marketing expansion
By Nancy Hyman

It all starts with one—your first office. That first office is the foundation upon which your practice is built, because the success of that first office will lead to your second and third and so on. Those additional offices not only expand your patient base, but they also expand your management responsibilities.

While there are several challenges inherent in managing multiple locations, there are also generous financial rewards when they are managed properly. Research conducted by Chris Bentson, president of Bentson, Clark and Copple, shows that a mature, 1-day-a-week satellite office will average $300,000 per year in collections. The same data shows that adding a satellite office will not significantly increase practice overhead, with most practices reporting that overhead increased by less than 3% when adding a satellite location.

Where Should You Go

But how does a practice decide where to open a satellite location? For one thing, it’s not as simple as picking a spot on the other side of town to have your bases covered in the community. Many considerations need to be made.

To get started, Bentson stresses the importance of conducting extensive demographic analysis. He recommends using services like those provided by Scott McDonald & Associates, a firm specializing in demographic site analysis and marketing research for professional healthcare practices, to help nail down the best area for a new office. But there are other factors to consider as well.

For a young orthodontist who got his or her start by purchasing an established practice in an older part of the community, it might make sense to open a satellite office in an area where younger families dominate. In fact, many studies indicate that convenience ranks among the top reasons for choosing an orthodontist. Therefore, a secondary location closer to a population of new orthodontic consumers can be a great strategic move. On the other hand, current patients may dictate the location of a satellite office for a more established practice.

When Mark Sanchez, DDS, and his colleagues Michael Stewart, DDS, Melisa Rathburn, DDS, Kent Starling, DDS, and Christopher Brady, DMD, decided to open an additional location of their Atlanta-based practice, they decided on an area where existing patients already lived and worked. The advantage: the location was seeded from the start, and patients were extremely appreciative of having a new location that was much closer to them.

Still, other orthodontists look to add a satellite location in a general dentist’s office. While this offers the ability to test market demand for an orthodontic practice in the area and to build a patient roster, there are a number of drawbacks. Most significantly, it can be challenging, if not impossible, to obtain referrals from other GPs if located within a general dentist’s office.

But for other orthodontists, it’s not all about location. The decision to open an additional location comes down to revenue needs. Often multi-generational or dual-spouse practices need to locate extra revenue, which the addition of a satellite office will provide. And for others, the decision to open another office comes from a desire to provide access to care in underserved communities, as frequently seen in rural areas.

Who Goes Where

However, before you can get the patients in the door, you have to have the staff in place. Often, the majority of your staff will work between multiple offices, while one or two staff members will be based at one location. Of course, square footage and the number of operatory chairs will determine staff levels from one office to another.

A successful travel scenario may include taking two or three dental assistants, one treatment coordinator, and one front office team member to a three-chair satellite location, while the insurance specialist and billing staff remain at the practice’s main location. The important thing to remember is that each location will need to have some type of system in place for answering patient calls regardless of where the doctor is that day—whether it is a call forwarding service or a receptionist permanently assigned to each office location. Patients should never have to chase a doctor down from office to office via the phone.

While multiple locations can create some staff redundancy, there are positions that can be filled by one staff member who serves all locations. As already mentioned, you can have one person who handles insurance or patient billing for all the practice’s locations. The same can be said of staff members who handle ordering or marketing. Even your practice representative can work across all locations, targeting your complete general practitioner target list and visiting each zone systematically to ensure that practitioners are impressed with the attention they receive.

But while you are thinking about where your staff is going to work, also consider how they are going to get there. What may have been a short and easy commute from their home to the main office can turn into a commuting nightmare with the addition of a satellite office in many large metropolitan areas. The goal is to find ways to eliminate the stress and financial costs of the new commute on staff. Among the creative solutions doctors have found to handle the transportation challenge include: having staff carpool from a convenient meeting point or having the doctor drive the team. Another option is to provide staff with a travel stipend if the new commuting distance is significantly greater than was previously expected of them.

While some staff members may appreciate the varied schedule and variety of moving from location to location, others may not. Take advantage of staff who want to work in the area in which they live, especially if they live near a new satellite location. By basing those members at the satellite location, you not only offer them the perk of a shorter and easier commute, you also create a better connection to the community. Local team members can be an invaluable resource as a community representative—promoting your practice at local GP offices, schools, and community events. Meanwhile, you can make an informal appearance at GP offices once annually with the practice representative.

Getting the Word Out

As for marketing multiple locations, you will need to rethink some aspects of your approach. First off, plan the annual marketing calendar to allow for multiple locations holding the same event, or focus in on one geographic area per promotion. Practice events such as a flu shot clinic for GPs and their team may be held in all office locations, a central location, or in an office location with the largest volume of referrals.

Now when it comes to marketing to fellow dental professionals, consider your target list. Are your offices within close proximity? Are they sharing one referral list? If so, design a marketing plan with an emphasis on convenient locations and commitment to an area. In addition, make sure referral sources are being accurately tracked. When you have multiple locations, it is crucial that every type of referral source or type be tracked. This information is vital to know if your secondary location is financially sustainable or not.

When communicating with GPs, it’s important to stress the benefits of multiple locations for their referred patients. It’s also important to get this point across to patients directly. You want to emphasize the convenience of having multiple locations to choose from. You want to emphasize that you are serving multiple communities within the area, and that this demonstrates not only your commitment to the community but to the region—”Committed to the San Gabriel Valley” or “Dedicated to serving the greater San Gabriel Valley.”

Again, the patient, as well as the referrer perspective, must be taken into account when it comes to print, emedia, and verbal messaging/branding, says Nina Grant, vice president and agency managing director for Practice Builders.

“Patient experience branding should include all the strengths that your practice possesses, such as personalized care, extended hours, or orthodontic methodology—recognizable brands, shorter treatment times, etc. This is especially important for a multi-location practice, as often patients might perceive your practice to be more corporate and less personalized simply by the nature of your multiple locations,” Grant says.

She adds, “Referrer messaging would similarly share information about all the benefits of your multi-location office, including efficiencies for the referring practice, as well as distinguishing characteristics of your practice and care quality. Print and emedia branding ensures each of these features of your practice are presented as benefits via messaging and art that conveys your unique distinction in your market.”

Nuts and Bolts

Managing multiple offices and an increased patient load will take up the bulk of your remaining time. Many doctors report that scheduling demands are the primary challenge they face when taking on multiple locations. In order to nurture a satellite office, the doctor needs to be present. However, the doctor and team should be looking at production and patient enrollment numbers to determine where they spend the majority of their time. Obviously, the doctor and staff should spend that time where the higher patient enrollment is, with other team members filling in at the secondary locations.

Still, patient interaction is important. And this interaction is often more meaningful and easier when the practice is located near the doctor and team’s home. The fact is it can be hard for a satellite office to compete when located near a competitor who is strongly entrenched in the community and aligned with community events. Still, there are things you can do to make your presence known.

Patient recognition in the office, on Facebook, and on an office slide show (for example, using Kaleidoscope) will secure patient loyalty. In addition, reward your patients for hygiene visits, compliance, and other accomplishments—and spread the word in person and online.

In the office of William Hyman, DDS, the treatment coordinator discovered that a patient had won a regional tennis tournament. The patient’s chart was flagged, and on the next visit the front office and clinical team congratulated the patient. A photo and announcement were also placed on the practice’s Facebook page and on the Kaleidoscope slide show that runs in the reception area.

Another factor that can make multiple locations a challenge is when multiple doctors share the locations—specifically with regards to whether those doctors decide to “share” or “own” individual patients’ treatment plans and visits. When doctors alternate a patient, there is a risk that the treatment plan may not be adhered to, resulting in patients with treatment overtime.

Beyond staffing and community connections, there will be some new overhead costs to factor in, including rent and/or facility costs, as well as x-ray equipment, computers, and travel expenses. All of this must be considered when managing profitability. In addition, more time will need to be spent managing inventory to confirm that all equipment is in the right place for day-to-day operations, as well as for times when performing unusual procedures.

Meanwhile, software, hardware, and connectivity requirements must also be seriously evaluated from the start, says Richard Kelley, an advanced systems specialist at Ortho2. From the outset, recognize the need to update current equipment and computer systems in order to facilitate the change to a multi-office setup. There will also be additional IT costs for upgrading equipment and maintaining multiple locations. That’s a fact.

From there, ensure proper bandwidth availability in all locations with your local Internet service provider (ISP). This is vital to ensure communication between offices. In addition, Kelley advises that practices evaluate whether or not to add an additional server or to switch to a cloud-based solution, and the feasibility of data portability between locations, if needed. Throughout this process, make sure that your current local IT person has the knowledge to support a multiple office setup.

Practices must also define office management parameters when working with their software company. Kelley advises that practices determine whether patients will be seen in both practices or exclusively in one office. The practice’s practice-management system must be able to support either scenario. In addition, if more than one office will be open at the same time, ensure that the practice-management system will be able to handle the shift.

“With multiple offices, it is imperative that your practice-management system be able to differentiate patients from one location to another,” Kelley says. “Offices need to be able to schedule laterally, while still having safeties in place to warn against accidently scheduling a patient in the incorrect location.”

Sanchez, who is also the founder and CEO of tops Software, adds that patient statuses can be a challenge for most practices, and more challenging with a multi-office practice. But ensuring that this is correctly reflected in the practice-management software is vital to good reporting.

“Staff members typically don’t know how or when to change a patient’s status properly, and they don’t have the proper set of statuses in the software to begin with; the mechanism is highly error-prone. If it’s not set up right in the first place, the reporting will be weak. The key is getting the information right with proper initial setup,” Sanchez says.

For example, in the case of active treatment, in a traditional report, you can look at which patients are beginning treatment, which are comprehensive, which are phase 1, etc, Sanchez says. But you need to be able to peel back the layers.

The ability to “drill down” and mine the data for information—from how many months of treatment remain, how many broken appliances, and how many emergency visits to how many patients are past-due from any subset of offices, or finding a subset of office patients with common referral sources—is critical in maintaining professional contacts, financial management, patient compliance, and conversions, Sanchez adds.

Kelley adds, “There needs to be a clear designation of which office the patient belongs to. It isn’t a matter of whether a patient can be seen in another office or not, but rather are you able to discern where the production came from. Without this simple field, it will be very difficult to track finances and production.”

Sanchez advises that orthodontists adding an additional location thoroughly look at the analytic capabilities of their practice-management software. “All reports need to filter out by doctor and by location—in a way that is meaningful. You want everything from appointment analysis to financial analysis; all those statistics have to be broken down,” he says.

And when it comes to assessing overall profitability, Sanchez points out that, “You want to be profitable at a certain level. You want an overall amount of profit, [and] you also want to have a percentage of profitability. Those kinds of numbers are important. I’ve always learned to back into those numbers. What would I have to do to achieve those things? What expense levels do I have to have, and how many patient starts? And you want to see those trends.”

With a comprehensive plan, you can not only reduce the stress of opening a satellite office, but you can create a foundation that guarantees a thriving expanded practice. OP


Hyman headshot 140 Nancy Hyman is a speaker and practice growth consultant specializing in referral systems and increased case acceptance exclusively for the orthodontic industry. She developed the Practice Representative program for the Practice Builders orthodontic division and established marketing plans for their clients. She now shares this same program through Ortho Referral Systems. Nancy is the author of Winning Marketing Strategies. She can be contacted at [email protected].