged , , , | 24 Comments

What’s Wrong With This Ad?

My chairside assistant sent this ad to me (from her Facebook feed).  It’s a local dentist. 

What is the appeal to viewers / prospective patients here?  Put yourself in their shoes, so to speak (you know nothing about dentistry). 

“What am I looking at?   Are those teeth he’s holding?  With his bare hands?  What’s that thing with the bolts in it?   What is ‘all on four’?  Is it only four teeth?  Where’s the smile promised by the ad?”

What is the benefit being presented here?   Who would want this service and why?  Which questions are being answered by this ad? 

It reminded me of another blog I wrote:  Don’t Show Them How We Make the Sausage!

But, it should also remind us that our marketing should answer prospective patients’ questions… in lay terms.  

  • Will my smile look good? 
  • Feel good? 
  • Last a long time? 
  • Can I eat anything with them? 
  • Do they stay in or come out?
  • How long will they last?

It’s akin to a plastic surgeon using this photo to advertise breast augmentation:

What do you think is wrong with this ad?  Comment below!

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Posted in Marketing | Tagged , , , , , | 5 Comments

Talk with and listen to your patients! You never know where the conversation will lead.

A short story for today’s blog:

Today a patient came in for his recall visit. He’s relatively new to the practice… maybe a year. Super-nice guy – 27 years old. We did some routine restorative treatment for him.

He has a history of orthodontic treatment as a kid… and left with a significant anterior open bite. He and his parents were told that was as good as it could be.

In occlusion!

Today, the patient asked me about bleaching his teeth.  He’s got a lot of decalcifications typical with ortho patients whose hygiene wasn’t so great with the appliances on.  That led to questions about porcelain veneers. Continue reading Digiprove sealCopyright protected by Digiprove © 2019 The Dental Warrior®

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Another Immediate Implant Provisional Case

It’s funny how things come in cycles / clusters. Immediate implant provisionals seem to be my “thing,” lately.

I enjoy the challenge, and each case is a bit different.  So, it seems I’m inventing new techniques as I go with each case.

Today’s case is a new patient.  She moved down, mid-treatment, from “up north.”  Her periodontist up north had placed an implant in site #9.  Apparently, #10 had been grafted to prepare for a future implant.   In the mean time, she has been wearing an Essix retainer as a temporary.

Her periodontist up north referred her to a periodontist here, who happened to be “my periodontist.”  And, then my perio referred her to me.  The plan was for my perio, Dr. Gornstein, to uncover implant #9 and place implant #10.  Then I would place immediate provisional crowns on both.

I started with an exam and study models.  I sent the study model for a wax-up of #’s 9 and 10.

Patient presentation pre-operatively.  She also requested replacement of crown #11.

Instead of getting a wax-up back, I got what appears to be a printed model and a putty matrix (I didn’t request the matrix – usually make’em myself, but OK).

Not bad… but, #9 and 10 are longish. I can correct intra-orally.

Putty matrix from lab.

The appointments were set, and the patient would come directly to my office from the perio.

Implant #10 added by my local periodontist.

This is how the patient presented at my office immediately post-surgery.  The periodontist provided the “PEEK” temporary abutments.

Occlusal view immediately post-surgery.

As I initially examined the surgical result, I didn’t think I’d need to reduce the temp (PEEK) abutments, but I wasn’t sure.  The putty matrix is opaque, so with that, I could only “feel” if there was any interference.  But, I wouldn’t be able to see if there was adequate clearance to avoid “show-through” of the abutments in the provisionals.

Then it occurred to me Continue reading Digiprove sealCopyright protected by Digiprove © 2019 The Dental Warrior®

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Even Office Staff Need TLD (Tender-Loving-Dentistry)

Yesterday, when I arrived at the office, my office manager told me that she felt tooth #7 “crack” and now it’s loose.  At the end of the day, I took a look.  I was able to remove the crown / post with my fingers.  And, then I saw this:

Can’t have this smile greeting patients at the office!

There was no way I could recement the crown, even temporarily.  It was about 4pm, so we made a quick call to our periodontist.  He could fit her in first thing in the morning (today – my office is closed on Fridays).

The periodontist was able to remove the tooth and place an implant.  My assistant and I met Jo-Ann at the office at about 10am.  The periodontist’s office is right down the street from mine.

Courtesy of Dr. Russell Gornstein, periodontist.

Here’s what we did: Continue reading Digiprove sealCopyright protected by Digiprove © 2019 The Dental Warrior®

Posted in Case Presentation, Clinical Technique, What Happened Today | Tagged , | 4 Comments

Using Dental Memes to Educate Patients on Social Media

This post will be very short!  Earlier today, a dentist friend posted a dental meme on Facebook, designed to educate patients about the effects of the progression of decay.  I saw it and thought, “That’s pretty good.  I like it.”

My friend’s meme.  To save a copy of this, click the image.  It will open in a new window.  Then right-click and “Save Image As.”

But, then I thought about a different version that might resonate better with the lay public (our patients).

My first modified version.

Then, moments ago, I updated it to this:

I think it helps to include the related procedures.  If you want a copy of this  image:  Click on the image to open in a new window.  Right click and then “Save Image As.”

What do you think?  I posted this on a big Facebook dental group, and it went “viral” (in the dental world).  Within hours, I started to see it pop up on dentists’ practice Facebook pages and in other dental forums.  Feel free to steal this one, if you find it useful.Digiprove sealCopyright protected by Digiprove © 2019 The Dental Warrior®

Posted in Marketing, Practice Management, Tips & Tricks | Tagged | 5 Comments

Strive for Perfection. Be Happy with “Darned Good.”

Dentistry is demanding in many ways.  It’s physically demanding.  It’s mentally demanding.  Dentists have to wear a lot of hats.  We are the primary producer in a business.  We are the doctor.  We are the manager.  We are the CEO, and we change light bulbs.

Never perfect!

When it comes to the actual dentistry, many of us can be perfectionists and our own worst critics.  I think that stems from the “beatings” we took in dental school.  I remember being told to change the pulpal floor of my first Class 1 prep by a QUARTER-MILLIMETER.  I thought the instructor was full of shit (well… most of them WERE!).  But, now a quarter-millimeter is a “mile” in my eyes.

Restoring anterior teeth is probably the most demanding procedure we do.  There is a LOT riding on the result… whether it’s one tooth or all of them.  The anterior teeth “enter the room first,” so to speak.  If something isn’t right, it stands out… big time.  The anterior teeth are important socially and psychologically for the patient.  They’re important, functionally, with occlusion and eating.  They’re even important in speech.

Here’s an example of an anterior restoration gone wrong (at another office).  I presented this case (a new patient consultation) in my blog about “Putting Out Fires.” You can click on the image to see that article.

Mission Critical!

So, when a patient comes in with a broken upper central or lateral incisor, it’s a BIG deal.  When that patient is an 8 year old girl, it’s critical!  It’s critical to her AND her parents.

Last Friday, I got a text from a local colleague.  A friend’s 8 y.o. daughter fell face-first on a tile floor and fractured both upper central incisors.  My colleague is an extraordinarily-gifted dentist, but he doesn’t see children.  So, he referred the family to me.  There was no pulpal exposure (by her dad’s estimation), so we scheduled her for Monday.

This is the photo, Dad sent by text.

On Monday morning, Dad and 8 y.o. daughter came to the office.  Continue reading Digiprove sealCopyright protected by Digiprove © 2019 The Dental Warrior®

Posted in Case Presentation, What Happened Today | Tagged , | 4 Comments

OnTarget Shot Group Calculator Software – a shooter’s review

I thought I’d do a quick review of a software program I’ve been using to analyze my precision rifle target groups.  It’s called OnTarget.”  If you want to skip the “intro” or “review” of what shot group size means and want to get right to the OnTarget shot group calculator software review and demonstration, click here (or scroll down).

How am I doin’?

Click on image for full-size view. This was a 300 yard target with 20 shots.  Red bullseye is 3-inches.

A competition or precision target shooter is always interested in measuring his or her performance.  Precision shooters are all about the… well… precision (and accuracy) of his shots.  We take a “group” of shots and measure them.   The tighter the group, the better.  A tight group means the shooter (and the gear) are CONSISTENT.

The size of the group is dependent on a number of factors, including the aforementioned consistency of the shooter and gear (rifle, optics, ammunition, etc.).  Other factors include the distance from the target and environmental factors, such as:  wind, temperature, barometric pressure, altitude, and even humidity.

The BIGGEST variable is the SHOOTER, of course.  😳

But, ultimately, small groups is what jazzes precision shooters.  It’s the same satisfaction as a dentist gets from smooth, sealed crown margins!  😎   Precision shooting is right in the “wheelhouse” of dentists!  It involves science (and math) and a bit of art!

A “primer” on group measurement…

Shot group size is traditionally expressed as an angle.  The shot group is measured in inches (or metric) on the target and then converted into an angular format (the angle formed by two imaginary lines from the borders of the group extending back to the muzzle at the shooting line).  So, it’s converted from inches to “MOA” (minute of angle).  You may recall that there are 360-degrees in a circle.  A “minute of angle” is 1/60th of a degree.  There are 60 “minutes” in 1 degree.  Roughly, a one-inch spread at 100 yards equals one minute of angle.  More precisely, 1.047-inches at 100 yards equals 1-MOA.  Since it’s an angle, the linear spread of the angle gets proportionally bigger as distance increases.  At 200 yards, a 1-MOA group is roughly 2-inches across.  At 300 yards, it’s roughly 3-inches across.  So, a 1-inch group at 200 yards would be roughly 1/2-MOA.  Make sense?

This was the only open-source image I could find online.  The measurements are metric (meters and millimeters), but the concept is the same, of course.  The same angle (1-MOA or 1/60th of a degree) projects a larger spot or “group” as the distance increases.  1-MOA at 100 meters (109.4 yards) would be a 29.1-mm (1.2-inches) group.  At 200 meters (218.7 yards) , it’s a 58.2-mm (2.3-inches) group.  Got it?

Perhaps not coincidentally, a 1-MOA shot group is considered the STARTING of “acceptable” precision performance.  Precision shooters don’t really start to get excited until Continue reading Digiprove sealCopyright protected by Digiprove © 2019 The Dental Warrior®

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Provisionalization of Immediate Implants With Screw-Retained Crowns

It’s been a while since I’ve written, and even longer since I posted a technique / case presentation article.

#12 is “FUBAR.” Options were to do a 4-unit bridge or place two implants.

One of my long-time patients had a 3-unit bridge (#12 – 13 – 14) fail due to unrestorable recurrent caries under one of the abutments (#12).  He was given the option of an even bigger fixed bridge or two implants and crowns.  He decided to go with implants.

I made a pre-op study model, so I could make a Sil-Tec putty matrix.  He was referred to a periodontist to extract #12 and section the bridge, saving the existing crown on #14.

The implants were placed immediately, and the patient came straight from the periodontist to my office.  The periodontist had placed two temporary abutments (plastic “PEEK” abutments from Nobel Biocare) and left them long.

I took a piece of wide Teflon tape Continue reading Digiprove sealCopyright protected by Digiprove © 2019 The Dental Warrior®

Posted in Case Presentation, Clinical Technique, Tips & Tricks | Tagged , , | 11 Comments

I’m NOT “Lovin’ it.” McDentists Strike Again.

It’s been a while since I’ve written!  Busy with life and uninspired.

Today I saw an emergency patient for a dentist-friend who is out of town.  She’s a new patient for my friend.  A veneer (on #9) that was done in another office (before my friend) just two months ago, came out.  The office that placed it was what I call a “McDentist”…. a local multi-location corporate office that turns over staff regularly, including the dentists.  But, hey…. these McDentists take any and all dental plans.  Their waiting rooms are full, so “they must be good,” right

So, they’re always busy, churning patients through the chairs. Quality and attention to detail?  Bah!  Churn and burn, baby!

It tooth #9 (a single central veneer case), and she’s leaving on an overseas trip Sunday.

Houston, we have a problem.

Here’s the thing…  The veneer was done just two months ago (again, not by my friend and colleague).  The FIRST time it came out was the DAY AFTER it was placed.  Something is VERY wrong, if that happens.  She went back.  They recemented it.  It came out again.  She went back.  Rinse and repeat.  She finally gave up and called my friend (who has seen her husband as a patient for quite some time).

This was the FIFTH time it came out.  Continue reading

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Posted in Editorial, What Happened Today | Tagged , , , | 15 Comments