The Dentist's Network #52


	Religious Discrimination Case Acceptance-Follow-Up Purchase Comparison

Michael Moore, Esq.
Director McKenzie
HR Solutions
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New Religious Discrimination Guidance Confusing for Employers

On July 22nd, the Equal Employment Opportunity Commission issued its latest guidance on religious discrimination, a major addition to its Compliance Manual. Unfortunately, the EEOC only made the doctor's position more ambiguous, and exposed to liability.

Generally, religious discrimination law follows the tests adopted for other protected characteristics, such as race or national origin. However, this area departs from the traditional tests in that the employer must reasonably accommodate religious beliefs. In this regard, the law aligns more closely with disability discrimination law.

The EEOC guidance, unfortunately, expands the employer obligations to accommodate religious belief and expression, and thus exposes the employer much more to both discrimination and retaliation claims. And, although the EEOC guidance applies to employers of 15 or more employees, states adopt the federal practices in enforcing their own laws—hence, a doctor who employs only a few staff is now exposed.

Let me give you an example of one doctor's unfortunate predicament that arose out of employer-sponsored prayer sessions. Our doctor is a very devoted Christian, and for some time had held office prayer sessions. Of course, she made clear to new hires that the participation was entirely voluntary, and that no adverse consequences would arise from a refusal to participate. Dr. B, as I'll call her, hired a chairside assistant who worked for her for some months. Rebecca was a less-than-outstanding employee, and Dr. B had to counsel her numerous times for poor performance. Like many practitioners, Dr. B had a human resources policy that was old, outdated and inadequate. On an ad hoc basis, Dr. B whipped out a "performance warning" that informed Rebecca she was in danger of termination. Things deteriorated dramatically from that point, and Dr. B had to terminate Rebecca shortly thereafter.

A few months later, Dr. B received a notice that Rebecca had hired lawyers and filed suit, asserting that she had been retaliated against by Dr. B's staff because she declined to participate in the prayer meetings. She asserted that Dr. B knew of, and acquiesced to, the harassment that was severe and pervasive. Without a policy and practice in place that would have documented this as untrue, Dr. B was forced into a "she said, she said" situation.

We assisted Dr. B by immediately obtaining statements from staff that (1) established the lack of harassment and (2) documented the performance issues with Rebecca. We also found for Dr. B a local lawyer with extensive experience in defending discrimination claims. Largely as a result of this quick action, the case settled and Dr. B paid less than $10,000 to Rebecca to make her go away. Unfortunately, she also had to pay her lawyer over $25,000 to defend the case to settlement. And this was a very good result under the circumstances. Without expert guidance and legal counsel, Dr. B would likely have been out-of-pocket six figures.

In advising Dr. B on how to deal with this issue in the future, I strongly urged her to stop any employer-sponsored religious devotional practices in the office. I felt, and feel, that this type of thing creates potentially devastating exposure for the doctor no matter how the practices are conducted.

In the guidance, the EEOC refused to establish a bright line rule. It decided that any such matter would be decided under the "reasonable accommodation" and "undue hardship" tests. Thus, the doctor is now required to address any religious issue on a case-by-case basis.

The "reasonable accommodation" test is pretty easy to deal with in the context of conflict between an employee's work schedule and religious observance off premises. On-premises activities, however, create real problems. The EEOC gives an example of such issues. In one example, a staff member who works in a relatively private area and a front desk employee both belong to the same church. The pastor hands out posters and urges the parishioners to display these at work. Both employees put the posters up. The EEOC guidance states that the employer may not order the back room staff member to take the poster down, but that it may be an "undue hardship" to allow the front desk poster to remain up because it may suggest an endorsement by the employer of the beliefs expressed, which may upset some patients and cause the employer loss of business.

The EEOC, however, also counsels that the employer must take care that co-workers are not discriminated against or harassed by those on staff who are engaging in religiously inspired activities. If the employer is required by law to allow an employee to evangelize her co-workers (perhaps, for example, by passing out literature at work), the employer then risks exposure to a claim of discrimination by a co-worker offended by the conduct.

The agency strongly recommends that every employer implement a strong, clear policy both affirming the duty to provide reasonable accommodation and anti retaliation. The McKenzie Employment Policy Handbook has been written to accomplish these recommendations. In addition to the robust employee concern policy, our handbook provides for exit evaluations that will elicit any concerns of the departing employee about her treatment by the doctor or staff. This gives a heads-up that there may be issues down the road, and allows the doctor to prepare for any future claims. Too often, the doctor's attitude towards a departed employee is "out of sight, out of mind." In the context of discrimination claims—particularly now, with claims of religious discrimination—that attitude can cost many thousands of dollars. An employee has, in most states, a year or more to bring suit for alleged wrongful termination. "Employment at will" is no protection from these claims—this misimpression by many doctors has been costly.

The lesson to be learned from the EEOC guidance on religious discrimination is that the doctor can no longer—if he or she ever could—sail along with either an outdated human resources handbook or none at all. The risk of an employee suit is actually greater today than that of a malpractice claim. If the doctor would not continue in business without malpractice insurance, it makes even less sense to continue exposing the practice to uninsured claims by employees.

Mike Moore is ranked among the best in employment law and named one of the top 10 lawyers in Ohio. As Director of McKenzie's HRSolutions, Mike is the creator of the Employment Policy and Handbook, geared to providing dentists who are unsophisticated in the legal arena with a step-by-step policy manual.

Click here to hear Mike present “7 Elements of an Effective Employment Policy.”
Email Mike at mike@thedentistsnetwork.net.

Interested in having Mike speak to your dental society or study club? Click here.

Joel Harris, President
ADA Intelligent Dental
Marketing, Inc.
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Improve Case Acceptance After Patients Go Home

Some dentists are uncomfortable with case presentation being a considered a “sales” process. Even If you have strong opinions about dentistry being unique and unlike other consumer purchases, I think you will agree that consumers can be fickle and sometimes impossible to understand. Most dentists I know would also be very quick to agree that case presentation is a critical skill set that could be improved in nearly every practice.

As you read this article, I’d like you to forget everything you’ve ever learned about case presentation and consider a completely overlooked problem that is damaging case acceptance.

The Problem? Lack of Follow-Up

In nearly every sales process outside of dentistry, salespeople must follow up with prospects multiple times to make a sale. In fact, entire sales seminars, specialized software and even job titles have been created to manage and perfect the sales follow-up process. You can even do a quick Internet search and find countless articles written about how to improve sales closure rates through better follow-up. If you asked most sales managers how sales would be affected if the follow-up process was eliminated, the typical answer would be that sales totals would plummet.

Here’s the catch: In dentistry, the follow-up process for patients that don’t accept treatment during the appointment is almost non-existent. Some practices do better than most but in almost every case, patients are left to make decisions on their own unless they actually accept and schedule during the appointment. And, even in those cases, a fair amount of buyer’s remorse results in cancellations.

Let’s not even begin to discuss the quality of the case presentation itself. Most dentists do a pretty good job, so for the purpose of this article let’s assume that the in-office presentation of treatment is flawless. Unfortunately, there are still a number of reasons that patients don’t accept treatment after they go home (even if the case presentation was great).

Problem 1: Patients forget almost everything they hear during an appointment. Maybe a patient was nervous or afraid of the expense, maybe you hurried through the case presentation or maybe any number of things happened or didn’t happen. The fact is, most of the information discussed with your patients during the appointment is forgotten soon after they go home—maybe by the time they reach the parking lot.

Problem 2: After appointments, patients are easily distracted by other priorities. Gas costs more than $4 a gallon and many consumers are experiencing financial problems. And, although patients may not think they can afford the dentistry they need, they are bombarded with consumer ads that make spending their money on a vacation or a new toy look so much more rewarding than four crowns and a root canal.

Problem 3: Patients are not sent home with a detailed treatment plan. Most professional salespeople are very careful to provide their prospects with detailed but consumer-friendly marketing documents that make their products look attractive and enticing to purchase. Whether for a hot tub, a new car or a big screen TV, brochures with beautiful photography and compelling benefits are an important part of the sales process. In dentistry, most practices rely on a black and white printout with no pictures or images and a lot of confusing insurance codes and clinical information.

Problem 4: Patients who consult with a spouse at home can’t explain treatment clearly. Most of us can only imagine how poorly a typical patient repeats the information delivered during an appointment. Not only is your patient empty-handed and likely to have forgotten nearly everything, but a patient doesn’t have the same ability as a dentist to enthusiastically communicate the importance of oral health. It becomes an easy way for your patient to say “no.”

Problem 5: Dentists are too busy to personally contact each patient at home. Dentists aren’t sales people; they are busy running a dental practice and providing treatment. Most office managers and other team members are just as busy or even unqualified to provide a meaningful follow-up effort.

Problem 6: Patients cancel appointments when they are unsure or confused. Most dental teams hate to admit it, but often cancellations or no-shows are due to poor communication that creates fear and confusion with patients.

I can promise you that if you will improve the follow-up process after patients go home then your case acceptance rate will skyrocket. Yes, it’s difficult to find the time and create the systems, but your efforts will be rewarded with a dramatic financial improvement. Improving your follow-up is one of the most important marketing efforts that can be made in your practice.

With the assistance of the American Dental Association, our company has developed a revolutionary new product to help you effectively follow up with patients who don’t accept treatment in the office. Check it out: treatmentpro

Joel Harris is CEO and Co-Founder of Intelligent Dental Marketing, one of the nation's leading dental marketing companies focused exclusively on dental practices. Intelligent Dental Marketing provides powerful marketing tools to help dentists grow their patient base, increase their profit and improve their image. Joel can be reached directly at 877.942.8855.

Interested in speaking to Joel about your marketing concerns? Email him at joel@thedentistsnetwork.net.

Interested in having Joel speak to your dental society or study club? Click here.

Thomas L. Snyder, DMD, MBA
Managing Partner
The Snyder Group, LLC
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You Choose The Practice

When lecturing to young dentists and dental students about practice valuations, I always give them a test to see if they understand the points I raise about the factors affecting practice values. For those of you who have been reading my articles on Practice Valuation, here is an opportunity to see if you would make the right choice on purchasing a hypothetical practice. For comparison’s sake, we have two practices with identical physical characteristics, in the same town and with identical revenue! But that’s where the similarities end. Here are the basic statistics on the two practices.

A Tale of Two Practices
	Practice A	Practice B
Revenue	$725,000	$725,000
# Active Patients	2,000	1,400
# New Pts./mo	20	10
Overhead	55%	63%
Net Profit	45%	37%
Practice Value	$478,500	$427,740
Your Choice	???	???

Although revenue is identical, Practice A has 600 more patients than Practice B. New patient flow is greater by ten patients per month in Practice A. Practice Overhead is higher in Practice B at 63% vs. Practice A at 55% (thus, a lower profit margin in Practice B). Practice A is valued at $478,500 and Practice B is valued at $427,750. Stop here and make a choice! Which practice would you purchase?

I hope that you selected Practice A. Even though the practice’s value is approximately $50,000 higher, you’d be getting more for the additional cost. Here’s why:

Number of Active Patients. Practice A has substantially more active patients and consequently a greater potential for more dentistry in those records. The size of the active patient base is a key determinant in affecting a practice’s value. So, Practice A gets high marks for a larger patient base.
Patient Retention. With 600 more patients, there are more opportunities to reactivate patients. Since practice revenues are identical, it’s highly probable that there is significant potential to increase recare revenue in Practice A as well as the amount of incomplete treatment that may await a Purchaser in those additional records. So that’s another plus in the value for Practice A.
New Patient Flow. It is obvious that a practice that is generating twenty new patients per month shows more promise than a practice generating ten new patients. Therefore, the value should be higher.
Operating Overhead. National statistics show that a general practice’s overhead averages between 63% and 65%. Practice A is well below those national averages and that is a real plus for its value.
Net Profit. Since Practice A has a 45% profit margin versus 37% profit margin for Practice B, there is a significant differential in cash flow. To further underscore this point, look at the Net Income differential over a twenty-year projection.

20 Year Projection
	Practice A	Practice B
Annual Net Income	$326,250	$268,250
Total Net Income	$6,525	$5,365

If we take Practice A’s Net Profit over a twenty-year timeframe, without accounting for any increase, this practice would generate almost $1,200,000 more over twenty years than would Practice B. More important, Practice A, as we discussed, has significantly greater potential for growth with twenty new patients per month plus a larger patient base by 600. So by applying effective reactivation strategies and effective retention management, there exists the potential for an even greater differential than what we’ve stated above. In the end, you may pay more for Practice A, but the differential is well worth it.

If you were to take out a ten-year loan, Practice A’s monthly payments would be $5,572 versus Practice B’s at $4,901, as seen in this example:

Debt Service Comparison
Term - 10 Years Rate - 7.2%
	Practice A	Practice B
Monthly Payment	$5,572	$4,980
Annual Payments	$66,860	$59,770
Total Payments	$688,600	$597,700

This is a difference of about $600 per month. Total principal and interest payments for purchasing Practice A would cost you about $71,000 more than Practice B. This is a small price to pay to gain a minimum of an additional $1,000,000 in earnings over your career.

At the end of the day, what matters most in making a purchase decision is the income stream that you are purchasing. In this example, Practice A is the clear winner!

Dr. Thomas L. Snyder is Managing Partner of The Snyder Group, LLC, a nationwide practice transition and financial management consulting firm. With more than 75 years of experience in the field, The Snyder Group can provide you a full range of services relating to practice transition matters and retirement planning. They can be reached directly at 1.800.988.5674.

If you would like additional help, email Dr. Snyder at drsnyder@thedentistsnetwork.net.

Interested in having Dr. Snyder speak to your dental society or study club? Click here.