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The Evolution of a Peak Performance Practice by Charlene White

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Orthodontists who work with an experienced orthodontic management consultant are going to be more profitable, productive and efficient. I have consulted with more than 700 orthodontic practices since 1983. My goal is to create a win-win-win for the doctor, team and patients. I evaluate all aspects of the practice to determine what systems are working well and what areas need focus. Once the baselines are determined I start to work on an action plan to facilitate the doctor reaching his or her goals.

I start with finding out the doctors’ goals. What systems do they want me to analyze first? Where do they want to focus? Some doctors want me to create a schedule that results in more production per day. Many are concerned that their case acceptance should be higher and, of course, in today’s economy, marketing has come to the forefront. Overhead costs are another concern.

Even a five percent increase in case acceptance numbers can result in a significant increase in annual productivity. I have several specific practices I’ve worked with which have increased their case acceptance by 20-30 percent. This could have resulted in a loss of hundreds of thousands of dollars over a 30-year career.

I start by evaluating the practice management reports via the practice software. One of my goals is to train the doctor and team to use their software as a management tool. I find this is an under-utilized area of the practice. Prior to an in-office consultation, I request practice statistics, have the doctors and staff complete a questionnaire and ask the doctor(s) to complete a goal questionnaire. Ideally a secret shopper call in advance of the consultation date is completed.

There are many aspects to consulting – scheduling for production and efficiency, case acceptance, practice image, marketing, teamwork, intra-office communications, budget and overhead control, collections, recall effectiveness, clinical efficiency, staff accountability and computer software utilization.

I also offer an “Off-site Office Manager Program” to my clients after the first in-office visit. This has proven to bring excellent results. I have monthly meetings (or more if needed) to oversee and manage the many aspects of the practice. Dr. David Paquette is one of the practices I have worked with since February 2010. Dr. Paquette and his team had multiple challenges to face in the midst of an economic recession. He had the foresight to know that they could achieve their goals faster and more efficiently with coaching and advice. Being accountable to me as their off-site office manager was also key.

Dr. Paquette, one of my clients, presents his experience.
After 21 years in practice, three years ago it was suggested to me by John McGill that I fire my office manager of 11 years for two reasons: one, she was quite expensive and two, he could not see what value she was adding to the practice. Of course after 11 years my wife and I were convinced the sky would fall and the practice would fall apart. Two weeks later my staff surrounded me and the spokesman (who by the way was the quietest member of the team) said, “We just wanted you to know that you made the right decision.” She went on to say that, even though we had written job descriptions for everyone, my prior manager had for years distributed her duties among the rest of the staff without telling me and then would create conflicts only to wondrously resolve them to, “keep me from having to worry about them.” She also had my wife convinced that the team members were afraid to talk to me when, after the fact, we found out that she had instructed the rest of the team that they were not allowed to talk about problems with me because that was her job. From my perspective she had persuaded me that the rest of the team was incredibly resistant to any changes I tried to implement regardless of how hard she and I tried. Oh, how wrong that was!

Fast forward one year later, the practice grew one percent while the rest of the country was in the midst of the economy spiraling downward. The team and I had re-oriented many staff responsibilities and felt like we were in need of an outside set of eyes and ideas to move us forward. That year Charlene White was one of the speakers for our state orthodontic meeting. A close friend and I sat and listened and at the same time decided we would have her come into our practice and do an evaluation. After the evaluation, I elected to hire her as my offsite office manager. The team was completely on board and over the course of the past two years it has been fantastic for both the staff and for me. I have a better handle on overhead, the staff is happier than ever and they all know what their duties are (again). As we have grown we have hired new staff and recently an associate.

So what does an off-site office manager offer? It gives us a perspective of years of experience with many practices, both successful and not so. Additionally, we get the ability to truly evaluate staff performance with a broader perspective and the ability to provide feedback without the baggage of having to work side by side 10 minutes later. We get a truly objective view of any input received from my staff or me as well as the ability to offer suggestions and shepherd them into action if needed. All of these benefits come to us at a lower cost than hiring an inhouse office manager.

Case Study
The first in-office consultation was conducted February 2010.

The patient flow and scheduling needed focus. Many days and certain times were overbooked. Patients were kept waiting. I determined the average number of procedures needed in the template daily. Also taking into account the number of assistants and number of chairs, I created a new template. Patient flow improved significantly.

Front desk staff was trained to only use the “search mode” in the software to make all appointments. This prevents scheduling outside of the template, which had caused problems in the past.

Specific staff members were put in charge of active patient no-shows and observation recalls. They were accountable for monthly reports on these two very important systems.

They were averaging 20 recalls per month yet they should have been seeing 30 per month according to the number of observations in the practice. In 2011, a goal was set for 25 recalls per month. The actual average per month in 2011 exceeded the goal by averaging 30 per month.

In order to complete the process of becoming completely paperless, fast scanners and signature pads were installed at every workstation used by the administrative staff and treatment coordinators. All documents could be scanned immediately into the patient file.

Clinical supply costs were at 13.3 percent. A goal was set at nine percent for clinical supplies. Dr. Paquette uses the Damon System. We were able to reduce their clinical supply costs to 10 percent by the end of 2011 through better inventory controls.

All of the profit and loss categories were reorganized and budget amounts were set. Overhead was high and the bookkeeping was sloppy. The bookkeeper’s performance was poor. She had been on the team for seven months. Although she had some great reviews from prior (fake) employers, no formal background check had been done. After observing some odd behavior and a complaint from a patient, I advised a background check be done immediately, only to discover a warrant was out for her arrest for embezzlement in another state. She was arrested and Dr. Paquette got his books in order. This took about four months. A new financial coordinator was hired whose performance is excellent.

The overhead has been reduced by 25 percent. Dr. Paquette meets with John McGill once a year. John just awarded Dr. Paquette with a Gold Achievement Award!

Case acceptance needed focus. Thirty-four percent of the patients were going into a pending status. Twenty percent or less was the goal. The exam to start ratio was 37.5 percent. The treatment coordinator had been involved in extensive handson training. Although there was a Webcam in the consultation room to record the exams, she failed to turn on the Webcam several times and she was not following the scripting and guidelines given to her. She was placed in an assisting position and another TC was hired. She did not perform well, and another TC was hired. In the interim, an assistant filled in and had outstanding results. Her pending ratio was 10 percent. She did not want to be a TC. Now Dr. Paquette has a well-trained, effective TC who is accountable daily, weekly and monthly for the results of exams report.

An incentive bonus plan was put into place for the entire team. The goals were set for the rest of 2010. The plan was to reassess the goals at the end of 2010 for 2011. The plan was based on a 10 percent increase in exams, starts and collections. For each goal reached, the staff received a $50 bonus. Eighty percent of the time, the staff reached all three goals.

The new patient forms were revised and simplified. They were also made available online and integrated automatically into Ortho2 to eliminate transcription errors.

The staff evaluation format was revised. I have several training products available on my Web site. One is call “Step by Step,” which is a complete program on how to conduct staff evaluations and salary reviews.

The person answering the majority of the phone calls was excellent. The challenge would become being able to handle the lines efficiently.

The position of the “greeter” or “concierge” was in place at the front desk. Her job was to greet all patients and log them into patient flow. She did not answer the telephone. That was done behind the scenes by the administrative staff.

Staff salaries were at 23 percent and are currently at 25 percent, and that includes the addition of four new staff members to provide service for all the new patients.

I returned to the office again in February 2011. Dr. Paquette wanted me to focus on the clinical area. He was concerned about the efficiency of the patient flow. The assistants were making the next appointments for their patients. They were running behind schedule certain times of the day. I needed to evaluate if the template needed to be adjusted or if there were other solutions.

I spent the day in the clinic observing patient flow. I calculated that the assistants were averaging four minutes to turn a chair around and get the next patient seated. I recommended hiring a full-time sterilization person. Dr. Paquette considered hiring a person to reappoint the patients. This was put on hold. The sterilization position has fixed the problem.

Chair turnaround was cut to two minutes. I recommended a 15-minute buffer of no patients be added to the template to catch up in the morning. This worked well.

The photo upload was slow. Two new computers and faster card readers were installed.

The observation patients were moved to the end of the day. Dr. Paquette could flow those patients in the clinic with two assistants while the others were doing their end-of-day duties. Great way to end the day with no possible repairs!

Growth days were targeted to see exams and starts. Dr. Paquette likes to work efficiently on his patient’s day. He averages about 10- 12 patient days per month for a template day. Non-school days and certain days in the summer are targeted for growth.

A vertical calendar has been put into place for 2012. The team member who enters the template has all of the current school schedules to consider in the annual planning.

Once the new financial coordinator was hired, and the backlog of work was completed from the other incident, it was time to focus on the past-due accounts. As of February 2011, the past-due percentage was 18 percent. The insurance accounts were not current. Forms had not been filed. The new team member had her work cut out for her. The goal was five percent or less. Starting patients were put on auto payment for monthly fees.

An additional administrative staff member was hired to answer the phones, which would free up the financial coordinator to focus on collections. A systematic approach was implemented. A daily collection report was printed so the financial coordinator could ask for payments daily and she could also email the responsible party a day or two in advance. A 10 percent discount was offered to many if they wanted to pay the balance in full.

Currently the past-due amount is one percent.

A new assistant was hired in order to maintain the 14 patients per assistant ratio.

The marketing plan was well-organized and effective. This area was working well when I came on board. The facilities and office image were excellent.

By the end of 2011, production increased by 22.5 percent and income increased by 20.1 percent over the previous year.
Author's Bio
Charlene White is the founder of the Virginia Beach-based company, Progressive Concepts, Inc. Call 757-456-0555 or visit www.charlenewhite.com for more information.
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September 2025
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