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to charge $17,000? How do I, as a practitioner and as a leader, signal to the marketplace – my patients, my team – that we’re worth it?” Because the difference between the $10,000 and the $17,000 reconstruction, when it’s done well, is huge. You can’t be doing reconstructions half-assed, because it will come back to haunt you. So the higher-fee cases are more difficult to sell. Case acceptance for the high-fee case is something that I have focused on for the last 20 years of my life. MD: Now, in those 20 years that you’ve been focusing on high-fee case acceptance, is there a huge difference between case acceptance for a $10,000 case and a $17,000 case? Don’t they both sound relatively expensive to the patient? 100% Case Acceptance 0% $1,000 $5,000 $10,000 Figure 5 PH: Absolutely, yes. You know there’s a case acceptance curve, where case acceptance is real high when the case is real low (Fig. 5). But as you cross that $5,000 to $6,000 mark, that’s where I see case acceptance drop down. Is case acceptance that different between the $10,000 and $17,000 level? Not really, but enough psychologically for the dentist. Not so much in the patient’s mind, but it is in the dentist’s mind. So factoring in proper case acceptance dialogues and essential conversations that you have, those conversations need to be entirely different at the $10,000 level up than at the $5,000 level down. And that’s been the topic of some of our other articles. MD: Yes, we’ve talked about that before. So a dentist who’s reading this or listening to this and realizes, wow, I bought this practice 13 years ago and I just took over at whatever Delta-approved fees the previous dentists had and we’ve tried to make increases every year based on our ZIP code as time went on. Maybe I should take a closer look at my fee schedule before I get too much farther into this to see if my fees are in the right place and make sure that when I’m operating at the sweet spot, I am making the net profit per hour that I deserve. PH: I’d contact Ken at <strong>Dental</strong> Practice Advisors. For years I did the fees and analysis, but they are far quicker at it and more complete. What they’ll have you do is submit two or three of the large cases you’ve done, your fee schedule and your profit and loss statement. And they’ll look at it comprehensively. They’ll look at how much money you need to live; that’s where they’ll start. How many days do you want to work? How much money do you need to live? This will create the profit per hour that you need to make. Then they’ll look at your practice overhead and your fee schedule. They’ll adjust your individual fee schedule such that the fees are balanced up to that 3-unit level. Then they’ll look at your complex-care cases to help you look at and see, what is the profit you have? And what’s amazing, when you come back from a profitability analysis or a fee analysis like that, you come back with some hard data on a piece of paper. Now you can sit down with your team and say: Listen, when we did Mrs. Smith, that case where we all pulled our hair out, we made less on a per-hour basis than when we’re just fixing individual teeth. When you can see it in black and white, Mike, that becomes a great leadership tool. It becomes more real to everyone. And now, I can sit down with my dental assistants and say: You know, you’ve been asking for a raise the last several months. See this profit point that we have right here? In order for me to give you a raise, we’re going to need to move that profit point up. A lot of that has to do with time. So let’s think together: How can we shave an hour or two off of these longer procedures without reducing quality. How can we do that? When the team is engaged – engagement means they’re thinking on their own without my direct influence – they’ll help create the solution, they’ll support the solution. MD: Sure. And now she is responsible for her own raise. The doctor says, I want to give you a raise. I think you deserve 36 www.chairsidemagazine.com
one; you’re a fantastic employee, and here’s what we need to do in order to get to the point where we can do that. Or, if the staff is on some sort of bonus plan, certainly adding that extra fee on there – especially if the doctor is a financial arrangements person who doesn’t want to quote the $17,000 versus the $10,000. The doctor has got to feel a lot better about making bonus payments to the staff when they’re charging the right fee for these complex cases. PH: And when you see it in black and white and you know it’s the right fee, now your leadership can take over. Establishing a fee for complex-care cases is a process. It’s not an emotional thing; it’s a process. When you have a process, you have the ability to lead because you can always go back to the tool. You can always go back to the fee analysis and say, OK, we’re doing better – now we just need to do a little bit better. You’re not just constantly raising the bar for the sake of raising the bar … because people get burned out on that. You cannot constantly ask people to perform better if they don’t have the right intrinsic reasons to do so. And the fee analysis provides that. It’s in black and white. I would suggest visiting the <strong>Dental</strong> Practice Advisors Web site to get started. For the skills related to case acceptance, visit my Web site: paulhomoly.com. I can teach you and your team the essential philosophies and conversations that make it easy for your patients to say yes. MD: That sounds like some great advice. I don’t know what the hardest job in the world is, but I can say that if every job in the world paid exactly the same, I’m not sure I’d still be a dentist. It is a difficult job. We’re working in a very sensitive area of people’s mouths and they tend to be afraid of us. It’s difficult and therefore we need to be compensated for it. PH: Highly compensated! MD: The only way to make sure that’s going to happen is to make sure your fees are in place. Whether it’s the 1-, 2-, 3-unit sweet spot crown fee that’s in place or the 12-unit case that you think is going to make you financially independent, in reality you’re going to make less money on that than on the 3-unit case unless you get your fees in order. So it’s something I would definitely encourage dentists to take seriously. Contact Ken for guidance on fees and to see if they are in fact in the right place. You don’t want to practice for 30 to 40 years and then find out you did everything right, except charge the right amount for procedures. hope the audience hears what I’m going to say right now. I’m not advocating that you go and raise your fees 40 to 70 percent. I’m not saying that. What I’m saying is, when the case is complex we need to think about taking our fees up. To make it easy for you: don’t take them up all at once. Maybe take that 6-unit case up 20 percent, just to build your confidence in quoting a higher fee, and keep bumping it. Don’t make the jump; don’t go cold turkey on this thing. Build your confidence with it. That way, when you begin to slowly escalate your fees for complex care, you will become more and more accustomed to quoting a higher fee. MD: That’s one part of it, but the other part is making sure that the base single-unit crown fee for the 1-, 2-, 3-unit case is in the right place as well. And it might be! Or it might need to go up only $40 or $100. Or maybe it is in the right place, and then you just need to worry about more complex cases. But why not find out? Isn’t it kind of like getting blood work done? The good news is that you find out everything is fine and you don’t need anything. You don’t say: Well, that was a waste of time and money. Instead you say: Oh good, everything’s all right. Why not find out that your fees are in the right place now so you don’t have to worry about it 20 years from now, when things didn’t turn out the way you thought they would. PH: And now you can pursue quality and be compensated at a level that will help perpetuate your practice and makes the pursuit of quality a sustainable event. MD: Excellent. Well, thank you for stopping by today. I loved the opportunity to finally discuss fees with you, and I know that the readers and listeners of Chairside will love it as well. CM For questions related to this interview or learn more about Dr. Paul Homoly, call 800-294-9370, visit paulhomoly.com or e-mail paul@paulhomoly.com. PH: Remember, Mike, you and I were going to have this fee conversation last year, at the beginning of 2009. And we both agreed: I don’t know if we should be talking about raising fees when the economy is tanking. So now, a lot of indicators say we’re coming out of that, and I Interview with Dr. Paul Homoly37
Page 1: Chairside® A Publication of Glidew
Page 4 and 5: Contents 45 Practice Management: So
Page 6 and 7: Letters to the Editor “Dear Dr. D
Page 8 and 9: Contributors Michael C. DiTolla, DD
Page 11 and 12: PRODUCT........ TrollFoil Dr. DiTol
Page 13 and 14: Dr. DiTolla’s CLINICAL TIPS PRODU
Page 15 and 16: Book Review “Aesthetic & Restorat
Page 17 and 18: Figure 5: The fractured ceramic sur
Page 20 and 21: Too Much Tooth, Not Enough Tooth Ma
Page 22 and 23: Creating suitable incisal edge posi
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Page 27 and 28: Interview with Dr. Paul Homoly 25 I
Page 29 and 30: grand scheme of things, that single
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Page 35 and 36: have to do that you didn’t forese
Page 37: Several years ago, Reader’s Diges
Page 42 and 43: 3. Acrylic provisionals should be p
Page 44: ■ Reasons for Biologic Shaping 1.
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Page 50 and 51: Second, if you’re not comfortable
Page 52 and 53: GL: Exactly. And the names of those
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Page 65 and 66: Dr. DiTolla’s Patient Product Rev
Page 67: The Chairside ® Caption Contest IN

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