Posted by Larry Silver

There are two areas in a practice that are targeted in marketing your practice. The first is internal; the second is external.

Internal deals with dissemination and promotion within your practice and to already-established patients. It includes things such as:

In-office patient referrals
Re-activation of old patients through letters and calls
Newsletters
Mailings to existing patients
Events such as open houses and patient appreciation events
Thank you notes for referring patients
Welcome to the practice letters

External deals with locating and reaching markets outside your practice. It includes things such as:

Prospecting outside of the office for new patients
Advertising by using direct mail, yellow pages, etc.
Forming referral networks with other professionals
Events and/or lectures to groups within the community

When starting out on a new marketing plan it is usually smartest, easiest and most cost effective to begin with internal marketing, as you have ready access to information about your current patients. Current patients are also more valuable because they are familiar with you and your practice.

Once you have an effective internal marketing program going, you can then look at what external marketing actions you want to do to potentially increase your stream of new patients.

Tags: External Marketing, Internal Marketing, Marketing Plans, Mrketing, Re-activation, referrals
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Posted by Larry Silver

To craft a successful marketing campaign for your practice you must first do some basic research actions that will start to isolate what your marketing plan and your promotional pieces will look like and what message they should deliver. The first step in your research is to work out what general mind-set and styles dominate your particular geographic area. Every state, city, town or area has its own mindset and styles that are unique to that place. If you have lived in the area where you practice, chances are you know the mind-set and general styles well. Additionally it is smart to check with others from the area to make sure your opinion coincides with the general consensus. If you are new to the area, ask locals as they generally have a good idea.

Some examples have been given below to give you an idea of what one might list as the mind-set and styles for their area.

Example #1:

Example #2:

Next, find out what the top three practices are in your area and find out how they market themselves. Doing this will enable you to see what marketing approaches have been successful for your area. Looking at your three competitors’ websites is a good start, as well as looking in the Yellow Pages, local newspapers, Valpak/ADVO, etc. to see how they are marketing. Look for what words they are using to sell people, what offers they are putting forward and what their designs look like.

The next step is to isolate what successful campaigns or promotional pieces you have created and used thus far. You want to look for any promotional pieces, slogans, brochures, ads, internal marketing campaigns, discounts, and word of mouth success that resulted in notable increases in delivery. Again, look at what words were used, what offers were being put forward and what the design looked like. It is also good to look at the general demographics of your area. A good website that provides this for free is: http://www.city-data.com Gathering this data should enable you to get a good idea both of what worked for you and what works for other similar professionals in your area. It also provides you with a general idea of what people in your area like and will respond to.

This basic homework will provide you a foundation of information that can be used as you work out new marketing campaigns whether internal or external.

Tags: Marketing And Promotion
Posted in Issue 12 | 1 Comment »

Posted by Larry Silver

Surveying is vital to any successful marketing campaign. Surveying takes the mystery out of anything because it enables you to get a very specific idea of what works and what doesn’t work when selling a product or service. It also helps you isolate your publics and enables you to find out more data about them.

Surveying comes in many shapes and forms. The definition of a survey is:

“SURVEY means ‘a careful examination of something as a whole and in detail.”

You might not know it, but you have immediate access to survey information from data that you have been collecting for quite some time. This survey information will tell you who your current publics are and, the great thing is, all the information is in your patient files.

If you have a computer database of patient information, gathering this data will be quite easy. If you only have physical files it might take longer, but is still worth it.

This action requires you to pull information from these patient records. To save time, you only need to look at your new patient files for the past few months as this should give you a good idea of your overall patient base.

Have your office manager collect the information from the files as to age, education, occupation, gender, income and location. This information should be laid out as a tally in different categories. Then put the raw numbers into percentages using the total number of patient files that were gone through. An example of what this might look like is as follows:

(One hundred patient files were used for this)

Age

Under 10 – 8%

10-18 – 20%

18-35 – 30%

35-55 – 30%

55+ – 12%

Occupation

Office Worker – 15%

Business – 26%

Educator – 6%

Service Industry – 13%%

Artists – 10%

Medical – 14%

Retired – 11%

Gender

Male – 65%

Female – 35%

Location

Bonkersville – 70%

Sumner – 10%

South East Connerstown – 10%

Sheridan – 10%

Having this data will help you see exactly who you have as current patients. This data will help you target the areas that are bringing you the most business. For example, based on this data it would be valuable to send out a promotional piece that targets well-educated males in Bonkersville between the ages of 18-55.

Doing the above is not the only survey action you will do, but it is a fast and effective means of locating valuable publics for you to start targeting.

Tags: Marketing And Promotion, Marketing Campaign, Surveys
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Posted by Larry Silver

Surveys can save you time and wasted effort. By properly utilizing surveys, you will not be shooting in the dark when you implement a new idea. You will not be left wondering why people are not coming back to your practice. You will KNOW what your publics need and want, so you can provide just that.

Have you ever come up with a “great” new idea, implemented it, and when nothing significant or productive occurred as a result, found yourself tearing out your hair wondering what went wrong? Or even worse, tearing out the hair of your staff because “New patients are down!”

Have you conversely wondered, pondered and meditated over why new patients have dropped off even though you’re doing the same things you have always done for 20 years? It might well be that the things you’ve been doing for 20 years are no longer appropriate. These scenarios are likely due to failure to survey.

There are answers to marketing problems that you simply cannot procure from any source other than your patients themselves. The motto in marketing is “know before you go”, which is done by surveying.

A sample survey is given at the end of this article to illustrate what a survey should look like.

CONSTRUCTING THE SURVEY

Although surveys will vary practice to practice, there are some guidelines to follow:

Indicate to your patient WHY you are doing a survey and thank them for participating.
Ask only relevant questions in your survey. Restrict your questions to important factors that will actually TELL you
Keep the survey BRIEF. Write the survey so that it takes no more than 3-5 minutes to complete. If the survey is too long patients may feel annoyed, overburdened, bored or will not respond.
Construct a survey that asks for specific answers. Create questions that provide you with information rather than having only “yes” or “no” answers.
Allow patients the option to remain anonymous if they so choose.
Provide a way for them to receive a response to their questions or input if they desire.
If appropriate, set a deadline for the receipt of the surveys. Tell participants why you have a deadline and when it is.
Graciously thank your patients for taking their time to fill out the survey.
For mail-out surveys, include a self-addressed stamped envelope. Recipients will be much more likely to send it back to you.

DISTRIBUTING & PERFORMING THE SURVEY

Surveys can be done in person, handed to patients to fill out while in the office, done over the phone or done via the mail or email. If the survey is done in person or over the phone, ensure that whoever is doing the survey fully understands the questions and why the survey is being done.

TABULATING THE SURVEYS

If you do not receive an adequate number of responses (an adequate response being enough surveys to see a clear majority in the answers, at minimum 30 responses) by the stated deadline, increase your sampling or extend your deadline. An inadequate response will give you a poor measure of patient trends.
Collect all survey results and tabulate each question by tallying responses. People’s answers can vary on open-ended questions, in which case you should group similar responses together. An example would be if your survey question was “Describe the perfect dentist”. If in response to this question 5% of the people surveyed said “happy”, 5% said “cheerful” and 10% said “always smiling”, these could all be grouped together in one category as they are all a similar response.
Once you have the raw number tallies of people’s responses, change these tallies into percents based on the total number of surveys done.
Ensure that you promptly respond to any requests for a personal response.
At a staff meeting, discuss the areas of the practice that are indicated to be in need of change.

The information gathered from doing the above is extremely valuable in deciding
what you provide and how you promote and present that.

CLICK HERE to download a sample survey.

Tags: Marketing And Promotion, New Patients, survey
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Posted by Larry Silver

The Lessons I’ve Learned

“The Lessons I’ve Learned in My Journey to Become a Professional Practice Owner”

Part One: “What I Did Wrong”

by Lee Shuwarger, O.D.

Right off the bat, I can guess what you are thinking – why would anybody write about everything they did wrong? Well, one only learns from mistakes and in the interest and hope that possibly some recent graduates and colleagues may read this and get some help and/or insight in some of the lessons I learned, I wrote this.

Being originally from Los Angeles, I wanted to see why people live on the East Coast. So I decided to go to an Optometry school back east and ended up at NEWENCO in Boston.

Just before I graduated, I wondered why job offers didn’t just arrive on my doorstep. I quickly learned that everything takes effort and I had better get pro-active real fast if I wanted to start working in the profession I had just spent years being trained in.

My first issue was where to practice. L.A. would be fine, but with all my student loans I felt I’d better find a cheaper place to settle down. Unfortunately, that only eliminated Honolulu, New York City, and San Francisco. So, I went to the library to look for places that need optometrists. At the time, Texas kept on appearing in the results. My brother was an OB-GYN in Houston so I thought, “Houston is like L.A., with the climate of Bangladesh- so why not go there?”

After moving to Houston, I was hired by a large chain in Texas. I remember having lunch with one of the co-owners of the practice while negotiating my contract. I wasn’t very happy with the salary but, being naïve, I knew that with the combination of my friendly personality and my abilities as an optometrist, I would be able to impress him in just a few months. I therefore worked out to get the following clause into my employment contract: “Employer will evaluate employee’s performance in 4 months and, based on that performance, will increase the employee’s compensation.” Fair enough I thought.

Satisfied, I went to work for him in a brand new building- even the carpet smelled new! After 4 months of working there, I went out to lunch with him. He told me that the practice had grown in 4 months what he expected to see only after 12 months, that they had received compliments about me from patients and ophthalmologists. “Well, now I get the raise”, I thought. “Sorry”, he said, “we’re not going to give you a raise.” Needless to say, I was a bit stunned. When I questioned him further on this he said, “Look, The University of Houston is graduating 100 optometrists every year that I could hire to replace you at a lower salary.” I couldn’t believe he’d turn his back on his agreement with me.
This brings me to the first three things I learned in this life of becoming a practicing professional:

Be very wary of practicing in an area that has a school of your profession.
Get EVERYTHING in writing.
Never underestimate the potential unethical qualities of your colleagues/employers when it comes to the “mighty buck”.

Within 10 minutes of this lovely lunch I went searching to find a place where I would be “appreciated”. During my time in Houston, I learned that Texas was saturated with optometrists that are practicing at or east of I-35 – one of the main transportation routes in the area. I discovered that if I went to the west I should be able to make a much better living. So I went as far west as I could go in Texas and ended up working for an optometrist in El Paso. He had promised me that he would give me a large bonus if I stayed for three years. I asked him what would happen if I was let go, for instance if business decreased. He said that he would give me that bonus as a severance pay. As he had this practice for about 40 years and he still had people working for him that were with him from the beginning, I thought that this was potentially great. To me it meant that, if he had staff for that long he must truly appreciate them and take good care of them and honor his agreements with them. Otherwise people would not stay with him for so long. That seemed obvious, I thought, and did not need any further investigation.

Wow, was I wrong! I soon learned that the area was very economically depressed and having a job – even a low paying job with no room for advancement, and not necessarily being appreciated – was far preferable to being unemployed. That’s why his staff had been there so long.

One day, while still working for him, I received a job offer in the mail. I’m sure many of you may have seen one like this before: “A wonderful opportunity is waiting for an energetic optometrist in beautiful (insert name of small, barely recognizable town)!”
I called out of curiosity just to find out how much I might be worth on the job market. On the phone, I explained that, even though I was not interested in moving and leaving my present job, I just wanted to call and see how much they were paying. He asked me who I was working for and I told him. BIG mistake. As you might deduce, I ignored rule #3 of never underestimating the potential unethical qualities of your colleagues/employer when the almighty dollar is at hand.

That day, my employer got a call from the potential employer that had sent me the job offer letter. I don’t know exactly what was said in that telephone conversation, but my employer told me, “If you are looking, you are obviously not happy. And if you are not happy, I need to find someone who will be happy here and I can’t afford two of you.”

I asked him about the bonus and reminded him how he had promised it to me if I were let go. He refused. Guess what – I had forgotten rule #2: “Get EVERYTHING in writing.”

Soon thereafter, I was in Lubbock, TX, working for the optometrist that sent me that form letter. That job lasted for just over a year- just long enough to complete my contract.

Through my experiences, I was able to observe the benefits of an individual working for oneself. That led me to wanting to have my own practice. Unfortunately, there was no way I could afford all the equipment and expenses. I was soon contacted by a “recruiter” for a very, very large national chain of stores (I’ll just call that store “Not-Smart,”) which had an in-store optometry office who told me about an opportunity at a their Vision Center in Amarillo, TX. It seemed like a really good deal for a recent graduate. You get to call the practice your own, all the equipment, materials, utilities, and even the phone were all paid for by the rent and the rent was just 10% of the gross receipts. But I soon discovered the negative points:

Since they collected 10% of your gross receipts you were strongly encouraged to take all the insurance plans you could, and pushed to work for over 60 hours per week. I was told to even charge my family for their eye care.
Management did not care about personal health issues, family issues, or religious holidays. You were required to either be there, or have another optometrist there during hours that you were suppose to be open. You were not allowed to close for any reason. You were required to have a replacement optometrist there even on religious holidays. If you miss any days for any reason, you are required to make it up by working on a Sunday or another holiday (like Christmas, Thanksgiving, etc.)
The renewal of your lease was constantly threatened if any of the above type violations took place.

As an example of my dealings with them, one day I asked them for another exam lane so I could see more patients. I ran all the numbers and presented it to them. It was projected that the cost for the construction and equipment would be made up in only 5 months since it was also projected to increase my business about 20%. The regional manager had a meeting with me. He told me, “You’re working about 50 hours a week now, right? Well, you could make that extra 25% if you were open 60 hours/week.” “Yeh”, I thought, “and I could increase by 75% if I was open 24 hours a day and slept there too.” With working relationships like this, it was obvious to me that my growth there was limited.

I will say though, that I made A LOT of money there although it really wasn’t easy or enjoyable. It has now been over 6 years since I worked there and I still have a bad feeling about it. I guess this is what it feels like to sell your soul.

Which brings me to an additional rule I learned, rule #4:

When you work for chains, the money you earn is inversely proportional to the degree to which you sell your ethics.

At this point, although I knew I couldn’t afford to build a practice from scratch, I still wanted to find a place to see patients, a place my patients could go where they would be treated the way I wanted them treated. I always had a good professional relationship with one particular optometrist in town and, after talking to him, we decided to “blend” our practices. We arranged that I would move in to his office and be able to use his staff to schedule appointments for my patients. I would then see my patients and the other optometrist would collect a portion of what I collect as “rent” on equipment and space. I even got this in writing (rule #2).

This seemed to work well for both of us in the beginning. But soon I noticed that my patient exam numbers were decreasing to the point that I was seeing only a patient or two a day. Way too slowly and too late I started wondering what was happening. One day, one of my partner’s employees confessed to me that her boss told her, “Make every appointment for me and NOT Dr Shuwarger- even if they are a previous patient of Dr. Shuwarger’s.” I couldn’t believe he told her that! But that was confirmed by the fact that the number of patients I was seeing was severely down and his was up by the same amount. Foolish me, I forgot rule #3.

During this same time period, I bought a new house and my wife got pregnant. So here I was, 6 months into this venture with my patients being stolen and major life changes occurring.

I decided that I needed to get out of there and save what patients I had. I started negotiations on leasing space in a shopping center to have my own office. When my “partner” heard about this (and I knew he eventually would), he threw me out of his practice.

So, there I was. No job, large house, no patients, and a baby on the way.

I made it work and, in my next article, will explain how I took these hard won lessons and ended up finally creating a very successful practice. I know that everyone will not go through all the trials and tribulations that I went through, but I though it could be helpful to new graduates who are figuring out how to proceed with their professional life to see what I went through and, hopefully, be able to avoid some of these mistakes.

Note from the publisher: The experiences and opinions of the author are completely his own and do not reflect the opinions of The Practice Solution Magazine or its publisher. We are however looking forward with enthusiasm to his next installment to see how the story ends.

CLICK HERE to read Part 2 of this article

Tags: economy, Optometry, Starting a New Practice
Posted in Issue 12 | No Comments »

Posted by Larry Silver

Newswise – Regular checkups and cleaning can save money in the end by heading off problems early. Nevertheless, when times get tough and people start losing their jobs, preventive dental care can be one of the first things to go.

However, the correlation between rising unemployment and a drop in preventive dental care is not necessarily due to people being short of cash, according to a new study appearing in the online edition of Health Services Research.

“We see that high community-level unemployment exacts a psychological toll on individuals,” said lead study author Brian Quinn. “Even for people who are working, or who have a working partner or spouse, there might be an impact if they’re stressed about themselves or their significant others losing their jobs.”

Quinn, a program officer for the Robert Wood Johnson Foundation, said the distraction of worrying about not having a job could make dental care drop off a person’s radar. “During stressful periods, those things that don’t seem as urgent may be ignored,” he said.

The researchers analyzed 10 years of information about visits to dentists’ offices in metropolitan Seattle and Spokane from Washington Dental Services, the largest dental insurer in the state, which covers roughly one-third of its residents. They compared this information to unemployment data from the Bureau of Labor Statistics and Washington’s Employment Security Department, and ruled out other possible explanations for a correlation.

In the Seattle area, for every 10,000 people who lost their jobs, there was a 1.2 percent decrease in visits to dentists for checkups. The drop was higher in the Spokane area, where the same increase in unemployment was associated with a 5.95 percent decrease in preventive visits. This is notable as the study looked at people who had dental insurance that covered routine care.

Dental care is way down at the bottom of the list of essentials for many people, said Gene Sekiguchi, associate dean of legislative affairs for the University of Southern California School of Dentistry. “When the economy gets tough, you’ll start eliminating the last items on the list and work your way up,” said Sekiguchi, who had no affiliation with the study.

Sekiguchi said that oral hygiene is important for overall health; for example, gum disease can lead to heart disease and diabetes.
Because preventive care is usually cheaper than tooth repairs, dental plan administrators and public health policy makers might want to promote cleaning and checkups during periods of high unemployment, the study authors say.

Health Services Research is the official journal of the AcademyHealth and is published by John Wiley & Sons, Inc. on behalf of the Health Research and Educational Trust. For information, contact Jennifer Shaw, HSR Business Manager at (312) 422-2646 or jshaw@aha.org. HSR is available online at http://www.blackwell-synergy.com/loi/hesr.

Quinn BC, Catalano RA, Felber E. The effect of community-level unemployment on preventive oral health care utilization. Health Services Research online, 2008.

Interviews: Susan Rosenthal at slrosent@utmb.edu

Source: Health Behavior News Service Released: Thu 28-Aug-2008, 15:15 ET Embargo expired: Fri 19-Sep-2008, 00:00 ET

Contact Information

Health Behavior News Service: Lisa Esposito at (202) 387-2829 or hbns-editor@cfah.org.

Tags: Dentistry, economy
Posted in Issue 12 | No Comments »

Posted by Larry Silver

Veterinary Researcher Studying Brain Tumors in People, Animals

Newswise – A veterinary neurologist on faculty in the Virginia-Maryland Regional College of Veterinary Medicine at Virginia Tech has been awarded funding from the Wake Forest University Translational Science Institute to study innovative approaches for treating brain tumors in dogs, cats, and humans.

Dr. John Rossmeisl, an assistant professor in the Department of Small Animal Clinical Sciences (DSACS), is working with Wake Forest University Medical Center researchers to develop better therapeutic approaches for managing very serious forms of brain tumors called gliomas.

Rossmeisl will work closely with a cluster of scientists and physicians at Wake Forest University and with VMRCVM veterinary pathologist Dr. John Robertson, director of the college’s Center for Comparative Oncology, on the project. The veterinary college is a participating institution on a major translational research initiative at Wake Forest University funded by the National Institutes of Health (NIH).

“Gliomas are an aggressive and deadly form of brain cancer that affects dogs and people,” said Rossmeisl, who is board certified in veterinary neurology by the American College of Veterinary Internal Medicine. “Because there are so many similarities between clinical signs and pathobiology, the dog has emerged as an excellent model for studying gliomas in humans.”

Every year about 120,000 new cases of primary and secondary brain cancer are diagnosed, according to the National Cancer Institute. Much less is known about the incidence of brain tumors in domestic animals, according to Rossmeisl. Clinical signs associated with brain tumors in both people and animals can include seizures, abnormal behaviors, weakness of the limbs, loss of balance, blindness and other problems.

Gliomas arise from glial cells, according to Rossmeisl, which play numerous supporting roles for neurons, brain cells that control thought, sensations and motion. Glial cells outnumber neurons by a factor of about ten to one in the brain, and they play an essential role in creating the architecture and structure of the brain and supporting its functions.

There are several different specific types of glial cells, but two that interest Rossmeisl and colleagues most are called astrocytes and oligodendrocytes. Oncogenic abnormalities associated with each of these can lead to cancers called astrocytomas and oligodendrocytomas, according to Rossmeisl.

The most common approaches for managing these tumors involve surgical excision, radiation therapy and chemotherapy. But conventional radiation and chemotherapy affect normal cells in addition to the cancerous cells they target, so perfecting approaches that exclusively target the molecular abnormalities present in each individual’s cancer cells and spare healthy cells is a major thrust in modern oncology.

To develop more precisely targeted systems for administering therapeutic agents to cancer cells, Rossmeisl and his colleagues are attempting to further establish the molecular similarity of human and canine gliomas.
Scientists know that when astrocytomas spontaneously arise in people, they over-express three proteins: interleukin 13 receptor alpha2 (IL-13R), which is a cancer testis tumor like agent; EphA2, a tyrosine kinase receptor; and fos-related antigen 1, an AP-1 transcription factor.

Rossmeisl and colleagues working in the college’s Center for Comparative Oncology have opened a clinical trial and are currently enrolling animals from around the region that have been positively diagnosed with a brain mass consistent with the appearance of a glioma on magnetic resonance imaging (MRI).

The researchers will be studying tissue samples from affected animals in search of these proteins that are not otherwise present in normal brain tissues. Identifying these proteins could further document the dog’s suitability as a model for studying pre-clinical human disease, according to Rossmeisl, and ultimately lead to the development of more precisely targeted methods for managing these tumors.

Another portion of the work is focused on the development of powerful new cancer treatments. Through a process known as convection enhanced delivery (CED), the researchers are removing the diseased tissues and testing the application of a proprietary experimental compound. This agent is used to “bathe” the margins of the area in which the tumor was removed and it has been designed in a way that it will only bind with receptors in tumor cells expressing abnormal proteins.

“Their potential value is tremendous to humans and dogs with cancer,” said Rossmeisl. These treatments may represent a significant advancement in prolonging survival in dogs and people with these highly aggressive cancers.”

The researchers will also be looking at improved processes for performing radiation therapy on brain tumors in dogs.

“Currently, the standard of care in veterinary radiotherapy is fractional radiotherapy delivered with a linear accelerator,” explained Rossmeisl. This form of radiation therapy is typically delivered with frequent administration of relatively small doses of radiation multiple days per week over several weeks. Though it can be fairly precisely targeted, it can affect tissues unrelated to the tumor.

The grant will enable the researchers to perfect protocols for treating canine patients with stereotactic radiosurgery – more commonly known as the “gamma knife.” The gamma knife uses a specialized head-frame to target an exactingly focused beam of killing radiation with pin-point accuracy on the tumor itself. As opposed to a traditional course of radiotherapy that can take weeks, the gamma knife can accomplish the task in one session lasting a few hours.

For more information regarding the Comparative Canine Glioma Trial (CCGT) study, view the CCGT General Information Form, or contact Luann-Mack Drinkard (clinical research technician) at lmackdr@vt.edu or by phone at (540) 231-4621, or the study co-director, Dr. John Rossmeisl at jrossmei@vt.edu.

The Virginia-Maryland Regional College of Veterinary Medicine (VMRCVM) is a two-state, three-campus professional school operated by the land-grant universities of Virginia Tech in Blacksburg and the University of Maryland at College Park. Its flagship facilities, based at Virginia Tech, include the Veterinary Teaching Hospital, which treats more than 40,000 animals annually. Other campuses include the Marion duPont Scott Equine Medical Center in Leesburg, Va., and the Avrum Gudelsky Veterinary Center at College Park, home of the Center for Government and Corporate Veterinary Medicine. The VMRCVM annually enrolls approximately 500 Doctor of Veterinary Medicine and graduate students, is a leading biomedical and clinical research center, and provides professional continuing education services for veterinarians practicing throughout the two states. Virginia Tech, the most comprehensive university in Virginia, is dedicated to quality, innovation, and results to the commonwealth, the nation, and the world.

Contact Information
Jeffrey Douglas (540) 231-7911 jdouglas@vt.edu

Tags: Veterinary, Veterinary Medicine
Posted in Issue 12 | No Comments »

Posted by Larry Silver

Tears Reveal Some of Their Deepest Secrets to Researchers

Newswise – It’s no secret why we shed tears. But exactly what our tears are made of has remained a mystery to scientists.

A new study sheds some light on the complex design of tears. What we think of as tears, scientists call tear film, which is made up of three distinct, microscopic layers. The middle, watery layer – what we normally think of as tears when we cry – is sandwiched between a layer of mucus and an outer layer of fatty, oily substances collectively called meibum.

It’s in this outer layer that researchers describe, for the first time, a new class of lipids – a type of fat – that make up part of the film. They also identified one of these lipids, oleamide, which had not been known to be a part of tears before.

With each blink, meibum spreads over the surface of the eye. It keeps the watery middle layer in place, ensuring that our eyes stay moist.
Finding these lipids may help scientists better understand the causes of eye-related disorders such as dry eye disease, which affects anywhere from 12 to 14 million Americans, said Kelly Nichols, the study’s lead author and an assistant professor of optometry at Ohio State University.
“The lack of certain compounds in the tear film may result in a number of different eye-related disorders, including dry eye,” she said. “The amount of oleamide and related lipids in tear film may be related to these disorders.”

Dry eye is really a collection of irritating symptoms that includes microscopic damage to the front of the eye. The eyes may ache, burn, feel extremely dry or excessively tear.

The researchers report their findings in the current issue of the journal Investigative Ophthalmology and Visual Science.

They collected oily meibum secretions from the meibomian glands of healthy volunteers. The meibomian glands are tiny, grape-like clusters of cells that line the rim of our upper and lower eyelids – the outlets to these glands are roughly adjacent to the eyelashes. Researchers gently pressed the volunteers’ lower eyelids and collected droplets of meibum in tiny glass tubes.

The researchers examined the meibum samples in the laboratory. They used a technique called electrospray mass spectrometry to differentiate between the different lipid components. This technique adds an electric charge to microscopic droplets of the oily substance, which allows the instrument to detect different components based on electrical charges and mass.

Nichols points out that researchers have used other techniques, such as chromatography, to characterize types of lipids in the tear film, but advances in mass spectrometry technology are improving research efforts.

“Other scientists used different techniques to try to determine the composition of meibum, but mass spectrometry is sensitive enough to detect individual lipid molecules, like oleamide,” Nichols said.

Oleamide was first identified as a lipid in the brain, where one of its roles is to induce sleep. It also has other key functions throughout the central nervous system. But the current study is the first to find and describe oleamide and related lipids in tear film.

“The finding could give us more insight into the role of lipid activity in humans and may also indicate a new function for oleamide and related lipids in cellular signaling in the eye and in the maintenance of tear film,” said Nichols, adding that researchers don’t fully understand the function of oleamide, or the other lipids in the meibum.

“Oleamide appears to be a predominate lipid in tear film,” she said. “It’s there for a reason, but we’re not sure yet what that reason is.”
Nichols and her team are currently studying the role of oleamide in cellular signaling and communication in the eye, along with the role that the lipid may play in dry eye.

“Dry eye is really a disorder of symptoms that irritate the eyes,” Nichols said. “Not everyone with dry eye responds to the same treatment. If we could find individuals with varying oleamide levels, then we may be able discern one cause of dry eye, and specifically treat that.

“Even though two people with dry eye may have the same symptoms, there may be very different causes underlying those symptoms.”

Nichols conducted the study with Ohio State colleagues Jason Nichols, assistant professor of optometry; Corrie Ziegler, a graduate student in optometry; Kari Green-Church, a research scientist with the Mass Spectrometry and Proteomics Facility; and Bryan Ham, a postdoctoral researcher at the Pacific Northwest National Laboratory in Richland, Wash.

Contact: Kelly Nichols, (614) 688-5381; KNichols@optometry.osu.edu
Written by Holly Wagner, (614) 292-8310; Wagner.235@osu.edu

Tags: Optometry
Posted in Issue 12 | No Comments »

Posted by Larry Silver

Researchers Use A Patient’s Own Bone To Accelerate Orthodontics

Newswise – Researchers at the University of Southern California School of Dentistry say they have improved upon a surgical procedure developed by periodontist Tom Wilcko that rapidly straightens teeth, delivering a healthy bite and attractive smile in months instead of years.

Led by Hessam Nowzari DDS, PhD, Director of the USC School of Dentistry and Advanced Education in Periodontology program, the researchers have published the first case study of the successful use of a patient’s own bone material for the grafting necessary in the accelerated orthodontic surgical procedure. The report appears in the May 2008 issue of the Compendium of Continuing Education in Dentistry.

Accelerated orthodontics is gaining popularity as a way for patients, particularly adults with mature bones, to speed up the time it takes to straighten misaligned bites and fix crowded teeth. Wilcko, who operates a practice in Erie, Penn., offers courses in the procedure, trademarked as “Wilckodontics.”

USC dentists used a procedure known as PAOO, short for Periodontally Accelerated Osteogenic Orthodontics. With this technique, a periodontist or oral surgeon uses special instruments to score the bone that holds the teeth in place and then applies bone graft material over the grooves. The procedure is done under local anesthetic in the dental office operatory.

As the bone begins to heal, it softens slightly, allowing teeth to be moved into alignment with dental braces in a matter of months, rather than the years required with traditional orthodontics. The cost for accelerated orthodontics typically ranges from $10,000 to $15,000, depending on the course of treatment.

Prior to the USC study, the bone graft material used for this procedure was bovine bone and bioactive glass particles to help the bone strengthen as it healed.

Nowzari says that his team believed they could improve the technique by using the patient’s own bone instead of the artificial or bovine graft.

“Given a choice for grafts, nothing is better than a patient’s own tissue,” Nowzari explains. “It encourages new, healthy bone formation in the grafted area. It’s very safe and eliminates the risk of any disease transmission.”

Contact Information
Angelica Urquijo (213) 740-6568 office (213) 271-4189 cell

Tags: Dentistry, Orthodontic
Posted in Issue 12 | No Comments »

Posted by Larry Silver

Newswise – New evidence from a laboratory study and a pilot clinical trial confirms the promise of a simple treatment for amblyopia, or “lazy eye,” according to researchers from the U.S. and China.

The treatment was effective on 20-year-old subjects. Amblyopia was considered mostly irreversible after age eight.
Many amblyopes, especially in developing countries, are diagnosed too late for conventional treatment with an eye patch. The disorder affects about nine million people in the U.S. alone.

Results from the laboratory study will be published online the week of Mar. 3 in PNAS Early Edition.
Patients seeking treatment will need to wait for eye doctors to adopt the non-surgical procedure in their clinics, said Zhong-Lin Lu, the University of Southern California neuroscientist who led the research group.

“I would be very happy to have some clinicians use the procedure to treat patients. It will take some time for them to be convinced,” Lu said.

“We also have a lot of research to do to make the procedure better.”

In a pilot clinical trial at a Beijing hospital in 2007, 28 out of 30 patients showed dramatic gains after a 10-day course of treatment, Lu said.

“After training, they start to use both eyes. Some people got to 20/20. By clinical standards, they’re completely normal. They’re not amblyopes anymore.”

The gains averaged two to three lines on a standard eye chart. Previous studies by Lu’s group found that the improvement is long-lasting, with 90 percent of vision gain retained after at least a year.

“This is a brilliant study that addresses a very important issue,” said Dennis Levi, dean of optometry at the University of California, Berkeley. Levi was not involved in the study.

“The results have important implications for the treatment of amblyopia and possibly other clinical conditions.”

The PNAS study shows that the benefit of the training protocol – which involves a very simple visual task – goes far beyond the task itself. Amblyopes trained on just one task improved their overall vision, Lu said.

The improvement was much greater for amblyopes than for normal subjects, Lu added.

“For amblyopes, the neural wiring is messed up. Any improvement you can give to the system may have much larger impacts on the system than for normals,” he said.

The Lu group’s findings also have major theoretical implications. The assumption of incurability for amblyopia rested on the notion of “critical period”: that the visual system loses its plasticity and ability to change after a certain age.

The theory of critical period arose in part from experiments on the visual system of animals by David Hubel and Torsten Wiesel of Harvard Medical School, who shared the 1981 Nobel Prize in Medicine with Roger Sperry of Caltech.

“This is a challenge to the idea of critical period,” Lu said. “The system is much more plastic than the idea of critical period implies. The fact that we can drastically change people’s vision at age 20 says something.”

A critical period still exists for certain functions, Lu added, but it might be more limited than previously thought.

“Amblyopia is a great model to re-examine the notion of critical period,” Lu said.

The first study by Lu’s group on the plasticity of amblyopic brains was published in the journal Vision Research in 2006 and attracted wide media attention.

Since then, Lu has received hundreds of emails from adult amblyopes who had assumed they were beyond help.

Berkeley’s Levi cautioned that the clinical usefulness of perceptual learning, as Lu calls his treatment, remains a “sixty-four thousand dollar question.”

“It’s clear that perceptual learning in a lab setting is effective,” Levi said. “However, ultimately it needs to be adopted by clinicians and that will probably require multi-center clinical trials.”

Lu is collecting patients’ names for possible future clinical trials. He can be contacted at zhonglin@usc.edu.

The researchers are also working to develop a home-based treatment program.

For patients who can travel, the Chinese hospital that hosted the pilot trial may be able to provide treatment. Contact Dr. Lijuan Liu, Beijing Xiehe Hospital, at lijuan_l@yahoo.com.cn.

The other members of Lu’s group are Chang-Bing Huang and Yifeng Zhou of the Vision Research Lab at the University of Science and Technology of China, in Hefei, Anhui province (Huang is currently a postdoc in Lu’s lab at USC).

Funding for the research came from the Chinese National Natural Science Foundation and the U.S. National Eye Institute.

ABOUT AMBLYOPIA (from PNAS)

Amblyopia affects about 3 percent of the population and cannot be rectified with glasses. People with the disorder suffer a range of symptoms: poor vision in one eye, poor depth perception, difficulty seeing three-dimensional objects, and poor motion sensitivity.

Also known as lazy eye, the disorder is caused by poor transmission of images from the eye to the brain during early childhood, leading to abnormal brain development. Lazy eye is actually a misnomer because in many cases the structure of the eye is normal.

Source: University of Southern California Released: Wed 27-Feb-2008, 13:10 ET Embargo expired: Mon 03-Mar-2008, 17:00 ET

Contact Information

Contact: Carl Marziali, (213) 219-6347 marziali@usc.edu

Tags: Lazy Eye, Optometry
Posted in Issue 12 | No Comments »

Posted by Larry Silver

Newswise – Dogs suffering from lymphoma will be able to receive the same type of medical treatment as their human counterparts, as North Carolina State University becomes the first university in the nation to offer canine bone marrow transplants in a clinical setting.

Dr. Steven Suter, assistant professor of oncology in NC State’s College of Veterinary Medicine, received three leukophoresis machines donated by the Mayo Clinic in Rochester, Minn. Leukophoresis machines are designed to harvest healthy stem cells from cancer patients. The machines are used in conjunction with drug therapy to harvest stem cells that have left the patient’s bone marrow and entered the bloodstream. The harvested cancer-free cells are then reintroduced into the patient after total body radiation is used to kill residual cancer cells left in the body. This treatment is called peripheral blood stem cell transplantation.

The machines, once used for human patients, are suitable for canine use without modification, as bone marrow therapy protocols for people were originally developed using dogs.

“It’s not a new technology, it’s just a new application of an existing technology,” Suter says. “Doctors have been treating human patients with bone marrow transplantation for many years, and there have been canine patient transplants performed in a research setting for about 20 years, but it’s never been feasible as a standard therapy until now.”

Canine lymphoma is one of the most common types of cancer in dogs, but the survival rate with current treatments is extremely low. Peripheral blood stem cell transplantation, in conjunction with chemotherapy, has raised human survival rates considerably, and it is hoped that dogs will see the same benefits.

“We know that dogs who have received bone marrow transplants have a cure rate of at least 30 percent versus about 0 to 2 percent for dogs who don’t receive the transplants,” Suter adds. “The process itself is painless for dogs – the only thing they lose is a bit of body heat while the cells are being harvested.”

Contact Information

Tracey Peake, News Services, (919) 515-6142 or tracey_peake@ncsu.edu

Tags: Veterinary, Veterinary Medicine
Posted in Issue 12 | No Comments »

Posted by Larry Silver

Veterinary Medicine Contributes $3.3 Billion to New England Economy

Newswise – Veterinary medicine contributes $3.3 billion to the economies of New England-and the region faces a shortage of as many as 658 veterinarians by 2014, according to a study released today by the Cummings School of Veterinary Medicine at Tufts University.

The study-undertaken by the UMass Donahue Institute and commissioned by the Cummings School, the only veterinary school in the six-state New England Region-reveals that veterinarians and associated staff comprise over 20,000 jobs in the area. Moreover, for every 100 veterinary medical jobs in the region, an additional 59 jobs are created in related industries, the study indicates.

Clinical practice-providing medical services for household pets, farm and food animals, and exotic animals-represents the largest percentage ($1.1 billion, or 65 percent) of direct veterinary expenditures in New England, which total $1.72 billion. Scientific research and development-which require animal health and husbandry services to test new drugs and devices and better understand animal and human health-comprises the next-largest category, with a total of 23 percent of veterinary medicine spending and 14 percent of the industry’s total employment. Laboratory animal veterinarians are responsible for the welfare of as many as 2 million laboratory animals in New England.

The study also highlights a growing critical need for veterinarians in the region. According to Bureau of Labor Statistics (BLS) data, the study found that the region will have 1,036 vacancies for veterinarians by 2014, both through new job creation and retirement of an aging workforce. With an average of 60 percent of Cummings School graduates remaining in New England, trends suggest that 378 of the school’s graduates will enter the region’s workforce, leaving unfilled 658 new vacancies for veterinarians.

What’s more, the study suggests that the region faces a flood of retirements among food animal veterinarians. Over a quarter of the region’s more than 100 specialized food animal veterinarians will reach retirement age by 2014. With current levels of food animal graduates, the Cummings School will be positioned to replace only half of these vacancies. Overall, 43 percent of New England veterinarians are over age 50; by contrast, 56 percent of livestock veterinarians are over age 50. Until 2014, the study suggests, food animal veterinarians will retire at nearly twice the rate of their companion animal colleagues. With the critical role that food animal veterinarians play in protecting the nation’s food supply, this shortage is especially alarming.

“This study confirms the importance and economic impact of veterinary medicine in Massachusetts and New England,” said Deborah T. Kochevar, DVM, PhD, dean of the Cummings School of Veterinary Medicine at Tufts University. “Cummings School is proud to serve the citizens of this region by educating veterinary professionals, advancing biomedical research, and serving as a clinical and public health resource for animals and their owners.”

The study was supported by the Veterinary Medical Associations of Massachusetts, Connecticut, Maine, New Hampshire, Rhode Island and Vermont, the New England Veterinary Medical Association and InTown Veterinary Group. Hill’s Pet Nutrition, Inc., was the study’s lead industry sponsor.

“In order to best understand the health of the animals in New England, we need to understand the industry that cares for them,” said Dr. Christine Jenkins, Director of Academic Affairs at Hill’s Pet Nutrition, the study’s lead industry sponsor. “This study does just that-and we hope it sheds light on the growing need for veterinarians in the workforce to ensure the care and safety of animals in the region.”

The study also revealed interesting findings in each state of New England. Among them:

Massachusetts has New England’s biggest veterinary scientific research and development sector, with more than 5 percent of the state’s veterinarians specializing in this area. The state is the fifth-largest in the nation for research animals registered under the Animal Welfare Act and veterinarians support the work of a vital life sciences industry in the state. With 8,000 employees statewide and a total economic impact of $1.3 billion in 2006, veterinary medicine is an essential part of the state economy.
In Connecticut, $83 is pumped back into the state’s economy for every $100 spent by the veterinary industry, a multiplier of 1.83. For every 100 jobs in the industry, another 55 jobs in Connecticut are supported. Connecticut boasts a total veterinary economic impact of nearly $1 billion in 2006, the second largest in the region.
Maine has the nation’s sixth-highest rate of pet ownership, with 70 percent of households (376,000 homes) owning one or more pets. The veterinary industry represents an economic impact of more than $290 million in the state.
New Hampshire residents spend the second-most in the region on veterinary clinical services per capita, at $94. The state also ranks second in median wages for veterinarians, at $78,180. Every $100 of veterinary industry spending in the state supports another $74 of economic activity in the state.
In Rhode Island, veterinary medicine employs an estimated 1,110 people, including 189 veterinarians. The industry invests an estimated $81 million on payroll, operating expenses and capital projects, including over $69 million in veterinary clinical practice, $5 million in scientific R&D and $6 million in academia.
Vermont has both the highest rate of pet ownership in the region and the nation-74.5 percent-and the region’s highest per capita spending on veterinary clinical services ($97). Additionally, the state boasts the region’s highest rate of veterinary practice ownership (52 percent of clinical practice veterinarians are self-employed).

Several leaders from the biomedical industry in Massachusetts spoke out in support of the study’s findings. “In order for the biomedical and medical device fields to continue to thrive in Massachusetts, we must maintain a very high standard for ethics and care in our research divisions,” said Kevin O’Sullivan, President and CEO of Massachusetts Biomedical Initiatives. “As such, veterinarians are our greatest resource, and provide a crucial element for the growth of the biotech sector.”

“The economy of Massachusetts is intrinsically linked with the growth of the biotechnical, pharmaceutical, and medical device sectors-and without a ready supply of veterinarians to oversee the clinical trials for these industries, the growth would be stifled,” continued Thomas J. Sommer, President of MassMEDIC. “The Commonwealth has a great resource in the Cummings School of Veterinary Medicine-not just as a excellent training ground for the next generation of veterinarians, but also as an economic incubator for small biomedical start-ups. This study brings the contributions of the Cummings School and of veterinarians in general to light.”

“The Cummings School of Veterinary Medicine is an essential resource for the Massachusetts life sciences super cluster,” said Robert Coughlin, President of the Massachusetts Biotechnology Council. “The close proximity of this global leader in veterinary medicine is another reason why so many companies and institutions find Massachusetts the best place in the world to do business.”

About the Cummings School of Veterinary Medicine

Founded in 1978 in North Grafton, Mass., the Cummings School of Veterinary Medicine at Tufts University is internationally esteemed for academic programs that impact society and the practice of veterinary medicine; three hospitals that treat more than 28,000 animals each year; and groundbreaking research that benefits animal, public, and environmental health. The school has secured more than $23 million in NIH funding to build a level-3 Regional Biosafety Laboratory for work with infectious disease organisms, the anchor tenant of a life sciences industrial development known as Grafton Science Park.

Tags: Veterinary
Posted in Issue 12 | No Comments »

Posted by Larry Silver

Cannabis Indicated as Possible Risk for Gum Disease in Young People

Newswise – Young people who are heavy smokers of cannabis may be putting themselves at significant risk for periodontal disease, according to new research.

The study, published in the Feb. 6 issue of the Journal of the American Medical Association, is believed to be the first to explore whether or not smoking a substance other than tobacco – in this case, marijuana more than other cannabis products – may be a risk factor for gum disease.
After controlling for tobacco smoking, gender, socioeconomic status and infrequent trips to the dentist by one-third of the participants, the study reported a “strong association between cannabis use and periodontitis experience by age 32.”
Study participants who reported the highest use of cannabis were 1.6 times more likely to have at least one gum site with mild periodontal disease – compared to those who had never smoked cannabis.

This group’s risk of having at least one site with more severe gum disease was estimated to be more than three times higher than the group who never used the substance.

Researchers defined the group of heavy cannabis users as participants who reported an average of 41 or more occasions of substance use per year between ages 18 and 32, equivalent to smoking the substance almost once a week through that period.
But people who reported even some cannabis (fewer than 41 times a year) were more likely to have mild and severe gum disease than people who never used the drug.

“In the United States, we think about periodontal disease as being a problem after the age of 35,” said James D. Beck, Ph.D., Kenan professor of dental ecology at the University of North Carolina at Chapel Hill School of Dentistry. “These findings, that almost 30 percent of individuals at age 32 had periodontal disease, indicate that this younger group may need more attention.”
The 903 participants are part of a longitudinal study of a group of children born at Queen Mary Hospital in Dunedin, New Zealand, between 1972 and 1973. The recent study’s senior author is W. Murray Thomson, Ph.D., a professor of dental public health at the Sir John Walsh Research Institute at the University of Otago’s School of Dentistry, in Dunedin.

Study participants received dental examinations at age 26 and a similar examination at age 32, and they gave self-assessments at ages 18, 21, 26 and 32 on their cannabis use during the previous year. In an effort to control for tobacco use, participants reported their tobacco use during four periods: up to age 18, ages 18 through 21, ages 21 through 26 and ages 26 to 32.
The study suggests that the benefits of public health measures to reduce the prevalence of cannabis use may carry over to gum disease. Additionally, researchers wrote, studying a possible association between cannabis use and periodontal disease in other populations “should be a priority for periodontal epidemiological research.”

Other study authors were Richie Poulton, Ph.D., David Welch, Ph.D., and Dr. Robert J. Hancox, all of the department of preventive and social medicine, Dunedin School of Medicine, the University of Otago; Jonathan M. Broadbent, the department of oral sciences, University of Otago; and Terrie E. Moffitt, Ph.D., and Avshalom Caspi, Ph.D., with the Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King’s College London, and with the departments of psychology and neuroscience, psychiatry and behavioral sciences and the Institute for Genome Sciences and Policy, Duke University.

Funding was provided by the National Institute of Dental and Craniofacial Research and the National Institute of Mental Health, both components of the National Institutes of Health; the Medical Research Council of the United Kingdom; and the Health Research Council of New Zealand, which supports the Dunedin Multidisciplinary Health and Development Research Unit.

Contact Information

School of Dentistry contact: Deb Saine, (919) 966-8512 or deborah_saine@dentistry.unc.edu

News Services contact: Clinton Colmenares, (919) 843-1991 or clinton_colmenares@unc.edu

Tags: Dentistry, General Dentistry, periodontal disease
Posted in Issue 12 | No Comments »

Posted by Larry Silver

Managing Your Practice’s Finances

The Bane and Boon of Your Practice

Did you go to medical school to learn how to juggle your accounts payables and receivables? Did you spend 10 years going to school to figure out how to set up workable collection procedures with your patients and clients? I didn’t think so. Over the years, many doctors have considered managing the patient/client financial arrangements as a necessary evil to practicing medicine. Others, however, turned around their disdain for managing finances and recognized that their net profit can be positively effected by having proper financial policies in place along with workable billing and collection procedures.

Many, many, many of the doctors surveyed by The Practice Solution Magazine’s survey team have little to no experience in managing the finances of their practices. Not surprisingly, many of them have been burned by less than ethical employees or contractors.

While some of the articles in this issue of The Practice Solution are not the cure to extensive training in handling all aspects of your financial procedures, you will find some articles that will be of use at least in getting better collections-to-production ratios and keeping your receivables from getting too old to collect.

Additionally we have three outside contributing writers this issue writing on various subjects.

Our first such article is from Brad Beck, Vice President of Bank of America Practice Solutions. In this article you’ll find very useful information regarding some new, very advantageous tax ramifications of purchasing equipment. This is something that is very relevant to the “bottom line” of all of our readers. It is written in an easy to understand way.

The second article is from Dr. Amy Shroff, owner and chief of staff at the Veterinary Emergency & Specialty Center of New England in Waltham, Massachusetts. Dr. Shroff was originally contacted by one of Solutions Online Magazine’s surveyors and expressed a desire to provide other veterinarians with her hard-earned experience, especially in the area of working with staff. We thought her information to be valuable enough to include in this issue so that other doctors could benefit from what she has learned.

Our other guest writer is Lisa Thayer, co-owner, with her husband Michael, of Goldfish Network.com. I have had the fortunate experience of meeting the Thayers through our local Chamber of Commerce. In the recent past, we have discussed online marketing and how it can be somewhat convoluted. Lisa felt that since many doctors don’t get as much of an opportunity to explore the Internet as most businesspeople get to, they might be able to use some direction in developing marketing for their own websites. The first installment of a four-part series of articles written by Lisa on internet marketing is in this issue.

Additionally, as we do in each issue, we have articles that are relevant to activities in the three health care professions that compose the majority of our readers.

As usual, we hope you find the information in this issue informative and useful. And, if this is your first visit to our magazine, please take the time to look at some of our past issues for additional material that you may find helpful in the management of your practice.

I should caution you, however. I have at least one report of a doctor who lost too much sleep reading back issues of The Practice Solution Magazine late at night.

I can’t be held responsible for missed appointments due to lack of sleep.

Sincerely,

Charles Mann

Managing Editor

The Practice Solution Magazine

Tags: From the Editor
Posted in Issue 10 | No Comments »

Posted by Larry Silver

Strategies for Obtaining Payment

When discussing financial matters with a patient/client, always assume that the patient/client can afford the service or product. Do not be shy, embarrassed or apologetic when discussing these matters. You MUST let the patient/client know how much your services are going to cost. You should feel comfortable and be able to speak with conviction. If it is at all uncomfortable for you, have another staff member practice with you until you do feel comfortable.

ASKING FOR PAYMENT

The goal when making financial arrangements should be to obtain the entire fee as soon as possible. It is important that the Accounts Manager avoid giving the patient/client the opportunity to say “No”. Never say, “Would you like to take care of that today?” Instead, give the patient/client options that are compatible with office policy. For example:

“Mrs. Smith, the fees for today are $50. Will you be paying cash or using your credit card?”

“No” is not one of the choices. Remember that if you make clear financial arrangements in the first place, you won’t have any trouble collecting the amount due.

Let us say that there is a misunderstanding and they can’t afford to pay the entire balance. You could say:

“Could you tell me how much you are able to pay?”

The idea here is to get the largest payment possible. Now you need to get the balance.

“Mrs. Smith, that will leave a balance of $560. When might I expect to receive payment on that balance?”

When they agree to a definite date for the payment of the balance, put the information on a financial agreement form and have the patient sign it.

EXTENDING PAYMENT PLANS

If it appears necessary to extend a monthly payment plan to the patient/client, adhere to the payment schedule as governed by office policy. Do not stray from established policies.

Although it may not occur commonly, you may experience a patient who cannot afford monthly payments but does want care. You might consider implementing a “lay-away” plan. This works by having the patient agree to set up an account where they will send a small amount to you each month (to be credited to their account), and when they have accumulated enough in the account to cover service, you would call them to schedule an appointment. This system would certainly require approval from the doctor prior to implementation.

DISCUSSING INSURANCE PAYMENTS

When a person has insurance, address payment such as:

“Mrs. Smith, your insurance will cover approximately 80% of this bill. Your portion will be approximately (20% of the total). Would you like to pay cash or write a check today?”

If they say, “I’ll just wait until the insurance pays, then I will pay you”, you might respond:

“Well, Mrs. Smith, I know from having worked with this insurance carrier in the past that they will cover about 80% of this service. Your portion will amount to $120. If your portion turns out to be less, we will certainly refund any overpayment due”.

If the patient/client ever becomes upset about insurance or appears unhappy, it would be advisable to explain to them how insurance companies operate, including how they can delay payments, challenge the service, etc. You can also remind them that their insurance is an agreement between them and their insurance company (or employer), and not with the doctor’s office.

Most likely, once you have clarified this with the patient/client, and they truly understand, you will not have to deal with it again. The best time to discuss this issue of insurance coverage is when the new patient/client first arrives.

Tags: Dentistry, finances, Optometry
Posted in Issue 10 | 1 Comment »

Posted by Larry Silver

Tips to Improve Your Performance

Patient/Client Billing

Those patients/clients who do not pay cash at the end of their appointment must be billed through the mail. Most offices receive a large portion of their monthly earnings in response to these billing statements. A person who receives a billing statement in the mail may or may not pay it fully or promptly, though. The Accounts Manager can increase the percentage of patients/clients who promptly pay their bills through the following:

Send all bills out promptly. Most people tend to pay bills that come in closest to the beginning of the month and postpone those bills received later in the month. Determine exactly when you are going to send your bills out, and get them prepared a couple of days prior to sending.
Make sure that bills are neat and professional in appearance. A neatly written or typed bill carries more authority than a sloppy one. Computer billing offers the most efficient and neat method of billing.
Accuracy of your bills is very important. Itemize the services performed. Avoid repeating a charge on the bill that has already been paid. Ensure that the spelling of the name and address is correct.
Indicate a due date on your billings. Any amounts that were previously billed, but not paid should be listed separately and the balance carried forward.

Collecting From Insurance Companies

While there is not really one best way to streamline claim processing, the following are some suggestions to avoid unnecessary delays:

Use electronic filing wherever possible.
Use approved insurance claim forms. Some other forms are easier to complete, but may not be processed as quickly.
Pre-print your identification information on the forms.
Pre-print your most frequently performed procedures on the forms. This helps to avoid typographical errors.
Submit your findings for predetermination of benefits any time extensive service is needed.
Have patients/clients bring their claim form with them to the first visit and have them fill out their section first.
Mail all claims from your office if not filing electronically.
Remind patients/clients that insurance plans are intended to help them pay for care, not to pay the entire cost for them.
Explain clearly and concisely, prior to service, what the patients/client’s financial obligation is.
Come to a mutual agreement about the assignment of benefits.

Working Patient/client Accounts

The Collections position involves more than just sending out bills. Often the accounts involve some work. Therefore an accurate records and a tracking system must be developed which will keep the Accounts Manager informed on when to expect payment and how much to expect.

Maintaining Accurate Patient/client Records

Your office should maintain a separate financial record for each family or individual patient/client. Financial records can take the form of a computerized account or a patient/client ledger card. In either case, the name on the account should be that of the person responsible for payment of bills.

Every financial transaction should be recorded in the correct account or ledger card. Every charge and every payment received should be recorded. This is done regardless of whether the payment is received at the time of service or not, in response to a bill sent by mail, or from an insurance company. The more details in an account, the better. This card or account becomes the source for the patient/client’s monthly statement showing charges and payments.

Using a Tickler

Since the Accounts Manager must “work” the accounts, it is advisable for her to develop a tickler system that she will use to track the accounts. There are a variety of software programs that can be used for a reminder/tickler system. What is explained below is a system that was originally designed for a non-computerized system. It is presented here to give you the basics of what you need, whether doing it with software or not.

This tickler system can be as simple as using a 5 x 7 file box. The file box should have 31 dividers, labeled 1-31, one for each day of the month. When you begin “working” an account (using the aging information that follows,) make up a tickler card with the patient/client’s name, account number, phone number, insurance information if applicable, and the date.

You will then note on the card every date and time that you have any correspondence with the patient/client and/or insurance company. You will also note exactly what was said and promised. If you have placed a call to an insurance company to find out exactly when you will receive payment on an account, note on the card whom you spoke with and when the money is to arrive. You would then place the card behind that date in your tickler file. When that date rolls around, you simply pull the card, see that money was to arrive that day, and if it doesn’t you place another call.

Each day when the Accounts Manager comes into the office, she should pull the cards behind the current day and “work” those accounts. As the day comes to an end, she would take the current tabbed date card and move it to the back of the box (the days then are constantly moving forward in the box). Any card that she was not able to get to that day must be placed behind the slot for the following day so that any necessary calls or follow-up can be made.

Monitoring Your Accounts Receivable

All accounts should be monitored using an accounts receivable aging sheet, whether this is done with a software program designed for such or not This acts as a valuable collection tool because the status of an account can be assessed along with an immediate determination of which patients/clients are not complying with the terms of payments. The accounts receivable sheet should be analyzed ten days after each billing period. Patients/clients who have not made their payments should be sent a second billing (31-60 days) with a reminder that their payment is past due. (A handwritten one, such as “your payment is beyond the time established by you to pay your account,” is most effective).

Patients/clients receiving a third billing (61-90 days) should receive a statement with a stronger memo. If payment is not made within ten days, this patient/client should receive a call and a firm arrangement must be established.

If still no payment occurs, it is advisable to create a “third party credibility” in the collection of this account. You could send a letter such as “We have been informed by our accounting firm that because your account is considerably overdue, it will be turned over to an attorney for immediate legal action if complete payment of your balance is not made immediately”. This correspondence creates the image of the account now being controlled by an outside, stronger source. The account then appears to no longer be in the hands of just the Doctor and staff, and may create greater credibility and enhance the collection process.

The most important factor in keeping your collection percentage high is maintaining continual communication between the office and the patient/client (and insurance companies). By really staying in communication, you will remain in control of your accounts, and you will enjoy greater success in receiving prompt payment for services rendered.

Tags: Client Billing, Collections, Insurance Companies
Posted in Issue 10 | No Comments »

Posted by Larry Silver

Tips to Control Your Accounts Receivable

Following are some guidelines to assist you in determining to whom you wish to extend credit and how to go about collecting on those accounts.

* Assess the patient/client’s credit worthiness before extending any sort of credit. Have them fill out a “credit application” (see sample in the Form section,) and verify the information supplied.

* Always charge for any credit extended, using a monthly percentage or a flat service fee.

* When extending credit of any kind, have the patient/client sign an agreement covering the terms of the credit. Ensure that they fully understand and agree to the terms of payment.

* Monitor all accounts monthly so that you know who may be delinquent. Take immediate action on any account over 30 days past due. The older an account gets, the more difficult it will be to collect. Call the patient/client right away and make arrangements to bring the account current.

* Flag past due accounts by putting a red self-adhesive dot on the upper right corner of the patient/client’s chart folder. In this way it is easier for any staff person to see that the patient/client has a past due account and it will be more likely to get addressed.

* Each day review the schedule for the next day so that you will be prepared to see any patients/clients whose accounts need addressing. Confer with the receptionist on anyone who will need to be seen after their appointment, or from whom the receptionist would collect over-the counter.

* If a patient/client you had planned to collect from has forgotten his/her checkbook or does not have the agreed upon amount, the receptionist should contact the accounts manager or the office manager so that the matter can be addressed.

* Patients/clients with delinquent accounts, who are not making an attempt to handle it, should be sent to a collection agency. Again, this should be done as soon as possible before the account gets too old to realistically expect payment.

* Ensure that statements are accurate and are being mailed out every month on time and without fail. Utilize appropriate labels on the statements such as: Thank you for your payment.”

Tags: Dentistry, Extending Credit, Optometry, Veterinary
Posted in Issue 10 | No Comments »

Posted by Larry Silver

Taking Advantage of the IRS Section 179 Write-Off

Written by Brad Beck, Vice President Bank of America Practice Solutions

What did you think the chances were that a banker would not start anything that is printed on paper without a disclaimer? Well if you took the safe bet you were right and here it is: I am not a CPA and therefore not certified to give tax advice. What you will read in this article are my thoughts based upon my experience in the equipment and practice finance industry. Any decisions you make about equipment purchase, and the tax benefits associated with those purchases, should be made only after careful consideration with your tax advisors. With that disclaimer out of the way, let me proceed with some information that may be helpful for you.

State-of-the-art technology and equipment has become more important than ever in a modern, competitive Health Care Office, whether you are a Dentist, Veterinarian, Optometrist, M.D., etc. The cost of technology has increased, and continues to increase, in the economic environment in which we live. Purchasing equipment is a difficult decision for many reasons but, somewhat fortunately, the government has decided to make the decision making process a little easier by giving large incentives to encourage purchases over the next few years. These incentives also help on many levels to stimulate the economy. Unlike most complicated tax legislation we see, in this case the government has gone out of their way to make the tax benefits to purchasing equipment very easy to understand.

Let’s clarify the language first. What is IRS Section 179? This refers to a small business tax incentive bill that Congress passed this year that allows small business owners a significant tax break on purchases of equipment. A taxpayer can elect to expense up to $125,000 in equipment purchases in 2007. This legislation, passed on May 24, 2007 is retroactive to purchases made since January 1st of this year. This is up from $112,000 that was previously set for this year and up from the $25,000 that it was previous to that! So this is a significant change in a tax advantage. The equipment must be used in the active conduct of a trade or business, which is just a fancy way of saying you must use the purchase in your practice. (A boat may be a valid tax deductible purchase for a fisherman but not for a Dentist!).

The dollar amount allowable to expense from Section 179 changes yearly according to inflation. The equipment purchase becomes a direct savings on your taxes due based upon your marginal tax rate. Any purchase amount that exceeds the 179 deduction amount of $125,000 for 2007 will go to normal depreciation schedules. That may sound complicated, but it is actually very simple. Below are two real world examples of the math which should explain it better.

I hope the above real world examples give you a grasp of the concept of the Section 179 tax benefits. If equipment purchases are in your near future, and you have not already used your “179″ benefit this year, you should give thought to purchasing and installing the equipment before the end of the year.

Before you all run to your sales reps and place equipment orders, there are a few points and limitations you should be aware of:

* This tax benefit is available from January 1, 2007 through December 31, 2010.

* As noted above, the “179″ write off is limited to $125,000 yearly (adjusted to inflation yearly).

* There is a phase out provision for 2007: If you purchase over $500,000 worth of equipment there is a dollar for dollar reduction of the $125,000 write off. As an example, if a Doctor purchases $550,000 worth of equipment, $50,000 of the $125,000 potential write-off would be lost and only $75,000 would be able to be directly written off and the rest would be depreciated as normal. Or, as another example, if a doctor purchases $625,000 in business assets this year, the Section 179 is completely phased out and there is no benefit.

* The practice must have taxable income to qualify and be used, but any write off not able to be used can be carried over and used in the following year.

* Business asset purchases (equipment) must be “Placed into Service”

In order for an equipment purchase to qualify as “Placed in Service”, the equipment must be delivered and installed and ready to perform its function. It must be available and capable to perform its function. It does NOT have to be paid for in full. The purchaser must be obligated to pay, which means they must have executed a contract to pay, or created a liability (loan) to pay, or actually paid for it.

This tax deduction will be in effect through 2010, so you should be planning accordingly. What happens January 1st, 2011? Section 179 reverts back to $25,000 and the phase out starts after $200,000. So at $225,000 in equipment purchases there will no benefit to the Section 179 write off. Using one of the examples above, a $300,000 equipment purchase in 2007 will give a savings of $56,000 (with a 35% tax rate), but that same $300,000 purchased in 2011 gives a savings of only $28,000. That’s a difference of $28,000. I’m sure you all can think of something to do with $28,000 other than give it to Uncle Sam (maybe that boat that the fisherman was able to write off under Section 179!).

Now as I say to my two sons, you have to make your own decisions in life and in business. In the end, if you have no need for new equipment this year, then this information may be irrelevant right now. But, if you do have a need for new equipment and don’t take advantage of this, you could be wasting money. The world will not stop turning but, like I said, we all have things we can do with some extra tax savings.

I hope this information is helpful and gives you some food for thought that you should discuss with your CPA.

Brad Beck Vice President Bank of America Practice Solutions

brad.beck@bankofamerica.com

800-214-6087

Tags: Dentistry, IRS Section 179, NEW EQUIPMENT PURCHASES, Optometry, Veterinary
Posted in Issue 10 | No Comments »

Posted by Larry Silver

By Dr. Amy Shroff, VMD

The success of any business depends on its employees. Figuring out what motivates them is the tricky part. Motivation, like employees, is highly individualized – what drives one person may not mean nearly as much to someone else. While some people excel with a pat on the back, others look for financial rewards and others still seek power or equity in a company.

In our fifty-person practice, I have learned there are seven key elements which motivate employees. Recognizing which employees fall into which categories is what makes for a happy and productive staff.

Fulfillment: Employees who fall into this category are motivated by the successful completion of a project. They are often self-motivated, if the job is challenging enough;

Power: These employees receive satisfaction when they can lead and direct;

Affiliation: People who enjoy interacting with coworkers like social aspects of the workplace and do well on teams;

Autonomy: This group wants independence and freedom. Setting their own schedules is the key to harmony;

Recognition: This is universal. Positive feedback on specific tasks is essential for everyone. No matter how busy the day seems, taking a few minutes to praise someone for a job well done makes an enormous difference in overall staff morale;

Safety and Security: A predictable work schedule, job stability and benefits drive this cluster;

Equity: Across the board, an environment that encourages interaction and feedback will help employees communicate their needs. For instance, an organized office system with a written policies and procedures manual, compensation guidelines and access to information ensures compliance and equity for all.

Whether the practice is large or small, strong leadership is critical. The ideal person is someone with patience and insight that can shape and guide the practice. In the high- stress world of veterinary medicine, this is a tough role. The leader must be in charge but approachable, respect each employee, and know their names and their position.

The majority of the employees in the veterinary practice setting usually fall into the Generation X (30s) or Generation Y (20s) age groups. When surveyed, I found these employees seek a work environment that’s fun, offers opportunities for growth, and provides competitive salaries, interesting new projects and excellent benefits as well as the chance to learn and develop new skills. They also wish to travel and attend conferences. And yes, they really want flexible work schedules.

Both these groups have grown up with computers and are more receptive to information found online. That can have its drawbacks. Because our hospital is open round the clock, we all work different shifts. I can go for weeks without seeing some of our staff. Often those questions that would be asked and answered in person need to be addressed via email. As valuable a tool as this may be, it is essential not to lose sight of the impact of face-to-face conversations. Important information is conveyed through voice and body language. Learn to read your employees so you can react and motivate them appropriately.

The P Word

Recognition was addressed above, but is worth taking a closer look at effective ways to use praise.

Be specific when praising an employee. For instance, take some time with the person to cite a certain task. It could be one that made the practice more efficient or helped a client or patient. Make it a point to do this in front of the employee’s peers whenever possible. Sometimes, we buy lunch for the office and make an announcement about a job well done.

Supervisors can easily keep track of good deeds if they always have a list of employees. They can check off the names of those recognized each day. Leaving a voicemail message for a job well done is another effective way to send someone a high five. Or, deliver hand-written notes on special occasions to make everyone stand out.

A supervisor or team leader can also use praise to improve poor performance. If an employee is handling the majority of their tasks well but lacking in one or two areas, sit down with the person and have a conversation. Praise them for what works and discuss changes to smooth out the rough spots.

Moving On Up

A raise isn’t necessarily always the answer. Providing opportunities for advancement stimulates many of us. Employees wear many hats in veterinary practices and quickly find out what they like best and can move in that direction. By offering staff training, opportunities to sharpen skills and career guidance, employees will work harder and smarter.

Show You Care

Make sure your employees have the tools they need to do their job. A functional and emotionally supportive work environment including appropriate lighting, ergonomic workstations, and Internet access with use of VIN or VSPN makes everyone’s job easier. Insure all diagnostic equipment is serviced regularly and fixed immediately if something malfunctions. Have enough supplies on hand to conduct training sessions. The small things do make a difference: quiet meeting rooms, interoffice e-mail, voicemail and even business cards say you value everyone’s role.

It is important for all employees to be part of the decision-making processes whenever possible. Our practice has grown and evolved since it began. To better define our hospital, employees were asked to review our collective and write individual mission statements for each department. Then, a new one was developed based on everyone’s input. This exercise was an excellent team builder.

We reward employees who generate ideas that can be implemented. Audio CDs, gift certificates, contributions to a person’s favorite charity are typical. We have even sponsored baby and wedding showers.

Along with the usual Christmas bonus, we also provide bonuses and appreciation for Veterinary Technician week as well as birthday bonuses.

Each department receives a monthly cash incentive if they gross above their target number. Bonuses are given to full as well as part-time employees and allocated based on number of hours worked.

It is important to reward hourly workers for taking a shift on a non-scheduled day, coming in early or staying late. If someone is called in for an additional shift in my hospital, they receive a monetary bonus. All employees working holiday shifts are provided lunch or dinner as well as double time pay. The goodwill and increased productivity this policy fosters more than makes up for the expense incurred.

Share Information

Employees need to understand where company dollars are spent if they are going to help a practice grow. By distributing cost information at regular meetings, our staff is always aware of what is going on and often makes suggestions to cut expenses.

Employees are the single most important investment any veterinary hospital can make to ensure profitability and success. Before you ask them what they want, understand what motivates you. If you know the answer, setting an example for your staff to follow will be easy.

Dr. Amy Shroff is owner and chief of staff at the Veterinary Emergency & Specialty Center of New England (VESCONE) in Waltham, MA. www.vescone.com.

Tags: Dentistry, Dr. Amy Shroff, Motivating Employees, Optometry, Staff Management, Veterinary, VMD
Posted in Issue 10 | No Comments »

Posted by Larry Silver

Article 1 of 4 part series

By Lisa Thayer,

GoldfishNetwork.com

Surveys show that over 80% of internet users find new web sites by using search engines.

The question that seems to be on everyone’s minds today is “How do I get my website top placement on the search engines?” If you have a website, you may have found other websites above yours when you have looked for your site in Google. In order to answer the previous question, I need to give you a little background on the way search engines work.

There are two primary ways (out of many) that your website gets to the top of search engines: one is to pay for placement, the other is to market and design your website so that it rises up through the page ranks “organically” in search engine results.

Before I begin to discuss pay-for-placement online marketing, I have to get on my soap box and make a special announcement: If you glean nothing else from this article, remember this – having a baseline BEFORE you start paying money for advertising is imperative as is tracking results of an online marketing program. A baseline is the point at which you begin a marketing campaign so you can compare the effectiveness of the campaign.

Programs such as Google’s AdWords and AdSense or Yahoo’s Sponsored Search are good examples of paying for placement. Each search engine has their own individual fee structure. The price you pay to advertise in this manner depends on the “keywords” you choose and the competition for those placements. Keywords can be thought of as the words a person would type into the search box on search engines. They can consist of words, phrases, or alphanumerical terms. If you are spending your marketing budget on keyword ads, you need to choose your keywords carefully.

Using keywords that are overly broad such as “best dentist USA” can result in bringing more traffic to your website, but if you only have dental offices in California, that search probably won’t result in a new patient. Conversely, choosing keywords that are overly specific might bring in too little traffic, like “veterinarians who graduated from Purdue in 1983″. Keywords are so important in fact, that selecting keywords has become an industry all its own.

The two top search engines used by the general public are Google and Yahoo. Google and Yahoo also supply some of the smaller search engines such as AOL, My Space Search, Netscape, Alta Vista, etc. with their search results. In fact, if you added up the huge market share of Google it would account for almost 70% of all searches!

As previously mentioned, having a baseline BEFORE you start paying money for advertising is imperative as is tracking results of an online marketing program. You obtain a baseline by having your web designer add a tracking program/ code to your website. We set up Google Analytics on all of our client’s websites.

Google Analytics (GA) is a free service offered by Google that generates detailed statistics about the visitors to a website. Its main highlight is that a webmaster can optimize his/her marketing campaigns through the use of GA’s analysis of where the visitors came from, how long they stayed on the website and their geographical position. Users can define and track conversions, or goals. Goals might include sales, lead generation, viewing a specific page, or downloading a particular file. By using this tool, marketers can determine which ads are performing, and which are not, as well as find unexpected sources of quality visitors.

Many of my clients have asked, “Wait a minute…why is Google Analytics free?” The simple answer is that Google knows that if you have the information to make informed online advertising decisions, you will be more likely to advertise. And, since Google is the giant of the search engine world, chances are they will be able to earn your business.

Next time, I’ll discuss spiders and crawlers and bots…oh my!

Lisa Thayer is owner of GoldfishNetwork.com, a website design and marketing company located just south of Portland, Oregon. GoldfishNetwork.com serves clients across the U.S. Lisa can be reached at 503-783-0440 or by e-mail: Lisa@GoldfishNetwork.com

Tags: Dentistry, Optometry, Search Engine Marketing for Doctor, Veterinary
Posted in Issue 10 | No Comments »

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