#923: End of Year Crunch? No Need to Panic!

Dental A Team Podcast

Tiff and Dana spell out how to avoid the crunch-time that always seems to crop up each December. They give advice on how to find the just-right daily metric for your practice, the power of adding procedure codes, how to get the whole team rallied for the cause, and more.

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Transcript:

The Dental A Team (00:01.174)

Hello, Dental A Team listeners. Dana and I are back at it today. We are bringing you some fantastic information today, if I might say so myself. Dana, thank you so much for being here with me. I know we both had calls. You've had a million calls.

a ton of clients and you had so many calls already this morning and you pop it on podcasts to just give away more information. So thank you for being here with me. Thank you for giving me this time this afternoon. What do you have going on this weekend? It's Friday for us right now. I don't know when this is dropping, if it'll be a Friday or not, but what do you have going on this weekend? Because I think the world needs to know. I was very excited and I'm going to need a picture of your outfit.

Dana (00:41.026)

Thanks, I'm super excited. We are going to PBR tonight. It's one of my kids' most favorite things and I will say in Tucson they do it up. They do get a lot of the top bull riders across the country. So my kids are pumped for that and indoor fireworks and country music. so we are pumped. I know, was like in my morning Friday five, like, yee-haw everybody, I'm super excited.

The Dental A Team (00:56.384)

Dang!

The Dental A Team (01:03.222)

Yeah, I'm excited. My sister and I went to PBR a couple years ago. It was up here in Phoenix and it was fun. We were honestly we went as like, I don't know, it's something to do. But we were like hyped by the end of the night. It was like two hours like 10, 11pm. And I was like, what else are we doing tonight? Like, where are we going? So I was like your kids so I get it. And my feet hurt because I wore her boots and that was the wrong idea. So it's fine. It's fine. Well, you have PBR. I have my

Dana (01:22.946)

Yeah, super fun.

Dana (01:27.746)

You

The Dental A Team (01:31.946)

tonight. You didn't get to hear that. I know. Mariah Carey's Christmas concert and I told the team this morning this is not meant to be political or offensive to anyone. This is just true from my heart. Mariah Carey is to me what Taylor Swift is to all the Swifties of the world. I am not. I I think Taylor's would just be fantastic. I do love her music. I think she's great but to me Mariah Carey is is that. So I'm excited.

Dana (01:49.584)

Yeah.

Dana (01:57.614)

I'll exchange pictures then.

The Dental A Team (01:59.958)

Yes, yes, we'll exchange pictures. You got PBR, I Mariah Carey, we've got it on lockdown. This is going to be fantastic night. I hope all of you are doing something fun, whatever day this might be, that you're listening to this. I hope that the weekend that we recorded this, you did one of those two things if you're here in Arizona. And really, we're looking at, I mean, we're looking at fun things towards the end of the year. This time of year,

is wild. I feel like this weekend specifically I've had like 16 different things come up that people are like, can you do this, can you do that? I'm like, my gosh, plus I fly on Sunday and I'm like, I can't cram anything else into the amount of time that I have remaining for the year and this is the crunch time, the end of the year.

where things just get really, really, really wild. And we really try to cram as much as we can into the time that we have. So personally and professionally, we start doing this, we start seeing practice, you know, schedules get a little wild. And I really want to talk about today, how to make the most of that. So end of year crunch, end of month crunch, but also Dana and I were talking and I want to not just talk about it for December, for the end of the year, I want to talk about it for

forever, for every month. How can we make sure that it doesn't get to the end of the year, the last two months of the year, that we're like, holy cow, guys, we've got $60,000, we've got to make up, we're behind. And I don't want you guys to get there. I don't want you to feel that crunch. I want you to be looking at numbers more succinctly throughout the year so that you don't feel that stress, but.

We do get there. We do get there sometimes during the year, during other months. And I want you to also be prepared for what that can look like. And Dana, you had just this really fantastic plan.

The Dental A Team (03:45.908)

that you've laid out that we use for a lot of our clients, all of our clients are doing it, where they should be. If they're not, slap on the wrist and talk to your consultant. Make sure you get it implemented. But I really want to hear, in your words, Dana, how you make sure that your teams and your doctors are constantly looking at those goals, that they don't have that weird crunch time, and they can accomplish what they're looking for.

Dana (04:08.067)

Yeah, and I think like you said, you start off by really looking at those numbers throughout the entire year. I think we set them oftentimes in November, December for the following year and then we're like, well, we set them, we know what they are, that's it. And that's great that you know what they are, but continuing to look at them throughout the year and really to continue to look at is there a gap in any of them? And then we are...

The Dental A Team (04:19.774)

Yeah.

The Dental A Team (04:23.178)

Yeah.

Dana (04:33.858)

pushing the needle or spreading the gap out for the rest of the year so that we are just doing our very best and we're staying on top of where we are in getting there.

Oftentimes when we set them in the beginning of the year, those are big numbers, right? They're big numbers and for the team to digest this, we walked through with a practice on our group consulting the other day and our consultant, Christy, just did a fantastic job of saying like, those are huge numbers and to team members sometimes we have to break it down into bite-sized chunks and what can we focus on every single day to get us there? And if we can take, let's say you set a $60,000 gap, if we can take a $60,000 gap and we can

The Dental A Team (04:49.62)

Yeah.

Dana (05:16.256)

break it down and say, guys, that is one crown a day. Boy, does that feel so much more doable to a team member than we've got to find $60,000. Right. And I love that you said not just in December, because December, like you and I were talking about, Tiv, is like a baby month this year, like where the holiday is placed and with the time off that happens in December and all the activities like December is such a tiny month this year. And so if we wait and we save and we say, okay, well, let's look at it in December, man, we have missed some

The Dental A Team (05:25.29)

Yeah. Yeah.

The Dental A Team (05:32.416)

Yeah.

Dana (05:46.16)

opportunities throughout the year and all the other working days that happened before we got to the month of December.

The Dental A Team (05:51.034)

Mm-hmm. Totally. I think that's brilliant and it's something that should be talked about like you said every day Really we should be looking at it especially when it's crunch time and I know I've had so many teams really rally At the end of the month when it is crunch time and not that they waited till the end of the month But they're like, okay guys like we're still needing this 10k Like where are we finding it today and teams will gamify it and they'll really rally around it

when they know what they need to gain, when they know how to win. So this kind of goes into that metrics conversation that we had on another podcast of really knowing how I can affect the metric on a daily basis. I love.

the idea of doing it and breaking that and what Christy said, like breaking a big goal down to something smaller. breaking that yearly goal down to quarterly, down to monthly, down to daily is huge. And I even have practices, I talked to one today that they were like, gosh, most of the days this week were fantastic, yesterday kind of sucked. But overall for the week, we were above goal. Fantastic. So it's from a monthly to a weekly to a daily. Like, as long as you're on track over the big haul, that's what matters.

I do have practices that almost focus too small and then I have practices that focus too big. The two big practices are like, okay guys, our goal is 250 this month and we're at 125, so let's keep going. It's like, okay, cool, but what else is left? And then I have practices that are like, we need $10,000 every day. So every day they're like, are we at $10,000, yes or no?

What they're not doing is what Dana's talking about is really looking at what was our goal minus what we've done minus what's scheduled, right? Divided by the number of days you have remaining because even if I'm at 12,000 of a $10,000 goal today, if I was at 8,000 yesterday and I'm not thinking about that now $2,000 gap between the two days, I'm $2,000 short at the end of the month and I'm like, wait, where did the money go?

The Dental A Team (07:47.338)

well, there's a gap somewhere that was missed. So we've got to look at all of those metrics and figure out every single day, my daily goal might change. I have a practice that I was like,

Just I Extended them that was hard to get out I extended them one year past what I they thought they could do I knew they could do it right But they had like a nine thousand dollar a day goal They had three hygienists and they had one and a half doctors had a nine thousand dollar a day goal and I was like No, you guys you guys can do 12 and they were like

No freaking way. And I was like, we're doing it. We're freaking doing it. I'm going to tell show you how I'm going to tell you how to get there. I'm gonna hold you accountable. We're gonna do it. And they did. But then next week, I get a text from the front office gal, the treatment coordinator and she's like, I'm sad to say that was really easy. And I think I know because you just didn't know what you were capable of because we weren't looking at the numbers before you had no idea that you were surpassing $9,000 on the regular.

Dana (08:24.813)

me.

The Dental A Team (08:48.694)

You guys were already doing it, you just didn't know. So I put that $12,000 in, blew your minds, and now you guys are like, wait a second, this was really easy, actually, if we could do more. You totally can with the right scheduling, with the right pieces put into place, but if we're not looking at it, we have no idea where we can go. So taking those pieces throughout the month, on the fifth day, you might see, hey guys, we're actually not, we're a little bit behind, we need to add $2,000 each day. Great, our 9,000.

$1,000 goal is now $11,000 until we get above that. But looking at it every day and making sure we do know what that gap is. Dana, you talked on another podcast about, like we said at the beginning of this one, how the little things that we do every single day can add up to a big thing. So even as far as you mentioned attaching all of the procedure codes, right? So what have you seen in practices that you've worked with or worked in where it's like, gosh, guys, we're only $500 short or something, like we're looking at it.

But then it comes down to those simple things. What are some areas that you feel like practices miss that are easily made up when they've got a gap like that? Like just attaching simple codes. What codes are you looking at?

Dana (10:00.524)

Yeah, x-rays for sure. Anything as far as adjunct services. Sometimes we're like, well, I'm just going to irrigate just this quadrant. Well, you irrigated them, right? Or bundling perio things so that our perio patients that get the best results also have laser or ozone or stellalight or all of the other perio adjunct services. Making sure that we're adding fluoride. Even I've got lots of doctors now that because fluoride helps crowns last longer are adding fluoride to all of their crowns.

they do the seat, they're administering varnish. Even coming up with, right, as we're seeing more of this fluoride pushback come out, you know what? There's a hydroxyapatite varnish. So let's have that in the practice so that even when we get pushback, there's still something we can do. So it really is just little, little things. And I use fluoride as an example because lots of patients can benefit from that or the hydroxyapatite alternative.

If we look at, say one hygiene day, average floor, will say is $30 for the varnish. We see eight patients in each hygiene column. If every hygienist even got 80 % of their patients, that's close to a thousand extra dollars every single working day. And it's something so small. You use the example of PAs and write PAs 12, $16. But if we're doing that routinely for all of our patients, that maybe we see a little bit something or maybe, you know, they're having some sensitivity here and we add that PA.

those things add up with the number of patients that we see each day. So little things like that really do have a huge impact.

The Dental A Team (11:36.16)

Yeah, I agree. I think the PAs are so easy. And I think even on like a limited exam, we'll have a limited come in and they'll do a limited and a PA. But then sometimes the doctor's like, can you get a bite wing of that? Then you did a bite wing too, right? So making sure all those are put in there. And then I thought how many times when I've done billing and gone back through and I've seen crowns, and I'm like, so many crowns and do we really not do build ups? Doc's like, we always do a build up. What are you talking about?

I'm like, well, we've never charged for a buildup. These patients are just getting buildups all over the place. And those are like $185. I've seen it all the way up to almost $300 for a buildup.

Dana (12:07.81)

Yeah.

The Dental A Team (12:17.174)

Making sure that every code is attached is insanely important, not just to the billing representative because he or she desperately wants that information, you guys, but also to your bottom goal. And when you come in and it's like, guys, we're so close. Or when I get the calls from the teams and they're like, we missed it by 2000. I'm like, well, where was the 2000? Where did you lose it? Was it in buildups or PAs or was it, know, two more, can we have done two more occlusal guards? Like, where does that look like? really

winning your month and knowing how you're going to get there is huge and then I think you guys talked you said on that group coaching call which I love because those doctors are just freaking fantastic and they have so many excellent questions and ideas that they're sharing but you guys brought it so granular as to like what is the thing that's going to get us there so we might be $1,200 short what is that so that's a crown

That's two occlusal guards. That's a handful of fillings for certain patients. Really looking at, where can we make that up? Where do we have time in our schedule to make that up? Do I have assistive time that if I had two night guards come through, so two occlusal guards, I could have the scans or impressions taken? Making sure that it's super applicable and that we can see the result very easily, I think is super key. And then also flip side, Dana, I have a lot of...

a lot of hygienists that I'm like, take the scan in your room. If this patient needs a night guard and occlusal guard, take the scan in your room and then get that credit over there as well. Do you have a lot of hygienists that are doing scans and occlusal guard scans, like full mouth scans to show teeth shifting, all those pieces? Are you seeing that a lot?

Dana (14:00.61)

Yeah, yeah, and I'm even seeing I had a hygiene team that they even started to build a whitening column in between their

re-care patients and they would both kind of just hop and run it and manage it together. And that was a fantastic boost in production. And sometimes too, is like doctors are hesitant. I just talked to another doctor and it was like, well, you know, I could do bone graft for membrane. And I'm like, why are you going to stop and think like, would this give this patient a better result? Maybe they're not interested in implant right now, but they didn't say no ever in the future. like, let's bone graft it and make sure that those bone levels are nice and healthy or why only popped a couple granules in there? No, that's a bone graft. So let's make

sure that we are accounting for it. So I think this is a team-wide thing. And if everybody can just be like, what is one little thing? What is one little thing that if I did consistently throughout my patient base, or if I added in one whitening patient, or combined as a hygiene team, we ran a whitening column, or our FDOT had their own column and they were doing sealants in a pediatric practice. Like what can we do? And there's oftentimes so many things. And if we put our heads together, we actually end up with this list and

The Dental A Team (14:37.78)

You opened it.

The Dental A Team (14:46.176)

Yeah.

Dana (15:07.44)

we're like, okay, well, actually, where do we start of all of these things that we can do?

The Dental A Team (15:07.946)

Yeah. Yes.

Yes, and putting your heads together on how do we implement this change moving forward and what's the verbiage to feel okay with it? Because I think also, we have a hard time sometimes charging for what we should get paid for. And we say constantly, charge for what you did, charge for what you did. So that means don't leave it off and charge for what you did, meaning don't charge the wrong code just because it feels better because it feels like less I know.

I love you all dearly, all of you who are doing this, but it needs to stop. Charging a pro fee for a perio maintenance, just do a perio maintenance. If this patient is a perio maintenance, if this patient has pocketing, if they have all the pieces that add up, they had SRP, they have all of those pieces, and you guys.

You guys, this drives me insane and I'm not a hygienist, so tell me if this is totally out of line. I am okay with it. Write me, email me, Dana, call me out on it now, I don't care. But it drives me insane when I see hygienists time over time over time say, okay, well, I'm going to do it this time. But really, it's if it's bad next time, still, I'm going to SRP, I'm going do a one to three or I'm going to go I'm going to have them do three profies. Because really, they need limited scaling. But I don't want to have

to tell them that or I think I can do it with the profis like my gosh I think we get caught up in not wanting to make a patient feel some certain way and we actually are doing them such a disservice in my opinion if I have perio tell me I have perio

The Dental A Team (16:42.036)

But I need limited scaling because I have had a body change. My physical body has changed because guess what? I'm older than the last time I was here. I'm on different medications or supplements or my breathing changed. I lost weight. I gained weight. I stopped sleeping at night. So many things add up to changes in our mouth that we don't give credit to and then we charge for the lesser because we feel bad. We feel guilty. That's my assumption.

That's me putting an assumption into the world. But for the love of all things that are holy, I implore upon you, charge for what you're doing. If you do a CBCT scan, charge for that. If you do a panel, charge for that. Charge for whatever it is that you're doing and stop charging for the lesser just to pad something. Now, if you want to charge it out and you're like, hey, I don't want to charge you for this, then do a write-off.

Do a write-off so that you see how much of that you're writing off and giving away as well. Because when you charge a pro fee, when it should have been a perio maintenance, you're not seeing that $60 to $100 difference of money that you're writing off every month that you guys are owed because you did the work. That's my soapbox, Dana.

Dana (18:00.854)

No, I will join you in that. I will agree with you. Same thing. I was even the classic hygienist who if you came with too much buildup, I would say I need to see you every three months instead of every six months. You're still a pro-fee, but you're just a heavier builder. And I only have an hour with you and I refuse to run 15 minutes into my next patient's appointment when I could see you more frequently. So...

Yeah, you do what your patient needs and if you're prepping the patient and if you're like, oftentimes you're like, well, they're just gonna be surprised or they're gonna be shocked that they need this this time. Well, no, because you build that into the entire appointment, right? You're saying these period charting out loud. You're making them say like, if you hear fours, hey, those are warning signs. If you hear fives, we're in a little bit of hot water territory here. So.

The Dental A Team (18:25.152)

Yes.

The Dental A Team (18:39.051)

Yeah.

Dana (18:49.64)

have the conversations that are needed to be had, do the services that are needed to be done, and bill accordingly.

The Dental A Team (18:55.57)

I agree. And doctors, the same thing goes to you for those buildups, for those x-rays, for those just to fix whatever it is. Charge for what you're doing. If you did a buildup,

put it in there. If it wasn't treatment planned as it was needing a buildup, then guess what? Have the conversation with the patient, hey, we weren't actually able to save it. We thought we were going to be able to, but once we got in there, it was a little bit deeper, a little bit bigger. And for the stability of this tooth and the longevity of your crown, the money that you are investing, we had to do a buildup.

Period. It's not that much, you guys. It is on the long run to you because if you're giving away 10 buildups, it's over potentially $2,000 a month, just charge for it. Do the right thing, charge for it. So that's not just a dig at hygiene. That is everyone. Charge for what you're doing, code for what you're doing. Make the best of your months by looking at what that gap is and how can we get there and then look back and think too.

How did we get here? Is it because we forgot to charge for things? We were missing things? Do we have open hours? Do we need to tackle something within the scheduling or the treatment planning? Really look at the trends of the practice, not just what can we add same day always. That's a huge benefit and something I want you to be looking at, but look at the trends that also got you there.

So take all this information our soapbox is done you guys we are stepping off of it. We are done for the day on that one. I hope you've gained some value there are some amazing tips within this we do work with clients constantly on these same pieces and if you have questions on what you should be charging for or shouldn't be we can help with a lot of those we don't know.

The Dental A Team (20:33.246)

the legalities for every single thing but we do know how to look really hard and find information and help you out as best as we can. If we don't, we know the people who can help you and we will always direct you in that direction. So [e-mail] message us there, message us on socials, whatever avenue you want to take. Drop us a five star review below, let us know how much you loved this. Dana, thank you so much for joining me on my soapbox today and for all of the invaluable information that you had to share today. This has been so much fun.

Thank you. Awesome you guys can't wait to hear from you. I hope you have a stellar rest of your day and into the week or weekend whatever that looks like today while you're listening to this. We'll catch you next time.