As Tina Byrne, of Byrne Consulting, puts it, comparing one orthodontic practice to another is like comparing apples to oranges. Every practice comes with its own unique orthodontist, with his/her own personality, and its own set of unique circumstances, from location to treatment offerings. But with over 40 years of experience in the field of orthodontics, and 20 of those years as a consultant, we reached out to Byrne to find out the most common challenges that cause clients to reach out to her for her services.
The New Orthodontist
When it comes to new orthodontists, Byrne says there are two different scenarios. First, there is the orthodontist who is building a practice from the ground up, which means he/she is looking for help with their marketing approach and how to grow the practice. Second, there is the new orthodontist who has purchased an existing practice, and those, Byrne says, are the most interesting consulting journeys.
For those practices, the numbers that made the practice seem like a good buy can often end up being misleading as they might not reveal previous trends. “I’ve come to the conclusion,” Byrne says, “that what sustains an orthodontic practice in terms of growth every year, and forward growth versus vertical growth, is several areas of momentum. Inevitably when a new doctor buys a practice, one or more areas of momentum are broken.”
What Byrne has seen is the new orthodontist coming in and finding patients in treatment who aren’t as far along in their treatment times; so the new orthodontist, who is building his/her reputation, can’t finish those cases within the quoted treatment time. In addition, factors that are not within a new orthodontist’s complete control can impact any momentum evident in the numbers that went into the purchasing decision. For example, referring doctors or patients with siblings that aren’t quite sure about the new orthodontist and may go elsewhere for treatment. “I do feel that unless there is a transition where the existing orthodontist does a really good job, in good faith, to promote that doctor and launch him/her, if the momentum is not sustained, it could be a struggle,” Byrne says.
Newer orthodontists can be further handicapped by a lack of business skills when they start out. “You have to have as much of a passion for the business side as the clinical side of the practice,” says Byrne. And that means establishing systems and accountability early on.
For example, a major system in any practice is the scheduling system. Yes, the goal here is to find the scheduling system that results in the highest efficiency. However, establishing the system alone doesn’t guarantee success. With every successful system comes accountability—and this means looking at metrics. For a scheduling system, this means looking at failure rates, the number of emergencies, the number of visits per treatment plan, and what Byrne calls the big one: how many patients are over treatment. “All of that,” she says, “is efficiency.”
The benefit of establishing systems, including an administrative system of accountability early on, is that they keep the orthodontist from having to micromanage the practice. “It allows them to lead versus manage,” says Byrne.
Going back to that idea of momentum, Byrne believes orthodontists should be transparent with their staff if they want to ensure practice growth and efficiency—and this holds for new and established practices. “Many doctors are reluctant to share their numbers like we did with an open book policy years ago. But I like to see that doctors share at least three statistics with their team. First, the new patient calls that come into the office; second, the number of exams they see; and third, the number of starts they see. In my opinion, those three statistics have to grow proportionally every year if you’re going to continue to grow and not experience any type of decline in your practice.
“They’re easy numbers to share with the staff,” and she adds, they are vitally important for team building and goal setting. In addition, when working with practices, Byrne recommends every staff member submit their own weekly and monthly reports, so they can see their own statistics and how they are contributing to the practice’s success.
And while, in Byrne’s opinion, newer orthodontists face different challenges than orthodontists who started out 10 years ago, they do have a leg up on their more established peers. “New residents coming out now, and doctors in the early stages of their careers, are much more tech savvy. They’re more involved in computers, in the programs, and in looking at all the metrics of the business.” And this can be a lifesaver for the new doctor’s practice.
What’s more, the newer technology itself, including practice management programs, is much more impressive. “There are so many tools and services out there that will help you look at your numbers and help you get established,” Bryne points out. “Take advantage of everything the software company offers in terms of training and reports. There’s a reason they’re there.”
The Established Orthodontist
According to Byrne, when an orthodontist with an established practice seeks her out, it’s usually because their numbers are in decline or they are seeing staff turnover and/or frustration. They are frequently stressed or unhappy with their current environment.
These practices will often need to open their minds to new processes and get out of their comfort zone to turn things around. And this can mean looking at new revenue sources and technologies.
Byrne often finds herself working with these practices to incorporate insurance acceptance. Many of these clients are coming to insurance for the first time in their careers, and the prospect can be daunting. Byrne, who offers custom programs to help practices incorporate PPOs, says she works with the practice to make the process manageable and profitable. She does not want the practice to feel overwhelmed or to feel that it is losing control.
“We look at fee schedules, the doctor’s fees, and we look at how we can maximize what we’re allowed to charge with [the practice’s] fees. We’re very regimented. We do not allow ourselves to create more work for the practice. We try to rein it in and manage it as the practice’s plan, not as the insurance company’s plan.”
And for those practices that do come to Byrne when things seem to be going well, she says there are often underdeveloped or unexplored efficiencies.
“I still see a lot of doctors who have been in successful practices for many years and who look at nothing but how their collections grow every year. So you still have a good portion of the population that should probably look very granularly into their numbers and [processes],” says Byrne.
This can often mean looking at how they incorporate technology, everything from new treatment technologies to automated patient communications systems. “The smart ones who can come out of their comfort zone and embrace technology and embrace looking at things more deeply in their practice than they did in the past will succeed. You have to. Unless you are in a very isolated area, you have to be competitive,” Byrne says.
What’s more, this new technology can often help address staff issues. Many of these technologies, from electronic treatment charts to communications programs, create an established framework within which staff members can work. They create a range of parameters, lists, and checkmarks that make day-to-day expectations of staff plain and training of new staff members more straightforward.
However, Byrne is quick to caution practices not to go out and spend money on some new technology for a quick fix.
“Very often when I encounter a doctor, it’s because they are losing money or not making as much money as they were. And yes, technology can help them with their practice, but the first rule I have is I’m not going to tell you to spend a lot of money that’s not going to make you a lot of money right now,” she says. Instead, Byrne will help a client make the most of what they already have. While all the bells and whistles of the latest and greatest technology can be enticing, they can be luxuries that require discretion as to when to be implemented. After all, she points out, “You can still be a successful practice without all the bells and whistles.”
While every doctor and practice is different, Byrne begins every consultation the same—with a complimentary evaluation. Once a business agreement is in place addressing security and HIPAA concerns, she asks for remote access to the practice’s systems and talks to the doctor about a range of topics, including types of treatment and types of insurance plans accepted. Her goal is to really get to know the doctor and the practice.
Byrne considers herself computer savvy and, with that remote access, makes a point of diving deeply into how the practice is using its practice management software and the data it produces. As she says, “It’s the biggest tool that you have in terms of treatment and the business end of your system. And if you’re not utilizing it to the maximum, you’re inefficient.”
Byrne looks at the practice’s footprints—everything from numbers to systems. “In other words, I look at everything from receivables to insurance. I can look at their schedule and see the way they’re scheduling and whether it’s automated and whether they’re organizing it. I can see the number of emergencies they have. I can take a procedure history. I can see the way they lay out their clinic. I will track new patients. With everything being chartless now, I can follow treatment charts to see communication and treatment plans. I can really get a big picture remotely,” she says. “I look at every benchmark within the system to see where they are.”
Only after Byrne has combed through the data and assessed what the doctor and/or staff has told her does she develop her recommendations for the practice. And even then, she doesn’t start the clock on the job. She makes her recommendations via conference call with the doctor and goes through them step by step. She ensures the doctor is on board with her recommendations and then offers up a couple of options for consulting programs.
Her goal is always to enter into a win-win situation. “I don’t want to quote a doctor a consulting fee and then go in there and have them, one, disappointed with what they’re getting, and, two, I don’t want to be ill-prepared for what I need to do when I get in there.” Byrne offers up an apt analogy. Just like the orthodontist offers a prospective patient a complimentary evaluation, giving away photos and/or films so he/she can give the prospective patient a detailed treatment plan before any commitment is made or contracts signed, Byrne evaluates a prospective client’s practice, digging into the numbers and systems, to make sure she and the client are on the same page before starting a business relationship.
Nor does she want to walk into a practice with a list of predetermined tips and tricks that have no bearing on the practice’s unique situation. “It has always been my desire not to go into an office for several days and lecture,” she says. “I like to go in knowing what the office needs, knowing what they have. I like to go in fully prepared.”
Many offices work with her on an on-going basis, keeping her on retainer. And every month, she and the client go over the practice’s progress. As she puts it, she becomes an additional staff member. “I’m there for them when they need to implement something through the year. I know the whole business aspect of the practice and am able to guide staff members to the next level in their positions. I watch the numbers and guide the doctor.” OP