LLISTS Here’S Our List of Lists

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Lists keep things simple. And we’re fans of lists at Dentaltown. Herein, we’ve collected and written lists for your entertainment and easy reference. From out-of-context quotes from the Dentaltown message boards (just for fun), to what you should have in your emergency kit (seriously!) – we’ve got a list for you. LLISTS Here’s Our List of Lists...

Watching your practice’s numbers is just as important p. 95 Numbers You Should Know as the dentistry you do

We all remember “P. Sherman 42 Wallaby Way, Sydney”… p. 96 In the Media here are 22 additional dentists on our TV screens

Things about Dentaltown and Dentaltown.com p. 98 Dentaltown you never knew you always wanted to know

Be prepared for the 72 hours following a disaster p. 99 Emergency Kit with this emergency kit for the office

Townies present hypothetical to-do lists for each other; p. 100 Townie To-Do Lists a snapshot of the camaraderie of Dentaltown.com

To prevent quarterly and annual practice maintenance p. 102 Maintenance from falling by the wayside

Insider strategies from p. 103 5 Ways Dentists Can Save Keating Dental Lab on Their Lab Bill

ADS answers your 10 most frequently p. 104 Top 10 Questions Dentists Ask asked questions about practice transitions When Buying or Selling a Practice

Curve Dental debunks your excuses p. 106 Excuses Dentists Give for regarding cloud computing Not Converting to the Cloud

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Total Accounts Receivable Each month compare the last four months on the same day each month. Pick a day when there are less insurance payments posted, as that can skew the numbers. The last Wednesday was always a good day for us. Other accounts receivable numbers are equally valid, yet this number is the most NYou Should commonly used and easiest to find. Are the numbers going up or down? Know by Douglas Carlsen, DDS Amount of Refunds and Write-offs Each month, compare the last four months. This is a new addition to the Your Payment Schedule list as the explosion of HMOs, PPOs and office embezzlement has taken a toll on collections. Each day, meet with your financial coordinator to check each patient who was scheduled to make a payment above a certain amount, say $200. This is either from patients who had pro- cedures that day, were scheduled for a treatment plan with possible payment or were to make an Number of New Patients electronic or check payment. Did that patient Each month compare the last four months. Are make the proper payment? If yes, good; if no, the numbers going up or going down? What have the financial coordinator provide the reason marketing strategies are most effective for getting and both the doctor and the coordinator should new patients? Keep track of what works and what decide on a course of action. does not work in your area, for your practice.

Total Accounts Payable Have your financial manager or accountant notify you of whether all accounts payable are current. Actually, this is not a “number,” just a yes or no. This includes practice loans, staff What to do when something is off: What does salaries, lab and supply bills, taxes… everything. one do if the numbers aren’t heading in the right If you are not current, find out why, pronto. direction? Go to the source directly involved with the errant number. This sounds a bit vague, Office Checkbook Balance but it works. If the checkbook is steadily wither- This is the real barometer of your practice. Your ing, ask the staff person who pays office bills and collections minus your expenses – your profit – the staff person who collects and posts pay- is inherent here. Each month find the low point ments. If accounts receivable are up, go to the for the last four months, not the high points, insurance and billing coordinators. The person the low points. Are the numbers increasing, who works directly with the number in question decreasing or about the same? will usually have an intuitive monitor to assess the reason for the change.

Total production, total expense and overhead percentage have been left off this list on purpose. I want to emphasize the importance of the office checkbook in evaluation. Production and overhead are not necessarily the holy grail of modern dentistry.

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From Seinfeld to The Simpsons, dentists are present throughout pop culture. Do you remember seeing these?

In The Movies

Most Requested n Dr. Nicholas “Oz” Oseransky (Matthew Perry) in I Celebrity Smiles The Whole Nine Yards – 2000

For Women: n Dr. Orin Scrivello (Steve Martin) in n Julia Roberts Little Shop of Horrors – 1986 n Angelina Jolie n Dr. Frank Sangster (Steve Martin) in n Halle Berry Novocaine – 2001

For Men: n Dr. Christian Szell (Laurence Olivier) in n Tom Cruise Marathon Man – 1976 n Tiger Woods n Dr. Sheldon Kornpett (Alan Arkin) in n Brad Pitt The In-Laws – 1979 n Barack Obama n Dr. Doug Madsen (Tim Allen) in Wild Hogs – 2007 Source: Chicago Dental Society Midwinter Meeting Survey, 2010 n Dr. Theodore “Ted” Brooks (Cuba Gooding Jr.) in Snow Dogs – 2002

n Dr. Phillip Sherman or better known as “P. Sherman 42 Wallaby Way, Sydney” (voice of Bill Hunter) in Finding Nemo – 2003

n Dr. Bertram Pincus (Ricky Gervais) in Ghost Town – 2008

n Drs. Steve and Ben Jessup (Phill Lewis and Bill Henderson, respectively) in City Slickers – 1991

n Dr. Julia Harris (Jennifer Aniston) in Horrible Bosses – 2011

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Famous & Fictitious

Dr. Tim Whatley (Bryan Cranston) of Seinfeld Dr. Wolfe (voice of

Hank Azaria) of The Simpsons Dr. Wilbur Wonka (Christopher Lee) of

Charlie and the Chocolate Factory Dr. Bernard Nadler (Sam Anderson) of

Lost Dr. Barry Farber (Mitchell Whitfield) of Friends Dr. Jerry

Robinson of The Bob Newhart Show Captain Walter Koskiusko “Painless

Pole” Waldowski (John Schuck) of M.A.S.H. Dr. Orson Hodge (Kyle

MacLachlan) of Desperate Housewives Dr. Glenn Martin of Glenn Martin,

DDS Dr. Bob Fish of Bob and Margaret Dr. Carl Howell (John

Stamos) of Glee Doc Holliday Dr. Barney Clark, the first recipient

of the Jarvik-7, the first implantable artificial heart

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continued from page 79

Things about Dentaltown you never knew you always wanted to know.

DDENTALTOWN Top Registered dentaltown password Countries on Dentaltown: pass123 United States Australia tooth123 [lastname, birthday] Canada Romania *Actually, we just made this up. Dentaltown’s India New Zealand Online Community Manager Kerrie wouldn’t help United Kingdom Saudi Arabia us out with this list. But if we hit the nail on the Egypt China head, you should probably go swap out your tired password with something not containing the actual Most Common Townie Passwords* Townie word “password.”

Locating the Elusive Root Canal – Dennis Brave, Most Common DDS and Kenneth Koch, DMD Townie Names: Practical Oral Surgery for the General Dentist: David Mark Surgical Extractions – Jay B. Reznick, DMD, MD John Richard Precision Based Endodontics – Dennis Brave, DDS Michael William and Kenneth Koch, DMD Robert Jennifer James Thomas CE Courses on Dentaltown Top 3 Completed 3 Top We won’t tell you who said it or on which thread, but these are all verbatim quotes from the message boards of Dentaltown.com.

“My pits and palms are getting sweaty just thinking about it.” “I’ve considered doing dentistry with my shirt off now.” “After all, if you want to catch a kangaroo, you need to think like a kangaroo.” “Hair straighteners, curling wands and refillable lighters.” “If they get blind drunk on Saturday, they are always fine on Monday.” “I love me some Gator.” “Tetley tea is also the official tea of the Harold Radford Society.” “Congratulations on your new chins.” “Usually the aliens are more careful about where they leave their probes.” “How can you go wrong with an inflatable pig?” “It would have to be a really smart monkey.” “I got a reindeer that poops root beer jellybeans...” Quotes from the Message Boards Out of Context “The Ferris Wheel won’t fit.” “Just ’cause Tiger Woods would have put it next to the pin does not make me wrong.”

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EMERGENCY KIT In just the last few years we’ve seen plenty of disasters strike – for some it’s been devastating, for others it’s been too close for comfort. From Hurricane Katrina, to the flooding of the Mississippi; from tornadoes in the Midwest to the California earthquakes, we all have to be prepared. Disaster preparedness organizations throughout the country insist having 72 hours worth of emergency supplies on hand is essential. Many of us have emergency kits at home, but what about at the office? Here’s what should be in your “Go Bag”:

Water – enough for each person to have one gallon per day. First aid kit including

essential medications. Non-perishable food (don’t forget the can opener!).

Blankets. A flashlight with extra batteries. Cash, in small denominations. A battery-

powered radio. Matches and candles. Duct tape. Utility knife. Extra clothing.

Personal hygiene items. Addresses and phone numbers. Pen and paper.

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TO-DO LISTS

Part of the appeal of Dentaltown.com is the camaraderie among friends and colleagues – a professionally cen- tered Web site with a casual feel. To show this spirit, we asked some of our most active-posting Townies to write hypothetical to-do lists for each other. We’ve certainly got some characters roaming the message boards Tof Dentaltown.com! [Editor’s Note: Each list has been pre-approved by the person about whom it was written.] Kerrie “kerriek” Kruse’s To-Do List (List written by Howard Goldstein) Howard “howardmgm3” Goldstein’s To-Do List (List written by Kerrie Kruse) q Wake up 15 minutes early to make decision on q whether to go curly or straight this day. Wake up. q q Make sign that anyone who touches hair dies. Check scotch supply to make sure there is enough q Get to office and show Ken Scott (I.T. Director) how for later. q to turn the Dentaltown server on. Style mustache with little comb and mustache wax. q q Check the new registrations to Dentaltown and Log in to Dentaltown. Edit post. Edit post. q delete all bogus ones. Go back to first edited post to make sure edits q Ban “Seymour Butts” for the thousandth time. were grammatically correct. q q Edit HoGo’s postings from the night before. Double-check scotch supply. q q Decide she made the wrong decision on the hair. Log in to Dentaltown on office computer. q q Change title from “Online Community Manager” to Fill cavity. Supervise new associate. q “Queen of All Media.” Get home. Pour scotch. q q Challenge every male at Dentaltown headquarters to Log onto Dentaltown. Edit post. q an arm wrestling contest. Pour another scotch for night side table. q q Collect winnings. Go to bed. Dream of scotch and Dentaltown. q Go home and look in mirror. Decide she made the correct decision on her hair after all.

Bradi “sfddds1” Boyce’s To-Do List (List written by Phil Zelmanow) Phil “philzelmanow” Zelmanow’s To-Do List q Wake up to kid crying. (List written by Bradi Boyce) q Log on to Facebook and Dentaltown, q Wake from restless slumber. simultaneously. q Remember not to go to work. q Grab breakfast and Diet Coke; eat on the q Take kids to school. way to work. q Take pictures of butt in jeans, post pictures on Dentaltown. q Running late; miss morning huddle. q Count days until retirement. q Work though lunch; grab Diet Coke. q Shop for watch that costs more than most cars. q Leave work early to see kid’s show. q Take pictures of shoes and socks, post on Dentaltown. q Back to work for eight more patients; grab q Mourn about having to work in three days. Diet Coke to power up for home stretch. q Browse current trends in ladies shoes and handbags; q Grab dinner on way to fundraising event. must stay current. Running late; grab Diet Coke. q Look for excuse to take more time off. q Exercise on elliptical machine. q Check 401(k) to see if retirement day can be moved up. q Log on to Dentaltown and Facebook, q Night cap with the Yankees. simultaneously… while on elliptical. q Celebrate one day closer to retirement. q Say hello and goodnight to husband. q Rinse and repeat.

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Rich “rgrosen” Rosenblatt’s To-Do List (List written by Armen Mirzayan)

Armen “nemrA” Mirzayan’s To-Do List q Climb out of bed; hit snooze button. (List written by Rich Rosenblatt) q Curse Tolkien for writing The Silmarillion as part of daily ritual. q Wake up late and rush to get to Scottsdale Center. q Pull out step ladder. Open fridge. Reach q Blast Justin Beiber to get pumped up for the day. into bottom shelf to get juice. q Log on to Dentaltown. q Head to work. Have driver’s license handy q Ignore all spell check corrections in posts. for when pulled over for potential under- q Make a post to create mass controversy. age driving. q Log in to Sirona beta testing forum. Post joke that q Start planning for gift wrapping over does not translate well, offending European testers. Christmas at double-secret location in q Ignore e-mail reminders about overdue blog post North Pole. on CerecDoctors.com. q Open image sent by Armen via MMS of a q Log on to Dentaltown. Stir pot once more before Keebler delivery truck driving by. calling it a night. q Prepare for onslaught of “little” jokes that q E-mail HoGo requesting no editing be done to have filled inbox over night. controversial post. q Log on to Dentaltown. Check message board regarding how to answer patients who ask “Are you old enough to practice?” q Remind staff to only stock small gloves.

Jason “jasonl” Luchtefeld’s To-Do List (List written by Gary Torres)

q Wake up. Gary “garyshooter” Torres’ To-Do List q Take Vibram five finger shoes out of (List written by Jason Luchtefeld) washing machine to air dry. q Oil bike chain. q Open eyes; flex eyelids. q Review endorsement contract from q Evaluate biceps in mirror on ceiling. Hammer Nutrition. q Power jump out of bed. q Post workout on Dentaltown. q Log on to Dentaltown; check p90x thread. q Check Facebook… and abs in mirror. q Bottle sweat to be used later in coffee. q Forget shaving; need to look primal at work. q Post workout update. q Put on office five finger shoes, helmet and ride q Shower. bike to office. q Check Dentaltown for comments of video. q Sell some implants. q Arrive at work for morning huddle q Ride bike home like bat out of hell. Pretend it is (aka, pushups and wall squats). race day. q Place implant in plank position. q Put on Vibram five finger slippers. q Do agility drills through office. q Contemplate meaning of life and post single-word q Drive home. status updates on Facebook. Wait for replies. q Flex in mirror while getting ready for dinner. q Go to bed with dreams of five finger shoes and q Post on p90x thread about dinner. Hammer Nutrition Invitational.

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AINTENANCE The daily and weekly maintenance tasks are delegated out to your staff and are part of the rou- tine that keeps your office running smoothly. However, the things that need to be handled quar- Mterly or annually can easily fall by the wayside. Here’s a checklist to help you stay on track! n Clean computer equipment n Wipe and oil furniture n Clean windows and window coverings n Shampoo the carpet n Organize storage space n Update displays n Check plumbing for leaks n Test security system n Apply pest control system n Test smoke detectors and carbon monoxide detectors (and replace the batteries) n Service heating and air conditioning n Check fire extinguisher n Repaint parking stripes n Clean or update signage n Check for practice management program updates n Update computer anti-virus n Re-evaluate phone and Internet contracts n Check your first aid kit for expired medications n Check that the “Go Bag” is ready and up-to-date (see page 99) n Lubricate door and window hinges n Get your teeth cleaned! n Get a new door mat n Take a walk around to see outside repairs n Replace burned out light bulbs n Conduct yearly evaluations for staff n Re-evaluate insurance policies

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1. Work with a lab with whom you communicate effectively. When doctors have a good working rela- 5Dentists Can Save tionship with their laboratory, mistakes on Their Lab Bill are less likely to happen. Effective com- Provided by Keating Dental Arts Contact: munication will increase consistency and You can find more information about Keating predictability and save money for your Dental Arts at www.keatingdentalarts.com. practice in the long run.

2. Give your lab a 3. Learn to make a 4. Work with an implant perfect impression. high quality provisional. surgeon you trust. Use a high quality tray and impression It is the blueprint for the final restoration Since implants are some of the most material. Whenever possible, use the (high quality temporaries with proper expensive products on the market, double retraction cord technique. The interproximal and occlusal contacts will remakes can be especially costly. clearer and more precise the margin significantly decrease your seating time). Implants which are placed in less- is, the less likely the case will need to High quality temporaries will help you than-optimum locations can lead to be remade. This saves on seating time avoid “rush” case fees from your lab. cases requiring more custom fabrica- and overall fabrication time. tion cost and lab time.

5. Choose restorative materials wisely. With the continued increase in alloy costs, your laboratory bill could be rising without any change in your technique. Consider consulting with your laboratory on metal-free options. Many zir- conia products are just as strong and ver- satile as metal, but more aesthetic and less expensive.

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Questions Dentists Ask When Buying or Selling a Practice Provided by ADS (with Greg Auerbach – transition specialist with ADS Florida and a financial analyst for Pride Institute) Contact: You can find more about ADS at www.adstransitions.com and ADS Florida at www.adsflorida.com. 10TOP

What’s the value of a What can increase or 1 dental practice? 2 decrease value? The value of a properly appraised practice is a function of two Fewer specialty services (in a general practice), less factors: risk and net income. The greater the risk is, the lower discounted fees or insurance (especially HMO/capi- the interest is from buyers. Higher risk translates to lower tation), more stability, higher gross and higher net practice value. Valuing a practice involves the review of three income yields higher value. Aesthetically, the more years of financial information and other practice management visibly appealing a practice is, the more a practice reports. While value is heavily influenced by the most current will sell for. Note, this will not necessarily affect the year of cash flow, to properly assess risk, a full analysis must appraised value, but might affect the sale price. be conducted. Value simply cannot be based on one or two Importantly, some procedural and nearly all finan- points of data or rules of thumb, or be made “on the spot” cial modifications to increase value might necessitate without careful review. longer range planning (three to five years out) to provide a return. Major equipment or aesthetic changes most likely will not yield a justifiable return in the immediate short term.

Can you provide an overview of the 3 transition process? After finding a practice, the purchaser makes an What is a covenant not offer which the seller can accept, decline or count- to compete/restrictive er. The offer should establish the general framework 4 covenant? (price, anticipated closing date, restrictive covenant The restrictive covenant establishes a time and geographic area terms, whether there will be a transfer of real estate) within which the selling doctor agrees to not practice or partic- for the purchase agreement that will be developed. ipate in another practice after a sale. The seller is also usually Once the offer is accepted, the purchaser applies restricted from soliciting patients or staff. The area for the for financing (if applicable) and completes the in- covenant is unique to each practice and location, and is usually office due diligence. Concurrently, purchase agree- correlated to the service area of the practice (where most of the ments (and lease, if applicable) are developed and patients live/work) taking into account local and regional fac- reviewed by seller and purchaser’s counsel. Once tors. Time limits are often established by state law or jurisdic- documentation is finalized and financing is tional court rulings and can be months (if at all) to a number secured, a closing date is set and the staff notified. of years. Many steps, if done incorrectly, can adversely affect future steps and jeopardize the sale, so it is important to consult with an expert.

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Are restrictive covenants Will the staff stay 5 enforceable? 6 in a transition? When properly developed and reasonable in its terms (distance and/or time), The staff typically are as worried about keeping covenants are enforceable in most areas. The specifics of the covenant are very their jobs as the purchaser is about keeping important and defined by local laws. Since a restrictive covenant is vital to them. If they leave, they have to start working almost every transition, it is important to consult with a local transitions for a new doctor and with a new team with a expert and legal counsel to verify the statutes and ensure legality of a new set of expectations, benefits and a reset on covenant. That said, in all states but Alabama (others do not allow them for their seniority. This amount of change sets a employees), restrictive covenant contracts are enforceable and care should be high incentive to stay. With a proper transition exercised when drafting them. strategy, the staff should stay in place unless the purchaser lets somebody go or somebody was already set to retire. In the case that he or she is ready to retire, this should be disclosed through- Will the seller’s patients out the due diligence process. 7 accept a new dentist? The patients of the practice will accept a new doctor if the introduction and transition are handled the right way. The How do you appraise or seller’s endorsement, coupled with staff acceptance and 8 value a practice? enthusiasm, is key but the purchaser’s participation in cre- No valuation is made on one year’s data alone, and metrics such ating a steady environment over a period of time will as percent of gross or multiple of net are not accurate appraisal val- enhance acceptance significantly. Generally speaking, we ues. A true appraisal process includes evaluation of several differ- see that patient retention is in the mid to high 90 percent ent methods of correlating value to residual net income of a prac- range knowing that those who travel from out of the area tice after reasonable expenses, including all those to produce the and some others might not return. The vast majority will dentistry are deducted from the gross income. There are methods return and give the new doctor a chance if the transition is that are generally accepted in the business valuation profession, handled correctly. legal community and banking industry that can be applied to valuing a practice. Appraisals should have detailed documentation that review the methodologies examined to determine final value. Does my dental practice need to be a certain size to accommodate an associate? 9 What is dual repre- There are generally recognized minimal requirements for a full- sentation and trans- time associate which include office size (square footage and 10 actional brokerage? operatories), production levels, available staffing, new patient Dual representation is the practice of representing both flow and overall transition plans. That list is just the beginning the seller and purchaser in a brokered transaction and and a careful evaluation is really necessary to ensure whether a being paid by both. In many states, this practice is ille- need or opportunity is really there and, if so, to make sure the gal. Not only is it illegal, it is unethical. Transactional addition of another doctor goes smoothly. If you are contem- brokerage is the practice of representing neither party, plating this in the near term, we suggest that you contact a tran- but rather, the transaction itself. This usually provides sition specialist to determine your needs. shelter for a broker whereby he or she minimizes the responsibility for accuracy and disclosure.

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Excuses Dentists Give for Not Converting to the Cloud Provided by Curve Dental Contact: You can find more about Curve at www.curvedental.com.

10TOP

1 What if the Internet goes down? We hear this every day. When you take a minute to identify exactly how many times this has happened in your practice you might discover that your hardware or server crashes far more often. Using the cloud doesn’t need expensive hardware and servers. Stuff happens, and if Internet service in your neighborhood is interrupted, trucks are rolling to fix it, just like any other utilities. But if your server crashes, no one cares but you.

2 What if someone hacks my data? When was the last time the media reported that a dentist’s database was hacked by a nerdy kid or by a really bored terrorist organization? The truth of the matter is that it rarely happens because, quite simply, your patient data doesn’t offer a motherlode of information. Stored on your server in your office, your data is more suceptible to hacking. On the cloud your data is protected by the same technology used by banks and other large corporations and organizations.

3 My dealer rep said I shouldn’t convert. Your rep is likely someone you trust. But ask yourself – is your rep a cloud computing expert? Stick to the experts on this one, at least until your dealer is selling a cloud-based system.

4 What would I do with my broom closet? Most practices were not designed to incorporate a server. As a result, you’ll find the server in the strangest places, like the broom closet. Cloud computing does not require a server. So think of the additional space you’ll have to store more brooms.

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5 I need to have my data in my office. If you won’t put your money in the bank, then you probably won’t put your data on the cloud. This is actually an emotional response rather than a log- ical one. Why? Because actually your data is safer on the cloud than it is sitting on your server in the broom closet (which might be crashing regu- larly). Your practice is more susceptible to theft, fire or natural disaster than the cloud. When you consider the amount of security, professional management, backup and redundancy in use by the cloud, the typical practice can’t afford to replicate it.

6 I don’t want to hurt my IT pro. Typically, cloud computing requires less attention and maintenance at the hands of a capable IT pro. A good IT pro will help you move to the cloud by making sure your connectivity and other processes are reliable and stable. Cloud computing does not require expensive servers, monster hardware, and hours and hours of continual tweaking and configuration.

7 Al Gore didn’t think of everything. You might not agree with his politics and his claim to the Internet. But one thing’s for sure: Al was smart to claim the cloud as his own.

8 The Internet hasn’t come to my community. With a little research and asking around you’ll quickly discover that there might be several Internet service providers in your community that you didn’t know about. Also look into satellite-based Internet access.

9 I don’t want my staff Facebooking all day. How your staff utilizes the cloud is a valid concern, but it is more of a staff management challenge than a reason for not moving to the cloud.

10 I don’t want to get a computer virus. Your computers can stay quite healthy if you use anti-virus software, keep your anti-virus software updated and make sure you and your staff stay clear of strange messages from Nigeria and Russia. Your IT guy can help, too.

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