Blog Archives

The Magic of Apple Employee Training

We often hear about how brilliant Steve Jobs was, and what a good job Apple does of marketing its products.  What I want to talk about is their employee training in retail stores, and how it can be applied to any small service business.  (And if you don’t think you’re in retail health care, take some time and read Chapter 3 of my book—it should convince you.)

As you may have noticed, Apple stores are the busiest stores in the mall.  For the statistic-minded, retail stores in malls average sales of $341 per square foot per year.  The top 20 retailers average $787.  Apple stores average $6,200!!  More than twice the next highest retailer, Tiffany & Co., which does $3,000 per square foot.*  And this is just what is sold in the Apple stores, not online.

So, now that I have your attention, here’s an acronym Apple uses in its employee training for the retail stores:

Approach customers with a warm, personalized greeting;

Probe politely to understand all the customer’s needs;

Present a solution for the customer to take home that day;

Listen for and resolve any issues or concerns;

End with a fond farewell and an invitation to return.

Do you see how these might apply to your practice?  I’m thinking they all do.  A warm, friendly greeting by everyone in the office who encounters the patient?  Check.  Probing politely to find out what their dental needs and desires are? Roger that.  Presenting a treatment solution that can be started and ideally completed that day?  Sounds ideal.  Listen for issues they may have, concerns about cost, treatment complexity, time involved, fears or misgivings they may have?  Pathway to success. And finally, ending with fond farewell AND an invitation to return or, better yet, an appointment already scheduled, and expressing how you’re looking forward to seeing them at that time.

In reality, it isn’t magic.  It’s just what we all want, and Apple is just smart enough to do it in a genuine and consistent way.

*Source: RetailSails Company Data 2012

The Junior Mints Principle

My wife is originally from Thailand, so when we visit there we bring a suitcase full of American items for her friends and family, such as Sonicare toothbrushes, Tide-to-Go, Doritos, and various other bizarre items.  My sister-in-law in particular loves Junior Mints, so we bring several boxes over, as they are not available in Bangkok.  One year, I decided to give her a real treat and brought her some expensive Ghiradelli Chocolates with mint, just so she could experience the next level of quality and flavor.  I gave them to her and she was polite and grateful.  The next year, before we went over, she told my wife, “Just bring Junior Mints this time.”

How often do we do that–automatically assume someone wants a first-class experience when their tastes don’t run that way?  It’s important to keep in mind that many patients don’t need premium-level dentistry. They don’t need a perfect smile.  Some of them have a smile that we can barely look at, but they don’t really care.  As long as they can chew their food, they’re fine.

And that has to be all right. Obviously you want to keep your patients informed on treatment that is going to preserve and protect their dentition, but not everyone wants veneers or cares how white their teeth are.  They aren’t going to die if they’re teeth aren’t perfect.  Often we try to impose our own sensibilities on other people, or believe that everyone wants the best of everything. One of the big mistakes people and businesses make in marketing is assuming that everyone is like them.  It’s almost never true. A whole lot of people are content with average, are comfortable with it, and maybe even prefer it.  They’re still going to need restorative dentistry as they age, but they need to know that you’re okay doing the minimum, not the maximum.

(As an aside, let me just say that your smile, and your team’s, should be PERFECT!)

Take the time to really listen to your patients. Find out what they want, make sure they always at least get what they need, and you’ll have a great practice serving a wide range of people.

Also, I believe Junior Mints outsells Ghiradelli Chocolate Mints by about 1000 to one.

Dental Blogs: Why and How

In a webinar that I did yesterday, I mentioned the increasing importance of blogging for a dental practice.  For those of you who don’t know much about blogs (you’re reading one now, so you have some idea!) the word is short for “weblogs”, which were created as a form of online journal, essentially with articles that are written, usually by one person, and archived and searchable for anyone who wants to read them.

You can also subscribe to blogs, which means you could get them sent to your email whenever they are published.  If you wanted to do this with my blog, you would click on the button to the upper right that says, appropriately enough, “FOLLOW BLOG VIA EMAIL”, and then fill in your email address.  Now, onto your blogging career.

First, the “Why”.  Most dentists would say to me, “Who the heck is going to read a dentist’s blog?”  The answer is, no one. Your patients most likely won’t ever read it. On rare occasions a potential new patient might read it. But this is who will always read it:  Google, Yahoo and Bing.  In other words, the search engines.   So what you are doing is providing relevant content for Google, etc., to associate with your website.  Google is out there on the internet all day long looking at everything, and inter-relating it so that when someone does a Google search they can present what they deem is the best possible result, based on hundreds of criteria that they use (but won’t tell us about.)  So your blog is one element in what I call “The Google Matrix”.

This consists of your website, your Facebook Page, your Twitter posts, your LinkedIn profile, your videos, and, perhaps most important, reviews that are written about your practice on Google, Yelp, Angie’s List or other review sites.  See my previous blog about these.

Assuming you have good content across this matrix, your website will then have strong SEO, or search engine optimization, which should make it appear on the first or second page of Google search results (or Yahoo or Bing).

This is why you want steady content going onto your blog on a regular basis.

Now, the How.

Creating a blog is remarkably easy.  Go to either Wordpress.org, or Blogger.com and download the software.  It is free to run a blog through these sites.  And they will also host the blog, so you don’t even have to deal with that.  Follow these simple steps:

1. Pick a design. (They call it a theme.) Doesn’t really matter what you pick, so choose what you like.

2. Come up with a name for your blog.  Something with “dental” or “dentistry” in it.

3. Fill in all the relevant information, especially your website. This is how the search engines are going to associate your blog with your website. Create settings that will allow you to automatically publish to Twitter and LinkedIn. This gives you fresh content on those sites.

4. Write your first blog and publish it.  Be sure to preview it to see how it looks.  And spell check it, I beg you.

5. Categorize and tag the blogs.  ALWAYS do this.  Google is looking for this to know what the blog is about.  It should always have “dentistry” and “dental” as categories and tags. The rest you can create and add based on what’s in the blog.

Your blogs should be short and sweet. Two paragraphs, two sentences apiece is plenty.  This is where you write about dentistry (as opposed to your Facebook page, which is where you personalize your practice.)  Write about procedures, technology, cases (no patient names), or whatever else you want.  Add a picture occasionally.  And a video.  Remember, you’re not trying to create a beautiful, comprehensive blog like the ones people read all the time, so don’t get perfectionist about it.  You are just feeding the matrix.

If you want to increase the relevance of your blog, figure out how to use hyperlinks (the words that appear in blue and allow you to click to go to another website.)  Also, list your favorite websites and blogs on your page.  But don’t expect blogging to magically jack up your SEO overnight.  It takes months.  And you need to be feeding the matrix at the other points as well to get the optimum result.

How Often?

I recommend blogging once a week.  Ideally this should be someone else’s job in the office, not the dentist’s.  And you can write a dozen blogs all in one sitting, and then schedule them to publish on specific dates. On WordPress, for example, as you draft the blog, you’ll see on the right where it says, “Publish immediately” and “Edit” next to it. When you click on edit you can choose the exact date and time you want each blog to publish.

Welcome to the blogosphere!

Further Thoughts on James Dwyer and Dental Insurance

Let’s start with what we know when it comes to dental insurance and patients.

First, the dental patient doesn’t really care if the dentist gets paid fairly or makes a different living. That’s the dentist’s problem, not theirs.

Second, dental insurance companies are out to make a profit.  And thus they benefit from under-utilization. Paying more for a treatment code, or for more patients being treated, doesn’t work. Neither does encouraging people to take care of their teeth.  All this either lowers profits or requires increased premiums. So what would seem to be the point of dental coverage––to get people to see a dentist and get treated––contradicts the business model it is managed through. But even when there is less utilization, these companies generally don’t lower premiums, but rather increase them every year.  That is, unless they do what Washington Dental Service did, which was cut payments to dentists so they could lower their premiums to businesses. These institutions are tax-exempt, but make no mistake, they are motivated by profit.  So dentists get to absorb the shock.

Third, for as long as I’ve worked in dentistry (since 1986), up until five years ago, the general trend, indeed the goal, was for dentists to gradually move their practices to full-fee-for-service, and not be a provider for any dental plan.  This came to a screeching halt in 2007, and has reversed itself continuously.  More and more practices are adding plans, for the simple reason that people are not spending money on their dental care like they used to.  The days when every month one or two patients would borrow against their home to do a full set of veneers or extensive implants are over.  Practices have had to adapt, accepting more plans, and in so doing have handed more power to the dental insurance companies.  And with this you get the arrogance exemplified in CEO James Dwyer’s remarks (see my previous blog on those, as well as Gary Takac’s call for Dwyer’s resignation.)

So the simple question is, do we want to go the way of general medicine, which is to say, let insurance companies call the tune?  For physicians, it is the insurance companies who determine the treatment, the fees and even the allowed medications.  If the doctor or the patient disagrees with that determination, then the patient has to pay out of his own pocket. And because 95% of physicians’ income comes from insurance, the average income for general physicians is now lower than that of general dentists. What’s more,  it is virtually impossible for a general physician to double or triple his income from the average level, while it is quite possible for most dentists to do so.  And everyone expects physicians’ income to continue to decline.  How’s that going to play out?

I think this problem needs attention right now, before control is fully surrendered to insurance companies, or before the government steps in to make sure that everyone in America has some sort of dental care, regardless of whether it provides a living income for a dentist who has a facility, leases, loans and employees to reckon with on a monthly basis.

And, as other people in this blog have mentioned, it’s not financially bearable for a dentist to drop the insurance provider when that company tries to cut their payments.  But in my mind that’s what your state dental society is for.  When Delta or any other company decides it’s time to do an across-the-board fee cut, then there ought to be an immediate call by the society for their entire constituency to drop that carrier the next month.  They don’t need everyone to comply; if 40% do, then the insurance company gets hit right where they care most–the profit end of their revenue.  It should be a swift, resounding and unequivocal response.  And my guess is after one or two states do it, and the results are proven, then an even greater number of dentists will join in the protest.  And the insurance companies will fall back into line.

Along with this response by the societies, there should also be a unified message sent out to each dentist’s patients as to why this is happening.  They should let all their patients know that the insurance company, in an effort to increase their profits, is paying less for the same services, and thus limiting care to the patients.  (In Washington, it was the insurance company who seized the opportunity, and communicated with the patients when a dentist stopped being a provider because of the fee cut, and recommended the patient move to a different dentist who accepted the plan, and even provided a list.  Outrageous behavior, unless of course you’re in business to make money, not provide dental care.)

This response by the society is only step one.  The next step is to take a hard look at how dental insurance is provided.  We live in a world where data can move instantaneously and simply between entities. Why do we even need a middle man to provide discounts on some dental services for a business’s employees?  In three months I could get five 20-year-olds to write a program that lets any business choose from a menu of services, calculate the premium, allow the employees to choose a dentist and get care, and subsequently the dental practice can file the claim and have the money in their account the next day.

Certainly there are regulations to follow, but does an enormous profit for an intermediary organization benefit anyone but that organization?  I don’t think so.  I say let them all work somewhere else where they don’t have a negative impact on the overall health of Americans.

One last point.  Dentistry in many ways is different from general medicine. There are millions of people in this country who will never be able to get high-end dentistry.  For example, we all know that implants are the ideal solution to missing teeth.  But this quite simply will never be insured, because eventually everyone will need them.  A quadruple bypass surgery is incredibly expensive, but not everyone is going to need one, so the cost gets spread over a thousand other people.  But as the population continues to live longer, most people are likely to lose some or most of their teeth. Either they can afford implants or they can wear dentures.  But it is not reasonable to imagine an insurance plan that provides virtually everyone with implants.  We need a wiser, more balanced solution that does not emulate health insurance.

Sometimes you can’t just modify business models.  They become antiquated, or fail to serve their original purpose, diverging from their mission to one that is more self-serving, (like Congress!) and we need to abandon them and start over.  Why not create a brilliant, modern solution that helps the greatest number of people, and is the envy of the entire world?

I’m open to your thoughts, and I will do my damnedest to get them in front of the right people.

 

Post Script: I have been told that the FTC views any such action by dental societies to be illegal boycotting, and precedent has been set.  Sounds like the wrong lobbyists got to the right ears (and pockets) to me, but if that really is the case, then dental societies are virtually powerless in this situation, until that precedent is challenged.  The Washington State Dental Association spent many hours and legal dollars trying to deal with this within the parameters of the FTC ruling, so other avenues may be more appropriate.  I’m not sure that the FTC could have much say about dentists using Twitter to say that they are personally dropping the insurance plan.  I’m not fond of laws or precedents that protect corporations to the detriment of individual citizens, and I can’t accept that boycotting of a company by anyone or any group can be considered illegal.  But I’m no lawyer, so the pathway through this is not clear to me.

Who Profits from Dental Non-Profits? Not you!

If you didn’t know the level of contempt that the dental insurance companies have for dentists, look no further than the actions and comments of Washington Dental Service and their CEO, James Dwyer.

Dwyer, in an interview with King5 TV station in Washington State this month, casually suggested that dentists “could start working five days a week” to make up for the 15% across-the-the board fee reimbursement cut WDS instituted in 2011.  Easy for him to say, as he makes $1.2 million a year.  He subsequently apologized, (which of course means nothing), saying also that his words were taken out of context.  So the TV station ran more of the video, where Dwyer says this not once but twice and also says, quite smugly, that dentists only work three and a half days a week.  “They certainly don’t work four days a week,” he adds, dripping with contempt.  I think this man believes that in saying this he will garner public support, that people don’t like dentists, and think that dentists make too much money already, and now he’s letting people know that they have short work weeks.  Excellent strategy, from an adversary.

And that’s my point. They are not in the dentists’ corner.  Washington Dental Services, part of Delta Dental, operates as a non-profit organization.   Of course, they are a non-profit in name only, and for one reason: to avoid paying taxes. WDS had a net income of $13.7 million in 2010, and paid no taxes on that.  On top of that, their executive compensation that year was $5.8 million (including Mr. Dwyer’s $1.2 million.)  Remarkably, the executive compensation of WDS has increased an average of 45% over the past five years, right through the recession.  How many dental practices grew 50% in the past five years? Only a few? Well, maybe they should work harder.  How many of your patients experienced that kind of salary growth? Maybe they should work harder too.

Why did they, and by “they” I mean Delta Dental, do an across-the-board cut?  They said to stay competitive.  Really?  They have 90% of the dentists in the market already.  They said they need to be able to lower their premiums to employers.  Why exactly should premiums go down?  Has the price of anything in dentistry gone down? I missed that.  Dwyer’s advice was “work harder”.  Work harder for less money is what he meant.  Making lots of money is for people like him, not for dentists.

Here’s the other reason why I think Delta did it.  They wanted to see  how the dentists and the societies would react, so that they could do it in other states.  To make more profit for their non-profit, and give bigger executive pay increases.  I mean, what better way to fulfill their stated mission, which is to promote oral health?

Yes, Mr. Dwyer actually stated, with no sense of irony, that the mission of WDS was to promote oral health.   How exactly are they doing that? The statement is ludicrous. Their clear purpose is to make money, crush the competition, pay no taxes, and pay themselves incredibly well.  You can’t do that and promote dental health, because that would result in more claims.  Which would hurt their profit.  I mean, their non-profit.

As I said, they are your adversaries.  Seldom are they so open about it, but Mr. Dwyer’s contempt is symbolic of an industry that is at crossed purposes to the health of Americans.  40 years ago in this country it was basically considered immoral and unethical to make a profit providing health insurance.  Now the opposite is true.  Now the  job is not to provide coverage and promote health, it is to be competitive, limit care, and pay extremely high salaries so you can attract better executives.  Recently, Blue Cross/Blue Shield of Massachusetts gave an $11 million severance package when they fired their CEO.  That would turn most businesses into a de facto non-profit, but BC/BS absorbed it nicely.  Because they don’t pay taxes.  It was chump change.

So what do I think the dental society should have done?  I think they should have recommended that their entire constituency drop WDS the next day–the old-fashioned American response to robber barons.  They didn’t do that, of course.  They sent a letter out recommending that dentists find cheaper dental suppliers. (Huh? How’s that going to offset 15% less in fees?)  And when an individual dentist did drop WDS, the company sent a letter out to all the dentist’s patients,  giving them a list of dentists who accepted their plan, and suggesting that their dentist simply wanted to make more money.

And there is that ridiculous statement: “They certainly don’t work four days a week.”  Really?  I personally know about 1,000 dentists, and virtually all of them work at least 4 days a week doing dentistry, and another day or more doing the business side of their practice or getting CE.  But Dwyer knows that.  He’s not an idiot. But he also knows how easy it is to turn public opinion against doctors and their incomes, which was exactly his intention.  So that WDS could maintain their fee cut, lower premiums and everyone still gets a raise next year.  Contemptible?  Reprehensible?  To be sure.  Does Dwyer care?  Not a bit.

So what is a dentist to do?  In the end, this is big business against the small businessperson.  So you work smarter, learn more procedures and techniques, and realize that some things are in your control, and some aren’t, and all your energy needs to go to those things that you can control, you can have an effect on.  And you’ll still have a great business.  And still change people’s lives for the better every day. The best revenge I think is doing good, and doing well.  I’d rather be you than Jim Dwyer any day.

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