Digital Operatories, Team Dynmics and Lease Restrictions

Issue #181-7.30.13

In This Issue: The Digital Operatory, by Dr. Lorne Lavine Team Dynamics, by Susan Gunn Dental Transitions Stymied by Lease Restrictions, by Bruce Bryen, CPA Dr. Lorne Lavine Dental Technology Consultants Printer Friendly Version The Digital Operatory By Dr. Lorne Lavine, Dental Technology Consultants Over the past few columns of The Dentist’s Network, we have examined some of the technologies that are part of the digital office, specifically looking at data backup, virus protection, an overview of digital radiography, and monitors. There is no doubt that of all these technologies, digital radiography appears to be generating the most interest right now. While choosing digital sensors and software is certainly important (and we will evaluate these systems in future columns), it has been my experience that many dentists do not fully recognize all of the factors related to this purchase. In most cases, dentists purchase digital radiography systems for a variety of reasons: lower cost, elimination of film and chemicals, faster time to view images, etc. However, the true benefit of digital radiography is seen when we involve the patient in the diagnosis of their condition; we often call this “co-diagnosis.” To adequately co-diagnose, though, there are a significant number of issues that need to be addressed, specifically related to the placement of these systems in the treatment rooms: Computers It is often not enough to choose a computer based on processor speed or hard drive. Other issues that must be evaluated are the need for DVD drives, video cards, etc. Just as important, although often overlooked, is the size and shape of the computer cases themselves. Many offices have cabinets at the 12 o’clock position where an area has been designated for placement of a computer. However, these spaces will not fit all computers and the dimensions of this space should be evaluated before purchasing the system. Dell computers, for example, come in four different sizes for their Optiplex systems. While it would be easy to say that offices should simply purchase the smallest case, there are trade-offs that are part of this decision. Many add-on cards, such as those used for video capture and digital radiography systems, will not fit into these smaller cases and will therefore have an effect on which case is chosen. Dentists may also elect to mount their computer systems on a wall or cabinet, although they should understand how much space is required to do this. Monitors The positioning of the monitors is crucial to get the most out of the digital systems in the operatory. The first decision that must be made is whether to have one monitor or two in the operatory. Many offices are electing to have two monitors: one positioned in front of the patient to show digital images, patient education, DVD or TV, and another behind the patient that can be used to show more HIPAA-sensitive information, such as the schedule or financial information. To properly design this, there are certain decisions to be made. First off, the exact location of the monitor is chosen. In many cases, an articulating arm, such as those from ICW or Ergotron, is used to give the monitor positioning some flexibility. Most offices will mount monitors to the ceiling, light pole, or wall. If mounting to a wall, the location and type of the wall studs will have a major influence on how the monitor is mounted. Secondly, there is the concern over cables and cords. Each monitor requires at least a video cable to be run to the computer, and each requires electricity. Monitors in front of the patient will usually need an audio cable run to the computer as well. Since most dentists do not want to see multiple cables snaking across the floor and walls, it is often a challenge to determine the best way to run these cables and end up with an esthetic solution. Input While touchscreens are an option, their cost often makes them prohibitive for dental offices. Most dentists still prefer to have a mouse and keyboard to input data. While wireless devices are almost mandatory in the operatory, the positioning is still important. If the dentist or staff members have to twist their bodies to use the devices, back and shoulder problems can develop quite rapidly. While the digital dental operatory is becoming increasingly evolved, dentists should understand that many minor issues need to be addressed in the planning stages to get the most benefit from their new systems. Lorne Lavine, DMD is the Founder and President of Dental Technology Consultants. Dr. Lavine holds two prestigious certifications, the A+ Certified Technician designation and the Network+ Certified Professional. These designations demonstrate proficiency in computer repair, operating systems, network design and installation. Dental Technology Consultants provides dentists a full range of services relating to the implementation of technology. Interested in having Dr. Lavine speak to your dental society or study club? Click here. Dr. Lavine can be reached at drlavine@thedentistsnetwork.net Hear Dr. Lavine’s FREE podcasts at The Dentist’s Network - HERE Forward this article to a friend Susan Gunn Printer Friendly Version Team Dynamics By Susan Gunn Most know I’m a pretty passionate Texas Ranger’s baseball fan. I have season tickets and the games are my mini-vacations, my vice. From my seats, I can see everything on the field and dugout, and I love watching the players themselves. Last season, my team fell apart in June and it was downhill for the rest of the season, losing the division title on the last day. The players no longer congratulated or encouraged each other. I watched a frustrated coach not respond or react. The players sat on the bench, with their heads down, not hanging on the rail to watch. It was heart wrenching to watch a team of talent fail. It was like witnessing a fatal hemorrhage but being unable to do anything except support the life-saving attempts, with heavy hearts knowing the outcome of such a “blood loss.” This year is different. We have new players in our dugouts. They are getting frustrated at their losses but they are still having fun in the dugout, still yelling for each other, laughing, and enjoying the game like little leaguers. What’s my point? One person in your dugout can poison the entire team Sometimes talent isn’t a good enough reason to keep a negative team influence Your patients “see” the attitudes of your employees A coach (leader) sets the tone Negative Players All it takes is one person to ruin a day, to pollute other employees' attitudes, to make staff members wish they worked elsewhere. Not everyone can be cheery all the time, but attitude makes or breaks the tone in the dugout. Baseball legend Tommy Lasorda said, “There are three types of baseball players: Those who make it happen, those who watch it happen and those who wonder what happens.” Talented but Negative Did you know that one bad apple can really spoil the bunch?  A gaseous hormone called ethylene causes the apples in the bunch to speed up their ripening process. A recent embezzlement investigation featured a practice manager pointing the finger at a front desk employee, continuously restating to the owners what she had allegedly been told by the employee. It was truly accusatory, but, I wasn’t seeing anything. I combed through the practice software and the bank records and found nothing. Yet the practice manager was tenacious with the doctors. At her insistence, they were ready to fire the employee until I convinced them to wait and watch. Sure enough, the practice manager was calling in prescriptions for herself using the doctor’s DEA number. This is a much larger problem than most realize and because it is, each state now has a prescription drug monitoring program which makes it easy to validate prescriptions by DEA number. Patients See Don’t you wonder what your patients say about your practice after they have left? I read a Facebook blast the other day from a friend about a local dental practice. “They have such bad attitudes there. The gal sitting at the desk was texting on her phone and didn’t even look up at me when I was standing there. There was no ‘friendly interaction with anyone. They don’t seem to like working there very much.  Well, guess what – I don’t like going there either and I’ve decided it will be my last visit.” I was mortified, but the reality is it’s more than this one patient, more than this one practice. What do your patients see? Do they see your team standing at the rail, cheering for their team’s successes and supporting each other during the busy times?   The Container Store says one great employee = three good employees. Are your employees great or are they just filling a spot on the roster? A Leader Sets the Tone 1940’s MLB catcher Al Lopez said, “Do what you love to do and give it your very best.  Whether it’s business or baseball, or the theater, or any field. If you don’t love what you’re doing and can’t give it your best, get out of it. Life is too short.” Lopez was right. Owning a dental practice is much more than clinical skills. It’s being determined to be the very best in every aspect of the practice. If you don’t know, you learn. You set that tone in your practice – the positive, upbeat tone. Develop a sense of curiosity – who is where, who does what and what is it this month? Be intentionally involved in every aspect of the practice.  Texas Rangers’ CEO and former major league pitcher Nolan Ryan said, “One of the beautiful things about baseball is that every once in a while, you come into a situation where you want to, and where you have to, reach down and prove something.” Digging deep to become and do what you need to be can be one of the most rewarding achievements in life. Never be satisfied with status quo. Asking “how can we make this team better” produces winning teams. Are you a fan of your own practice? Are you your team’s biggest supporter? Now, if you’ll excuse me, I need to go change and get ready for the game against the Yankees tonight! Play ball. Susan Gunn has over 20 years of business automation experience, has written 25 books for professional practices and has been an Advanced Certified QuickBooks Pro Advisor since Intuit® established the program. She is a Certified Fraud Examiner, a Member of the Academy of Dental Management Consultants, and lives in Arlington, TX.  Dentistry Today magazine has recognized Susan's experience and expertise by naming her as a "Leader in Consulting" since 2006.  For more information, go to www.SusanGunnSolutions.com Susan Gunn can be reached at susan@susangunnsolutions.com Forward this article to a friend Bruce Bryen, CPA Managing Partner Bryen & Bryen LLP Printer Friendly Version Dental Transitions Stymied by Lease Restrictions - Lessons Learned by an Unfriendly Lease By Bruce Bryen, CPA Managing Partner Bryen & Bryen LLP Unfortunately, the hardest lesson learned by executing a lease that is too restrictive may be that the sale of a dental practice won’t just be delayed by the issue, it possibly will not take place at all. It is frustrating that after negotiations have been completed between buyer and seller and representatives of each, that a landlord can have the ability to stop the sale from occurring. Many times the terms of the transition have been agreed upon and the attorneys have finished writing and rewriting the sales agreement. The parties are ready to close the transaction when the landlord appears, postponing the transition until the terms of the lease can be settled. A dental practice that has been operating for some time with all lease payments current and little or no adverse landlord contact over the lease term may lose that relationship when the possibility for a landlord to get more money from a new tenant occurs. There may be nonfinancial issues as well that become available to a landlord with a new tenant requesting a lease assignment, such as the hours a practice will be open during the daytime, evenings and weekends. What Makes a Lease Restrictive? There are quite a few scenarios that may cause the ability to assign a lease with a remaining term to become restrictive, at least in the eyes of the landlord, who may be the only party to a lease that can stop a sale from happening if the buyer and seller agree to the lease terms. Most leases have a clause that prohibits a landlord from unreasonably withholding the assignment of the lease. People think of a transfer from a dental practice to a nonprofessional business as an example of an approach for a landlord to withhold the assignment. No one would think that the transfer from one dental office to another could be a reason for the landlord to object to the assignment. What about a situation where the dental practice is located in a shopping center where it is one of the larger rental spaces and is most visible for the remaining tenants of the center for drawing customers to their stores? In that instance, if the dental office sold and became abandoned, there would be fewer patrons available to frequent the other shops in the center so they might lose revenue. This may be a reason for the landlord to withhold the assignment to the buying dentist. This lack of assignability could occur even if the prior tenant continued on-time lease payments. Another obstacle may be the demand by the landlord that the selling dentist remain a guarantor of the lease. If all other aspects of the assignment were agreed upon, the lease term or renewal option at existing rates may be a cause for the landlord not to agree to an assignment. A prospective tenant may have informed the landlord that he or she will move as soon as the lease expires. It may be that the prior tenant “told” the landlord that the lease would be renewed. How can Restrictions to the Lease be overcome?  The proverbial “chicken or egg” scenario occurs when the buyer and seller of a dental practice start negotiating terms of the sale such as transition price, tax allocation and the timing of the transaction while waiting to contact the landlord to get acceptance of the assignment of the lease. The contact with the landlord may seem to be a “back burner” issue but it takes almost a simultaneous approach on all points to move the process along at the most reasonable cost and the quickest timetable. Before spending the money with representative accountants and attorneys, the landlord should be approached at least at a similar time as the advisors to allow the lease assignment process to proceed smoothly. If there are issues with the lease assignment, the sooner they are addressed the faster they will be resolved. If they can’t be resolved, an enormous amount of money can be saved in advisory fees that would have concluded a satisfactory transaction with the acceptable lease assignment. Before thinking of lawsuits to settle the issue, be sure to retain an experienced advisor who has been involved with many dental practice transitions and landlord negotiations. That person will know to negotiate on an almost current basis with all parties to the transition, including the landlord. Bruce Bryen is managing partner of Bryen & Bryen LLP, certified public accountants. Bruce has forty years of experience in assisting dentists with their financial concerns. He has a strong expertise in retirement planning and has testified on numerous occasions as an expert witness regarding partnership disputes, business valuations and divorce proceedings. Email Bruce at: Bruce@thedentistsnetwork.net or call 800-988-5674 ext. 112 His web site address is www.bryen-bryenllp.com Forward this article to a friend

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