Closing a Dental Practice: Patient Safety Considerations

By David O. Hester, FASHRM, CPHRM, Director, Department of Patient Safety and Risk Management, The Doctors Company

Dental practices undergo closure for many reasons, including dentist illness, death, relocation, or the dentist’s decision to sell, practice solo, join another group or retire. As a service to our members, the Department of Patient Safety and Risk Management of The Doctors Company provides this information to make the transition easier.

What should be done in an emergent situation?
During any change in practice, the continuity of patient care to ensure that no patient is neglected is of paramount concern. If the change is abrupt — as in the circumstance of a death — the safety measures below will assist in ensuring patient safety and continuity of care.

Review all previously scheduled appointments to determine the appropriate action. Immediately contact a dentist of the same specialty to arrange patient care or provide patients with a list of dentists of the same specialty within the area. You also should take the following steps:

  • Ensure the availability and accessibility of dental records as needed for the continuity of patient care.
  • Post a notice of closure in the office and in the local newspaper. (Contact your patient safety risk manager for a sample notice.)
  • Call all dentists who customarily refer patients to the practice and all contracted managed-care organizations, and the medical malpractice carrier.

Who should be notified if it is a non-emergent closure?
If the practice closure is non-emergent, notify the following individuals and entities:

  • all patients and legal representatives in the “active” caseload; this includes any patient seen in the past six months to three years or others the dentist considers “active,” and any patient in an acute phase of treatment
  • all peer dentists within the community
  • local dental societies
  • all third-party payers (including Medicare and Medicaid) and managed-care organizations
  • the DEA (if you are retiring or if you are moving to another state)
  • the state licensing board
  • professional associations in which you hold membership
  • your CPA or financial adviser
  • your employees
  • landlords, lenders and creditors
  • insurers that cover the practice, the employees and the physical facility

How should the notice be communicated?
Draft a letter to each patient that contains all the necessary details. The same letter can be used for everyone listed above. (Contact your patient safety risk manager for a sample letter.) It’s recommended that letters be sent with return receipt requested and that a copy of the letter and return receipt be kept. If a patient is considered high risk, send the letter certified with return receipt requested. Post a notice in a local newspaper to inform inactive patients or those who have moved away. Include directions for obtaining acute, critical or emergency care if a new dentist has not been selected by the time the practice closes.

Is there a time limit for sending the closure notice?
Yes. In a non-emergent situation, send the notice at least 60 days prior to the anticipated closure. This gives patients an opportunity to locate a new dentist and to obtain copies of their dental records without undue stress.

What other responsibilities should be undertaken by the practice that is closing?

  • Provide patients with easy access to their dental records by enclosing an authorization document in the notification letter you send to them. (Contact your patient safety risk manager for samples.) When the signed authorization is returned, you can provide copies and apply appropriate charges.
  • Provide information on where the dental records will be stored in the future, the length of time (in years) that the records will be retained, and a permanent mailing address or post office box number for all future record requests. Arrange a secure storage place for the original dental records that is safe from theft, fire, flood or other weather-related disasters.
  • Maintain the dental records in accordance with The Doctors Company’s recommendations: 10 years after the last adult visit and 28 years from birth for pediatric patients. The records should be easily accessible and retrievable.
  • DO NOT give original records to patients. The easiest method is to find another dentist to take over the practice and turn the records over to that provider or turn the records over to another dentist of the same specialty.
  • Stress the importance of continuing care for all patients. Provide information about where they can find another dentist, such as the Yellow Pages and the local or state dental society.
  • Make provisions for the completion of all dental records.
  • Place a notice of closure in your waiting room and in the local newspaper for at least one month, giving pertinent details of the closure.
  • Consult with your personal or practice attorney and the state licensing agency to ensure that you have met all regulations.
  • Destroy remaining prescription pads.
  • Keep the narcotics ledger for a minimum of two years.
  • Dispose of any drugs.

 

Contributed by The Doctors Company. For more patient safety articles and practice tips, visit www.thedoctors.com/patientsafety.

The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each health care provider in light of all circumstances prevailing in the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.

Disaster Preparedness for Your Dental Practice

By Julie Brightwell, JD, RN, Director, Healthcare System Patient Safety, The Doctors Company

Recently, hurricanes, floods and fires nationwide have highlighted the importance of planning for disasters. Hurricane and flood damage in Texas and Florida left practices without power for days or even weeks. Wildfires in California forced several dentists to quickly relocate their practices ― some permanently ― and to move scheduled procedures to different facilities. Is your practice prepared for this type of situation?

A disaster can overwhelm a dental practice, with damage that can include shattered windows, flood debris, power outages, disrupted telephone systems, computer and system outages, unsafe drinking water, destroyed dental records, medication exposure to temperature and humidity extremes, contaminated instruments and building structure failure.

Disaster preparedness requires a continuous cycle of planning, organizing, training, equipping, rehearsing and evaluating. Dentists are critical participants in disaster preparedness, ensuring that patient care and critical services are not interrupted.

Plan Ahead Now
Before the next disaster strikes, make sure your practice has a plan in place. A checklist, ordered by priority and customized to specific types of disasters, can provide the framework for a comprehensive plan. The checklist should include these elements:

  • A full-circle call tree that outlines who contacts whom.
  • Instructions for setting up instant messaging technology that enables staff to communicate without a wireless network or cellular data connection.
  • A Certificate of Insurance for your dental malpractice coverage, or instructions for contacting your agent or insurer directly to obtain proof of coverage. This document will be necessary if you are forced to temporarily relocate your practice or procedures.
  • Steps to follow upon returning from evacuation.

When Disaster Strikes
Planning today makes accomplishing the following tasks more feasible during a disaster:

Communication

  • Contact staff immediately to determine realistic time frames to return to work.
  • Notify external vendors and business associates of your practice interruption and targeted resumption of operation.
  • Implement staff briefings at the beginning and end of each day.
  • Create temporary phone, fax and answering services.
  • Establish patient telephone triage.
  • Implement temporary controls to ensure HIPAA compliance.

Computers and systems

  • Contact computer service vendors to ensure integrity and recovery.
  • Verify insurance coverage for repair or replacement costs and losses.
  • Evaluate applicable warranties and consider an information technology restoration service contract.
  • Inventory and document hardware and software.
  • Document the type and extent of both lost electronic and paper data.
  • Ensure data backup and periodically test compliance.
  • Re-establish filing systems and internal programs.

Dental records

  • Determine the extent of damage to, or loss of, patient records and filing systems.
  • Attempt to restore all damaged charts and document inventory findings.
  • Notify the state dental board for specific guidance pertaining to lost or damaged records.
  • Document all efforts to restore and protect existing records.
  • Reconstruct lost charts at the next patient encounter.
  • Contact your insurance carrier for restorative services and/or claim procedures.
  • Re-establish a filing system and temporary storage if necessary.
  • Obtain legal guidance for patient notification during recovery efforts.
  • Contemporaneously date and initial all late entries and duplicate information in context of recovery efforts.

In addition, create an inventory of all equipment and medications that may have been exposed to water or extremes in temperature. Repair, replace or discard damaged items appropriately.

Once your plan is in place, regularly re-evaluate its steps and update all contact information. Practice and rehearse the plan’s protocols. An effective disaster preparedness plan will help keep your practice focused on delivering care during an emergency.

The guidelines suggested here are not rules, do not constitute legal advice and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each health care provider in light of all circumstances prevailing in the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.

Reprinted with permission. ©2017 The Doctors Company. For more patient safety articles and practice tips, visit www.thedoctors.com/patientsafety.

6 Reasons to Call in the Dental Office Lease Negotiation Pros

By Cirrus Consulting Group

There’s an old saying that goes, “Leave it to the professionals.” When you need a haircut, go to a barber. When you need your car fixed, see a mechanic. Seems obvious when you put it in these terms, but in today’s do-it-yourself (DIY) culture, business owners are increasingly circumventing professional services to go it alone. In the world of dentistry, negotiating a risk-free dental office lease with fair and reasonable economic terms is an essential component to mitigating risk and running a successful practice — and yet — it’s not always obvious to practitioners why they should consult a professional dental office lease negotiator.

Signing your lease is one of the most important, expensive and significant commitments you’ll ever make as a dentist, and going in blind or ill-prepared can have lasting implications. Here are a few reasons why you should leave your lease negotiations to the pros.

1. The Doomed DIYer
The obvious upside in not hiring a professional dental office leasing negotiator is that you won’t have to pay their fees. Often, this is the single biggest motivator for dentists who view the task as one they can easily tackle themselves. Of course, as with many such tasks, you get what you pay for.

Consider the amateur handyman who decides to build his own furniture; he can save money by building his own bookcase, but what happens one month later when the shelves give out because it was poorly constructed? The bookcase collapses, the objects on the shelves end up broken, it creates a mess and leaves the “handyman” right back where he started — no bookcase, plus one mess and minus several treasured objects. Because poor planning and mismanagement of a dental office lease permeates every aspect of a practice, this is one area where an investment today can save big bucks tomorrow.

If you sidestep the experts, you won’t be getting their professional guidance and advice that exposes you to significant financial repercussions and the unnecessary risks that come with a poorly negotiated lease agreement. Every time you renegotiate or renew your lease, you are committing to another $500,000 to $1 million contract. Spending a fraction of this contract value to ensure that your future is protected just makes good business sense. The value that a professional dental office lease negotiator brings — both economically and in terms of risk reduction — is worth far more than the initial investment of their fee, not to mention the substantial, long-term savings that can be achieved with proper representation.

2. More Time to Dedicate to Your Practice
The most immediate benefit to working with a professional lease negotiator is the amount of time saved. Spending more time chairside is critical to the practice’s success. When you decided to open a dental clinic, you probably didn’t realize you were signing up for all of the administrative burdens required to run a successful practice. Whether you’re just starting out or are growing an established practice, taking chairside time away to review the lease, research market rental rates, negotiate with your landlord and understand tenant rights is a time-consuming nuisance.

Don’t be fooled into thinking that the only step in lease negotiations is the initial review and signing of the contract, or that your landlord has prepared a fair lease that will see you through your career. Lease negotiations are a dynamic and potentially lengthy, ongoing process that require a dedicated time investment — if you’re doing it right. A reactive tenant acts only when prompted, or upon finding themselves up against a deadline. Often, this means it’s too late to get a favorable outcome, i.e., when your lease is about to expire and you’re at the mercy of your landlord. A smart dental tenant is pro-active, and by working with a professional negotiator, you will ensure that you have both the leverage and knowledge to be successful in securing a favorable lease agreement for the practice.

3. Reap the Benefits of Comprehensive Services and Support
Working with a professional dental office lease negotiation firm is an eye-opener for most practitioners because they don’t realize how much more they can be doing to optimize their practice. Professionals will not only identify landlord-set lease traps and negotiate the best deal for you, but also provide a wealth of business acumen and resources to improve your practice. Lease negotiation is a core function, but there is a wide spectrum of services that a lease negotiation firm provides, including insight from market research and data analysts, in-house brokers, attorneys and ex-landlords. Whether designing asset protection terms, or leveraging emerging market trends to help you map out practice goals, your lease negotiator is backed by a team of experts who put all the pieces together, and deliver a results-focused business solution for your peace of mind.

4. Your Future Self Will Thank You for Strategy-Planning Now
Most dentists are naturally eager to build out the practice and open their doors. However, in their haste, they often fail to consider their mid-range and long-term goals. The details in your office lease dictate key aspects of your business, such as the ability to bring in associates or specialists, the conditions under which you sell the practice, obligations and restrictions for remodeling or expanding, etc. — which is why the details within the lease should not be taken lightly. A skilled dental office lease negotiator will outline a comprehensive negotiation strategy that aligns with both your short- and long-term goals, and takes the big picture into account — so your lease doesn’t hinder you as you progress in your career.

5. Relax! Someone Else Will Fight Your Battles
Lease negotiations with a current or prospective landlord sometimes means playing hardball, and some individuals are simply not comfortable with, or capable of, getting tough and asking for what they want and deserve. But it’s not just about being assertive; you also have to know what the stakes are, and how to best achieve the desired results. A lease negotiator acts as your own personal advocate to represent your best interests, and ensures that your leasing needs are being met. For example, as a dental tenant, you may not immediately appreciate the importance of addressing “relocation language” that prevents your landlord from moving your clinic, or the amendment of the “assignment” clause, preventing your landlord from taking 50 percent or more of your practice sale proceeds at transition time. Your negotiator, however, knows that strategic tactics today will certainly pay off later, and that every word in your lease agreement can have major implications down the road.

Keep in mind that your landlord will draft a lease that benefits them, not you. In their hands, the lease is a tool towards achieving financial flexibility and power. Your lease negotiator can convert a bad lease into armor to protect your assets, family and estate, and optimize the lease in your favor. They will negotiate the best terms and rental rates possible so that you, not your landlord, are in control of your financial future.

6. Do you speak “Legalese?” We do!
Dental office lease agreements can be complex and lengthy, full of technical legal jargon and contain terms that aren’t tenant-friendly for the average business owner. Navigating the tricky and complex language is just one challenge. The bigger obstacle is identifying expensive traps and risks, and understanding what must be done to reduce or eliminate them. Most leases leave the tenant vulnerable to expensive penalties and inconvenient pitfalls that can have devastating effects on their career or practice. Before signing, it’s your responsibility to review the proposed terms. But how will you know what to look for? A seemingly innocuous statement may harm you down the road, and similarly, the absence of a key clause can leave you, your assets, your family and your practice exposed.

For example, did you know that you can be held financially responsible for the practice even after a sale or transfer of the lease? Or that you could be forced to bear the financial burden of a forced relocation? Dental office leasing professionals will review your lease and identify risky terms that have been intentionally buried or obscured by your landlord. The negotiator will use their skills to revise the lease to work in your favor — something that an untrained professional simply cannot do. This is one of the key differences between a professional dental office lease negotiator and a general commercial lawyer/attorney. While lawyers can be experts in contract management and negotiation, they often lack dental industry and real estate experience to produce a lease agreement that both protects and enhances the value of a dental practice. If you’ve retained an attorney, ask them how many dental office leases they’ve negotiated. Dental lease negotiators have specialized expertise in contract negotiation, dental tenant rights, practice optimization — and, they understand the industry inside and out.

Would you go to a mechanic to get your haircut, or a barber to fix your car? If the answer is “no” to both, why would you, as a dentist, handle your own lease negotiation? Gambling with the fate of your entire practice hardly seems worthwhile when you have a team of specialists just a phone call away. Some things are just better left to the experts! For more information, go to www.cirrusconsultinggroup.com.

Know What’s Driving Your Dental Practice’s Inbound Calls

By Allison Doyle, Demandforce

Whether your dental office is staffed by two or 20, in order to maintain growth and profitability, you need to keep your chairs full with a steady stream of new and returning patients. Yet according to a Health Policy Institute study released by the American Dental Association, the projected growth rate of dentists per capita between 2015 and 2035 is 7.9 percent. This means that your practice will soon be (if it isn’t already) immersed in a competitive marketplace.

The modern Florida dental practice knows its patients and markets to them.
With more options for your patients to choose from when it comes to their dental health, it’s now more important than ever to know who your patients are, and what drives them to book an appointment. You not only have to attract new patients to your practice, but you also have to nurture relationships with your current patients to keep them coming back — and to keep referring you to their friends and family.

You may already be sending email marketing to your patients like recall promotions or referral rewards. You could even be actively posting on your Facebook page and running ads. These are all great ways to get your dental practice to stand out among the crowd, but how do you know which are the most effective, and which you could do without?

Call Tracking removes the mystery from your marketing campaigns.
Call Tracking is the ability to assign unique, trackable phone numbers to specific marketing campaigns, so you know exactly what’s driving your inbound calls. In some Call Tracking portals, you can even see helpful data such as call duration, caller name and a recording of the call itself.

Having this data not only helps you gain valuable patient insights, but also allows you to identify your most effective campaigns and make data-driven marketing decisions. For example, if you see that a certain email promotion has had success in bringing in new patients, you might try sending it to your inactive patient base as a recall campaign.

 

If you’re looking for a way to track campaign performance, or learn more about Call Tracking and other marketing tools designed specifically for Florida dentists, visit demandforce.com. Call Tracking is available to all Demandforce customers, and Florida Dental Association members receive special pricing on the Demandforce platform. For more information, or to set up a live demo, visit demandforce.com/FDA.