How to Calculate Your Marketing ROI

By Sarah Woods, Core Dental Solution

In my last blog post, I outlined the important key performance indicators (KPIs) to determine how well your practice’s marketing tactics are working. I discussed eight of the most important KPIs for every dental practice and the ones I often use as the directors of the overall marketing strategies I create for my clients. These KPIs are sales revenue, cost-per-lead, traffic-per-lead ratio, lead-to-customer ratio, number of calls (leads), patient retention percentage, number of patients reactivated and new patient source.

Before we start, what’s a lead? A lead is a prospective patient who has reached out to your practice in some way. This could be a phone call, a walk in or a website inquiry. A lead is different than traffic. Traffic is the people who go to the website, social media page or see your advertisement.

Now, let’s breakdown these KPIs and understand how each is calculated.

  • Sales revenue: It is important to look at both the production and collection numbers every month. Production is the raw amount before collections, adjustments and overhead is subtracted. When determining whether marketing efforts are working, production is more reliable than collections because many factors can affect collections. For example, marketing is not related to whether the correct copays are collected, how much insurance is adjusted or the amount of overhead.
  • Cost-per-lead: This measurement is important when determining how much a practice is spending for each lead. Simply divide the cost of marketing campaign by the total number of leads, like this:

cost of marketing campaign
      total number of leads

  • Traffic-to-lead ratio: This measurement is what I use to determine whether a marketing campaign is effective. It is calculated by converting the traffic to leads into a ratio, (traffic : leads). Remember, the traffic is everyone who sees a campaign, website, etc., and leads are the amount of people who reached out to the practice in some way. For example, to see how a website is doing, its analytics are used to determine the traffic. Leads can be measured manually (a staff person collecting information and documenting how many calls are coming into the practice) or with call-tracking.
  • Lead-to-customer ratio: This KPI is similar to the conversion rate in that it determines the amount of leads that convert to customers. The ratio is leads : customers, and can also be reduced.
  • Number of calls (leads): It is crucial to track every lead. The most effective and reliable way to do this is by using a call-tracking service. I don’t recommend staff members tracking leads because these numbers are significantly less reliable. This KPI is the foundation for the rest and it is crucial that it’s accurate.
  • Patient retention percentage: This KPI is calculated to determine the percentage of patients retained in the practice. It is calculated by taking the difference of the number of deactivated patients from the total patients, and then dividing by the total patients and multiplying by 100, like this:

(Total patients- deactivated patients)   x 100 =  Patient retention %
Total patients

  • Patient reactivation percentage: This KPI determines how many overdue patients (hasn’t been seen in at least nine months) are being reactivated. The patient reactivation percentage is calculated by taking the difference of the number of reactivated patients from the total number of overdue patients, and then dividing by the total number of overdue patients and multiplying by 100, like this:

(Total overdue patients – reactivated patients)  x 100 = Patient reactivation %
Total overdue patients

  • New patient source: This KPI is crucial and just like the number of leads KPI, the foundation for all the KPIs. It is crucial that the source of every new patient is entered correctly. This sometimes takes training staff on the importance of marketing and asking the right questions when a prospect calls.

There is one last KPI that I forgot to add to my last blog. It’s the annual new patient growth. This number is calculated by taking the difference of the number of patients in a given year and the number of patients in a previous year, and dividing by the number of patients in a previous year, then multiplying by 100, like this:

(Number of patients in given year – number of patients in previous year) x 100
Number of patients in previous year

Accurately calculating these KPIs is extremely important when determining whether your marketing is effective — and if done correctly, can prevent wasteful marketing spending.

 

Sarah Woods is a marketing consultant and president of Core Dental Solutions, a full-service dental marketing agency that provides digital, traditional and inbound marketing to dental practice owners meeting them where they are in their life cycle. They approach dental practice marketing with a “holistic” mindset. Rather than incorporating “set-and-forget” marketing tactics to generate revenue and address shortfalls, they turn a dental practice into a well-oiled machine. Sarah can be reached at Sarah@CoreDentalSolutions.com.

 

 

 

How to Maximize Your Marketing ROI

By Sarah Woods, Core Dental Solutions

Recently, I was on a dental forum and a dentist posted that he was looking for some help with his marketing. In the thread, a disgruntled dentist stated, “Marketing consultants are the worst, they will promise the moon, but leave you with crap.” I was taken aback by his comment, and was even a little insulted. However, I wasn’t surprised by his point of view — measuring marketing return on investment (ROI) properly hasn’t been clearly defined to many dentists. I’ve been in practices where their only marketing ROI measurements were monthly production or the number of new patients that come into a practice every month. These are the absolute worst ways to measure whether a dentist’s marketing efforts are working. Many factors outside of marketing affect this data. For instance: Was the prospect’s call answered? Did the team member use proper sales techniques to solidify that the patient would be seen in the office? Was the prospect scheduled within 24 to 48 hours?

Understanding the key performance indicators (KPIs) and the life cycle of marketing are both vital to accurately determine how effectively your practice is achieving its marketing goals.

Data from KPIs should be collected monthly and include:

  • Sales revenue: again, many factors outside of marketing can affect this data
  • Cost-per-lead: cost of marketing campaign and the production from each lead of the campaign
  • Traffic-to-lead ratio: how much traffic is going to your website, social media and other marketing tactics, and how many calls from each
  • Lead-to-customer ratio: how many calls turned into patients
  • Number of calls (leads): the number of calls generated from marketing efforts
  • Patient retention percentage: patients deactivated of total active patients
  • Patient reactivation: how many patients were reactivated
  • New patient source: this is VERY important and must be tracked accurately!

Understanding how to accurately measure whether your marketing is working will help when creating and adhering to your overall marketing strategy. These numbers will determine which marketing tactics are working and which are just a waste of money!

 

Sarah Woods is a marketing consultant and president of Core Dental Solutions, a full-service dental marketing agency that provides digital, traditional and inbound marketing to dental practice owners meeting them where they are in their life cycle. They approach dental practice marketing with a “holistic” mindset. Rather than incorporating “set-and-forget” marketing tactics to generate revenue and address shortfalls, they turn a dental practice into a well-oiled machine. Sarah can be reached at Sarah@CoreDentalSolutions.com.

 

Referral and Negligent Referral in a Dental Practice

By Kim Hathaway, RN, CPHRM, Patient Safety Risk Manager, The Doctors Company

Failure to diagnose and failure to refer are common issues seen in dental claims.

Dental practice claims alleging failure to refer, or failure or delay in diagnosis may arise from a general dentist’s lack of referral to a specialist. On occasion, patients have asserted their general dentist referred them to a specialist who provided substandard care and that the referral itself was negligent. Dentists referring care outside their background, experience or training must take care to avoid liability issues associated with referrals.

Case Study
During a routine prophylaxis visit, a middle-aged male reported a mass under his tongue, which his general dentist evaluated as an aphthous ulcer (benign and non-contagious). Several months later, another provider biopsied the mass and diagnosed Stage IV squamous cell carcinoma. Surgery and radiation treatment were undertaken, and plastic surgery was required. The patient alleged dental negligence and failure to refer to a specialist. The defendant dentist claimed that the patient had been told to follow up with his primary care physician (PCP) or an oral surgeon.

There was no documentation of a formal referral to a specialist or PCP, nor was there documentation of the dentist’s observations or referral recommendation. The adverse result in this case may have been avoided or the impact lessened if the dentist had documented his observation, evaluation and testing to demonstrate a low suspicion of cancer, or if there had been a documented referral with follow-up on the referral.

Clinical Comfort Level
When specialists are unavailable, or the necessary care takes a patient outside of his or her local community, the patient may ask you to provide the treatment. Treatment that is outside your training or experience may increase the risk of injury to the patient. The risk generally lessens if the treatment is undertaken by a specialist. In addition, the patient cannot waive your professional duty by consenting to a negligent act. If the patient is injured, you will be judged against the standard of care for that specialty.

Do not let the patient pressure you into a treatment plan beyond your comfort level. It is important that you know your own and your staff’s limitations. Explain that the referral is the best treatment plan for the patient. Discuss that choosing no treatment may result in an adverse outcome, disability or death. Spend more time helping the patient find the necessary specialist and clearly document your discussions with and counseling of the patient. If the patient refuses specialty care, carefully document an “informed refusal.” Consider terminating the patient from your practice if after thorough counselling the patient continues to refuse your recommendations.

The American Dental Association’s General Guidelines for Referring Dental Patients notes: “In some situations, a dentist could be held legally responsible for treatment performed by specialist or consulting dentists. Therefore, referring dentists should independently assess the qualifications of participating specialist or consulting dentists as it relates to specific patient needs.” Vicarious liability is a concern if you refer a patient to a specialist who lacks skill or judgment.

Patient safety is the primary focus when making a referral. Familiarize yourself with the specialists’ communication skills, clinical judgement and competence. Explore complaints or evidence of poor care provided by the specialist. Find another provider in the community if a pattern of poor care develops. Consult with colleagues before recommending a specialist who you do not know well. Solicit feedback from both the specialist and the patient.

Communication
Effective communication is critical to a successful referral. Explain to the patient why the referral is needed for a particular treatment or condition and that you will remain the general dentist. Let the patient know what to expect from the specialist and the treatment, and reassure the patient that you will remain in contact with everyone to ensure the best possible outcome. Schedule the appointment while the patient is still in your office. If the patient needs to reschedule or cancel, the patient may; however, your staff has facilitated the referral.

Proactively avoid miscommunication between the dentist and specialist by providing a formal written referral. Always document the details of phone referrals followed by a written referral after the call. Referral letters should include the following information:

  • patient demographics and identification
  • date of the referral and last date the referral may take place
  • evaluation and treatment completed to date
  • copies of diagnostics performed, including information about when it was collected
  • diagnosis and prognosis
  • desired evaluation or care the specialist is requested to complete
  • your plan for after-care following the specialist’s intervention
  • a request for a consultation report and ongoing status reports

Tracking
Tracking patient referrals and return visits is essential to efficient patient care. A centralized and uniform tracking process should be kept separate from the patient’s record. The tracking should cover the timeframe from the patient’s referral to the return visit to the general dentist. Have your staff make this return appointment at the time they make the specialist appointment to avoid missed attempts to follow up. The tracking system should provide a reminder or task to move the process along or documentation for why it has not progressed. If the referral is not completed in a timely manner, the process should include contacting the patient and specialist to facilitate care.

Documentation
Carefully document the referral process. In the event of a claim resulting from the referral and treatment, documentation is the best evidence. Documentation of the evaluation, treatment and discussions with the patient that lead to the referral is critical. Copies of written communications and evidence of verbal communication, including phone messages with both the patient and specialist, must be kept in the patient record. Refusal or nonadherence to care must be recorded, with evidence of efforts to overcome the refusal or nonadherence. Finally, if the patient fails to seek specialist care despite your efforts, carefully document the events that lead to a decision to withdraw from further treatment of the patient. This decision should be followed by a properly executed letter terminating the dentist-patient relationship.

 

Reprinted with permission. ©2017 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.

Good Communication Improves Patient Care

Donald Wood, CRNA, CPHRM, Patient Safety/Risk Manager, The Doctors Company

Multiple studies have shown that communication challenges can cause health care errors and complications. Dentists regularly provide care to patients who require a health care team with several medical specialties. In these circumstances, dental care provided to a patient requires effective communication among all team members and the patient.

Case Study
A patient presented to a dentist for a scheduled procedure. As the patient was being prepared for the procedure, the patient inquired about the use of an antibiotic. The patient explained that he had undergone joint replacement surgery, and his orthopedic surgeon had instructed the patient that an antibiotic should be provided prior to any dental work. The dentist explained to the patient that current guidelines don’t support the concept of administering antibiotics prior to a dental procedure and was reluctant to prescribe an antibiotic. The patient wanted to discuss the dentist’s explanation with his orthopedic surgeon. He cancelled the procedure and left without being treated.

When a patient’s medical history reveals a prior surgery, the need for collaboration between the dentist and any previous treating physician may warrant a discussion. In this case, an orthopedic surgeon performed the joint replacement. The 2013 clinical practice guideline published jointly by the American Association of Orthopaedic Surgeons and the American Dental Association (ADA), further clarified by the 2014 guideline from the ADA Council on Scientific Affairs, does not specify the need for antibiotic prophylaxis for patients with a prior joint replacement surgery. However, many variables should be considered. The guidelines report that a patient with a medical history of osteomyelitis, acquired immunodeficiency, or drugs or disease that suppress the immune system may require antibiotic prophylaxis before dental procedures.

Effective collaboration, in this situation, includes notifying the orthopedic physician about the need for the dental procedure, the extensiveness of the procedure and inquiring about the need for pre-operative antibiotics based on the patient’s orthopedic history. This collaborative process should begin as soon as a need for a dental procedure is determined.

A similar situation may arise with patients on antithrombotic therapy. This therapy requires a collaborative approach with the physician prescribing the medication. Although the number of antithrombotic medications was relatively limited in the past, several new medications have been approved. These new medications are noteworthy in that for some, there is no testing for therapeutic effect and some have no antidote or reversal agent. To reduce the risk of excessive bleeding, it may be necessary for a patient who is undergoing antithrombotic therapy to temporarily cease taking the medication for several days. As a part of the communication process, the dentist and prescribing physician should determine when the patient can safely resume taking their medication. Documentation in the dental record should indicate the patient’s understanding of when to stop the antithrombotic medication and when to resume taking it. With effective communication among the dentist, treating physician and patient, the overall impact on the patient’s health can be minimized.

Risk Management Strategies
Clear, concise communication can be enhanced by implementing the Situation-Background-Assessment-Recommendation technique. This technique can help a dentist organize communication and present specific details while collaborating with a patient’s previous physician. The following is an example:

  • Situation: A 58-year-old patient with pain, cold sensitivity and advanced periodontal disease.
  • Background: History of total knee replacements in 2010 and 2015.
  • Assessment: Patient needs to have four teeth extracted, bone grafting and preparation for implants.
  • Recommendation: Assess the need and timing of any antibiotic therapy that may be necessary prior to this procedure. If indicated, provide the patient with a prescription for the antibiotic.

Track these requests in a log or other format to determine if a response was received prior to the procedure. Follow up to ensure that communication among the dentist, prior specialists and patient is successful.

 

References:
Jevsevar D, Abt E. The new AAOS-ADA clinical practice guideline on prevention of orthopaedic implant infection in patients undergoing dental procedures, J Am Acad Orthop Surg 2013; 21: 195-197. http://www.aaos.org/Research/guidelines/PUDP/dentaleditorial.pdf.

Sollecity T, Abt E, Lockhart P, et al. The use of prophylactic antibiotics prior to dental procedures in patients with prosthetic joints. J Am Dent Assoc. 2015; 146(1); 11-16 e8. http://jada.ada.org/article/S0002-8177(14)00019-1/fulltext#sec3.

SBAR technique for communication: A situational briefing model. Institute for Health care Improvement website. http://www.ihi.org/resources/Pages/Tools/SBARTechniqueforCommunicationASituationalBriefingModel.aspx. Accessed February 16, 2017.

 

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