THE FRONT OFFICE Capitation General dentist choices of capitation Background.—Increasingly, dental care is being paid for through health maintenance organizations, preferred provider organizations, and capitation arrangements. Patients and employers choose to participate in these arrangements partly in response to dentists’ willingness to participate. Patient satisfaction, self-reported oral health, quality of care, and cost of care can influence the client’s choice of payment plan. The factors that influence dentists in choosing to participate in capitation arrangements were explored. Methods.—Surveys were mailed to 1605 general dentists in Oregon in December 2006. The survey explored dentists’ perceptions of the importance of having control over practice parameters, their willingness to participate in capitation payment arrangements, their employment or owner status, and the characteristics of the practice. Results.—The practices surveyed tended to be modest in size, with a mean of three dentists in each, but a broader range was represented. More than 40% of respondents were sole proprietors, 17% were shareholder owners, 17% associates, and 6% partner owners. Of the 729 dentists responding to questions about capitation, 22.7% indicated that they accepted capitation payments. The fees ranged from $60 for an initial oral examination to $800 for porcelain crowns. Although the likelihood that a dentist would accept capitation payments was associated with the number of dentists in the practice, owners were just as likely to accept capitation as employee dentists. A significant negative relationship was noted between the average level of fees and the acceptance of capitation. Having more Medicaid patients was positively related to accepting capitation. When more of the practice’s patients were uninsured, it was
more likely that the dentist would accept capitation. The acceptance of capitation was also related to a longer average wait for an appointment, but the effect was minimal. Discussion.—Fewer than one-quarter of the dentists surveyed accepted capitation arrangements to pay for their services. Specifically, larger practices accepted these payments most readily, being better situated to bear the associated risks. Dental practices that charged higher fees for services were less likely to accept capitation payments. Lower average fees were charged by those who participated in a capitation arrangement. Clinical Significance.—The dentists’ decisions to accept capitation payments followed patterns predicted by the microeconomic theory of provider behavior. The determining factors were dental practice and patient population characteristics. Practitioners, plan managers, and researchers may benefit from these data.
Conrad D, Lee R, Milgrom P, et al: Determinants of general dentists’ decisions to accept capitation payment: A conceptual model and empirical estimates. Community Dent Oral Epidemiol 37:189-198, 2009 Reprints available from D Conrad, Dept of Health Services, Univ of Washington, Box 357660, Magnuson Health Sciences Ctr, 1959 NE Pacific St, Seattle, WA 98195-7660; fax: (206) 543-3964; e-mail: [email protected]
Dental Practice Bringing a new team member aboard Background.—The dental team can be seen as a group of leaders who are working cohesively toward shared goals. The dentist sets the minimum standards for excellence in each position and views compromise as the first step
down a slippery slope. The process of hiring a new team member involves defining the position and hiring the right person, orienting and training the person, and maintaining team empowerment.
Defining and Hiring.—Before hiring any new team members, it is important to collaboratively or individually write a description of the person being sought, noting attitudes, skills, and characteristics. Of these, skills are the least important because they can be taught. From this description, it is possible to write a job description, stating exactly what the position entails and the responsibilities of the team member. To find people to fit the practice’s vision, the dentist can ask current team members as well as patients if they know someone who would be perfect for the position. The local dental society can be contacted to see whether resumes have been submitted. Local employment agencies may have resumes from persons moving into town. Friends and acquaintances from other businesses may be ready for a career change and able to bring valuable crossover skills into the practice. Dental-assisting schools are also sources for personnel. The Internet and social networking sites can be used to spread the word about the opening. The method most used by the community where the practice is situated should be the primary conduit for job information. To contact quality people, it is necessary to advertise effectively. The candidate should be encouraged to send a resume. Sources such as Internet listings will likely generate several responses. Once resumes and/or inquiries are in hand, it is good to identify the top choices and call them to schedule an interview and complete an application. The person who calls for the office should spend several minutes obtaining information and paying attention to the candidate’s phone manner and vocal quality. The interview is conducted by a qualified team member and the dentist. An application should be completed at this time. The interviewer should spend about 30% of the interview time speaking, leaving 70% for the candidate. The best questions are open-ended, encouraging communication. The candidate is being evaluated for the ability to think quickly, write well, spell, punctuate, and perform other skills needed for the open position. The top two or three candidates should return for a second, final interview that will be longer, more detailed, and more specific about the responsibilities of the position, salary, benefits, etc. The 30%/ 70% rule also applies to this interview. Orienting, Training, and Growing.—Orientation involves making the person aware of the characteristics of the practice as well as the job responsibilities. First, the dentist should take care of personnel issues, such as payroll, benefits, hours, and attire. The personnel policy manual should
be given to the new hire, who is to read it and sign a form, agreeing to cooperate with the protocols. A personnel file should be started as well. Training will follow the outline in the job description, with priorities set for each of the listed responsibilities. The training program should be conducted during nonpatient time as well as during work. The trainer should ensure that the new team member understands what is expected, how each system is to be managed, and what are the acceptable time frames. Generally, new team members appreciate the structure of knowing what to do and will integrate more quickly into the team. The new employee performance review should be a daily or weekly occurrence at first. It is vital to know what aspects the person believes are going well and where there is confusion or uncertainty. This offers the opportunity for ongoing instruction and makes it easier for the new team member to ask questions. During this initial period it is also important to make efforts to integrate the new hire into the team. This can include having lunch as a group, hosting a family-included get-together, or scheduling a retreat for reviewing the practice vision, goals, communication skills. Empowering the Team.—The process of hiring and training staff can be stressful, but the key is to take charge and not allow the stress to be in control. Communication, training, and a clear vision of shared goals will build unity, which helps to manage stress. Rather than feeling overwhelmed, the team will be empowered and able to actively and constructively meet the challenges it faces. Clinical Significance.—Team building not only helps to further your practice but actually can make it an enjoyable pursuit. Rather than stressed out, you can be energized and actively engaged in motivating the entire team toward your dream practice. Team members can be happy, fulfilled, and glad to serve your clients if stress is under control and everyone is moving in the right direction.
Jameson C: Increase production and reduce stress. Dental Economics 99:June 2009 Reprints available from http://www.dentaleconomics.com/dis play_article/365106/54/none/none/Feat/Increase-production-and -reduce-stress
Selling dentistry Background.—Traditional sales training presents the selling process as a series of strategies, gimmicks, or
attempts to control behavior and persuade a potential buyer to say ‘‘yes.’’ For many dentists, the concept of selling