Four Quadrants Advisory

Recent Posts

The Insurance-Free Dental Practice - Is it Fantasy or Reality?

Posted by Four Quadrants Advisory on Thu, Dec 19, 2013

qdpThis guest blog post was written by Dr. Dan Marut of Quality Dental Plan and Naomi Cooper of Minoa Marketing.

As a health care provider, it’s frustrating not to be able to help people because of perceived affordability issues. Most dental patients are effectively trained to understand their dental insurance based on the comprehensive/catastrophic medical insurance model, where there may be a small copay or deductible, but beyond that, everything within reason is “covered.” Many patients don’t realize that in contrast, dental insurance is neither comprehensive nor catastrophic, but rather a defined benefit program with high administrative costs and bureaucracy. And because dental insurance maximums are so low, having hardly changed in the past 20-30 years, insurance ends up effectively limiting treatment rather than facilitating it.

What you may not know is that your patients are confused by this not so subtle difference between medical and dental insurance. The medical insurance model has taught them to believe that if insurance doesn’t cover it, it must be unnecessary, discretionary, experimental or exploitative. And they’re secretly resentful that they’ve paid high dental insurance premiums and still have to fork out additional out of pocket costs; it just doesn’t seem fair compared to how their medical insurance works.

I created Quality Dental Plan to help patients get past that hurdle – and to allow them to feel as if they truly “belong” in your practice. QDP is a dental savings plan within your practice that incentivizes preventive care. It allows you to help patients say yes by giving them “benefits” that are available exclusively within your practice, regardless of whether they have insurance. Beyond that, patients have the freedom to choose a provider of your caliber rather than be forced to select from the insurance provider list, and QDP helps your patients know up front what their out of pocket costs for preventive dental care will be.

The most important thing to remember is that Quality Dental Plan isn’t dental insurance. Rather, patients pay a simple, set annual membership fee directly to their local dentist, bypassing the third party entirely. In return, they receive a preventive dental care package for the whole year at that dental practice. There’s also a further savings for additional family members, and patients also save on any treatments (restorative, cosmetic, implants), with no limit, and no deductible.

Meanwhile, QDP member dentists remain in control of their own practices, choosing their own QDP membership fees, setting their own fee schedules, and keeping 100 percent of what they collect, including their membership fee

Another exciting part of the program is the host of positive changes that tend to happen after a dental practice begins offering QDP to their patients. First, word of mouth referrals increase because of the excitement QDP creates among patients. Next, new patient value increases because case acceptance goes up. Recall intervals begin to tighten up and revenue increases. Collections increase because more services are paid for in advance to take advantage of member discounts. Predictable, recurring annual revenue is created so cash flow improves. Patient loyalty is fostered, and both referrals and long-term patient value increase dramatically as a sense of belonging and value are created in the practice.

At the end of the day, an in-office dental membership plan has huge benefits to a practice, but implementing one on your own takes a lot of time and focus – resources that are likely better spent on patient care and running the practice. It took me three years of experimenting, learning and refining to figure out how to make QDP run seamlessly. By working with us, dentists get to eliminate all that trial and error and leapfrog ahead to a tried-and-true system that is customized for their individual practices.

As a result, QDP member offices can skip the time, money and energy that I invested creating web sites, consulting legal counsel, crafting advertising and marketing materials, conducting market research, hiring copywriters, designers and public relations professionals, and soliciting feedback from patients. QDP is a turnkey solution that doctors can put into place right away, while they use their own time, energy and expertise to treat patients.

Another benefit of working with QDP is the extensive resources we provide. We make available a comprehensive implementation guide, including checklists with all the steps dentists need to get started, as well as live training and video tutorials. We help promote the membership plan to a dentist’s patient base with professionally designed marketing materials and advertising templates – all of which can be tailored to the practice. We even employ a full-time PR team to that can help practices get exposure in local media and attract more new patients, and offer geographic exclusivity so you know that you’re the only dentist in your area who can offer QDP in the practice. In short, QDP lets dentists easily implement a plan proven to increase revenue, loyalty and collections without taking time away from patient care.

Dr. Dan Marut, DMD founded Quality Dental Plan to connect dentists looking to make a difference in their communities with new patients while giving people without dental insurance a compelling reason to go to the dentist. He is also the founder of, a sought-after lecturer and a published author. Dr. Marut is committed to giving back to his community and the world through his profession, and founded his practice and both of his companies with that vision in mind. For more information about QDP, visit Dan can be reached via email at or by phone at 888-960-1221.

Naomi Cooper is President of Minoa Marketing, a dental marketing and social media consultancy based in Los Angeles, CA and also serves as Chief Marketing Consultant for Pride Institute. Naomi has over fifteen years of marketing experience – and a decade-long track record of enabling dental practices and dental companies to achieve their marketing goals. Naomi is a published author, a sought-after speaker and an industry opinion leader. She can be reached via e-mail at For more information, visit

New Call-to-Action

Read More

Topics: dental advisor, Financial Planning

Telephone Skills in Dentistry: What You Don't Say Means More

Posted by Four Quadrants Advisory on Thu, Dec 19, 2013

larryThis guest blog post was written by Larry M. Guzzardo, author and expert in practice management solutions.

Dentistry is part art, part science, but all about people. In dental school, the “people” part of the equation was overlooked, and it takes a number of years in practice to realize it’s importance. Dentistry is a service business, and communication is paramount to its success. Communication, by definition, is “the exchange of ideas, messages, or information.” It is not tangible. In fact, communication is one of the most dynamic elements of the human condition. Effective communication begins with listening and opens the door to understanding.

You’ve heard many times before, we come into this world with two ears and one mouth and we should use them in that same proportion. In conversation, this simply means that you should listen twice as much as you talk if you want to get a reputation for being an enjoyable person with whom to converse.

The art of a good telephone conversation centers very much on your ability to ask questions and to listen attentively to the answers. You can lace the conversation with your insights, ideas, and opinions, but you perfect the art and skill of conversation by perfecting the art and skill of asking good, well-worded questions that direct the conversation and give other people an opportunity to express themselves. Ask open-ended questions that cannot be answered with a simple “yes” or “no.” Open-ended questions encourage your patients to expand on thoughts and comments. And one question will lead to another. You can ask open-ended questions almost endlessly, drawing out of the caller everything that he or she has to say.

In order to be an excellent conversationalist, you must resist the urge to dominate the discussion. The very best conversationalists seem to be low-key, easy-going, cheerful, and genuinely interested in the other person. They seem to be quite content to listen when other people are talking and they make their own contributions short and to the point.

In fact, good conversation has an easy ebb and flow, like the tide coming in and going out. Whether it is between two people or among several, the conversation should shift back and forth, with each person getting an opportunity to talk. Conversation in this sense is like a ball that is tossed from person to person, with no one holding on to it for very long. Listening is the most important of all skills for successful conversation. Many people are very poor listeners. Since everyone enjoys talking, it takes a real effort to practice the fundamentals of excellent listening and to make them a habit.

There are the four major rules for active listening in a conversation. They are powerful, practical and proven techniques to increase your influence with other people dramatically. The first key to effective listening is for you to listen attentively, without interruptions. When you pay close attention to another person, you convey to that person that you very much value what he or she has to say. Individuals you are speaking to find this very flattering, and they will respond warmly to your attentiveness.

The major reason why most people are poor listeners is that they are busy preparing a reply while the other person is still speaking. In fact, they are not even listening closely to what the other person is saying. We act very much like boxers waiting for the other person to let their guard down so they can jump in with a quick verbal punch and take over the conversation. In addition to listening without interrupting, you should give the speaker a few verbal cues every now and then to indicate you are listening. Be active rather than passive. Indicate that you are totally engaged in the conversation. Say things like; “Oh”; “Hmm”; or “I see”. The second key to effective listening is to pause before replying. A short pause, of three to five seconds, is a very classy thing to do in a conversation. When you pause, you accomplish three goals simultaneously.

First, you avoid running the risk of interrupting if the other person is just catching his or her breath before continuing. Second, you show the other person that you are giving careful consideration to his or her words by not jumping in with your own comments at the earliest opportunity. The third benefit of pausing is that you will actually hear the other person better. His or her words will soak into a deeper level of your mind and you will understand what he or she is saying with greater clarity. By pausing, you mark yourself as a brilliant conversationalist.

The third key to effective listening is to question for clarification. Never assume that you understand what the person is saying or trying to say. Instead, ask, “Let me see if I understand you correctly. Can you explain that again?” This is the most powerful question I’ve ever learned for controlling a conversation. It is almost impossible not to answer. When you ask, “Can you explain that again?” the other person cannot stop himself or herself from answering more extensively. You can then follow up with other open-ended questions and keep the conversation rolling along. The fourth key to effective listening is to paraphrase the speaker’s words in your own words. Start like this; “Let me see if I’ve got this right. What you’re saying is . . .”

By paraphrasing the speaker’s words, you demonstrate in no uncertain terms that you are genuinely paying attention and making every effort to understand his or her thoughts or feelings. And the great thing is, when you practice effective listening, other people will begin to find you fascinating. They will want to be around you. They will feel relaxed and happy when they are in contact with you.

The reason why listening is such a powerful tool in developing the art and skill of conversation, especially on the telephone, is because listening builds trust. The more you listen to another person, the more he or she trusts you and believes in you.

Listening also builds self-esteem. When you listen attentively to another person, his or her self-esteem will naturally increase. Finally, listening builds self-discipline in the listener. Because your mind can process words at 500-600 words per minute, and we can only talk at about 150 words per minute, it takes a real effort to keep your attention focused on another person’s words. If you do not practice self-discipline in conversation, your mind will wander in a hundred different directions. The more you work at paying close attention to what the other person is saying, the more self-disciplined you will become. In other words, by learning to listen well, you actually develop your own character, your own personality, and become more like-able.

These are my best pointers to help you listen better on the telephone.

Stay focused. Prevent yourself from being distracted by other staff members or external noises and concentrate on what your caller is saying.

Detect emotions. Listen to the emotion in your caller’s voice. Does it match or endorse the words they are using?

Ask questions. Ask questions to gain more information on points you need to clarify.

Don’t interrupt. You listen more effectively when you’re not talking, so refrain from interrupting your caller. Let them finish what they are saying; interruptions may break their train of thought.

Don’t pre-empt. Avoid pre-empting what your caller is going to say, chances are you will be wrong and miss some of the content of their conversation.

Paraphrase key facts. Paraphrase and reflect back to check you have heard the key facts and content of the caller’s conversation correctly. It also lets the caller know you have understood them. Statements such as “What I’m hearing is…” and “Sounds like you are saying…” are great ways to reflect back and paraphrase.

Pen and paper handy. Have a pen and paper on hand and get into the habit of making short quick references to any questions you want to ask or points you wish to raise or comment on. When your caller has finished speaking refer back to your notes and take action. If you are thinking of answers and responses while the caller is speaking, you are not listening.

Say it again. If you are having difficulty listening, make the necessary adjustments. You might say, “I’m afraid I missed that last point. Please repeat that for me.”

Watch the stereotypes. Avoid stereotyping individuals by making assumptions about how you expect them to act and what you expect them to say. This will bias your listening.

Be aware of the barriers to listening

  • We think we’re right and the other person is wrong
  • We feel we have to provide help right away
  • We prefer to talk rather than listen
  • We are waiting for gaps or pauses to jump in with our response

Larry M. Guzzardo who has co-authored two books, “Powerful Practice” and “Getting Things Done” conducts in-office practice management consultations exclusively for dentists to enhance trust, create organization, increase profits, and to develop patient relationships that last. Larry has presented numerous workshops including, “Winning Patient Acceptance,” “Business Communication Systems,” and “The Leadership Challenge.” Larry can be reached at 800-782-5770 or if you have further questions.

New Call-to-Action

Read More

Topics: Financial Planning, business of dentistry

How to Adapt to Changing Trends in Dental Practice Accounting

Posted by Four Quadrants Advisory on Thu, Dec 19, 2013

closedSometimes it’s hard to believe that well-known, American brands are no longer here – or on the way out. Companies and products that include Blackberry, American Airlines (stay tuned), Talbots, and Woolworths are just a few examples. Jon Baron, president of the highly respected tax and accounting giant Thompson Reuters, says “the trouble stems from a reluctance to migrate away from a business model that worked well in the past, or from a desire to protect customers from the confusion that a change might cause.”

People don’t adapt to change well. Unfortunately, in this digital age, change is constant, and keeping up with the advantages of technology can be a challenge and a blessing. For example, Jon Baron’s company developed a secure and safe way to put Quickbooks on a “clouded” server so a CPA and client can work and share in real time. Here at Four Quadrants Advisory, we take advantage of that innovation for our dental accounting.

The benefit to the dentist is seeing errors or dental practice accounting trends quickly and clearly. Dental offices, like big business, must always evolve and embrace technology as they go. Companies like Curve Dental that are putting dental software on the cloud, and Ads Next, advancing dental websites and healthcare marketing, are just two examples. As Baron says:

I know change can be a difficult thing, whether it's a new tax law, the transition to the cloud, or just a new user interface. But one thing I like about the software business for our profession is that change rarely happens for its own sake. Major changes stem from real innovation, and from new ideas about how to be more productive, more flexible, and more efficient. And in this business, those new ideas can go from concept to implementation very quickly.
All that change can be unnerving to some. But it also gives us a unique opportunity to see and shape the future, to make every day more productive, more efficient, and more profitable than the last. And if that's not a good reason to get up and come to work every morning, I don't know what is.

In this age of the Internet and the global economy, understanding how technology can help a business while still protecting individuals’ privacy is paramount. Thompson Reuters leads the industry with secure, HIPPA compliant “clouding” technology that enables advisors and dentists to share, communicate, and plan for change – in real time.  They will continue to evolve and take on new technologies with the risk that it doesn’t always work out perfectly.

Whether you are contemplating CAD/CAM, digital technologies, cloud computing, or the vast universe of complex internet marketing, push your business to the edge – not over the cliff – and don’t be afraid to evolve and change. Your legacy depends on it.

New Call-to-Action

Read More

Topics: dental financial planning, dental software, dental accounting, Financial Planning

9 Ways Dentists Can Stop Fraud Today

Posted by Four Quadrants Advisory on Thu, Dec 19, 2013

hackingThis guest blog post was written by David Harris and William Hiltz of Prosperident, North America's foremost experts on dental fraud.

Fraud takes place in dental offices far more frequently than most dentists realize – published statistics suggest that the chance of a dentist being defrauded in his or her career exceeds 60%, with an average loss of over $100,000.

When fraud in your practice becomes apparent, emotions like anger, despair, guilt and, in some cases, even fear are common. All of that, and a desire to act – when a dentist suspects embezzlement, there is a strong urge to deal with the problem immediately, usually by confronting the suspect.

This urge to take action, combined with a dentist’s likely inexperience in matters relating to fraud, often results in missteps that often can worsen their position. These missteps can lead to destruction of evidence, wrongful dismissal lawsuits, denied insurance claims, and failed prosecution. Don’t make things worse. Instead:

1. Stealth is paramount. This is so for several reasons – normally at this point fraud is suspected but not confirmed.

If there is no fraud, it is far better that staff members are unaware that the dentist had a “crisis in confidence” in them. But if fraud is happening and the thief thinks that you’re onto them, their normal inclination is to take steps to destroy evidence.

If a theft is taking place, the best outcome for the dentist will be achieved by preserving evidence, conducting a quiet (stealthy) investigation and confronting the thief only when fully prepared.

2. That investigation should not be done alone. Obtain professional advice. Some dentists approach fraud investigation as a do-it-yourself project. Given that the dentist typically does not know what to look for, self-guided fraud investigation is likely to accomplish little other than tipping off the fraudster.

At this point, knowing where to turn is vital. What is needed is expertise in investigative techniques, fraud methodologies specific to dentistry, evidence preservation and knowledge of dental software. At this juncture many dentists consult their CPA, their attorney, law enforcement agencies, or their dental software vendor. All of these people can offer some help, but each typically lacks an element necessary to properly guide the dentist forward.

When engaged, an experienced fraud investigator should take charge of the process and coordinate the work of the other actors involved.

3. Preserve evidence. Your computer’s hard drive contains a cornucopia of information that will be needed to confirm the fraud, quantify losses, prepare an insurance claim, and proceed with prosecution. But this information is volatile and can be deliberately erased or overwritten by the normal activities of your dental software. It is absolutely vital that the computer-based evidence be preserved. Normally this is accomplished by performing a backup that is not “rotated” like most backup media. In certain cases, we also perform a procedure known as “ghosting” a hard drive – this makes an exact copy of an entire hard drive including working or “temporary” files that are not normally captured by a backup, but may contain important information. We also typically move a complete copy of your dental software onto one of our servers so that we can both preserve and study it.

Dental software vendors make continual improvements to their software. A common recommendation of vendors, if contacted with concerns about theft, is to upgrade your software to the latest version. This is probably not a good idea in most cases. Forensic investigation often involves retracing the steps of the perpetrator, and this is made complicated if the software has changed.

4. Do not place “bait” (e.g. put an extra $20 in the cash to see if it goes missing). Employees who target their dentists often perpetrate sophisticated frauds involving tens or hundreds of thousands of dollars. If you were doing this and the dentist offered a (fairly transparent) chance to demonstrate your honesty by returning the $20, wouldn’t you give it back? Also, if the money does disappear, you won’t necessarily know who took it.

5. Do not change financial protocols. Looking to make changes without being able to explain the rationale will certainly be seen through by a thief.

6. Do not report the incident to police until you have sufficient evidence to confirm fraud. Making a police report before you have gathered all the evidence serves no purpose and may limit your options in dealing with a thief.

7. Do not confront the suspect. There will be a time when this is appropriate – our success rate in obtaining confessions from thieves is 100%, but it requires careful preparation.

8. Do not contact insurance companies. If a theft involves obtaining extra funds from insurance companies, the insurance company may have recourse against the dentist for amounts misappropriated. Some insurance companies will provide agreement not to hold the dentist vicariously liable in situations where the dentist had no involvement in the theft, but this amnesty needs to be set up correctly, with an intermediary approaching the insurance company on behalf of an unnamed client.

9. Whatever you do, don’t fire anyone until evidence has been gathered. The amount the employee may steal from you in the few weeks that it will take to complete an investigation pales in comparison to the cost of a wrongful dismissal lawsuit.

If you suspect, right now, you might be a victim of fraud in the dental office, contact us at

David Harris B. Comm MBA CMA FICB CD TEP and William Hiltz MBA CET can be reached at (888) 398-2327, Skype ID prosperident, and

Prosperident is North America’s only company specializing in the prevention, investigation and remediation of frauds against dentists. The authors have been involved in many fraud investigations, have acted as expert witnesses in court cases and are regularly consulted by law enforcement agencies on the topic of dental fraud. They have also spoken at regional, national and international dental conferences on the subject of fraud against dentists.

New Call-to-Action

Read More

Topics: dental accounting, Financial Planning, dental computing

The Future of Dental Accounting is in the Cloud

Posted by Four Quadrants Advisory on Thu, Dec 19, 2013

cloudHave you heard of cloud computing? Have you checked your credit card or bank account balance online? Do you have an iPhone? Do you use iTunes, Gmail, Facebook, or Netflix? Have you used Dropbox or some other file sharing company to move and store important information? Maybe you’ve read articles in the latest dental journals about cutting-edge dental software like our friends at Curve Dental. If so, you are a veteran cloud user and may not even know it.

Clouding QuickBooks is the future of dental accounting. Do you get frustrated by sending a backup copy of QuickBooks to your accountant, only to receive untimely feedback two or three months later? We call that “driving while looking in the rear-view mirror.” That archaic process doesn’t allow you to have real-time financial data on your dental practice and it prevents you from making positive changes quickly enough. Constant tweaks are essential to becoming more profitable without producing more. That is exactly why clouding QuickBooks is so important. It enables you and your accountant to work in your QuickBooks file at the same time, obtaining real-time data and making real-time changes in your dental business.

Analyzing deep swings in variable expense, like lab fees, is another good reason for clouding. With the dentist and their CPA/advisor accessing the bookkeeping in real time by logging into through the cloud, you can achieve fast and accurate reconciliation of profit/loss and balance sheets. Because you also scan all your lab invoices to the clouded server, your advisors can look at the invoice level and help determine the reason for increases and offer some analysis to consider, rather than having to settle for speculation. Technology allows for fast reconciliation which leads to more accurate and timely advisement on how to improve the business.

Another great reason for clouding is accounting security. Did you know that three out of five dentists experience some type of fraud in their practice? Removing check writing capabilities from your office server is one way to prevent unauthorized use of your practice funds. Years ago, I discovered that an office manager was maintaining two sets of QuickBooks files on the office server. One file was there to print fraudulent checks while the other was to record fake payments. This fraud risk is removed when the check writing authority is removed from the practice and put in the cloud.

Only authorized users are allowed access to the ultra-secure cloud partner, Right Networks, a Thompson Reuters product. Furthermore, we can limit their access to QuickBooks functions with the available security features. For example, you can customize it so an office manager can only enter bills when they are due. This allows you to match statements and invoices to bills entered and pay them directly from QuickBooks – very efficiently. Or you might want to manage the bills yourself. Either way, we can set appropriate security levels.

The future is cloudy, but we think cloudy is bright. Are you ready?

New Call-to-Action

Read More

Topics: dental software, dental accounting, Financial Planning, dental computing