Catalyst Magazine

AA MMAGAZINEMAGAZINEAGAZINE DEDICATEDDEDICATED TTOTOO TTHETHEHE SSUCCESS SUCCESSUCCESS OOF OFF DDENTISTRY DENTISTRYENTISTRY ISSUEISSUE 4 42010 2008

Patient-Centric Practice Dr. Chris Hammond & Dr. Chad Ellis

Technology Digital Radiography — Quick, Easy and Highly Visual

Practice Management How to Keep $114,816 from Slipping Through the Cracks Burkhart Dental — Issue 42010 —Issue Dental Burkhart ™™ SpectraSpectra GXS-700 Digital Intraoral Sensors: isis YourYour The Vision To Advance Your Quality Of Care DopplerDoppler NEW from Gendex! RadarRadar forfor CariesCaries DetectionDetection Direct USB

Enhance your treatment forecast with Spectra ™ Caries Detection aid. The only handheld imaging device on the market that provides numerical and color readings to precisely indicate the extent of decay.

Using fluorescent technology, Spectra emits high-energy LED light onto the tooth surface As the eighth generation digital Cone Beam 3D Imaging Systems causing cariogenic bacteria to fluoresce red and healthy enamel green – providing a view sensor from Gendex, the GXS-700 Panoramic X-ray Systems system comes from a strong lineage similar to how you see weather on a Doppler radar. Intraoral X-ray Systems Introducing the new GXS-700, of imaging excellence, raising the P Digital Intraoral Sensors designed to make migrating from performance bar for other digital  ‡&RORUVDQGQXPEHUVSUHFLVHO\PHDVXUHGHFD\WRJXLGHH[FDYDWLRQ film, or upgrading a digital system, sensors. From ease-of-use and Digital X-ray Phosphor Plates easier than ever. portability, to enhanced acuity and Intraoral Cameras sustainability, these new direct USB Imaging Software  ‡$OORZVTXDQWLWDWLYHWUDFNLQJRIFRQGLWLRQSURJUHVVYLDVRIWZDUH sensors underscore our desire and commitment to help advance your  ‡$ELOLW\WRGHWHFWSRWHQWLDOFDOFXOXV SODTXH practice with innovative and affordable solutions.  ‡0RUHRSSRUWXQLWLHVDQGKLJKHUFDVHDFFHSWDQFHPHDQV  PRUHUHYHQXHSHUSDWLHQW For more information, ask your Burkhart Account Manager Gendex Dental Systems 7RRUGHURUIRUPRUHLQIRUPDWLRQ or call us at 1-800-562-8176 www.gendex.com Imaging Excellence Since 1893 YLVLWZZZDLUWHFKQLTXHVFRP ZZZDLUWHFKQLTXHVFRP Contents In This Issue:

Patient Centric Practice Business of Dentistry Hammond & Ellis ...... 26 Here Come the Taxes ...... 46 Contributing Writer: Holly Kean, Marketing Manager Contributing Writer: Bob Creamer, CPA Contributing Photographer: Mark Bowers Wealth Management Practice Management Major Tax Hikes in the Offing? Top Performing Dental Practices: Start Preparing Now...... 51 What’s Their Secret? ...... 4 Contributing Writer: Sam Martin, CPA, CFP® Contributing Writer: Margaret Boyce-Cooley, MS Director, Practice Leadership, Burkhart Consulting How To Keep $114,816 From Slipping Index of Advertisers: Through The Cracks! ...... 7 A-dec: Access ...... 11 Contributing Writer: Practice Leadership, Burkhart Consulting A-dec: Proven ...... 17 Burkhart Office Manager Superstar...... 10 Accutron: Put your Patients at Ease ...... 34 Acteon: Technology Innovations from the Industry Leader .....42

™ Office Design Air Techniques, Inc.: Spectra ...... Inside Front Cover Belmont®: Bel-Cypher ...... 35 Plan Ahead, Execute and Customize ...... 12 Brewer: Ergonomic Seating ...... 50 Contributing Writer: Andy Hutson, Branch Manager, Burkhart Eugene Bosworth Company: Super Values ...... 21 Contributing Photographer: Randy Taylor Creamer & Associates: Powerful Tax & Business Solutions ...... 49 Assistant Success Coltene Whaledent: Coltolux® LED ...... 39 DentalEZ: everlight™ ...... 50 Supply Savings Guarantee: Worksheet ...... 18 DentalGroup LLC: Is Your CPA a Dental Specialist? ...... 53 Burkhart Assistant Superstar ...... 19 Dentsply Professional: Midwest® Stylus™ ATC ...... 22 Gendex: GXS-700™ ...... Inside Back Cover Clinical EMS: Air-Flow® Handy Perio ...... 33 Instrumentarium: Orthopantomograph® OP30 ...... 43 Creating Real Value for Aesthetics When It Is at the Bottom of The List ...... 23 Kerr: Vertise Flow, Herculite Ultra and Premise ...... 45 Contributing Writer: Rhys Spoor, DDS, FAGD, FADIA, L&R Ultrasonics: Because Clean Matters ...... 20 Midmark: Elevance™ ...... Back Cover Technology Pelton & Crane: Embrace your Surroundings...... 37 Practice Leadership, Burkhart Consulting: PracticeView ...... 6 Digital Radiography — Quick, Easy, and Highly Visual ....38 SciCan: Great Savings! ...... 44 Cloud Computing: What is it and Sunstar: GUM™ Soft-Picks® in “PINK”! ...... 9 What Does it Mean for Dentistry? ...... 40 Summit Dental Study Group ...... 36 Contributing Writer: Dawn Christodoulou, President, PEB/XLDent Wells Fargo Practice Finance ...... 41 XLDent™: Bringing Your Whole Practice Together ...... 2

Cover Photo: Doctors Chris Hammond and Chad Ellis at their office in Utah. Photo by Mark Bowers.

CATALYST MAGAZINE Issue 4 2010 1. ™

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;dXjh^c\dcYZci^hignÉh]^\]iZX]cdad\ncZZYhh^cXZ&.,&#8dbeVi^WaZl^i]L^cYdlhœ,+)7^i Windows is a registered trademark of Microsoft Corporation in the United States and other countries. 1.800.328.2925 or visit www.xldent.com Serving the Dental InTouch Profession since 1888... MISCONCEPTION #1: BURKHART IS NOT PRICE COMPETITIVE. More Information: Sometimes when people are getting great service they think that it must cost a lot more. The truth is that great service is a mind set and an expectation and At Burkhart we realize that isn’t necessarily tied to higher cost. It is actually our clients are both dental our great service of focusing on getting our professionals and business customers more for less that allows us to cost owners. It is our goal to help less. If we were not competitive we would not them be successful at both GREG BIERSACK, Burkhart Vice President of Operations succeed with our Supply Savings Guarantee aspects of their careers. program more than 96% of the time. We prove Catalyst is fully dedicated that you can get great service and lower costs. to that success. The articles couple of years ago, I attended a in this publication vary from leadership training program that MISCONCEPTION #2: BURKHART IS TOO product use and selection to A focused on the power of feedback. business management topics During this training, I learned that the people SMALL TO EFFECTIVELY SERVE YOUR OFFICE. th and provide information and in my group had developed perceptions More information: Burkhart is the 4 guidance that can lead to of me early on that did not match my intent largest dental supply company in the US. We a more successful practice. nor the reality of people that worked with me represent over 400 manufacturers and more of Throughout the publication on a regular basis. I heard from them that I was the major brands than the other large full service are stories of Burkhart clients overly intense and it made them uncomfortable. companies. We have 3 large distribution centers who have succeeded in the Those around me at the training had gathered and employ more than 350 associates. We are areas that are highlighted. some bits of data at the start of the program to plenty big enough to take care of your needs. We hope that you enjoy. develop this perception. Maybe it was the way I greeted them or how I sat that morning. In MISCONCEPTION #3: BURKHART DOES any case, I appreciated the feedback because NOT HAVE A STRONG SOFTWARE OR If you have a request for a topic that you TECHNOLOGY SOLUTION. would like for us to cover in Catalyst, it gave me insight into how others may have please contact Holly Kean at: been thinking. The only thing that I could do More information: Burkhart represents the [email protected] was to thank them and allow them to gain most technologically advanced and progressive more data points. By the end of the training software on the market, XLDent. It was built I was able to use their feedback and built for today’s systems’ architecture not the 1980’s CATALYST MAGAZINE is published with an attempt to convert to today’s needs. by Burkhart Dental Supply friendships with my group members. It was a 2502 South 78th Street wonderful learning experience. We sell and service the best technology Tacoma, WA 98409 from Planmeca, Gendex, Instrumentarium, TEL. 253.474.7761 Recently, we contracted with a marketing Sirona, 3M, Cadent, Air Techniques, and FAX 253.472.4773 group to survey a number of our clients and Progeny among others. Most importantly, our possible clients and learn what they think salespeople have received more training in about our company. It was great to hear the technology than the other full service companies. Publisher We have what you need. Greg Biersack accolades from our existing clients. It was also extremely valuable to hear from doctors Principal Editor and staff who are not working with us. They Perceptions are based on the information that Holly Kean shared some of their perceptions that may people have. We are thankful of the feedback we have received on how we are perceived. It is Graphic Designers result in our businesses not working together. Brittany Staten Some of these perceptions were not necessarily certainly our hope that through this additional Sara Wisely accurate and were tough to hear. But, like my information and the everyday efforts of our Burkhart team that we can create the positive Advertising leadership training, the only thing we can do Jamie Bragazzi is give thanks for the feedback and provide perceptions that will allow us the opportunity information or experiences that might change to serve more and more dental offices. All rights reserved. Reproduction of any part of this publication without written permission from the a person’s perception. Publisher is strictly forbidden. Images are not Sincerely, necessarily to scale. Below is a list of some of the perceptions from those not working with Burkhart and some Customer Service: additional information regarding these areas. Greg Biersack, VP of Operations 800.562.8176 CATALYST MAGAZINE Issue 4 2010 3. By Margaret Boyce-Cooley, MS Director, Practice Leadership, Burkhart Consulting Top Performing Dental Practices What’s Their Secret?

roduction is up, few openings in the schedule can be in house. “Adding surgical procedures to my repertoire really found, a strong short-call list is in place to fill those helped maintain our schedule, gave me the opportunity to P last minute opportunities and the number of non-PPO expand my skills, and serve a need for our patients. It was a new patients are on the rise. The team synergy is palpable and win-win for everyone. It also gave my clinical team members a an additional hygienist may need to be added to accommodate renewed sense of purpose; they traveled to some of the courses, patient flow. Does this sound like your practice? If not, read on… had hands-on training, and were very excited to share their knowledge and skills with our patients,” reports Dr. Santiago. We polled dentists in top producing practices to find out their The additional training affords her the confidence to provide “secrets” to not just surviving in this unique economic window, some treatment that was previously referred out. but actually thriving in it. They are by no means ignoring the challenges that loom around us, yet their numbers certainly FOCUS ON INTERNAL MARKETING don’t reflect the economy most of us are reading about in the Everyone knows the best way to grow any business is through papers everyday. These are the practices that still produce a internal marketing. However, you can’t expect patients to healthy financial statement, committed patients, a harmonious refer family and friends if they didn’t have an experience staff and a delighted dentist. The leaders that met or exceeded their expectations. of the practice have taken steps to be We polled dentists Nor can you expect them to refer if you proactive and, even more importantly, don’t ask them to! Coach your staff are willing to share their thoughts on the in top producing to target patient bases you’d like to see why they are continuing to be successful. practices to find out expanded and gently and sincerely ask Here’s what we found out: them for a referral. Asking for a referral their “secrets” to not just should never sound like a desperate plea LEARN TO BE MORE CURIOUS surviving in this unique for new patients. At the completion of This may be the time to break out of economic window, but a successful appointment, the hygienist that routine commentary that can be or assistant can simply add, “It’s always heard in operatories every day. Become actually thriving in it. a pleasure to see you and we would be more curious about what is going on in honored to take care of your family and your patients’ lives in order to facilitate friends, please take one of my cards to planning to best utilize available resources. Dr. Eric Ellingsen, pass on” to the usual, “thanks for coming in today!” routine in Spokane, Washington has found that more patients than many of us fall into. A great lead-in to a referral request from ever may be in the process of or are considering changing jobs, the administrative area is to ask for the referral on the heels of moving or retiring. So change up the conversations to include a compliment. Asking the patient, “How did the appointment something like, “In this economy we’ve learned not to make go today?” can set you up nicely. Once the patient shares any assumptions. Let us know if you are anticipating a change their great experience let them know that you appreciate their in employment, insurance benefits, retirement or moving so comments and that, of course, the highest compliment you that we can help you plan for dental treatment.” The patient can receive is a referral from terrific patients like themselves! will appreciate knowing that you are there not only to provide Make sure your patients know that you are not just accepting care but are also available to help them best utilize their time new patients, but that your practice loves new patients! The and insurance benefits as well. bottom line: the patient experience must be top notch to further internal referrals. EXPAND YOUR SKILL SET Dr. Kimberly Santiago, in Issaquah, Washington reports that DEVELOP HIGH-QUALITY TRANSITIONS she has taken advantage of the downturn in the economy to Transitioning information regarding patient wants, needs expand her skill set in order to keep previously referred treatment and desires to the dentist is critical. For many successful

4. Issue 4 2010 CATALYST MAGAZINE Practice Management

practices the dentist is only afforded 5–10 minutes to complete neglect a single business system in your practice and enjoy a hygiene exam. The hygienist often times is better able profitability. Exhibit financial prudence by setting benchmarks to uncover patient desires and possible barriers to treatment that are easily tracked allowing greater accountability of your through an interview process that occurs throughout the staff and a heightened financial awareness for yourself. appointment. With a proper interview and transfer of information Review your Accounts Receivable to make sure you don’t to the dentist in front of the patient, all three become have more than 5% in the over 90-day column, and if you part of the solution process, ultimately increasing case do, make a plan to reduce it. Check your total A/R and acceptance. Successful transitions should include information monthly production numbers to make sure they are in sync. about their periodontal condition, current state of existing Staffing needs to be adequate for demand and evaluated restorative treatment and esthetic desires the patient may periodically to make sure it is still sufficient without being have. Transferring the information in front of the patient over staffed. A system for recare is one of the key elements to keep will allow the patient to add any additional information and your hygienists busy and the hygiene department successful. sense that they are part of a team in treatment planning. PROFESSIONAL COACHING CHECK THE HEALTH OF YOUR PERIODONTAL PROGRAM A single area of your practice rarely stands alone nor can it In this day and age the “buff and polish” hygienist is a thing be successful without a motivated staff. Many of the doctors we of the past, replaced by more comprehensive clinicians that polled pointed to professional coaching as one of the most integrate overall health and periodontal health. Patients that valuable investments they made in their career. Gaining the understand their gum condition and consider you a partner tools to monitor and evaluate every aspect of their practices in their efforts to maintain a healthy oral environment also as well as developing their leadership skills and creating an appreciate the value of your care, are more committed to environment that promotes energetic teams is a life-long treatment and less likely to no show for their future hygiene skill that will prove successful long after this glitch in the appointment. Take a temperature check of your program. Add economy is over. up the number of 1110, 4910, 4341 and 4342 that have been completed over the last 12-month period. Divide the number Lastly, keep in mind that successful dentists prevent emergencies completed for each code by the total to get a percentage of each by being proactive in their practices. A good leader monitors service. A healthy program that is less likely to face supervised and reflects on data and trends in their practice whereas a great neglect lawsuits and more likely to have a loyal following of leader uses monitors and trends as a blue-print for change. dedicated patients will find 50% or less in the 1110 category, Practice Leadership, Burkhart Consulting is an excellent 30–40% in the 4910 category and 10–20% involved in active resource to develop leadership skills, evaluate systems and therapy (4341+4342). motivate teams, especially in this economic downturn.

TEAM SYNERGY Dr. Jenny Thornton, in Poulsbo, Washington can’t say enough about her team. “Our team is enthusiastic, upbeat and positive. We are excited to work with our patients and to help them get the best dental care possible. We enjoy each other’s company. When we are not burdened down by interpersonal conflict or negativity, our personalities shine and patients know that we are excited to be with them. They know that we are happy and giving them 100%, not giving them the minimum.” Create an environment that nurtures your staff and motivates Practice Leadership, Burkhart Consulting, is a full-service consulting team specializing in developing leaders and teams in dentistry. For them to continue providing the patient experience that is more than a decade, Practice Leadership has helped hundreds worthy of referrals. Look into professional coaching if your of practices achieve new levels of success. Contact your Burkhart staff hasn’t become a true team partnering for the best care Account Manager or Practice Leadership directly at 800.665.5323 possible for each patient. for more information.

BUSINESS SYSTEMS A good economy can mask a lack of systems or poor leadership. In this economic downturn you certainly can’t expect to

CATALYST MAGAZINE Issue 4 2010 5. Burkhart and Practice Leadership’s team of experts can help you assess your current practice by:

Performing a comprehensive analysis of the business systems in your practice to discover strengths and identify areas that may need more focus. Assessing your facility and dental equipment’s ability to refl ect your desired practice image. Identifying technologies that could improve effi ciency or quality of care for your patients. Exploring ways to achieve the vision and goals for your practice.

Contact your Burkhart Account Manager for a complimentary comprehensive PracticeView Analysis to get started today!

www.burkhartdental.com www.practiceleadership.com Practice Management

HOW TO KEEP $114 ,816 From Slipping Through the Cracks!

It is Burkhart’s goal to partner with the offices and doctors we serve to achieve healthy practices, even in these changing times. There are specific systems in your practice that, if enhanced, can lead to higher profitability and decreased stress. The following is an example of how “little things” can easily slip through the cracks, and add up over the year:

PER DAY PER WEEK 4 days PER YEAR 48 weeks

One opening in hygiene per day (prophy, exam, bitewings) $212.00 $848.00 $40,704.00

One posterior composite recommended — but not accepted 288.00 1,152.00 55,296.00

One perio maintenance procedure performed; billed as an adult prophy 50.00 200.00 9,600.00

The need to hire one extra staff member in the afternoon to help with tasks 48.00 192.00 9,216.00

TOTAL AMOUNT SLIPPING THROUGH THE CRACKS $114,816.00

Now, let’s talk specifics… $ $ $ CATALYST MAGAZINE Issue 4 2010 7. Practice Management

Complete the grid below using YOUR fees and hourly wages. $How much is potentially slipping through the cracks in YOUR practice?

PER DAY PER WEEK 4 days PER YEAR 48 weeks

One opening in hygiene per day (total fees for prophy-D1110, exam-D0120, bitewings-D0274)

One posterior composite recommended — but not accepted (fee for 3 surface posterior composite-D2393)

One perio maintenance procedure performed; billed as an adult prophy (fee for D4910 minus fee for D1110)

The need to hire one extra staff member in the afternoon to help with tasks (hourly rate X 4)

YOUR TOTAL AMOUNT SLIPPING THROUGH THE CRACKS

Little things DO add up. Improving systems in your practice directly impacts your bottom line and your practice overall. Practice Leadership, Burkhart Consulting and your Burkhart Account Manager can help maximize your profitability.

Practice Leadership, Burkhart Consulting, is a full- service consulting team specializing in developing leaders and teams in dentistry. For more than a decade, Practice Leadership has helped hundreds of practices achieve new levels of success. Contact your $ Burkhart Account Manager or Practice Leadership directly at 800.665.5323 for more information. 8. Issue 4 2010 CATALYST MAGAZINE $ $ GO PINK

featuring SOFT-PICKS® in “PINK”!

For every featured “PINK” product purchase, Sunstar will donate $1 to the Breast Cancer Research Fund*

The Breast Cancer Research Fund is a not-for-profit organization in which a minimum of 85 cents of every dollar donated goes to research and awareness.

ORDER NOW! To order, please contact your Burkhart account manager or call customer service at 800-562-8176 *Select products include: GUM® Pink Soft-Picks®, GUM® Pink Technique® Deep Clean, GUM® Crayola™ Pink Crayola Marker, GUM® Chlorhexidine Gluconate Oral Rinse, Butler® Fluoride Varnish - Bubble Gum. Donation will be up to $5,000.

© 2010 Sunstar Americas, Inc. P10159 Office Manager Superstar

Hobbies: Continuing education, outdoor activities, scrapbooking and theater.

What I like about my job: Being a part of improving patient’s dental health. Helping people to understand the connection between dental health and overall health.

My Greatest challenge is: Overcoming the insurance-driven mindset.

Success at our office means: Exceeding patient expectations and company growth.

What Burkhart means to me: Responsive, great customer service and affordable dental supplies.

Trinidad Pereira Office Manager, Dr. Frederick G. Guerra ― Colorado Springs, Colorado

10. Issue 4 2010 CATALYST MAGAZINE CATALYST MAGAZINE Issue 2 2010 10. $FFHVV

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‹$GHFŠ,QF $OOULJKWVUHVHUYHG Office Design

Plan ahead, EXECUTE & Customize It starts as you drive into the parking lot. The attractive stand-alone building is inviting, and the environment that greets you as you walk through the front door into the waiting area is impressively peaceful. After a warm greeting from the receptionist, you have a few minutes to relax in a beautifully decorated waiting area before being escorted by the hygienist through a winding hallway painted in relaxing tones and decorated with colorful and calmingly distracting artwork into the exam room where you wait for Dr. Johnson to arrive.

By Andy Hutson, Photos by Randy Taylor

12. Issue 3 2010 CATALYST MAGAZINE Office Design

LEFT: The Adec 511 chair anchors a private operatory. BELOW: The new sterilization area features a “no touch” autoclave system that drains and fills automatically.

was this patient, engaged in a simulated walk-through, IT’S ALL ABOUT SYSTEMS and treated as if I were new to the practice and in need of Of all the systems instituted by Dr. Johnson at the end of his tenure I dental services. By the time I was seated in the comfortable in the first office and into his new one (e.g., marketing, insurance, A-dec 511 patient chair, I was relaxed and impressed with this collections, and financing), case presentation and the manner office, where I knew I would certainly be taken care of. in which the staff handles new patients are critical to their success. “Hygiene is the core element for us as far as getting our new patients Dr. Damon Johnson is a lifelong resident of Edmond. He attended to stick with us. It’s where they ‘try you out.’” Dr. Johnson the University of Central Oklahoma with a major in Biology. goes on to explain, “The pattern that emerges like clockwork He then graduated from the Oklahoma University College is this: one child will receive a cleaning and exam, and it of Dentistry in 1993. Not interested in starting his career as an will go well. Then another child, the mom, and finally the dad associate, Dr. Johnson dove right in and purchased half of an will make an appointment. This is where we really dialed up existing four-operatory practice. “I had a pretty rough start from our approach.” 1993–97; my partner sold out to me during that time period, and I was doing maybe 30–40k/month. But in 1997, I invested in A great staff makes a great practice, and the staff at this office practice management systems that really got me on track.” really works well together. All roles are well delineated, from professional responsibilities down to cleaning duties. There During the next year, Dr. Johnson’s practice saw a 20% spike are no grey areas regarding who does what and how it will in growth, and his 4-op office quickly became a liability. be accomplished. Limited space was only one of the issues at hand; the mixed demographic of his current office offered little growth for the After the prophy, Dr. Johnson conducts an exam in an easy-going kind of dentistry Dr. Johnson was well trained to do. manner that is also highly organized and polished. Areas covered

CATALYST MAGAZINE Issue 4 2010 13. Office Design

ABOVE: The beautifully appointed interior helps to build warm and positive impressions about the office ― a strategy Dr. Johnson uses for growth. RIGHT: Dr. Johnson visits Adec and stops in at Multnomah Falls along the way.

with every patient include: Pt. Chart, Pano, BWX, Perio, Exam, Photos, Black Book and CAD/CAM restorations. Technician provided the impetus to make the move. Lynn Fulks found himself at Dr. Johnson’s office for a routine repair Since the office is completely digital, with 21" displays at each when Dr. Johnson asked him his thoughts on his adding patient chair, it makes it easy for Dr. Johnson to move from topic operatories to his existing lease space. After a few questions to topic while the hygienist stands behind and handles the exam and rough calculations on lease expenditures for the past 13 progression with command of the computer cursor. This system is years, they agreed that the time was ripe to make the move! so well-synched, it looks as if the doctor is utilizing a touch screen. “I use a Nikon with ring flash in lieu of an intraoral camera. I Dr. Johnson purchased land in 2005 and began the process of think the images are just plain better, and I can upload them assembling his building team. Michael Burleson, Dr. Johnson’s in the operatory in seconds. My ‘Black Book’ is a fantastic case Account Manager, was the quarterback for this project presentation tool. It is a collection of photos of a wide range of and assisted him both in the early stages and throughout the restorations I have completed. After I show the patient what I see in project. Michael involved his Equipment Specialist, Baker their mouths, I can point to identical cases in the book that show Flesher, and they worked on a plan to proceed. stunning before-and-after scenarios. My acceptance rate is 75%.” Michael advised Dr. Johnson early and often about the benefit of LONG-TERM PLANNING PAYS OFF: CUSTOM DESIGN IN VIP trips offered from any one of our equipment manufacturing SUPPORT OF OFFICE SYSTEMS partners. Since he was happy with the features and durability of his Dr. Johnson had been considering building a new office A-dec equipment, which was purchased for his first lease space, it for several years, but a conversation with a Burkhart Service made sense for him to take a trip to Newberg, Ore., to visit A-dec’s

14. Issue 4 2010 CATALYST MAGAZINE Office Design headquarters. In March of 2006, Dr. home for all of his auxiliary equipment monitor mount built into dispensing Johnson and his Burkhart team made their inside the cabinetry and/or integration units for a seamless, clean look. (Figure 3) way to Newberg and met up with A-dec’s into the delivery units. (Figure 1) • Large staff meeting area that is comfortable Territory Manager, John Onorato. • Comfortable atmosphere for patients with and private, with full kitchen amenities ample interior detail to keep eyes moving for morning huddles. The staff area can Dr. Johnson reflects, “Everything came and distracted — a nice touch to help the also double as a meeting space for local together for me on the trip. The combined dental-phobic patient feel at ease. community groups with its separate creativity and knowledge of John, Baker, • Closed/private operatories as opposed entrance and exit, plentiful counter and Michael were very impressive. Nearly space for catered events, and an AV every design idea for my new space had at to an open concept. least one custom feature, and they made it FIGURE 1 FIGURE 2 happen. The visit also solidified my choice of delivery systems integrated with electric handpieces, casework, and color schemes. I fully understood the patient experience utilizing monitors in the operatories and the importance of heightened patient care via the latest in sterilization systems. Not to be overlooked, the reasoning behind op layout dimensions and sizing really made sense. Plus, while in the beautiful state of Oregon, I took in the Evergreen Aviation FIGURE 3 FIGURE 4 Museum, a tour of the Columbia Gorge, and the Willamette Valley wine country. It was great.”

The A-dec trip soon laid the foundation for the remaining part of the project. This eye-opening experience helped him focus not only on how he wanted to practice, but also on how to develop his vision of what kind of dental experience he wanted for his patients. Along with Dr. Johnson, • Highly-organized custom merchandise system for presentations; office tours Michael and Baker also toured other drawer storage with easy staff access can then be conducted post-meeting. offices completed by the Burkhart and re-supply. (Figure 2) (Figure 4) Oklahoma City Branch. The benefit • Creative office layout separating of these tours was a better perspective restorative and hygiene operatories in The entire planning process, including on operatory layouts, floor and opposing wings, which allows for land acquisition, engineering, wall finishes, lighting, and outside the efficient utilization of central development (streets/utilities), equipment building elevations. Steve Blair (Blair sterile and imaging areas. selection, architectural final plans, and Remy Corporation) was selected as permitting, took over 24 months. All of the project architect and worked in • One space with two sterile areas. A the careful attention to detail yielded great conjunction with the Burkhart Dental custom sterilization center is designed results, both in the finished product and Supply design team to complete the with dual entry, allowing ‘dirty-to-clean’ as the recipient of the Burkhart Dental final plans. This collective vision has OSHA flow from either direction. Design Build of the Year. since contributed to a 38% growth • “No touch” autoclave system that in production. automatically fills and drains without “The planning and engineering phases requiring the purchase of distilled are so critical and take much longer than DR. JOHNSON’S PRACTICE NOW water (utilizing a filter system for both you would normally plan for. The key to a CONSISTS OF THE FOLLOWING: autoclave, thermal disinfector, and successful project, however, is tied directly • Large, comfortable operatories (11'4" filling of clean water system bottles). to amount of time and energy spent in its planning and preparation.” x 12.5') with minimal clutter and a • Custom wall-mount operatory light and

CATALYST MAGAZINE Issue 4 2010 15. Office Design

Clinical Support Area Staff/Private Area Clinical Area Public Area Business Area

EXAM #1 EXAM #2 EXAM #3 EXAM #4 EXAM #5 EXAM #6 Clinical Support Area Clinical Area Business Area Staff/Private Area Public Area PANO.

EXAM #7

STERILIZATION

TOILET

FINANCE EXAM #8 1 RECEPTION TOILET LAB 2 CHECK-OUT OFFICE TOILET BUSINESS

WAITING AREA

TOILET CONFERENCE ROOM UPS MECHANICAL NO2 CLOSET

16. Issue 4 2010 CATALYST MAGAZINE Proven.

Unrivaled innovation, thoughtful design, lasting integrity: A-dec 500® is based on decades of collaboration with dentists worldwide. Such cooperation has led to pressure-mapped patient comfort, robust integration of handpieces and technology to minimize reach, and a touchpad that provides single-point system control.

In a world that demands dependability, A-dec delivers a proven solution without a single compromise.

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or more than 30 years, we have What is included in the total cost Burkhart is the only company to offer lowered the total cost of dental of supplies? Line item price, excess a written guarantee to reduce you F supplies for thousands of inventory, outdated supplies, purchas- total dental supply cost. However, dental practices. This continues to ing mistakes, freight costs, handling our guarantee is about more than be the most sound business approach charges not to mention your staff’s saving you money — it is proof of our to managing your supplies. We’re so time spent on ordering, stocking and commitment to making decisions that confident we can lower your supply handling returns are all a part of the are consistently in the best interest of percentage, we’ll put it in writing. supply purchasing process. your practice.

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18. Issue 4 2010 CATALYST MAGAZINE Assistant Superstar

Hobbies: My hobbies are family-oriented. TTheyhey iincludenclude vvolunteeringolunteering atat school,school, goinggoing onon familyfamily walks and hikes, helping my husbandd ttrainin hhisis bblacklack labslabs fforor hhuntunt teststests andand toastingtoasting my own coffee beans.

What I like I am truly blessed to have worked for Dr. Lemire for the past 20 years. The team about my job: of people I work with are amazing. Our patients and the community we live in are wonderful.

My greatest My greatest challenge is seeing a high number of people in our community who challenge is: cannot afford quality dental care. Fortunately we have a number of local dentists, hygienists, and assistants who are willing to volunteer their time to address this need.

Success at our Success at our office means listening to our patient’s individual needs and focusing office means: on ways to make their dental experience as pleasant as possible. Our office believes that a strong rapport with our patients makes a successful practice. A large number of referrals has contributed to Dr. Lemire’s practice growing over the last 20 years..

What Burkhart We love having Burkhart as our dental supplier because of their customer service, means to me: the quality of their products and the knowledge that Brett our Sales Rep brings to the office. When Brett is challenged with a question or concern by Dr. Lemire, he has always done an outstanding job researching the topic and provides us with the answers that not only satisfy Dr. Lemire, but more importantly benefit the needs of our patients.

Wendy Forrester Dental Assistant, Lori Lemire, D.M.D. — Coos Bay, Oregon

CATALYST MAGAZINE Issue 4 2010 19. because clean matters.

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©2010 DENTSPLY. All rights reserved. MID20-0310-6.2 Clinical Success

Creating Real Value for Aesthetics When it is at the Bottom of the List

By Rhys Spoor, DDS, FAGD, FADIA Accredited Member of the American Academy of Cosmetic Dentistry

conomies around the world have seen a downturn gets tight, many patients will delay or ignore dental care to and tightening in the last several years, and our dental save on expenses. To successfully counter this tendency, it is in E practices are affected by these same forces. As we all our and our patients’ interest to make sure that the dentistry are, our patients are making choices about how to spend their that we offer to our communities is based on value, not just money and prioritize what is the most important. All of us in cost. Below I have listed the factors that I have found to be private practice are in the healthcare business, and as such we important in presenting the real value of aesthetics and help ultimately need to create a profit or we won’t be able to stay patients maintain the priority of seeking our care. in business. Good oral health is an integral part of a higher quality of life, and the definition of what constitutes good oral DEVELOP TRUSTING RELATIONSHIPS health is both objective and subjective. Aesthetics often falls WITH YOUR PATIENTS into the most subjective end of the spectrum, but the longevity Before you can begin producing successful aesthetic of aesthetic dentistry is based on sound overall oral health, so cases, you must first develop a proper relationship with the argument can be made that a person can’t have one without your patients. Aesthetic dentistry presents not only the the other. Dentistry has the charge and the ability to improve challenge of techniques, artistic skill, material selection, and the level of oral health for all of our patients, but as money communication, but also the demands of emotion. This area

CATALYST MAGAZINE Issue 4 2010 23. Clinical Success

of dentistry affects how the final result looks and feels to the share of treatment plans for patients who never wanted the patient and as such becomes very subjective. The patient is treatment in the first place, which ultimately wastes my time and the final determiner of success or failure; in fact, the case is theirs. Treat each patient as if he or she were a member of your only a success when the patient is happy and satisfied. We own family. If you don’t have the clinical skills to perform all of now are required to become commissioned artists and add the treatment necessary, then refer to a trusted source. Better the complexities of art and science to our necessity to please yet, for the future, seek education on how to do a particular the client emotionally. procedure, as we can all be trained and learn new things.

We are instrumental in enhancing the lives of our patients The treatment plan starts with complete and accurate records. through improvements in oral health that affect both the These records include a medical history with special emphasis body and the mind. The impact of that effect can be readily on any maladies that will compromise the patient either seen in the newfound happiness and increase in self-esteem during treatment or afterwards. Do a comprehensive clinical seen in patients after changing the form and function of examination of the dentition, oral structures, and hard and soft their smiles. Often there is a metamorphosis in overall tissues of the head and neck with radiographs, periodontal and appearance and improved social interactions, as these people endodontic evaluation, photographs and accurate diagnostic feel the satisfaction of knowing they really do look their models. An occlusal analysis is critical to the success of every best, and for most, looking good makes them feel good. case, because form must follow function. Violate the functional envelope, and the form will not last. The Exceptional aesthetic dentistry is based occlusal analysis includes the dentition, on the concept of form following We now are the muscles of mastication (head and function and involves all disciplines in required to become neck) and the tempromandibular joints. the dental field. Aesthetic dentistry is as much about the physical task as it is commissioned Important analysis about the emotional aspect, and as such, artists and add the factors are as follows: the dental team must clearly identify complexities of art 1. Closed dimension of the cemento- and precisely delineate the desires of enamel junction of the maxillary and and science to our a patient in order to create a more mandibular central incisors, termed the than satisfactory result. This involves necessity to please Vertical Index (a guideline is 15–19mm finding what values the patient has and in clinically healthy patients). matching them with the skills you and the client emotionally. the dental team possess. 2. Open dimension at maximal effort between the maxillary incisal edges Aesthetic dentistry can be remarkably demanding and (usually around 50mm). Inability to emotional for not only the patients but also for the dental open in this range or beyond may indicate muscle spasms or team. This work includes high demands and rewards, an intracapsular disorder with TMJ. including higher risks. Each case usually deals with multiple 3. The presence of wear facets on the dentition teeth, usually due to a deficiency in symmetry, and as such, (indicates bruxing). our work tends to be relatively expensive. Consequently, it is 4. Chronic, acute, spontaneous, or provocated pain. The pain important to establish relationships among the patient, the may not exist directly in the area of the teeth, but may be dentist, and the entire team on good terms so that when the related to headaches and neck or upper back pain. emotional highs and lows inevitably come, the relationships will endure. A deep sense of trust and commitment between An extensive photographic series is important in aesthetic the patient and the team can develop that leads to a real cases, as a picture is worth a thousand words. With the sense of satisfaction. advancements in digital camera technology, the ease of use and the immediacy of excellent clinical photographs becomes a DECIDING ON THE BEST TREATMENT PLAN cornerstone in documentation, treatment planning, laboratory Once you know you have a patient that is truly interested and communication, and future marketing. A high quality digital motivated in treatment, only at that time should you take the camera with proper lighting, and depth of field and clarity for next step in designing the case. I have created more than my intraoral and portrait use is as important as the handpiece.

24. Issue 4 2010 CATALYST MAGAZINE Clinical Success

Discussing with the patient the specifics about the shape and shade of the teeth they would like is worthwhile. Most patients want teeth that are whiter and straighter and display more than they presently do. In my observation, most patients see but are often unable to describe asymmetries. In your smile design, if you can regain some semblance of bilateral symmetry, then you are 80% closer to a successful clinical result.

Finally, obtaining truly informed consent after reviewing the positives and negatives to various treatment options may effectively avoid possible dissatisfaction and even legal problems later on. As much as we all try for perfection, our work is called the practice of dentistry for a reason. efficiency in mind. Be prepared for your commitment to be there for them in We are dealing in a complex and not patients’ appointment times, and if you the future. This is where your efforts fully understood biologic system that respect their time, I have found they to provide comprehensive, high quality doesn’t always respond to our treatment will do the same for you. If the patient care pay off, and patients who reach the protocols in the way we would hope. sees the true value of the result they are level of dental health and concomitant Continue to strive for your best, and seeking, then they are willing to invest aesthetic improvements that it supports with a clear understanding between you the time to get to that result. tend to have very few emergencies. and your patients, cases will usually be successful, even if you experience a few Pain — With the broad range of effective The process of fighting dental disease bumps in the road. local anesthetics, analgesics, and sedative continues on, as does our patients’ agents, dentistry can and should be desire to have beautiful, healthy smiles. MAKE THE TREATMENT totally comfortable. Learn to use all of Excellence endures, and by being AS EASY AS POSSIBLE these methods and allow time in the sensitive to the desires and challenges Overcome the three major objections to practice to utilize these wonderful our patients’ experience while at the dental care from patients: the cost, the medications to their full advantages. same time providing dentistry with real time it takes and fear of pain. Also, remember to pile on a good and value gives us the opportunity to flourish sincere dose of compassion. even in an economic downturn. Cost — If a proper explanation of benefits is given, the value of the WARRANT YOUR WORK treatment becomes apparent, and the Nothing speaks louder to a patient than issue of cost becomes one of affordability. your belief that the work you do has enough value to warrant your practice. Rhys Spoor, DDS, is a 1983 I believe that anyone who has a job graduate of the University can afford any of the dentistry services Be prepared to do what it takes to of Washington School of we can provide; it’s about priorities. make them happy, and be available in a Dentistry and is an Accredited Most treatments can be staged over a timely manner to help them out under Member of the American Academy of Cosmetic time frame that can fit any budget and the occasional circumstance when something doesn't go as planned or Dentistry and a Fellow of the still give a perfectly acceptable result. Academy of General Dentistry and the Pierre doesn’t match expectations. Make a Additionally, financing is available. Fauchard Society. He welcomes contact at point to ensure that the patient knows [email protected]. Time — Quality care does take time, from the beginning that quality work but it can and should be planned with comes with quality service and a quality

CATALYST MAGAZINE Issue 4 2010 25. 26. Issue 4 2010 CATALYST MAGAZINE Feature HAMMOND ELLIS: By Holly Kean, Marketing Manager &Photos by Mark Bowers Patient-Centric Practice

ost of the details in dentistry are focused on “My wife has been a visionary part of the practice for a long treatments and therapies. time now and we recently visited an upscale resort hotel for our M anniversary. We must have written down six or seven things For one practice in Utah the details are the practice — not that they’ve implemented for us to try to fit into our practice.” just in the treatment. Hammond and Ellis, the office of Dr. Chris Hammond and Dr. Chad Ellis advocate that a happy “When we explain some of the things we’ve done and the sources patient experience is really what their practice is all about. From of inspiration, some dentists may say, ‘now that is weird.’ But the way the patient is greeted, to the people they encounter when you see it in place you can see how it works and how it during treatment, the sounds they hear and the smells they fits into what patients are looking for. This approach really gives smell, nothing has been left to chance. Everyone working there us a chance to build relationships with our patients one-on-one,” has been selected for a specific reason. Everything there has a cites Dr. Hammond. purpose — to make the patient experience dynamic, pleasant, and memorable. Take for example their entrance. When a patient walks into Hammond and Ellis, they are met by their assistant or hygienist, Says Dr. Ellis, “We want to ‘wow’ them with customer sometimes even their dentist standing by a beautifully curved service and as a bonus, they get some of the best dentistry mirrored wall that doubles as a cascading waterfall, a personal available to them.” and serene welcome for patients and their families. No waiting. No glass partition. No front desk. Thanks to an earpiece Some industries use the term concierge for this style of customer communication system and a ceiling mounted camera, the service — Dr. Hammond & Dr. Ellis just call it unique, warm team knows when patients have arrived and they are quick to personable service. make their way to the front area to welcome them just as if they were guests coming for dinner at home. Dr. Hammond really sees the trend in concierge service taking shape in other industries. “The old term ‘customer service’ really The practice also features a private, relaxing quiet room for isn’t good enough any more. Now it’s on a completely different anxious patients or parent’s of patients so those who are level because of companies like Ritz Carlton and Apple — uncomfortable waiting can get away. Patients also enjoy the companies who have elevated service for the consumer.” snack bar area, stocked with healthy snacks and drinks. The kids’ room is stocked full of everything a kid could want to The inspiration can come from anywhere and at any time. occupy their time. Television, books, stuffed animals and A recent trip for Dr. Hammond provided some new sources. other toys are stored on pint sized patient-accessible shelves,

CATALYST MAGAZINE Issue 4 2010 27. Feature

making the room feel like a play area, We know that we have do it right every well kept and full of up-to-date toys. time, otherwise we’ve missed the mark.” Another patient-centric feature of the office includes doors that close When new patients are scheduled at on all the operatories which reduces Hammond & Ellis, they are treated with off-putting noises and smells wafting the utmost care and communication. throughout the office. The new patient exam room has been designed to be the most comfortable “My dad used to pop popcorn to cover room in the office. It features a carpeted the clinical smells that most people floor (where the others have hardwood), don’t like about the dentist’s office,” a closing door for the highest level of commented Dr. Hammond. “Sometimes privacy and confidentiality, and large we’ll bake bread or cookies to do the space with plenty of seating. But the same thing in our office.” real feature of this room is the set of posters hung on the wall. Directly The doctors and the team know how opposite of the patient chair is a large critical it is to execute at a high level poster with photos and names of the every time. This approach can be entire staff. You might say, so what? But challenging for new patients, even how many times have you been in an TOP: The private exam rooms offer doors that close, containing smells and after explaining over the phone that office for the first time and forgotten noises that could travel through the office. MIDDLE: Photos of patients are their approach is different. “With new the name of the person who escorted displayed proudly throughout the practice. BOTTOM: Patients can enjoy the snack bar area, stocked with healthy snacks and drinks. patients, we have to get it right the you to your meeting area? This helps first time. And when we do, after a few new patients get familiar with their staff visits, they start to think its ‘normal.’ and feel more comfortable.

28. Issue 4 2010 CATALYST MAGAZINE Feature

It’s a concept Dr. Chris Hammond work here with us. Most people don’t Disney facilities in Orlando, Florida. and Dr. Chad Ellis inherited from get it until they walk in the door,” cites While there, this group of dentists and Chris’ father, Dr. Roy Hammond (who Dr. Hammond. their spouses were able to tap into some Chris began practicing with when he of the ideas the Disney corporation uses graduated from dental school). Dr. Most who join their team do so because in hiring, training, and in ensuring the Hammond joined his father’s practice they feel they want more from their work. experiences people have while at Disney after completing his undergraduate parks are consistently the “happiest” degree at Brigham Young University and “Their pay might be ok, they might they can be. This access to a company then completing his education at Oregon be bored, and feel like they’re just like Disney who shapes experiences Health Sciences University School of punching a time clock but want more. really brought out some things that Dentistry. The concierge approach was When they come here, they find they Dr. Hammond and Dr. Ellis have something his father was inspired by after get more satisfaction from their job. We implemented in their practice. a trip to Hawaii and it’s really the only offer profit sharing so they have a real way Dr. Hammond has ever practiced. part in our success. They really sense For instance, at a Disney theme park, that working as a part of a team, they all employees who play characters are “When my dad was a dentist in the ‘70s, benefit,” says Dr. Ellis. called “Cast Members”. Anytime a Cast customer service was sending a birthday card to a patient. Now that just doesn’t cut it — everyone does it.”

FINDING & HIRING THE RIGHT PEOPLE With such a unique way of shaping their patient experiences, Dr. Hammond and Dr. Ellis are challenged to find team members who are able to deliver the level of service their patients have come to understand, appreciate, and expect. “We seek out people who we want to work for us from other service industries.”

Dr. Hammond and Dr. Ellis and their wives actually have a list of people they’ve encountered — either at dinner, while shopping or at the spa — that have provided a very high level of personable service. The practice might not have a need at the time, but when it does, the doctors approach those ABOVE: Dr. Hammond values the relationships they build with their clients. “We treat people, not teeth.” people to see if they’d be interested in joining their team. At first, some are Every morning before patients begin to Member is in costume and in a park, hesitant but once they have a chance arrive, the entire team meets for a morning they are supposed to be “in character” to understand the practice, get to huddle. Each member of the team takes — to act as that character would know the team and see how different turns running the huddle — one day interact while meeting park guests. it is, most opt to take the doctors up someone might read a quote or share a They are to leave any personal problems on their offer. thought that provides inspiration, another they have behind for 8 hours and forget day might be one of the doctors asking the spat they had with a spouse before The doctors involve their team in the their team to recite one of their core values. coming to work or that flat tire so the process. “If we can get potential team Disney guests can have an amazing, members to the office to just see how The Crown Council, a national consistent experience. Disney calls it we work and what the team is like, association of dentists that focus on “Show Time.” Taking cues from this how we treat patients, then we have a treating patients, not teeth, helped idea, Dr. Hammond and Dr. Ellis have lot of success in getting them to come organize a trip a few years ago to the a small sign hanging just by the door

CATALYST MAGAZINE Issue 4 2010 29. Feature USING SOCIAL MEDIA TO STAY CONNECTED TO PATIENTS Dr. Hammond & Dr. Ellis actively utilize social media to stay connected to their patients. “We’re trying to create a culture of people who want to be around us not just for their dental appointments but that want to be here all of the time. It’s worked for us. We use Facebook, Twitter, and our blog site to stay in constant communication with our patients. We have a chance to remind them every day of what we do and what we’re about. Most patients only get to experience this place once or twice a year so we need a way to stay in contact with people regularly. We want them to feel attached to us.

ABOVE: Team members touch the sign that reads “TEAM: It's Show Time" every time they All social networking is managed by one of their team get ready to start their day. members. This ensures regular and constant communication with their patients and that the information they’re posting is in the office where they meet every morning to remind their always fresh and relevant. team about that concept. As a daily reminder, each member of the team taps the little sign as the leave the office and go out True to form, the two sought out someone in their area who to start seeing patients for the day. was using social media to build business in another industry and borrowed some of their ideas and utilized their experience Dr. Hammond and Dr. Ellis find that to shape their social media marketing plan. training the hard skills of dental assisting is often times easier than finding the One of the things they do that patients look right people. Finding the people who forward to are the parties they host twice are comfortable communicating with a year for their younger patients — once patients about things as personal as the usually around the holiday in December health and appearance of their smile, and once right before school starts back and being comfortable in their patients’ up again in August. The parties are always personal space is not as easy to train. something their school-aged patients really look forward to and are something the Dr. Hammond approached finding a team enjoys planning as well. partner in a similar fashion about seven years ago. Dr. Ellis enjoys how immediate contact is with patients through social media “When my dad retired from the sites like Twitter and Facebook. “With practice, I looked for someone who social media we can immediately send matched up with our ideas about a message out like with our kids’ parties outstanding patient experiences. I didn’t just look to hire just and right after the event, two of our team members were able anyone; I was looking for a real partner. I wanted to find to get pictures up on FB from the party to share with our someone who could bring new skill sets but could appreciate patients and their families. What a great way to reach all our the master vision started by my dad.” patients really quickly without all the trouble of writing and mailing, editing and printing a newsletter.” Dr. Ellis received his Bachelor and Master of Science degrees from Utah State University. After serving in the Air Force for With all the stuff they do in their office, there are some ideas five years, he decided to attend dental school at the University they’ve tried that just didn’t stick around. “We were doing of Texas Health Science Center, San Antonio. After receiving printed paper newsletters and we realized that once we printed his Doctor of Dental Surgery degree, he completed a one- them, the information was already old. In the end we decided year residency and received additional training in cosmetic it wasn’t worth the trouble because we never really knew how dentistry, dental implants, IV sedation, endodontics, and many of our patients read them,” cites Dr. Ellis. oral surgery. Dr. Ellis really enjoys the balance of technical knowledge and creative skill. “The balance between the WORK ON, NOT JUST IN science and the art is what attracted me to dentistry.” So what does it take to implement new ideas or even promote change in your practice? “Set time aside in your life to put the

30. Issue 4 2010 CATALYST MAGAZINE Feature

TOP LEFT: An adapted logo appeals to kids and shows them where the kid spaces are in the office. BELOW LEFT: Kids fill in a logo card with their name to hang on the wall after treatment. ABOVE: DR. Ellis and one of many pedio patients.

new ideas to action. We probably spend 80% of our time IN ourselves out of business?’ We’ve gotten some pretty wild ideas but our practice and 20% ON our practice. Take uninterrupted it gives us something to think about,” commented Dr. Ellis. time to work on your practice to try new stuff, clinical and non-clinical,” says Dr. Hammond. “Plastic surgeons understand the concept of appealing to patients through appropriate messaging and marketing. They These guys practice what they preach. Every other Thursday get that things should be pretty, that the marketing pieces is a non-patient work day. It’s time they and their wives should be put together well. Why doesn’t that fit into dentistry? take to work ON their practice with their staff. They train, We’re a service organization just like them.” brainstorm, implement changes, big and small, and outline new processes but they know the investment is worth it. BELIEVE IN YOUR IDEAS One thing is clear about this office. Both Dr. Hammond and Dr. “It takes a lot of work to implement new things and keep the Ellis truly believe in creating patient experiences that draw their energy up. People get used to things. You have to find ways to patients closer to them and they recognize that each patient is stay fresh, new and WOW your patients,” says Dr. Ellis. more than just a chart and 32 teeth (give or take). They continue to evolve their practice by taking ownership of their ideas. “It’s a model we’ve proven can work,” points out Dr. Hammond Dr. Hammond spells it out like this, “If you were going to open They encourage the free thinking vibe with their team too. “We’ve up a restaurant, you’d want it to look different, taste different, held meetings where we brainstormed for a half an hour with our feel different. You’d want your customers to experience team. We might ask, ‘If we were going to open up a practice across something at your restaurant that they’d never experienced the street to compete against ourselves, what would we do to put anywhere else. We try for the same thing.”

CATALYST MAGAZINE Issue 4 2010 31. Feature

PICTURED ABOVE (left to right): (BACK ROW) Demri Johnson, Hollie Van Orden, Melanie Ellison, Ashley Elggren, Kelly Jo Baird, Tracey Beekstrom (MIDDLE ROW) Tiffany Tuttle, Dr. Chris Hammond, Kellie Sizemore, Dr. Chad Ellis, Neena Andersen (FRONT ROW) Kristen Wildeboer, Paula Swenson, Tonya Campbell

For Dr. Hammond & Dr. Ellis, this way of practicing works They also rely on their association with the Crown Council, to for them but they know it’s not right for everyone. stay in touch with other dentists from across the nation who take a similar approach to their practice. “Networking helps “We know we do things different,” commented Dr. Ellis. “We us ‘jump ahead’ and be on that cutting edge — maybe it’s try to stay focused on the vision that’s right for us. When you happening elsewhere in the country but hasn’t yet made its allow negativity in it can make you start doubting what you’re way to Utah.” planning. ‘Maybe we shouldn’t be expanding our office or maybe we shouldn’t be hiring another hygienist or maybe we shouldn’t For Dr. Chris Hammond & Dr. Chad Ellis, it’s clearly all about be investing in more technology…’ Don’t talk yourself out of it.” the patient. The team loves what they do and they truly enjoy their patients. Their office is filled with pictures of smiling The vision they have doesn’t mean being stuck to an idea happy people, all actual patients who appreciate quality of the and excluding all others. Dr. Hammond and Dr. Ellis say, dentistry, the comfort of the office and the level of personal “We know what we want but we’re not afraid to be shaped care, and support from the team. by other industries like a hotel or Nordstrom. We know where we’re headed and we’re looking for other industries Their marketing material sums it up, “Being a Hammond and who have laid the groundwork for similar outcomes and we Ellis patient just feels good.” That’s one detail that the team look to them to help us shape our practice.” and the patients can all appreciate.

32. Issue 4 2010 CATALYST MAGAZINE THE AIR-FLOW® HANDY PERIO } SUBGINGIVAL BIOFILM REMOVAL IN JUST 5 SECONDS

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· a N i the 22010-2011 I d g e C e C z l N i l · n o A g n C H o N c · E e s Summitmmmm Speakers R u · c u G · o d N y F E I it V l l g O a a n R u i i eg u Q l n l i · o t d Dr. Davidd GGarber n Dr. Michael Simmons e C o z · i C n s g u · “Resolving“RoR Controversiesntttrr in Your n “Sleep Disordered Breathing: Why c o o e F i l t R Clinical IImImplantma p Practice” a Dentistry? Why Now?” · gi c ty e u li ll d a San Diego,Diegiegeggogo CA - January 28, 2011 E San Diego - March 7, 2011 u · C g Q s in · cu u ed o n iz l F ti n ia n og leg o ec ol C R C Dr. John Flucke · Mr. Rolfe Carawan · s · n ty cu io ali Fo t u ial a Q leg “Day to Day Technology that can Improveprrrou o “Winning Together: The Key to Building d· Col d ize cus · E gnial Fo Your Pr actice” g Unified Teams” s · Coeclleg in Focu R u ity· n ual ti Q Seattle, WA - January 13, 2011 n Tulsa, OK - March 24, 2011 o · C San Diego, CA - April 14, 201101i11 at uc Ed Jan Hargrave ng ui Dr. PeterrrJ JaJJacobsenaacicn “Let Me See Your Body Talk: People · C Reading Through Understanding “Drugs, Bugs aanandnnddio nDentistry: What to c du Nonverbal Communication & Personality g EPrescribe!”P uin Differences” tin on · C Seattle, WA - May 19, 2011 on cati Yakima, WA - February 25, 2011 Edu uing ontin on · C ducati Dr. Norm Ickert nuing E ducation · Conti “Adjacent Implants in the Aesthetic Zone: Ask your Burkhart account Truth of Consequences” manager about the exciting Seattle, WA - March 10, 2011 continuing education opportunities near you! Dr. Marc Geissberger “Quarterbacking Difficult Cases in www.summitdds.com Restorative Dentistry” Seattle, WA - April 14, 2011 1-800-765-7277

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www.pelton.net www.kavousa.com Technology Digital Radiography — Quick, Easy, and Highly Visual

“ eople only see what they are prepared to see,” said Dental Care in Dublin, California, had worked with traditional American author Ralph Waldo Emerson. While this film and digital x-rays. “The new Gendex sensor is much Pphilosophy applies to many of life’s lessons, it also clearer and gives more detail,” he says. In addition, he notes is pertinent to the everyday dental practice. For this reason, that “digital x-rays come up on the screen immediately, so there having the most up-to-date dental radiography is an imperative is no waiting for developing. Patients like that the process is when trying to build a successful dental practice. quicker, and it saves time for us in the office too.” The sensor shape is more comfortable than traditional film. “Because Technology gives dentists the opportunity to expand their of its rounder corners, the patients are more accepting when knowledge and scope of practice. Digital x-ray, especially with x-rays are being taken,” he says. “So the whole process is easier new sensor technology like that of the Gendex GXS-700™ for the staff and less stressful for the patient.” sensor, provides concise, clear images for diagnosis and treat- ment planning. Digital gives clinicians choices — rather than While adult patients, such as Dr. Ramirez’s report a more squinting at a small film x-ray while looking up at the light or comfortable experience, the GXS-700 sensor comes in two sizes, on a light box, with the assistance of imaging software, such as one for adult, and one for pedodontics. With dimensions similar VixWin Platinum™, digital x-rays can be enlarged, spotlighted, to Size 1 film, the sensor provides a more comfortable experience Optimized or magnified. The GXS-700 sensor was developed even in the distal part of the mouth, boosting cooperation and with advanced CMOS sensor technology and yields more trust between the clinician and the younger patient. than 20 visible line pairs per millimeter. The ability to capture high resolution images can help the dentist gain more succinct Dr. Ramirez concurs that digital information on a wide range of dental conditions, radiography is being recognized as including the progression of caries and canals. an integral part of the modern Information such as this makes treatment decisions dental office. “Before we for restorative and endo procedures clear to both moved, we had traditional the dentist and the patient. film,” he says. “If anyone is going to build a modern Clearer x-rays also assist the dentist with office, they should equip patient education, and as a result, increase and speed up case acceptance. When digital x-rays are displayed on a computer screen, patients, who usually are not schooled in the art of reading x-rays, are able to not only see the problem, but understand the potential risks of not pursuing treatment and the advantages of choosing one type of treatment over another. Because the x-rays are digital, the practitioner can use the various software tools available to highlight or point out certain areas of concern.

Before implementing his GXS-700 sensor about six months ago, Burkhart customer, Dr. Ferdinand D. Ramirez owner of Almond

38. Issue 4 2010 CATALYST MAGAZINE LEFT AND RIGHT: Photos showing the high level of detail achieved by using a digital X-Ray.

it with modern technology.” He adds, “After a short learning the dentist sees, they will not only understand and accept the curve, everything is working out quite well.” While Ralph best course of treatment, but they will also be convinced that Waldo Emerson contended that people see what they are their dentist is interested in offering them the most modern prepared to see, owners of digital x-ray systems have first-hand and effective dental care. experience that when patients see with their own eyes what

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By Dawn Christodoulou Cloud Computing What Is It and What Does It Mean for Dentistry?

he current buzz in the IT world is all about the “cloud.” for additional hardware. InContact, for example, began as a It’s been the featured subject of many IT publications reseller of telecommunication services and has evolved into T for months and recently has become a topic some the leading provider of cloud-based, on-demand call center dental gurus are writing about. What is the cloud exactly, and software solutions. Salesforce, another leader in software-as-a- what new services will it bring to the dental community? service applications, provides customer relations management (CRM) applications to sales and service organizations. According to Wikipedia, the free web-based encyclopedia, “cloud computing is Internet-based computing, whereby For the dental community, cloud computing offers many shared resources, software, and information are provided to possibilities. However, the inherent benefit of the technology computers and other devices on demand, like the electricity — reduced computer infrastructure — cannot be realized due grid.” At its most basic level, the “cloud” is simply the Internet, to our specialty’s need for digital image capture and direct or the vast array of servers around the world that compose it. integration of these images into patient records. The cloud When people say that a digital document is stored or a digital simply cannot offer the platform, power, performance, and task is being performed in the cloud, reliability needed to support the specialty digital they mean that the file or application devices used in a dental office. In addition, lives on a server you access over an If anyone is there are some fundamental issues surrounding Internet connection via a Web browser or going to build a this new era of software subscription services, application, rather than on a local device, including data control, data ownership, and data such as your computer’s hard drive. modern office, security, to name a few. they should equip Cloud computing is not new, and it is Recently, our payroll provider introduced a it with modern not a new concept to dentistry. For years, new cloud-based product. Prior to year end, there have been services that back up your technology. our company faced the need to either upgrade files to off-site locations via the Internet. our current PC version of the software or move XLBackup is one such example of an off- to the new offering on the Internet. At first, I site storage service that caters to dental approached the decision as a no-brainer. Why offices using digital imaging. Web-based email programs, wouldn’t we move this application to the cloud? We’re already like Yahoo Mail or Hotmail, are familiar examples of cloud- transmitting the data via the Internet twice per month for based applications. Those of you who follow the technology processing. The new service would allow us to enter the payroll trends of the dot-com (.com) era will remember a few dental information directly, without the hassle of maintaining a Application Service Provider (ASP) models that attempted to PC-based application. At the same time, I thought it wise to make their mark in the dental practice management market. go out and get other bids to see if the offering was competitive. In the process, I asked the same question of all three payroll The advantage to cloud computing for contact between small companies bidding on our account. The question was, “If I and medium-sized businesses (SMBs) is the ability to obtain want to move to your competitor’s service in a few years will instantly the benefits of an enormous infrastructure without you provide me with my data so I can make that move?” After having to implement and administer it directly. There is no need the deafening silence and looks of confusion from each sales to invest in or maintain large in-house servers or redundancy person, do you know what the resounding answer was? “No, solutions when subscribing to cloud-based applications. The we can’t provide you with your historical data if you choose to cloud permits accessibility to multiple data centers anywhere discontinue our service.” At present, there are no mechanisms around the globe. It also means that, as the need for resources or standards in place to do that, and there are limited consumer increases, companies can add additional service as needed protection laws to regulate how data are governed in the cloud. from the cloud computing vendor without having to pay For our business, payroll data does not hold the same importance

40. Issue 4 2010 CATALYST MAGAZINE Technology

as our customer data and its historical value is not really that real-time services like electronic remittance advice (ERA) and great. But the bottom line is that it’s my data; I own it, I want real-time insurance eligibility checking. In the state of Minnesota, to control it, and I want the power to use it in any way I choose. mandated electronic prescribing is just around the corner. While Needless to say, we will be upgrading to the new PC version in patient portal services like XLPortal will continue to evolve in November. To capture the benefit of the new Internet solution, the cloud, practice management and image capture systems will I’ve requested that our service include paperless paycheck and continue to be better served in a client/server-based environment employee links, which are cloud-based offerings. for a variety of reasons. New services like ddsWeblink, a doctor-to- doctor collaboration cloud tool, will not only become increasingly Cloud offerings in dentistry will continue to grow as we get important to coordinating multi-disciplinary care but will also see closer to a standardized electronic health record (EHR) Consider demand from patients wanting the best out of their dental care that our industry has already achieved and is benefiting from team. We have a lot to look forward to.

Matsco is now Wells Fargo Practice Finance

While our name has changed, the value and service you expect from us has not. We remain committed to helping you achieve your practice goals, and are still the only practice lender endorsed by ADA Business ResourcesSM . Contact us at 888.937.2321 or wellsfargo.com/practicefinance and let’s talk about how we can support you.

© 2010 Wells Fargo Bank, N.A. All rights reserved. Wells Fargo Practice Finance is a division of Wells Fargo Bank, N.A.

ADA® is a registered trademark of the American Dental Association. ADA Business ResourcesSM is a service mark of the American Dental Association. ADA Business Resources is a program brought to you by ADA Business Enterprises, Inc., a wholly owned subsidiary of the American Dental Association.

CATALYST MAGAZINE Issue 4 2010 41. 2,200 mWcm2 Power Output!

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RLYYKLU[HSJVT 2,99 Your practice is our inspiration.TM Business of Dentistry Here Come the Taxes By Bob Creamer, CPA

ver the last few months, Congress has been busy must offer health insurance to its employees as part of their passing a lot of new laws, some of which bring compensation and contribute at least half the total premium O about many tax changes. In fact, the Health cost. Owners and their families are generally excluded from Care Reform Act has already been labeled as one of the most the calculation. The business must have no more than 25 prominent examples of tax legislation in the history of our full-time equivalent employees (FTEs), and the employees country. Many dentists fall specifically into the oft-mentioned must have annual full-time equivalent wages that average no and openly targeted group of income earners making over more than $50,000. However, the full amount of the credit is $250,000. With that in mind, you could use a summary of available only to an employer with 10 or fewer FTEs and whose what to watch for while doing your tax planning with your employees have average annual full-time equivalent wages from accountant this year! the employer of not more than $25,000. Most dental offices will not qualify for the full benefit due to higher salaries, but many We all know that tax law does not provide an easy read. will be eligible for a portion of this benefit. Make sure to discuss Luckily, the focus of this article is not to fully educate you with your tax advisor or payroll administrator who can help on tax law or to provide specific tax advice. determine eligibility and produce estimates The purpose is to give you, the dentist, for you. The credit is available beginning in some highlights regarding those provisions The Healthcare tax years after December 31, 2009. most likely to affect you and to emphasize the importance of meeting with your tax Reform Act has Medical Expense Deduction Reduced advisor to maximize your benefits and already been — after 12/31/2012 minimize your exposure. For tax years beginning after December labeled as one of 31, 2012, medical expenses taken as an THE HEALTH CARE REFORM ACT the most prominent itemized deduction will be reduced to the Let’s tackle the foremost issue first. This examples of tax amount in excess of 10% of Adjusted Gross reform actually combined two new laws Income (AGI). For individuals age 65 or together as the Healthcare Reform Act, legislation in older (and their spouses) the effective date also known as “Obamacare”. First, it the history of is delayed until after December 31, 2016. offers healthcare reform and availability our country. and also lays out the revenue provisions Small Employers May Establish for funding healthcare spending. “Simple Cafeteria Plans” — after 12/31/2010 The law includes some major changes regarding benefits, including For years beginning after December 31, 2010, the healthcare new tax credits. However, it also includes penalties, excise taxes, reform relaxes some rules by carving out a safe harbor from non- payroll taxes, and income tax increases. A variety of factors discrimination requirements to encourage more small employers determine who will be impacted, such as the number of employees to offer tax-free benefits to employees. and the type of industry in which each company conducts business. For most dental practices, this will give dentists the opportunity The following is an overview of the provisions that will have to provide employee benefits for health, group term life, and/or the biggest impact on small businesses — specifically dentists. dependent care assistance affordably. Contact your tax advisor for the eligibility requirements of this provision. Tax Credits to Certain Small Employers Who Provide Insurance — after 12/31/09 Most Small Businesses Exempted From Penalties for The new law provides small employers with a tax credit (i.e., a Not Offering Coverage to Their Employees dollar-for-dollar reduction in tax) for up to 35% of non-elective — after 12/31/2013 contributions that the practice pays to purchase health insurance The new law imposes penalties for not providing health care for their employees. The credit can offset an employer's regular coverage to employees (the so-called “pay or play” clause). tax or its Alternative Minimum Tax (AMT) liability. However, most dental practices won't have to worry about this provision, because employers with fewer than 50 employees Eligibility Requirements: To qualify for this credit, a business aren't subject to the “pay or play” penalty. For businesses with at

46. Issue 4 2010 CATALYST MAGAZINE Business of Dentistry

least 50 employees, the possible penalties Additional vary depending on whether or not the Medicare Hospital employer offers health insurance to its Insurance (HI) Tax employees. Since most dental offices do — after 12/31/2012 not have 50 employees, you can rest easy For tax years regarding this potential penalty beginning after which goes into effect after 2012, an additional December 31, 2013. 0.9% of HI tax will be applied Increased for taxpayer earnings Penalty for in excess of $250,000 Non-qualifi ed for joint returns, $125,000 Health Savings for married taxpayers filing Account (HSA) separately, and $200,000 in all other Distributions cases. This change does not affect — after 12/31/2012 the portion of HI tax that employers The penalty is 20% of funds pay, but the business must withhold withdrawn for non-qualified this additional 0.9% on wages paid over expenses (qualified expenses are $200,000 per individual, regardless of items such as prescription drugs or The “Cadillac tax” on High-Cost the spouse’s earnings. The tax is applied physician office co-pays). In addition, Health Plans — after 12/31/2017 to self-employed and LLC dentists in Health Flexible Savings Account (FSA) The new law places an excise tax on the form of additional Self-Employment plan contributions have a new annual high-cost, employer-sponsored health Contributions Act (SECA) tax. This tax limit of $2,500 under cafeteria plans, coverage (Often referred to as “Cadillac applies to many dental professionals, beginning in 2013. This will affect health plans”). This applies a 40% since the average dentist’s wages are over how dentists configure their employees’ excise tax on insurance companies, $250,000 per year. benefits as well as how they manage based on premiums that exceed certain their own plans. amounts. The tax is not applied to Unearned Income Medicare employers unless they are self-funded, Contribution Tax Information Reporting Required which is typically the case in larger — after 12/31/2012 for Payments to Corporations practices — the average dental office For tax years beginning after December — after 12/31/2011 may not be directly affected. However, 31, 2012, an unearned income Year-end Forms 1099 must be filed expect that employers and workers will Medicare contribution tax is imposed for previously excluded payments to ultimately bear this tax in the form of on individuals, estates, and trusts. corporations. This requirement will hit higher premiums passed on to all by the For an individual, the tax is 3.8% on all businesses and will impact dental insurers. The tax becomes effective after the lesser of either (1) net investment practices by reducing production time December 31, 2017. income or (2) the excess of Modified to do more administrative work. For Adjusted Gross Income (MAGI) over offices that outsource Form 1099 Excise Tax Imposed on Medical the threshold amount (i.e., $250,000 preparation, this policy will increase Device Manufacturers for a joint return or surviving spouse, costs. The failure-to-file penalty ranges — after 12/31/2012 $125,000 for a married individual filing from a minimum of $15 per Form This provision directly impacts dental a separate return, and $200,000 for all 1099 to a maximum of $250,000. Plus, manufacturers but will end up impacting others). Again, since dentists’ average additional penalties will be applied for dental offices in the form of higher costs earnings are more than $250,000 per intentional disregard. The requirement for equipment and supplies. The tax is year, consult your tax advisor for some goes into effect for payments made after 2.3% on medical device sales transacted investing options that could help avoid December 31, 2011. after December 31, 2012. this additional tax.

CATALYST MAGAZINE Issue 4 2010 47. Business of Dentistry

THE HIRE ACT and the retention bonus, but only wages paid after March 18, Another new law is the HIRE Act. The centerpiece of this 2010 receive the exemption for payroll taxes. law is a payroll tax holiday and an up to $1,000 tax credit for businesses that hire and retain previously unemployed Other features of this law include the following: workers. In addition to these new hiring incentives, the HIRE • The tax benefit is immediate. It puts money into the business Act includes a one-year extension of the enhanced small cash flow right away, since the tax is simply not collected in business expensing option under Code Sec. 179. Both of these the first place. provisions are extremely important for dental practices. • There is no minimum weekly number of hours that the new Payroll Tax Holiday and up-to-$1,000 Credit for worker must work to be eligible, and there is no limit on the dollar amount of payroll taxes per employer that may Employers Who Hire Unemployed Workers be forgiven. — after 2/3/2010 The payroll tax holiday and tax credit applies to most dentists. • For workers that would otherwise be eligible for the Work In order to stimulate the hiring of workers, and incentive has Opportunity Tax Credit (i.e., another type of employment been instituted for the employer who hires a worker who had tax credit), the employer must select one benefit or the other been unemployed for at least 60 days. This employer will not for 2010. Double dipping is not permitted. have to pay the employer's 6.2% share of the Social Security • An employer cannot claim the new tax breaks upon hiring payroll tax on that worker for the remainder of 2010. family members.

A practice could save a maximum of $6,621 if it hired an • A worker who replaces another employee who performed unemployed worker and pays that worker at least $106,800 (the the same job for the employer is not eligible for the benefit maximum amount of wages subject to Social Security taxes) by unless the previous employee left the job voluntarily or was the end of the year. Additionally, for any qualifying worker hired terminated for cause. In other words, the practice cannot that the employer keeps on payroll for a continuous 52 weeks, the fire one employee for the purpose of filing the position with employer is eligible for a non-refundable tax credit (also known as a new employee that would qualify for the credit. a “retention bonus”) of up to $1,000 after the 52-week threshold • For the hiring to qualify, the new worker must sign an is reached. The credit is to be taken on the 2011 tax return. In affidavit, under penalties of perjury, stating that he or she order to be eligible, the worker’s pay in the second 26-week period hasn't been employed for more than 40 hours during the must be at least 80% of the pay given in the first 26-week period. 60-day period ending on the date the employment begins.

Workers hired after the date of introduction of the legislation Extension of Enhanced Small Business Expensing (February 3, 2010) are eligible for the payroll tax forgiveness — after 12/31/2009 The HIRE Act law includes a one-year extension on enhanced expensing rules, which allows qualifying businesses the option to deduct the cost of business machinery and equipment currently, instead of recovering it through depreciation over a number of years.

For tax years beginning in 2010, the maximum amount that a business may expense through Internal Revenue Code Section 179 is $500,000. Up to $250,000 of that limit may be used for qualified leasehold improvements. The expensing election begins to phase out when a business buys more than $2,000,000 of expensing-eligible assets. These dollar limits were recently increased retroactive to the first of the year.

48. Issue 4 2010 CATALYST MAGAZINE Business of Dentistry

These limits are especially important for dentists looking to expand It is also important to remember that your state may observe or build, as well as those with higher collections and less expenses rules differently from the federal rules on some deductions for 2010. The dentist can choose to replace old equipment or or credits. Since writing this article, further new laws may add new equipment and/or technology to take advantage of already have been passed, and adjustments to current laws this benefit. Keep in mind that the $500,000 expensing limit is may have been enacted. Therefore, think ahead and plan to scheduled to drop to $25,000 in 2012. be prepared now. After all, it’s just good business!

In addition the increased Section 179 limits, for 2010 only there is a Bonus Depreciation expensing limit which is 50% of qualified expenses, and the auto expensing limit has been increased to $8,000 for qualifying vehicles. Bob Creamer is a CPA and President of Creamer & Associates, PC, an accounting NOW IS THE TIME TO MEET firm in Salem, Ore. In addition, he is an WITH YOUR DENTAL PROFESSIONAL! owner with partner Joanne Humphrey, Congress is still considering bills which could directly impact CPA/PFS in Salem Asset Management, dental practices in a big way. The largest of these considerations LLC. For the past 34 years, his firm has are the Bush-era tax cuts that will expire at the end of 2010. If emphasized financial and retirement planning, dental transitions, practice enhancement, wealth creation, tax the cuts are not extended, the top tax rate for individuals will savings and related accounting and consulting services for rise from 35% to 39.6%. New phase-out provisions for some maintaining an efficient and profitable dental practice. He is itemized deductions and personal exemptions will have the effect a founding member of the Academy of Dental CPAs. Bob can of increasing tax rates by an additional 1-2%. Additionally, the be reached at 800.248.1120 or [email protected]. maximum tax rate on long term capital gains and dividends will increase from 15% to 20% (18% for assets held over five years).

POWERFUL TAX & BUSINESS SOLUTIONS FOR THE DENTAL COMMUNITY SINCE 1977 Our member firms represent We know the dental business dentists in all 50 states! and the issues you face. Our services are industry driven and client specific.

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CATALYST MAGAZINE Issue 4 2010 49. TM

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50. Issue 4 2010 CATALYST MAGAZINE Wealth Management

Wealth Management Major Tax Hikes in the Offing? Start Preparing Now! By Sam Martin, MBA (tax), CFP®, CPA

ven if Congress does not act, the in 2010, especially in light of slow 25% bracket, the 31% bracket would “Bush” Tax Cuts will end at the economic recovery and the impending replace the current 28% bracket, E end of 2010, leaving us with the mid-term elections, the automatic the 36% bracket would replace the highest tax rates in a decade. In short, increase in tax rates and loss of certain current 33% bracket, and the 39.6% without congressional action, tax rates credits for middle and lower income bracket would replace the current will be reset to the start of the previous taxpayers may be a compelling reason 35% bracket. decade. This means there will be tax for Congress to act. increases for virtually all taxpayers. PHASE-OUT OF ITEMIZED There have also been some rumblings DEDUCTIONS AND Interestingly, lack of congressional in Congress regarding extending 2010 PERSONAL EXEMPTIONS action would in large part result in what tax rates and provisions into 2011. In In addition to the increase in stated the current presidential administration a Wall Street Journal article dated July marginal tax brackets, additional had advertised as its federal income tax 22, 2010, three Democratic Senators, hidden brackets would also apply to plan for high income taxpayers. The Conrad (ND), Nelson (NE), and Bayh higher incomes. 2010 is free of any administration has proposed legislation (IN) were quoted as having made “phase-out” limitation on itemized that would increase the top two tax rates comments recently in favor of extending deductions for the first time since from 33% and 35% currently to 36% the tax cuts for all taxpayers, given the their inception in 1991. However, if and 39.6% respectively. In addition, current state of the economy. Congress fails to act, the phase-outs the administration would put limits on will return full force in 2011. In short, itemized deductions for those making IF CONGRESS FAILS TO ACT these “phase-outs” take away a portion more than $250,000 on a joint return Through lack of action, the tax law of otherwise allowable deductions or $200,000 on a single return. Capital reverts to pre 2001–2002 tax rates. The for high-income taxpayers. The gains rates would also be increased for following is an estimate of 2011 tax rates calculations are arcane, but in short, high bracket taxpayers from the current based on reversion to pre-2001 law: they work as follows: 15% to 20% or perhaps 28%. Tax Bracket Married Filing Jointly Single WHY LEGISLATION MAY BE PASSED THIS YEAR 15% Bracket $0 – $70,040 $0 – $35,020 In general, the existing lower brackets would be retained under the 28% Bracket $70,040 – $141,419 $35,020 – $84,872 administration’s proposal. Despite the all-too-common statement in the media 31% Bracket $141,419 – $215,528 $84,872 – $177,006 that the “Bush tax cuts favor the rich,” in reality, those tax reductions provided 36% Bracket $215,528 – $384,860 $177,006 – $384,860 tax cuts across the board and percentage- wise, probably reducing tax burdens 39.6% Bracket Over $384,860 Over $384,860 at the lower end of the spectrum proportionately more, especially for moderate income families. Compared to current rates (more or less), Itemized Deductions: These are reduced Although it is not clear whether the 15% would replace the current by 3% of Adjusted Gross Income Congress will have the stomach to 10% and 15% brackets, the 28% that exceeds about $168,000. The pass significant income tax legislation bracket would replace the current maximum phase-out is 80% of itemized

CATALYST MAGAZINE Issue 4 2010 51. Wealth Management

deductions. At the maximum phase-out, PROACTIVE PLANNING Shifting Pockets: Tax- you will receive the greater of either 20% There is no doubt that it is difficult to plan Qualified Retirement Plans of your actual itemized deductions or ahead if next year’s tax law is uncertain. The first stop in the tax planning process the standard deduction. Nonetheless, there is planning to be done. First is to determine the most effective tax- and foremost, get in contact with your dental advantaged retirement plan for you and Personal Exemptions: These are reduced CPA or other tax advisor and make certain your practice. It is important to note that by 2% for each $2,500 of Adjusted Gross that they are staying abreast of developments the “best plan” will change over time due Income that exceeds the following: through the fall and are updating you as to changes in your age, the configuration • About $250,000 joint legislation does or does not occur. of your practice, tax and pension law, and • About $170,000 single what you can afford to fund. The latter Ultimately, you will need a year-end criterion, what you can afford to fund, is The impact of these limitations is the planning strategy. For nearly 20 years, key in terms of the type of plan that is creation of “hidden” tax brackets for higher tax rates generally have not increased. likely to be the best fit at this time. With income taxpayers. For example, a dentist Consequently, in most cases, standard higher tax rates, the benefit side of the with $400,000 of taxable income and a year-end planning included accelerating cost vs. benefit relationship will increase. family of four would have a stated marginal your year-end expenses so as to reduce your tax rate of 39.6%, but due to the interaction current year tax burden and your required Deduct What You Already Spend with the phase-outs of exemptions and estimated tax payments or withholding In this category, we list expenses that we itemized deduction, he or she might have for the coming year. This strategy almost all incur during our lives that we may be an effective federal tax rate of about 41.6%. always makes sense if your bracket will be able to qualify in part or whole for tax similar or lower during the following year. deduction. These include: Qualified Dividends: The tax rate on qualified (corporate) dividends was reduced For 2010, we have the prospect of higher Automobiles: There are a variety of ways to a maximum of 15% starting in 2003. tax rates in 2011. This would cause us to to optimize your business-related driving, This rule is also subject to end at the close reverse course on year-end planning and and there are slightly different rules for of 2010, leaving dividends potentially taxed actually defer expenses into 2011. By incorporated dentists and specialists versus at ordinary income tax rates in 2011 (as high holding payment of normal operating unincorporated doctors. For a starting as 39.6%). Should this change occur, it will expenses that could be paid in early January point, record all of your business driving require you to reevaluate your investment vs. December, you will be increasing the in a log — either throughout the year or portfolio strategy to optimize after-tax returns tax value of those deductions. Granted, perhaps two months out of the year as on the taxable portion of your portfolio. we will have to wait and see what actually a valid sample. Most dentists would be develops, but in the meantime, you can surprised at the amount of business miles Long-Term Capital Gains: Under current start thinking about being prepared to go they actually drive. law, those in the 15% bracket or lower pay in either direction as soon as we see what a zero percent long-term capital gains rate, Congress actually does or does not do. Meals and Entertainment: By truly while those above the 15% bracket pay understanding these rules and the required a maximum of 15%. These rates would OTHER PLANNING documentation, dentists and specialists can increase to 10% and 20% respectively It is always recommended and appropriate optimize their tax deductions. We know in 2011. Again, this will impact your to check on an ongoing basis for the best generally that meals and entertainment are investment strategy on the taxable portion strategies to reduce taxes or more accurately only 50% deductible; however, you might of your portfolio as well as have an impact maximize your after-tax income (it’s not be surprised at the number of exceptions on other major asset sales, such as your what you pay in taxes that really matters included in this category. practice or other investment property. — it is how much you keep that counts). With the prospect of higher taxes, every Travel: Here is an area in which you can S Corporations: It appears that, based deductible item becomes more valuable. exploit the rules to maximize business on the Senate Amendment, the final Consequently, this fall is a very appropriate deductions if you are very familiar with Unemployment Benefits Extender time to consider other tax savings strategies. them. Although the details of these rules bill, signed into law just as I write, has are too lengthy for this article, I think any dropped the provision that would have Refer to Catalyst Magazine, Issue 4 of dentist who likes to travel or who frequently prevented service (including dentists) S 2009, for a detailed list of some of the travels for purposes of continuing education Corporations from avoiding a certain items you should be evaluating within the or other business purposes might be amount of self-employment tax, a article titled, “Advanced Tax Planning.” A surprised at how the rules can be made to benefit that is currently available. few of those ideas include the following: work in his or her favor.

52. Issue 4 2010 CATALYST MAGAZINE Wealth Management

STRATEGIC OFFICE management plan. You are likely to find your strategy for the future. With tax INVESTMENT PLAN that this approach makes you a much law in flux, it will be crucial to work As we move into the fall, dentists start more profitable dentist while at the closely with your dental CPA or other thinking about what they should buy same time reducing taxes through the tax advisor and your tax-enlightened before year end in order to secure a tax significant tax benefits currently available, personal wealth manager. The goal deduction. We are all in favor of income such as the Internal Revenue Code outcome: added profound value to your tax deductions, but we would rather see Section 179 deduction recently increased long-term financial success. this as part of a well-thought-out three- to $500,000 and extended to 2011. to-five year plan for office improvements or modernization. By planning ahead, If you are planning to invest in your you not only take advantage of income office, and you should, the fourth quarter Sam Martin is Director of tax deductions, but you also take of 2010 may be crucial. On the one hand, Wealth Management Services advantage of maximizing your return you might put off certain expenditures and Advanced Tax Planning for on investment by plotting out the into the potentially higher tax rates of the Dental Group, LLC / Martin right timing, scheduling training, and 2011 or take advantage of utilizing some Boyle PLLC / Dental Wealth Advisors, LLC, a CPA, practice promoting for your new technology. of your Section 179 deduction in both advisory, financial planning and 2010 and 2011 to hedge your bets. Keep Wealth Management services Right now is a great time to sit down in mind, that tax savings in 2010 also group exclusively serving dentists and their with your dental CPA and your Burkhart lowers your required quarterly payments practices. Sam is a Certified Public Accountant Equipment and Technology Managers and/or income tax withholding in 2011. (CPA), a Certified Financial Planner (CFP), and to plot out the next three to five years holds a Masters Degree in Federal Income Taxation. Located in Kirkland, WA Sam can be CONCLUSION — of practice investment. Coordinate reached at 425.216.1612 or [email protected]. this with your tax planning and your Fall is always an important time to fine comprehensive financial or wealth tune your current tax plan and update

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