adventure - Burkhart Dental Supply

Issue 3 | 2015
ENJOYING THE
ADVENTURE
Meet Dr. Matthew Wimmer of Denver, Colorado
ANCHORED IN SAN
PEDRO LA LAGUNA
Lending a hand with
Proyecto Fe International
CREATING A
PARTNERSHIP
With the Supply
Savings Guarantee
The BRAVO™ gives you fast and consistent dry loads every time.
With closed-door drying, fresh water every cycle and a large capacity,
you can process your instruments with unparalleled efficiency.
Loads are reprocessed from start to dry in a scant 35 minutes so they
are ready when you are. Experience the leading edge speed of Bravo.
scican.com
BRAVO and Your Infection Control Specialist are a trademarks of SciCan Ltd.
Time really is on your side.
UPDATE
YOUR
WAY
CHOICE
Updating your practice over a period of time, as you
do with your home, following a plan that works with
your budget, is one of your most important longterm financial considerations. You’ll minimize the
financial impact while improving curb appeal and the
enjoyment of patients and staff.
forestdental.com
Success
16
Table of contents
Enjoying the
adventure:
Dr. Matthew Wimmer
REFLECT YOUR
By Elaine Dunn, photos by Sean Holveck
24
“Pelton & Crane produces
beautiful equipment that
contributes to the aesthetics
of my practice while still
GIVING BACK:
anchored in san
pedro la laguna
offering great functionality
for excellent dentistry.”
- Dr. Bradford Picot
By Anne Baer, photos submitted
by Dr. Biederman and Proyecto Fe International
Practice Management
16
Meet Dr. Matthew Wimmer
in Denver, Colorado
44
Are you thinking of
adding an associate?
6PracticeView: How does
your practice stack up?
9Thanks for asking
24
12Form Follows Function:
Testing the Occlusion
Before You Start, part I
We are passionate about creating clinical environments
Assistant Success
22Supply Savings Guarantee:
Creating a Partnership
30
comfortable knowing Pelton & Crane is a name you can trust.
Your Image Reflected.
Reflect your success with Pelton & Crane’s innovative new products
Learn more at pelton.net/newproducts
Chairs | Delivery Systems | Lights | Cabinetry | Water Treatment | www.pelton.net | 800.659.6560
064924/ rev 0 / 02.15
By Derek Johnson, Burkhart Branch Manager
an electric relationship
with kavo
By Christopher C. LeCuyer, DDS
OFFICE DESIGN
32
that enhance the dental experience for practitioners and
patients - and with 115 years of experience, you can feel
By Dr. Rhys Spoor, DDS, FAGD
Technology
Dr. Paul
Biederman
gives back
to create innovative products that reflect your success.
By the Practice Support Team
Clinical Success
At Pelton & Crane, we combine design and functionality
By Kathy Edwards, RDH
Index of Advertisers:
A-dec...........................Back cover, 5
Dental Group LLC......................... 42
acteon............................................ 39
Forest.............................................. 1
air techniques............................. 29
Kavo................................................ 31
Akt advisors................................ 42
Nomad......................................................15
Burkhart dental supply:
Practice Support Team........................ 8
Handpiece Repair Center...................14
Supply Savings Guarantee................. 23
Nsk............................................................14
gendex........................................... 27
Scican............... inside front cover
Instrumentarium...inside back cover
Vatech............................................ 43
the tangibles and
intangibles of a
successful office design
By Russ Cornelius
Wealth management
40Death and taxes:
Focus on what you can
control (part II)
By Sam Martin, MBA (tax), CFP™, CPA
Pelton and crane.......................... 2
Planmeca.......................................11
CATALYST MAGAZINE // Issue 3, 2015 // 3
What would your
dream look like?
Serving the Dental
Profession since 1888
FROM THE
president
B
urkhart is passionate about providing exceptional
service for our clients. We aim to identify each
client’s unique needs along with their personal and
professional goals. We strive to provide helpful information,
skilled service and specific products. We earnestly
work in the best interest of others because at the end of
the day, that’s what makes our work most satisfying.
Passion is not a virtue developed overnight. Since 1888,
Burkhart has worked to make sure every service we provide
in some way improves the career or life of the client. Many
of the services we provide help free up our clients from
smaller day-to-day tasks and allow them to focus on their
top priorities. Some of those services include: managing
inventory, controlling supply costs, and making sure
digital equipment and software work well together.
At Burkhart we realize our clients are both
dental professionals and business owners.
It is our goal to help them be successful
at both. Catalyst is fully dedicated to that
success. The articles in this publication
vary from product use and selection to
business management topics and provide
information and guidance that can lead to a
more successful practice. Throughout the
publication are stories of Burkhart clients who
have succeeded in the areas highlighted.
We hope you enjoy!
If you have a request for a topic that
you would like for us to cover in Catalyst,
please contact Mark Beagley at:
[email protected]
Catalyst Magazine is published by:
Burkhart Dental Supply
2502 South 78 th Street
Tacoma, WA 98409
p) 253.474.7761
f) 253.472.4773
Publisher
Greg Biersack
EDITOR
Mark Beagley
Designer
Sara Wisely
Advertising
We are focused on one central goal of providing the best
client experiences. Staying focused is what makes us
efficient, knowledgeable, and current in the marketplace.
Melissa Gill
All rights reserved. Reproduction of any part
of this publication without written permission
from the Publisher is strictly forbidden.
Images are not necessarily to scale.
Time to create that treatment room you’ve always wanted. From your
computer or any mobile device, explore all your options. Choose your
layout and equipment, apply your favorite color combinations and even
request your color samples.
Customer Service:
Lori Burkhart-Isbell
President
4 // Burkhart dental supply
800.562.8176
It’s easy to dream big at a-dec.com/InspireMe.
© 2015 A-dec Inc.
All rights reserved.
PRACTICE MANAGEMENT
PRACTICE MANAGEMENT
PracticeView
How does your practice stack up?
by Kathy Edwards, RDH
N
principle training and planning for
et income for dentists started
stacks up when compared to
to decline in response to the
“best practice” models
an associate are just some of the
economic climate in 2007 and
areas addressed
• An in-depth analysis of the numbers
has remained flat since—even though
in your practice—from overhead,
• Ongoing coaching support for
the economy started picking up in 2009,
to new patient flow, to hygiene
you and your staff through phone
and surpassed 2006 levels by 2012. Yet
department profitability
calls, emails, and webinars
here we are in 2015 watching dentists face
• A review of existing equipment and
• Did we mention this is all at NO FEE
an ever-changing and evolving business
technology in the practice, as well
as a value-added service for
environment and finding themselves
our Burkhart clients?
as
forecasts
for
maintenance
working harder with less profitability.
Increased competition, overhead,
We have helped many practices
and PPO participation are
through this unique
just a few of the challenges
offering, and we love
that keep dental
doing it! It’s rewarding to
profits flatlining.
uncover small changes
On the bright side,
that have the capacity
our experience
to provide big impacts
indicates that key
for the practices we
systems within
support. According
each practice can
to Dr. McManus,
be incorporated
as published in
or modified to
Practice Booster,
improve the bottom
“the ADEA’s 2013
line, even with the
survey of graduating
—Nelly, Office Manager, Summit Dental Group, Idaho
above-mentioned
seniors revealed
challenges. Enter
that, out of 23 distinct
Burkhart’s Practice
areas of instruction in
Support Team—we’re
the dental curriculum,
here to help level the
the student’s perspective
playing field, with the
was that practice management
rest of your Burkhart team!
was the second most inadequate topic
Burkhart offers complimentary
covered. With so much to learn in different
• A comprehensive binder
“PracticeViews” to doctors that want
disciplines, practice management has
that details our team’s reports,
to explore their practice systems and
been on the short end of the stick for
recommendations, and resources
protocols with the intent of uncovering lost
decades.” Burkhart’s Practice Support
• One-on-one time with the
profits, improving systems, and enhancing
Team addresses this deficit by providing
professional practice consultant
the patient experience. It is part of our
practice management tools in a structured,
via Skype, FaceTime, or phone
commitment to provide an exceptional client
comprehensive and written format to
experience. Our complimentary support
contribute to the success of each individual
• Consideration of your philosophy and
services are geared to help you reach
client we are fortunate to work with.
vision, with steps to reach those goals
your goals and jump-start that flatline!
• Verbal scripting, forms, compliance
Read some of the experiences past clients
issues, fees and coding, team morale,
PracticeView Basics:
have reported after completing
compensation issues, and business
• An overview of how your practice
a PracticeView:
You and your Burkhart Practice
Support team have been
helpful, knowledgeable,
informative
and a great support for our office.
6 // Burkhart dental supply
“You and your Burkhart Practice Support
team have been helpful, knowledgeable,
informative, and a great support for our
office. I appreciate our talks and your
follow-ups. Thank you! Thank you!”
— Nelly, Office Manager,
Summit Dental Group, Idaho
“The PracticeView analysis of my
practice really highlighted some weak
points in my practice growth plan. I
was completely unaware of how low
my fee schedule was and the feedback
I received gave me great strategies for
adjusting my fee schedule to maximize
current and future collections. I was also
given valuable insight on some insurance
billing strategies that I didn't know. With
a few simple changes, we are now able to
increase revenue significantly. In addition,
the general practice tips I received helped
me get new insight on how patients may
be experiencing our office and helped
me make some necessary changes to
create a better work environment for staff.
—Dr. Sheila Farahani, San Jose, California
The members of the Practice Support
Team are passionate about providing
resources, tips and tricks, and sound
business and best practice guidance—
and sometimes an empathetic ear for
our doctors that are facing challenges
and need a sounding board or a
different perspective as they work
through problem-solving options.
Katey Speegle, one of our Account
Managers in Idaho, routinely refers her
clients to the Practice Support Team
for full PracticeViews as well as help
with individual practice challenges:
With a few simple changes,
we are now able to
increase revenue
significantlY.
—Dr. Sheila Farahani, San Jose, California
“I love the
PracticeView program.
Customers almost always ask how
we as a company can provide such
a valuable service at no charge. I tell
them Burkhart sees the value in helping
to build our customers’ practices. It is
the right way to do business. In almost
every case, the PracticeView program
has brought me closer to the client
that I have provided this service for. It
gives them invaluable information and
cements my relationship with them. It
also helps me to understand their goals
and how I can best support their practice.
During a recent PracticeView, I had a
customer share they felt the information
provided was better than what they
had paid another large consulting firm
for and was not as ‘cookie-cutter,’ but
more customized. Great program!”
How to participate:
• Contact your Burkhart Account
Manager to get started
• The Discovery meeting lasts
approximately one hour, with an
opportunity for you to share your
objectives, history, goals, and
concerns with the PracticeView team
• Specific
reports will be
requested for a
Practice Support Team Member
to start an analysis
• A second meeting will take
place to review the findings and
put together action items
• It doesn’t stop there—your Account
Manager, Equipment Specialist, Service
Technician, and Practice Support Team
are on board to support those action items
through providing resources, staff training,
webinars, and ongoing support
Team
The Burkhart Practice Support Team
provides business insight and strategies to
Burkhart’s doctors and our branch teams to
help our doctors build stronger practices.
Whether it is a valuable phone call,
a webinar, or a PracticeView, we have the
resources to support your practice.
CATALYST MAGAZINE // Issue 3, 2015 // 7
PRACTICE MANAGEMENT
Thanks for
asking
Burkhart’s Practice Support Team receives calls and emails every day from offices
regarding their business questions and needs. In each issue of Catalyst, we’ll compile
some of the most frequently asked questions and share our insight with you.
Kathy Edwards, RDH, Margaret
Boyce-Cooley and Dana Morano
of the Practice Support Team
Q.What does a healthy hygiene Department look like?
A.
A healthy general practice’s hygiene department should have 50-60 percent of their
patient base receiving preventative care (1110), 30-40 percent in perio maintenance
(4910), and 10-20 percent in active perio therapy (4341, 4342). In addition, 30-35
percent of production should be generated within the hygiene department. In
a general practice, 90 percent of the doctor’s
restorative schedule is a direct result of diagnosis
4341,
made in the hygiene chair.
4342
10%
My overhead is perfectly healthy.
For all the questions out there, you have a team of experts at your fingertips who
can help you through it. From overhead to compliance and beyond, Burkhart's
Practice Support team is an email or phone call away—free of charge.
Check out our remaining 2015 webinars—
now also offered for free!
Are You Compliant? HIPAA Awareness
Friday, July 17, 2015: 8:00 am PST
Monday, July 20, 2015: 3:00 pm or 5:00 pm PST
Managing Office & Staff Overhead
Friday, September 18, 2015: 8:00 am PST
Monday, September 21, 2015: 3:00 pm or 5:00 pm PST
Overcoming the Challenge
of Failed Appointments
Friday, November 13, 2015: 8:00 am PST
Monday, November 16, 2015: 3:00 pm or 5:00 pm PST
To register, visit our website at burkhartpracticesupport.com
or contact Dana Morano at [email protected]
40%
4010
50%
1110
PATIENTS
FEE
$
1110
2058
$125
$257,250
4910
401
$175
$70,175
4341-2
50
$215
$10,750
Total
2509
$338,175
Typical hygiene production in a healthy
2,500 patient-base practice
Typically, RDH staffing is determined based on the following formula: one hygiene day per
week for every 250-300 patients. That range is determined by the strength of the periodontal
program and the scheduling protocol for new patients. A strong perio program reduces the
number of patients required per hygienist. Scheduling new patients in the hygiene column
for initial assessment rather than the doctor’s column will also reduce the number of patients
required for a day of hygiene per week.
Ideal Practice Statistics
Adult patient base
Q.I know the back is
running great, but I
sometimes lose sight
of the front and I’m
beginning to think I’m
overworking my front
office staff. How do I
know when it’s time to
hire another person
up front?
PPO plans. Many practices will
consider adding a full-time person
who can operate as a floater to be
shared between the front office
and sterilization/assisting.
There are several monthly
reports you and your front office
team member should review
on a monthly basis. These
include your month-end report;
accounts receivable aging report;
outstanding insurance claims
report; and unsubmitted insurance
report. The focus of the review is to
enlighten the doctor’s knowledge
of the front office progress and
provide individual accountability
to each staff member’s role in
reaching practice goals.
1.
Month-End Report – Evaluates
how close you were to production
and collection goals.
A. A single front office staff member
will start to feel challenged when
production reaches a steady $75$80K per month. On average, when
practices start producing in that
range, a part-time person should
be considered. The production
range could be as low as $65$70K/month if you have a high new
patient flow (it takes more time
to enter new patients into your
system, transfer records, etc.) or
you participate in five or more
2.
Is Accounts Receivable (AR)
staying within ten percent of the
total AR? AR over 90 days and
outstanding insurance claims
reports are worked together. It
is important to know if there are
system challenges that are creating
outstanding or denied insurance
claims versus uncollected patient
balances. It
is also
important
for the
doctor
to
know
Team
www.practicesupportteam.com
CATALYST MAGAZINE // Issue 3, 2015 // 9
PRACTICE MANAGEMENT
Thanks for
which patients are not paying for
services. This helps doctor and
front office establish guidelines
for emergency patients. It is not
helpful to the patient to keep adding
to their debt load when they are
already behind with payments.
Financial challenges should also be
announced at the morning huddle.
This reminds staff members to only
provide treatment that has been
pre-planned with a signed financial
arrangement. Providing treatment
without a financial arrangement
discussion with the patient leads
to future collection challenges.
It’s not fair to the patient who may
not understand their financial
obligation, or to the practice now
struggling to collect payment.
3.
Unsubmitted Insurance Claims
Report – Use this report as a
double-check to ensure no claims
have fallen through the cracks.
I’ve often thought if I were applying
for a front office position, I would
want to see these reports. They let
you know what you are inheriting
and whether there are effective
asking
systems in place. It also allows
the front office team member an
opportunity to show their value as
they either get these numbers into
the healthy zone or continue to keep
them where they are.
Q.I am looking to bring
a specialist into my
practice to share
the space. I want to
work out how this
relationship will
function best since
the specialist will
bring his own staff
and products but
will be using my
equipment. Is there
a list of things I
should consider?
A.
1.
>>continued
4.
What does the term “professional
ethics” mean to you?
5.
How would you characterize
your ethics?
6.
What are your personal goals
(short-term and long-term)?
7.
What is your definition of quality
dental care?
8.
Do you have any interest in a
partnership agreement in the future?
PLANMECA
ProMax 3D Family
®
A good resource to check out is Office
Sharing for the Dental Practice, by Boyd
W. Shepherd, D.D.S., J.D. Here are some questions to ask
when bringing someone in to share
your practice space:
How long are you hoping this
arrangement will last?
Ø5 x 8cm
ProMax 3Ds
Ø8 x 8cm
ProMax 3D
Ø16 x 9cm
ProMax 3D Plus
Ø20 x 17cm
ProMax 3D Mid
Ø23 x 26cm
ProMax 3D Max
Versatile 2D/3D Imaging Technology
Exclusive CBCT Ultra-Low Dose imaging protocol reduces patient radiation
by an average of 77% without loss of diagnostic quality*
Patented SCARA technology, allowing limitless imaging possibilities
2.
Why are you interested in leasing
space rather than starting your
own practice?
Offers optional ProFace 3D facial photos for advanced case presentation, operation
pre-planning, and treatment follow-up
3.
What interests you in having
a practice within my practice?
Provides the tools to reduce radiation based on clinical need, including Planmeca’s
Ultra-low Dose Protocol, adjustable kV and mA, selectable volume sizes, and
pediatric mode for a 35% lower dose
The Burkhart Practice Support Team provides business insight and strategies to Burkhart’s doctors
and our branch teams to help our doctors build stronger practices. Whether it is a valuable
phone call, a webinar, or a PracticeView, we have the resources to support your practice.
Optional digital impression and cast model scanning available for ProMax 3D, 3D
Plus, 3D Mid, and 3D Max
Upgradable all-in-one technology
Call or email us today for free with your business questions at
800.665.5323 or [email protected]
Open-architecture Planmeca Romexis software included
Mac and PC compatible
*According to “Dosimetry of Orthodontic Diagnostic FOVs Using
Low Dose CBCT Protocol,” by J.B. Ludlow and J. Koivisto.
For copies of this study, please contact Planmeca USA.
Team
10 // Burkhart dental supply
To schedule a demo please
contact your Burkhart
Representative at
800.562.8176
CLINICAL SUCCESS
Form
Follows
Function:
A
ttractive teeth stay attractive
over the years because the
form of the dentition fits into the
functional envelope of the muscles of
mastication and the temporomandibular
joints. This includes both functional
and parafunctional movements. When
you observe a wear pattern in a patient,
what you are looking at is a history of the
forces of attrition (Figures 1 and 2). When
we want to restore a smile to youthful
beauty, unless you change the functional
environment that caused that wear
pattern, it will be recreated. This case
illustrates a very common wear pattern
where the mesio-incisal of the mandibular
cuspids have worn the disto-incisal of
the maxillary laterals (Figures 3 and
4). These Class III mandibular cuspids
will certainly be a factor in potentially
chipping the disto-incisal edges or
When we want to
restore a smile to
youthful beauty,
unless you change
the functional
environment that
caused that wear
pattern, it will
be recreated.
12 // Burkhart dental supply
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Testing the Occlusion
Before You Start (Part 1)
By Rhys Spoor, DDS, FAGD, Accredited Member of the American Academy of Cosmetic Dentistry
debonding newly placed maxillary lateral
restorations because most of the time
the new smile includes teeth that are
slightly straighter, slightly longer, and
usually lighter. If the vertical dimension is
conservatively opened, restorations can
be designed that require fairly minimal
reduction of natural tooth structure.
This leaves maximal strength for the
supporting tooth and enamel surfaces
for the most secure bonding (Figure 5).
In this case the proposed occlusal position
was determined by using a combination
of low-frequency TENS (trans-cutaneous
neuro stimulation), electromyography,
and jaw tracking. There are a variety of
ways to get this preliminary position but
the this technique for this case made for
rapid advancement through the testing
phase. A bite registration was taken
and diagnostic models mounted to that
occlusal position. A minimal diagnostic
wax-up was done to level the occlusal
plane and maximize intercuspation
of the new centric occlusion. Cuspid
guiding surfaces were also waxed in.
Stints were made over the diagnostic waxups and each was filled with B-1 Zenith
Luxatemp. To reinforce the maxillary
and mandibular anterior areas, a 2mm
wide band of Kerr Connect fiber was
bonded to the teeth before placement
of the Luxatemp fixed orthotic (Figures
6 and 7). The stint (#6-#11) was placed
intra-orally and the Luxatemp allowed
to cure for two and a half minutes and
then removed. The cured Luxatemp was
finished intra-orally with diamond burs
and polishing cups before being tinted
and glazed (Figures 8, 9, and 10). Even
though this was a temporary restoration
to test function, by finishing the form to
a very refined level the patient had the
opportunity to begin evaluating and
accepting the aesthetics (Figure 11).
The lower arch was then completed
(Figure 12) in the same manner. The
included teeth were #18-#21, #23#26, and #28-#31 (Figures 13, 14, and
15). Again the goal was to get maximal
intercuspation at the new occlusal position
but not all of the tooth surfaces had to be
included. This supported the philosophy of
minimal dentistry to get to the best result.
Under the influence of TENS, the
occlusion was lightly adjusted and a
follow-up appointment about a week
later further balanced and refined
the occlusion. The great advantage
of this approach was the ability to
determine an acceptable and tested
occlusal scheme before proceeding
into the final restorative phase.
(Stay tuned for Part 2 in the next issue of Catalyst
which will continue to the final restorations.)
Dr. Rhys Spoor is a 1983 graduate of the
University of Washington where he was an
Affiliate Assistant Professor in the Department
of Restorative Dentistry for ten years. He
is an Accredited Member of the American
Academy of Cosmetic Dentistry, a Fellow
of the Academy of General Dentistry, the
American Dental Implant Association, and
the Pierre Fauchard Society. He is also
an Editorial Reviewer for the Journal of
Cosmetic Dentistry. Dr. Spoor maintains
a private practice in Seattle in aesthetic,
implant, and restorative dentistry. He may
be contacted at [email protected].
Figure 1: Pre-treatment centric occlusion. Figure 2: The wear pattern was a history that can repeat again unless the environment was changed. Figures 3
and 4: Class III mandibular cuspids caused the severe wear of the distoincisal edge of the maxillary laterals. Figure 5: Maintaining enamel lends to strength and
longevity of the final restorations. Figure 6 and 7: Kerr Connect fiber placed for reinforcement fixed orthotic. Figure 8, 9, and 10: Completed Luxatemp fixed
orthotic #6-#11. Figure 11: Even though this was temporary, a refined restoration can be used to evaluate and gain acceptance of the aesthetics. Figure 12:
Mandibular incisors were etched for attachment of Connect fiber and fixed orthotic. Figures 13, 14, and 15: The new occlusal position to be tested was adjusted
to maximal intercuspation.
CATALYST MAGAZINE // Issue 3, 2015 // 13
Your
HANDPIECES
are an important part of your practice.
HANDPIECE
REPAIR
Keep them well cared for with
the Burkhart Handpiece
Repair Center
> Turbine Replacement
The Burkhart Handpiece Repair Center Turbine
Replacement service includes labor, testing, new
turbine, o-rings and washers (as needed)
> Professional & Dependable
Your handpiece will be taken care of promptly and
normally completed within 1-2 business days
Contact the Handpiece Repair Center to learn more today!
877.311.3856 | www.burkhartdental.com
With an unprecedented 26W of air-powered torque, you’ll experience
a level of smoothness, consistency and comfort not available until
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coating. An optimized ergonomic design for more leverage and less
fatigue. And a new cartridge design and bearings that dramatically
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Longest Warranty.
Ti-Max Z900L*
26W 30-mo. warranty*
23W 24-mo. warranty1
KaVo M8900 L1
W&H Synea 500 Series TK-98L
2
*Internal data
21W 24-mo. warranty
2
1. As listed at http://www.kavousa.com.
Warranty extends to 30 months, if maintained in a KaVo QUATTROcare Plus.
2. As listed at http://us-a-dec.com
SPECIAL OFFER
Details at:
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FREE TRIAL
NSK instruments are available from:
Details at:
NSK Dental LLC
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1800 Global Parkway • Hoffman Estates, IL 60192 USA • Tel. (888) 675-1675
NSK_Z900LTurbine_Burkhart_half_7.875x4.825.indd 1
14 // Burkhart dental supply
www.NSKDental.us
© NSK 2015. All rights reserved.
5/19/15 2:31 PM
The 1970s called, they want their wall-mount back!
©2015 Aribex, Inc. NOMAD is a registered trademark of Aribex, Inc. Regulatory requirements can vary in every
jurisdiction. Please check with your local authorities or Aribex for any necessary radiation authority approvals needed
to operate NOMAD Pro 2 in a particular region. For indications for use, please visit www.aribex.com/ifu. ND0003/B 04.15
Ti-Max® Z900L Air Turbine
Intraoral X-Rays have evolved, and so should you! No
clunky, drifting wall-mounted units, fewer retakes, and a
more efficient workflow so you can spend your time where
it matters most — with your patients. Can you dig it?
With the NOMAD Pro 2™ handheld X-Ray device you can
do just that and experience:
FA S T E R W O R K F L O W S — Stop walking back and forth
and start spending more time with your patients.
M O R E F L E X I B I L I T Y — Move freely from operatory to
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ENJOYING THE
aDVENTURE
dR. mATTHEW wIMMER'S ROAD TO A
SUCCESSFUL PRACTICE IN dENVER
BY ELAINE DUNN | PHOTOS BY SEAN HOLVECK
D
r. Matthew Wimmer’s interest in dentistry developed while he was still in
high school and working part-time as a lab technician for his orthodontist.
Like many teenagers, he had to have braces for several years so he had
some firsthand experience. After high school, Dr. Wimmer moved from
his home in New Jersey to Milwaukee, Wisconsin, where he completed his
undergraduate studies in Biomedical Engineering at Marquette University in 2004.
Then he moved to Boston, Massachusetts, to attend dental school at Tufts University.
After graduating, he completed a one-year oral and maxillofacial surgical residency in
Detroit, Michigan, with the Veterans Hospital. >>
me r w a s
Dr. Wim
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e of 5 2 8
voted on
i n e 's
M ag a z
n t i st s
Top De
!
i n 2015
CATALYST MAGAZINE // Issue 3, 2015 // 17
FEATURE: Dr. Matthew Wimmer
Dr. Wimmer traveled to Denver, Colorado,
for vacation and to visit his brother.
While there he enjoyed skiing, cycling,
and climbing. He decided that, with his
brother living in Denver and his parents
in Arizona, moving to Denver would
allow him to be closer to his family. The
lifestyle seemed a perfect match for his
interests—so he decided to move across
the country and purchase the practice in
July of 2012.
Redesign,
efficiency
and use of
space were
at the top
of his list.
Dr. Wimmer’s practice
is in a great location—a
freestanding building on
the corner of a very busy
intersection. Inside the
building there was a lot of
room for improvement as
the equipment was aging
and the space was not as
efficiently. As he thought
about redesign, efficiency
and use of space were at the
top of his list. Dr. Wimmer
said
that
Equipment
Specialist Paul Trehus
was “instrumental in getting the project
done and was always there if I had a
question.” He was extremely pleased
with the contractor Paul recommended
for the project, Jo Temmer with North
Star Construction Services.
Dr. Wimmer has partnered with Burkhart
for about two years and enjoys working
with Account Manager Greg Castro.
When referring to Greg, Dr. Wimmer
said, “He is very personable and has
done some great things for us.” Some
of the most impactful changes with the
remodel included going digital and
adding a cone beam unit. Dr. Wimmer is
pleased with the improved image quality
and how it has helped with the team’s
diagnostic skills. The practice now
boasts four operatories, and Dr. Wimmer
is thinking about growing the practice
in the future, possibly expanding into
specialty dentistry.
Dr. Wimmer is an avid cyclist and
has become more dedicated to the
sport since moving to Colorado, and
reconnecting with a high school buddy
who had also moved to Denver. His friend
asked if he’d ever raced before, and Dr.
Wimmer decided to give it a try. Last year
he joined a local team, “Devout Racing,”
and now races cross country mountain
bikes and Cyclocross. This year, the
office sponsored the teams and the office
logo was displayed on the team jerseys.
Dr. Wimmer credits his team with making
the practice successful. Many of his team
members have been with the practice for
a number of years, including Rosemary
who has been there for about 30 years.
She has seen some of the patients, now
adults, since they were children. Dr.
Wimmer recently hired a new associate,
Dr. Laura Benesh, as his schedule was
becoming extremely busy. When thinking
about the kind of individual to hire, Dr.
Wimmer knew he wanted someone who
was outgoing, had good experience, and
who would be a positive addition to the
existing team.
Dr. Benesh grew up in Wisconsin
where she attended the University
of Wisconsin-Eau Claire and earned
her undergraduate degree in Marine
ow in
r is a Fell ress
e
m
im
W
Dr.
C o ng
nationa l
r
te
n
I
a nd
e
h
t
ntolog ists us
la
p
m
I
f
o
io
e r of v a r
a mem b loca l denta l
a nd
e s.
nationa l
a l societi
n
io
s
s
fe
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Rosemary Condit and
Candy Fik with a patient
18 // Burkhart dental supply
FEATURE: Dr. Matthew Wimmer
PICTURED (front): Rosemary Condit (Dental Assistant), Candy Fik (Hygienist), Lisa Jenkins
(Receptionist) (back): Dr. Laura Benesh, Michelle Taylor (Office Manager), Dr. Matthew Wimmer
Biology. After graduating
from Marquette University
dental school, she accepted
a residency program in
Cincinnati, Ohio, then asked
to stay on as a staff dentist.
After four years there, she
had the opportunity to
work at a small practice
in a rural community, an
experience she loved. Next,
Dr. Benesh joined the Army
Reserve and was mobilized
to Texas. After several
years in Texas, she started
looking for something new.
She had friends in Denver,
so she decided to move
there. She interviewed at several offices
and was pleased when she got the call
from Dr. Wimmer with a job offer. She
felt that her personality was a good fit
with his team.
They take
what
they do
seriously,
but like
to have
fun, too.
all Colorado has to offer. Her proudest
accomplishment so far is becoming a
dentist—especially earning the patients’
trust and helping them overcome
nervousness and achieve a positive
outcome. When asked what advice she
would give to a fourth-year student, Dr.
Benesh said, “keep an open mind, do a
residency program, see what there is to
see, and learn as much as you can.”
Dr. Wimmer and his team members
clearly share a passion for dentistry
and a similar approach to patient care.
They involve patients in their treatment
plan and explain to them why things
need to be done. They take what they
do seriously, but like to have fun, too.
When asked about what differentiates
the practice, Dr. Wimmer said, “We want
the best for our patients and treat them
like family. We want to see them improve
their oral health and want to help them in
any way we can.”
In her free time, Dr. Benesh enjoys skiing,
hiking, CrossFit workouts, and exploring
Dr. Laura Benesh is a great
positive addition to the team.
20 // Burkhart dental supply
Supply savings guarantee:
CREATING A PARTNERSHIP
D
r. Skip Pierce graduated from University of Washington Dental school in
1974 and opened his dental practice in the same year. Since then, Dr.
Carson Mooney, Dr. Robert Studebaker, and Dr. Lance Ritchie have joined
the practice. Although the name of the practice has changed since Dr. Pierce first
opened, the exceptional care they provide is still the same. Nelly Gomez, Office
Manager, sat down with Derek Johnson, Burkhart Branch Manager, to share their
experience with the Supply Savings Guarantee.
What was it that
made you want to
work with Burkhart?
What part of the SSG do
you find most valuable to
you and your practice?
In 2012 we were building a new office, and
Burkhart asked if they could be part of
the bidding process. We were extremely
impressed with Burkhart's attention to detail
and their team, and decided to go with
Burkhart even though we didn’t have much
of a history with them. Our expectations
were exceeded while working with John
Elliott, Equipment Specialist, and Chad
Alger, Service Technician, with both our
new equipment needs and with the move
of our existing equipment. Even though we
were impressed with our experience we
decided to keep our merchandise business
with the current supplier we had used for
almost 30 years.
The quarterly business review meetings—
we like to know where we are with
our numbers. Katey also presents less
expensive product options that meet our
clinical standard.
How does your Burkhart
Account manager help
you reach your goals
as a dentist and
business owner?
Shortly after we started on the SSG,
Katey presented PracticeView. We were
reluctant at first because we had used
well-known national consultants in the
past but didn’t see much of a return on
investment. We decided to go through
Between rebate checks, free goods, and
inventory control, she is looking out for our
best interestS.
What was it about the
guarantee that originally
caught your attention?
Saving money was intriguing but it was
Account Manager Katey Speegle’s vision
that sold us. She explained how she
approaches business with her clients and
that she views it as a partnership. She
spent time on how much money we could
save and how she would do this. This was
very different from what we experienced
with our other suppliers.
22 // Burkhart dental supply
PracticeView because there was no cost
and we were hopeful we would get insight
on some areas of concern. Not only were
we amazed with the initial information
and direction we were provided, Practice
Support Team’s on-going support has
been greatly beneficial to our practice.
This is another example to us of how
Burkhart Dental is a partner in the success
of our business.
Pictured (left to right): Nelly Gomez (Office Manager),
Dr. Robert Studebaker, Dr. Skip Pierce, Dr. Carson Mooney,
Katey Speegle (Burkhart Account Manager) Derek Johnson
(Burkhart Branch Manager), Chad Alger (Burkhart Service
Technician), John Elliott (Burkhart Equipment Specialist).
Not Pictured: Dr. Lance Ritchie
How has the SSG helped
your business?
First and foremost, it has saved us money
by lowering our overhead dental percent. It
has also added a level of transparency and
accountability to our merchandise ordering.
How has the SSG
helped your staff
be more efficient?
Katey is very organized and has implemented
new systems for ordering supplies. This
has kept our inventory to a minimum.
What would you say
to a doctor considering
the SSG program?
Take a chance and do it. You have nothing
to lose. It started with just the numbers but
we have benefited in so many other areas.
Do you have any
final thoughts?
Partnership. Katey is part of the staff.
She cares about our practice’s success.
Between rebate checks, free goods, and
inventory control, she is looking out for our
best interests. We trust her decisions are
for our benefit and not for her benefit.
Do you need to control
SUPPLY
overhead in your practice?
Our unique Supply Savings Guarantee can
help you keep your supply overhead low!
> Your Burkhart Account Manager can:
- Identify & recommend products
that deliver the best value
- Carefully manage inventory
- Take advantage of
manufacturer coupons
& specials
Contact your Burkhart Account
Manager to learn more today!
800.562.8176
www.burkhartdental.com
GIVING BACK
Anchored
in San Pedro La Laguna
by anne baer
photos provided by Dr. Biederman
and Proyecto Fe International
T
owering, jungle-draped volcanoes overshadow
the lakeshore town of San Pedro La Laguna,
which sits at over 5200 feet and is home to
Guatemalans of predominantly Mayan descent. In
the heart of the town rests the school where Alaskan
businessman Joe LoMonaco first encountered a pastor
and his wife who dedicated their lives to changing
their community through education. Twenty years
ago, the duo laid the foundation for the school, slowly
building and expanding on their dream. Inspired by
both the deep poverty of the locals and humbled by
the great faith of the school organizers, LoMonaco
eventually founded Proyecto Fe International, which
now sponsors anywhere between 275 to 300 students.
A health clinic affiliated with the school
flourishes, finally ready after ten years—
except for one essential element: dental
volunteers. Good thing LoMonaco had
24 // Burkhart dental supply
shared his travels with his dentist, Dr.
Paul Biederman, back in Anchorage. Dr.
Biederman, a general dentist who after
30 years recently transitioned from owner
CATALYST MAGAZINE // Issue 3, 2015 // 25
GIVING BACK
ARE YOUR SENSORS
MAKING PATIENTS
SAD OR HAPPY?
3 STEPS TO HAPPINESS
The town readily greets the volunteers with smiling faces.
Arriving by boat is the least arduous way to reach the city.
to associate, was ready
for a new challenge and
was stirred to share his
faith in an active way. “I
was inspired by what Joe
would tell me about the
kids he sponsored in San
Pedro and the desperate
need for dental care,” Dr.
Biederman recounts. “But
it was also a chance for me
to help transform the lives
of these people, in addition
to offering my heart.”
When he finally accompanied
LoMonaco, Dr. Biederman
was completely blown away
by his own transformation. Dr.
Biederman states, “I thought I
was the one who was going there to
give something—my skills as a dentist
and help in relieving suffering. That did
happen as the need for dental care is
1
massive, particularly with the children, but
I was the one who came back changed.
My time there was transforming.”
Another Anchorage contact, Dr. Mark
Keller, accompanied Dr. Biederman on
that first visit. As a pedodontist, Dr. Keller
was bowled over by the sheer number
of children with issues to be relieved
and the kids’ response. “The kids are so
happy when we help them. They have
been in such pain, laying their faces on
the cold concrete floor to get relief. It’s
not so much that your heart is broken, but
that your heart is broken open. We are
superheroes to these kids, taking away
the pain and providing them a future.”
Dr. Keller goes on to explain what
happened for him while in Guatemala.
“People will say, ‘Wow, you guys did a
lot,’ but I feel like I got a lot more than I
gave. You are basically given a lesson
in loving people by this culture.”
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26 // Burkhart dental supply
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GIVING BACK
The World’s Smartest Air Compressor
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Additional information about
Proyecto Fe International
can be found at its
Facebook page:
www.facebook.com/
ProyectoFe or its website
at www.proyectofe.co.
At this stage, trips are
typically organized twice a
year, in April and October.
No dental experience is
necessary to join a team.
Digital pressure display with
cut-in/cut-out setting
Continuous voltage and
temperature monitoring
Dr. Keller’s comments reflect
what LoMonaco found in San
Pedro La Laguna during
his initial visits. He was
introduced to a people
who harbored a
deep-seated sense
of low self-regard
and, therefore, had no
faith their lives could
be changed. With a
corrupt government,
the native Mayan
descendants are often
“low man on the totem
pole” when it comes time
to provide healthcare
or any basic necessity
to the population. “We
are changing the culture
via education. The locals
have always known poverty
28 // Burkhart dental supply
and don’t historically value good health,
particularly dental health,” LoMonaco
explains. “We are showing them that
good health can transform lives.”
Encouraged by the efforts at the school
clinic, Dr. Biederman recently expanded
his dental reach. On his last visit, Dr.
Biederman asked permission to venture
into the surrounding remote mountain
villages and came away with another goal:
mobile dental vans, fully self-contained
so he can offer relief as well as initiate
change beyond the border of San Pedro.
Dr. Biederman invites everyone to be
part of the change. “You can make a
difference, regardless of your skill set.
You will leave having given so much more
than a healthy mouth. You’ll come away a
new person for having shared hope.”
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To order, please contact your local Burkhart Dental representative.
For more information, visit www.airtechniques.com
A woman waiting in line to see the doctor shows her beautiful henna design.
CATALYST MAGAZINE // Issue 3, 2015 // 29
advertisement
Raising the bar
TECHNOLOGY
An Electric
Relationship
with KaVo
By Christopher C. LeCuyer, DDS
M
any changes occur during the
course of a 30-year practice.
But, as a clinician, I want
certain important things to stay the same.
As a general dentist, my handpiece is
an extension of my own hand. It is for
that reason, and many others, that my
handpieces are always KaVo. When I
first started my Seattle-based practice,
I used another brand, but switched to
KaVo air turbines very early because of
the improved torque. Now I use KaVo
electric handpieces high speed/low
speed for a variety of reasons.
KaVo air-driven handpieces are
dependable, and they are still used in
our hygiene areas. Electric handpieces
are used in restorative areas because
of the improved torque and quietness.
Having electric handpieces impacts
my ability to practice more effectively.
Electric handpieces run at a more
consistent torque, so I can be more
efficient, tooth preparations can be
more precise, and I can perform dental
procedures more quickly. I can run the
handpiece at my preferred RPM, and it
won’t slow down due to the air turbine
being bogged down with the increased
load. Also, KaVo has noted that the
higher, more constant torque can also
reduce a dentist’s wrist and hand stress.
I always appreciate that.
Another greatly appreciated aspect of the
electric handpiece is the noise reduction.
The office is much quieter without the
high speed whine of an air turbine.
The new brushless motor was a very helpful
development. We have not experienced
any maintenance issues at all since the
handpieces became brushless. Before that,
the brushes would have to be replaced
periodically. When the handpieces do
require factory modifications, upgrades,
or repairs, they are returned in a timely
manner at a fair cost.
With eight operatories in our office,
we currently have about ten KaVo
handpieces, enough to keep us on
schedule with patients while some
handpieces are sterilizing. But, our
practice is still evolving and expanding,
and our KaVo handpiece collection is
growing along with us. I am excited
to say that we are building two new
operatories and will soon add two of the
latest model KaVo electric handpieces.
The KaVo Master Series has a unique
gear system, is quiet and has lowvibration, and is extremely durable. It
has a 1:5 transmission for the highest
power on the tooth and a maximum
operating speed of 200,000 rpm. This
will allow me to be more productive and
makes dentistry much easier.
All of these solid, well-built,
dependable, and durable handpieces
need maintenance, just like any other
handpiece, and for that we use the
KaVo QUATTROcare Plus. According
to KaVo, more than 70 percent of all
handpiece failures are due to insufficient
maintenance. For this reason, we
religiously use the QUATTROcare Plus
Introducing KaVo MASTERmaticTM
Small Yet Powerful.
system per manufacturer’s directions
every time we use handpieces.
It is consistent, efficient, and can
accommodate up to four handpieces
in one cycle. It automatically cleans,
purges, and lubricates the handpiece,
and all the assistant has to do is push
a button! The programming of this unit
is flexible, as we can choose and set
the total cycle time from 15-40 seconds
per handpiece. I believe this is one of
the reasons why we have had virtually
no maintenance problems with our
handpieces. Sterilizing is hard on
handpieces, so this is a welcome way
to eliminate mishandling or insufficient
care or maintenance.
Over the years, as a KaVo customer, I
have received phenomenal customer
service. Burkhart Equipment
Representative Steve Stimson and I
have worked together for 25 years. He
first recommended that I explore Kavo
handpieces back in the 1980s, and I
purchased them on his recommendation.
Years later, he and I discussed the solid,
well-built electric handpiece, and he
piqued my interest. He brought over a
demo; I tried it, and loved it. I appreciate
that he does his research very efficiently,
so when he recommends a product, it is
usually a winner.
Having an electric handpiece from
KaVo is like driving a Tesla — nice and
smooth. Want to try a test drive? KaVo
has a program called TryKaVo.com that
allows dentists to try their handpieces
free of charge for five days. You can just
select a handpiece from the website, try
it, and return it, or if you like it like I do,
buy it! This is a great way to try out these
handpieces that I consider the best on
the market for operation, reliability and
low maintenance.
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Go to TryKaVo.com to start your
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*Compared to GENTLEpower 25LPR
TM
30 // Burkhart dental supply
©2015 KaVo Dental Corporation.
1.011.3908/ rev01/ 06.15
OFFICE DESIGN
the
TANGIBLES
and
intangibles
g
OF A SUCCESSFUL OFFICE DESIGN
ood dental practices should be designed and developed with both
tangible and intangible qualities in mind. Certainly, the best equipment,
merchandise and ambiance are critical in delivering the best clinical
care. Nevertheless, a true desire to serve and care for both client and
patient, an unrelenting pursuit of knowledge and experience and a determination
to deliver the highest quality care are equally detrimental to a successful office
design. Prosper Dental Health in Prosper, Texas, offers a perfect example.
By Russ Cornelius
photos by Roger Hein
For eight years, Dr. Marisol Trautman lived in Prosper and dreamed of opening her own
dental practice there. After being introduced to Dr. Bill Gerlach, they soon realized they
shared the same vision and became business partners. Dr. Gerlach already had plans
in the works, and both doctors even had the same location in mind. They consulted
with Burkhart Account Manager Karen Glessner, who brought in Equipment Specialist
Stephan Nugent and together put into action the plans for Prosper Dental Health.
Dr. Gerlach: My background in dentistry actually started way back in high school. I
knew little about it—I had always been blessed with good oral health—but one of my
counselors asked me what I wanted to do with my life and I didn’t really know. Play
baseball perhaps? He linked me up with an orthodontist, I spent the day with him, and
that was it. From there I went on to Northwestern University where they have a program
in the engineering department for biomedical engineering that is a seven-year B.S.
DDS—three years in undergrad and then four years in the dental program. I did the
three years in undergrad, but then went on to Baylor Dental School where I met my wife,
who is also a dentist. I started as an associate in 1987 and had my first office as a solo
practitioner in 1990. I’ve been in many locations as the practice has grown, and along
the way I enjoyed dentistry more and more as it was delivered in a comprehensive
manner. To me, doing all the aspects of dentistry myself, in my office, was a
disservice to my patients. I felt the best thing I could do for my patients was to focus on
preventative and restorative care and let the other talented specialists in the area do
what they do. For the last 15 years, we’ve worked entirely in a comprehensive model.
Dr. Trautman: Unlike Dr. Gerlach, I had to go to the dentist a lot growing up. My first
32 // Burkhart dental supply
CATALYST MAGAZINE // Issue 3, 2015 // 33
OFFICE DESIGN
OFFICE DESIGN
Just take really good
care of people,
and the rest is going to be just fine.
– Dr. Gerlach
visit was at four years old, in Costa Rica where I was born and raised. My pediatric
dentist was wonderful. So I decided at four that I was going to be a dentist. I saw
him a lot and he started showing me his interesting cases through the years. When
the time came to choose what to do, it was very easy for me. Costa Rica is very
different from here, because even though it’s a seven- to eight-year program, you are
attached to the dental school the whole time. You are taking dental anatomy in year
one. I graduated in 1991 and in Costa Rica you have to work for the government for
a year. You can either go to the hospital to see adults, or you go with the Ministry
of Health and work on a mobile unit serving school-age children, which is what I
did for a year. But, at the same time, we opened a dental office of our own—so we
worked from 7 a.m. to 3:30 p.m. with the children and 4:30 to 9 p.m. in a private
office. We did that because we wanted to come to the United States. At the same
time, I wanted to learn more. So I sent off a bunch of applications and planned a
trip. I went to the schools the day after the applications were received and met with
them and was lucky enough to get in at Ohio State University. I had four cousins
there at the time, and it was a lot of fun having family in town. I graduated from
there in 1997, but I couldn’t work in the U.S. However, I could teach, so I applied for
teaching jobs. I got into Baylor as a teacher in the AEGD program. The timing was
great because they were going through accreditation, and having a specialist in
prosthodontics was really great for them. I knocked on the door at the right time.
After that my family and I went back to Costa Rica so I could start a practice from
scratch. I wanted to be a multi-specialty practice so we had a periodontist, an
orthodontist, an endodontist, a general dentist, and me. But I missed the States. I had
become an American in those six years, and my kids were born here, so we sold the
Costa Rica practice after four years. That practice is now one of the biggest practices
for dental tourism in Costa Rica. We came back to the U.S. in 2004 and I took a break
from dentistry that was supposed to last two years, but it turned into four. During that
time I had my third son, and I loved being a stay-at-home mom for a while. I got back
into dentistry in 2008, and by 2014 I had decided I wanted my own practice again.
34 // Burkhart dental supply
CATALYST MAGAZINE // Issue 3, 2015 // 35
OFFICE DESIGN
Before Dr. Trautman and Dr. Gerlach had even met, Dr. Gerlach was working
on a business plan to replicate the success he had at another location. The key
tenets were to have a high-quality practitioner and practice in an area with a
high potential for quality referrals. The city of Prosper fit the bill for a location
due to the high-quality specialists in the area and the potential for growth.
Dr. Gerlach decided the area had room for high-quality restorative care that
utilizes the highly trained specialists nearby. Those specialists agreed. The
business plan was complete except for the dentist. That all changed when Dr.
Gerlach was introduced to Dr. Trautman through a transition specialist.
Every time we needed something,
Burkhart was there for us.
Each person in each department really did a good job.
– Dr. Trautman
36 // Burkhart dental supply
Dr. Trautman had already lived in Prosper for eight years, and happened
to be looking for a practice to buy into. It was a perfect fit for the plan Dr.
Gerlach had put together. “From the initial meeting with Dr. Trautman, it
has all been water flowing downhill. This was really meant to be.”
The fact that Dr. Trautman was from Prosper has been very important to their success.
CATALYST MAGAZINE // Issue 3, 2015 // 37
OFFICE DESIGN
The connections she had made as a
person, not a dentist, proved invaluable.
Some advice they had been given was
to “make sure you are in the parade.”
So, they did just that. Literally. Before the
practice was even open, they created a
float and joined the homecoming parade.
Now that the final piece was in place, plans
for the new practice were ready to move
forward. Dr. Gerlach had a relationship
with Burkhart account manager Karen
Glessner for several years, so they turned
to the Burkhart team for office design and
equipment selection. Equipment Specialist
Stephan Nugent guided Dr. Trautman
through the selection process and
consulted with her regarding her options.
Together they spent time at the Burkhart
office looking at chairs and cabinetry.
Ultimately, they decided on A-dec for
their core equipment. A team approach
involving both doctors and the entire
Burkhart team made for a smooth process.
Pictured: Stephan Nugent (Burkhart Equipment Specialist), Tracy Madden (Office Manager), Dr. Bill Gerlach,
Dr. Marisol Trautmann, Karen Glessner (Burkhart Account Manager), Izabela Zaleski (Registered Dental Assistant)
38 // Burkhart dental supply
Once the practice was built, the perfect
team was put together. The goal was
to create a team that allows patients to
become familiar with the staff and have
a relationship with them as well. Isabelle
moved over from another practice to
become the dental assistant. The hygienist,
Tammy, is the daughter of one of Dr.
Trautman’s former patients. Tracey, the
office manager, actually approached them
about joining the team after working on
their website for them. It is evident that the
family approach has paid off. The team
works in perfect harmony and the future
looks bright for Prosper Dental Health. The
relationship-building, family-style approach
is a perfect fit for the local community—
and for a prosperous future as well.
C
M
Y
CM
MY
CY
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K
WEALTH MANAGEMENT
WEALTH MANAGEMENT
tune of $3,000 for an income tax
savings of $990 and a Medicare
tax savings of $114. The excess
is carried over to the following
year where it will first offset any
gains and otherwise be deducted
in the same fashion against ordinary
income resulting in similar savings.
DEATH AND TAXES:
Focus On What
You Can Control
PART II
by Sam Martin, MBA (Tax), CFP®, CPA
This article is Part II of ‘Focus On What
You Can Control.’ Read about
Part I in Catalyst Q2 2015.
there are insufficient funds to hold all of
your bonds in tax-deferred accounts.
T
Locate tax-efficient asset classes to your
taxable account. Generally, this will
consist of equity (stock) asset classes.
However, not all funds or strategies
are created equally. Actively managed
funds which buy and sell frequently
AX-MANAGING
YOUR PORTFOLIO—
TOOLS OF THE TRADE
1. Income Tax Location: If you have both
taxable accounts and tax-deferred accounts,
you have an opportunity to increase your
after-tax return by simply determining
where various asset classes should be
located. By utilizing the tax-deferred or
tax-free accounts to place tax-inefficient
assets, you avoid paying ongoing income
and healthcare taxes. Inefficient assets
classes include fixed income (bonds, bond
funds, CDs, etc.), real estate (REITs), and
commodities. These all pay out ordinary
income that would be taxed at your marginal
income tax bracket if held in your taxable
account. Further, couples making more
than $250,000 and single filers making more
than $200,000 are subject to an additional
3.8 percent Medicare tax on investment
income under the Affordable Care Act.
You might say, “But I could put taxfree municipal bonds in my taxable
accounts, and they would not be subject
to income or the 3.8 percent Medicare
tax.” True, but tax-free municipal bonds
pay significantly less than their taxable
equivalents. In fact, on average, taxfree municipal bonds trail their taxable
counterparts by 30 percent or more.
Consequently, individuals should only
own tax-free municipal bonds if they
are very high-bracket taxpayers and if
40 // Burkhart dental supply
Face it:
taxes bite.
Anything
you can
reasonably
do to reduce
taxes is a
good thing.
in order to attempt to pick mispriced
stocks and/or to time the market are
extremely tax-inefficient, as well as more
costly due to the frequency of trading.
preponderance of peer-reviewed
research (which includes Nobel
Prize-winning foundational
principles), you know that it’s not
necessary nor in your best interest
to invest in actively managed funds
or individual securities. Rather,
you will use index or asset class
funds that are very low cost and
tend to have very low turnover (i.e.,
very little buying and selling and
therefore very low taxable income).
To further increase portfolio tax
efficiency you can utilize tax-managed
funds where available. The manager
of a tax-managed fund goes to great
lengths to avoid taxes–especially
the short-term gains that are taxed at your
highest marginal tax bracket (plus 3.8
percent Medicare tax if applicable).
Oh, and asset location is important
for estate planning also. The federal
(and perhaps your state) government
looks at $5,000,000 in your IRA or your
taxable account in the same way for
estate tax purposes. However, if you
hold the appreciating assets in your IRA,
your heirs will end up paying ordinary
income tax on that appreciation. If the
appreciating assets (at least those that
are income-tax efficient) are held in your
taxable account, your heirs receive a
“step-up” in income tax basis and pay
no tax on the applicable appreciation.
2. Tax Loss Harvesting: The vast
Alternatively, if you have taken the time to
study evidence-based investing and the
majority of Wall Street firms and mutual
funds ignore income taxes on individual
investors. Why? Too much trouble. Some
advisors will take a peek at your portfolio
in November or December and perhaps
recommend selling a loss position or two
to offset gains taken earlier in the year.
In our case, we believe that Tax Loss
Harvesting is a 365 days per year activity.
Tax Loss Harvesting is the process by
which you purposely sell a loss position in
your taxable account in order to make the
loss deductible, regardless of whether you
have capital gains to offset. A capital loss
first offsets any capital gains and then you
can deduct up to $3,000 per year against
ordinary income. Let’s say a dentist in
the 33 percent tax bracket takes a $10,000
capital loss in her taxable account and
that dentist had taken a $4,000 capital gain
earlier in the year. The $10,000 loss will
first offset the $4,000 gain leaving a $6,000
loss. That offsets taxable income to the
Federal income tax law includes
the “Wash Sale Rule.” This rule
disallows the loss on the sale
of a fund or security if you
purchase the same
asset within 30
days before or after
the sale. This rule
might give you pause
if you felt being out of the
market for 30 days might be
more risky than the value of
taking the loss. However,
the law only forbids
purchasing a “substantially
identical” security or fund.
Consequently, you simply
replace the loss position
with another fund that
represents the same asset
class. This way you do not
have to be out of the market at all and
your portfolio allocation is maintained–yet
you still obtain the benefit of the loss.
Beyond the current savings a tax loss
may provide, banking long-term capital
losses can be very valuable. For example,
let’s say we implemented a portfolio a
few months ago including a $100,000
investment in the Large US Value Fund.
Today, we find that the value of that
fund has dropped to $90,000. We have
a paper loss of $10,000. What is our
expectation if we do not harvest the
loss? The expectation is that over time
the fund will appreciate not only back
to its $100,000 but also well beyond. If
we take the loss when it is $10,000 and
replace the fund with a similar fund our
expectation is exactly the same; however,
we obtain the tax loss and related savings.
Eventually, you will have capital gains
that you will need to take. If you own
a practice or rental property you will
eventually sell such assets, and having
banked capital loss carry-over will
reduce the tax owed at sale. Even if
you do not have such assets you will
eventually liquidate small portions of your
appreciated investments to create cash
flow during retirement. It is very nice to
have a bank of losses to offset such gains.
3. There are a number of other tax
management techniques, including
avoidance of short-term gains, utilizing
specific lot identification when selling
a portion of a position, utilizing taxmanaged funds where available, being
sensitive to mutual fund distribution
dates, and maximizing the advantages
when charitable giving opportunities
are desired—among others.
Even if you have only or mostly taxdeferred investments there is still
substantial tax planning to consider: Roth
conversions, indirect Roth contributions,
and ultimately how to best manage the
taxable income you will incur in your
withdrawals phase. We will devote
a future article to planning during
retirement—but investment tax planning
before and during the withdrawal
phase remain equally important.
CONCLUSION
Face it: taxes bite. Anything you can
reasonably do to reduce taxes (that is
otherwise in your best interest) and/
or optimize after-tax returns is a good
thing and something over which you
have a certain amount of control.
Keeping unnecessary taxes out of the
hands of the government, along with
a strong cup of French Roast, is what
gets me out of bed in the morning.
CATALYST MAGAZINE // Issue 3, 2015 // 41
HELPING DENTISTS REAC
EI OALS
 TAX PLANNING AND DVISORY ERVICES
 OS EGREGAION
 PRACICE PURCHASE AND TRANSIIONS
 RAEGIC BUSINESS PLANNING
 PRACICE MANAGEEN AND LINICAL
ERAIONS
 PRACICE ALUAIONS
 ORORAE, PARNERSHI, AND NDIVIDUAL
TAX PREARAION
 EIREEN PLANNING
 WEALH MANAGEEN
C
M
www.aktadvisors.com
Y
CM
MY
There Is No Substitute For
Dental Experience and
Financial Expertise...
CY
CMY
K
DentalGroup
LLC
Dental Practice Advisors
The Dentist’s CPA
(425) 216-1612
SM
SM
[email protected]
Integrated Financial Services
to Enhance Your Income and
Quality of Life
Members
www.adcpa.org
42 // Burkhart dental supply
BUSINESS OF DENTISTRY
BUSINESS OF DENTISTRY
the surrounding neighborhoods
stable or transitory? Are new
housing developments in the works?
How much competition do you
face? Do you have a competitor
that is ready to retire and you
could purchase their practice?
Are You Thinking of
Adding an
Associate?
by Megan Urban (Consultant), AKT ADVISORS
other considerations necessary when
bringing on an associate dentist.
a strategy for business transition
that makes sense for your patients
and your financial future. Having
an associate with skin in the game
allows you a couple of years to
potentially slow down, save more
money, add extended hours for
your patients, and prepare the
associate to improve skills and gain
business management knowledge
before taking over the practice.
Are you Ready?
Whether you’ve been thinking
about bringing another dentist
into the practice or not, there are
a few signs that suggest it’s time to
give expansion some serious thought:
W
hat should you do when your
skill, hard work, and passion
have resulted in a successful
practice? There are many experts that
claim the only way for you to make more
money is to add an associate. While
that can be true, some have leapt at the
opportunity to grow revenue by adding
an associate and (perhaps) opening
another office, often with disappointing
results. Unlike the “field of dreams,”
they built out their practice but the
patients didn’t come. Or they added an
associate and their income dropped.
This article helps practitioners look before
they leap by identifying the following:
early indicators for expansion, key factors
that impact financial performance, and
44 // Burkhart dental supply
•
You are scheduling new patients
out more than several days.
•
You aren’t able to keep pace
with periodic exams for
your hygiene patients.
•
You aren’t able to perform treatment
for patients in a timely fashion or
may not have availability for your
patients’ referrals. Both result in
a loss for your dental practice.
•
•
•
Your patients and/or team have let
you know your quality of service is
slipping and they are stressed out.
You are working longer hours and/
or more days per week than you’d
like, leaving you in bad health,
physically and emotionally, and
short on family or fun time.
You are contemplating retirement in
the not-too-distant future and need
Ideally, you’ll catch a glimpse of one
or more of these thresholds and start
the planning process long before you
bump into them. As noted below, you
need lead time to assemble your team of
advisors, consider your options, and set
the wheels in motion to move forward.
Preparing for Expansion
According to industry benchmarks, a
full-time dentist typically serves 1,8002,000 active patients on a sustained
basis. If you choose to add a full-time
associate, you need to sort out how
you’ll swell your patient ranks by that
amount. Some questions to consider:
•
Is the local market ripe for
expansion in dental services? Are
•
Given an effective marketing
campaign, what constitutes a
reasonable expectation for the
number of new patients that you
will attract each month? How might
you engage your current clientele
to stimulate referral business?
•
Are you prepared to transition some
of your existing patients to the
new associate? If so, how will you
manage your relationships such
that you maintain their loyalty to the
practice and promote trust
in the new associate? Is the
associate open to working
part-time as you work
together to build their practice?
As you forecast revenue associated
with adding a dentist, be mindful of the
fact that while an experienced general
practitioner may produce/collect $4,000plus per day, daily production for a new
graduate could be closer to $2,500. If
you have PPOs or Medicaid, you have
to allow for the associated write-off
to production that is uncollectible.
In addition to adding an associate, you
may also need to add a dental assistant
and hygienist to help the new associate
and take care of the increase in patients.
When fully occupied, each hygienist
should account for $1,200 to $1,500 in daily
revenue, at least 35 percent of total office
production, and they should produce
3-4 times their compensation. Hygiene
capacity is a good way to increase not
only hygiene production, but also the
dentist’s production due to the additional
diagnosed wanted or needed treatment
from all the added periodic exams.
Hygiene is patient retention but we often
see the continuing care part of the dental
software not set up and utilized correctly
which means patients are slipping through
the cracks. Before adding an associate it
is important to ensure this system is set
up correctly and is consistently utilized.
Beyond labor costs and associated
supplies, you may also need to make
a capital investment to provide two to
three operatories per full-time dentist,
depending on the type of dentistry being
done. Whether you expand your existing
office, move to larger quarters, start up,
or purchase an additional location, you
need to consider how the expansion
will be financed as well as the required
lead time until the new quarters are fully
operational. When working with your
CPA, consider asking them if you
could apply IRC Section 168
adjusted production for a recent
graduate is $52,500 for the month,
collections should be at least $51,450.
•
Your total accounts receivable
should be less than a halfmonth’s production, unless you
allow in-office payment plans.
•
Aged accounts receivable (i.g.,
90 days or more past due) should
be less than 5 percent of total
accounts receivable unless you
allow in-office payment plans.
If your statistics fall outside these
guideposts, focus on collecting
unpaid insurance and patient
balances while establishing effective
policies and procedures to set
solid financial arrangements and
keep your accounts current.
What should you do when
your skill, hard work, and
passion have resulted in a
successful practice?
or Section 179 to help you find the dollars
to reinvest in your dental practice.
Taken together, all of the foregoing
provides a baseline understanding of how
practice growth affects cash flow. You
also need to think about how these new
revenue streams impact your accounts
receivable. If you do not collect payments
in a timely fashion, service expansion
could further strain your resources.
Here are a few benchmarks to help
you gauge performance in this area:
•
You should collect at least 98 percent
of your adjusted production (i.e.,
total billings less all write-offs such
as insurance and courtesy). So, if
Once you’ve made the decision to
move forward with staff expansion,
there are a host of details to iron out.
A few considerations include:
•
Will the new associate be working
as an independent contractor or an
employee? The IRS has a specific
definition for independent contractor.
•
How will you compensate the new
dentist? What benefits should you be
prepared to offer or have to offer if the
associate is a full-time employee?
•
What type of agreements and
contracts are necessary to define
mutual responsibilities and
expectations, non-compete, non-
CATALYST MAGAZINE // Issue 3, 2015 // 45
BUSINESS OF DENTISTRY
solicitation, future potential buyin, termination details, etc.? Do
you have a solid office manual in
place to cover all other details?
•
Who pays for licensing, malpractice
insurance, continuing education,
and related expenses?
•
Will the new associate need insurance
credentialing and how long will that
take? Do you need to work with a former
employer to receive any insurance
payments that go to them in error?
•
Will this dentist complement you—
can they add procedures or services
that you do not offer so you can keep
that treatment in-house? Are they
able to work different hours/days,
such as evenings and weekends,
to provide extended patient hours?
Are they different in age or gender,
allowing your patients options
that make them comfortable?
Whether you choose to leverage fulltime or part-time staff for dentists, dental
assistants, and hygienists, think carefully
about your ideal candidates. Consider
the technical competencies and levels
of experience that complement existing
staff and/or bring more options to your
patients. Think about the personal
characteristics that best fit your work
style and enhance the patient experience.
You may get a sense for “fit” by asking
questions for which there aren’t ready
answers on a resume. For example:
•
If I asked you to write a one-page
memo about yourself that did not
include any of the information on
your resume, what would it say?
•
Which of your accomplishments
has given you the most
satisfaction in life? Why?
•
What’s the hardest life lesson
that you had to learn in your last
Think about the extent to which
each candidate’s skills, experience,
internal motivations, and personal
style align with the environment in
which he or she will work.
practice? In what ways have you
changed as a result of it? If we
asked the team and dentist at your
last practice to describe you, what
do you think they would say?
If the prospect of adding a full-time dentist
proves daunting, you could consider
options for instituting a gradual increase
in capacity. Possibilities include:
•
Finding dentists who want
to work part-time, such as
associates transitioning into
retirement, or young parents with
childcare responsibilities.
•
Hiring a part-time associate
who works part-time for
another practitioner.
•
Reducing your work schedule on
a temporary or permanent basis.
46 // Burkhart dental supply
•
What kind of practice are you
looking for? What motivates you to
give your best effort to take care of
your patients and lead your team?
•
Describe one or more situations
that occur frequently in the
position that you seek to fill. How
would you handle it/them?
•
What would you say are the top three
to five characteristics that make a
dental practice successful? Which
of your personal characteristics
contribute to that success?
•
What specific goals have you
established for yourself in the
next two years and ten years?
Think about the extent to which each
candidate’s skills, experience, internal
motivations, and personal style align with
the environment in which he or she will
work. Are they in accord with your plans
and expectations? How will your team
and patients respond? Do you think this
individual will find the position satisfying?
Seeking Professional
Advice
Experienced practice management
professionals can provide the
guidance and analytical support to
assess your business opportunities
and craft a plan consistent with your
unique circumstances, timetable,
and goals. They’ll provide detailed
recommendations to strengthen
your current operation while setting
realistic expectations for your financial
performance going forward. They’ll
also outline the up-front investment
necessary to achieve growth.
While a successful practice provides the
foundation for growth, the right team of
advisors helps you build a solid future.
Megan Urban (Consultant), has been serving
the dental industry for over 25 years. She
began her journey as a dental assistant and
ultimately became a Regional Manager for
a large dental group. She has an extensive
background in helping dental teams reduce
stress and become more profitable, by
locating areas of opportunity and helping
set solid systems within the practice.
Her clients appreciate that she customizes
their plans to their practice so they can easily
maintain them and have continued growth.
She also assists her clients in buying or selling
their practices. You can reach any one of
our team members at [email protected].
WHAT KIND OF OPPORTUNITIES ARE
IN YOUR WAITING ROOM?
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IMPLANTS
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What are you capable of with
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Call 800-558-6120 to supercharge your practice.
www.instrumentariumdental.com
There’s strength
in numbers.
A-dec is honored that we have been selected as dental’s top
choice for decades. But of all the facts we can share, the most
important is helping doctors perform better dentistry—today
and far into the future.
#1 choice of dentists in the U.S. and Canada—more than
the next three competitors combined.
#1 A-dec’s industrywide ranking for reliability,
service and value.
62 Townie Choice Awards , since their inception
®
in 2003, have recognized A-dec products as
“Best in Class.”
85% of the dental schools across the U.S. and
Canada are equipped with A-dec. Worldwide, more
schools and government facilities select A-dec than
any other brand.
Together, we’ll only get better. Call 1.800.547.1883 or
visit a-dec.com to learn more.
Based on research by Strategic Data Marketing.
Dental product categories include chairs, delivery
systems, lights, and cabinetry.
© 2015 A-dec Inc.
All rights reserved.