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Introduction
As the COVID-19 crisis emerged, practice production consulting firm Levin Group shifted all its energy to helping the profession in any way possible. "Our focus has been on designing models and high-value strategies to help practices navigate the recovery phase and move back to operational and financial health, wrote Dr. Roger P. Levin, Founder and CEO, Levin Group, Inc. "We have launched a COVID-19 Recovery Resource Center on our website, participated in dozens of webinars and produced numerous articles and blog posts on the topic. We hope the answer to these questions will be a benefit to endodontists."

The AAE recently conducted a Q&A interview with Dr. Levin to get his insights on what the recovery process might look like for endodontists, and what they can be doing right now to ensure they can recover properly.

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Join Us May 4 at 6 p.m. CST for a Webinar With Dr. Levin

Dr. Levin will present specific management and operational steps to take now, and outline systems to put in place during the recovery phase once practices reopen.

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What can endodontists do to increase awareness that they are open to treat patient emergencies?

In any type of crisis and certainly the COVID-19 crisis, where most dental practices had to shut down other than for emergencies, one of the most important factors is communication. In a crisis of any kind the most important leadership principle is communicate, communicate, communicate.  

Here are three specific suggestions for endodontists regarding communication and playing a leadership role in the COVID-19 crisis:

  1. Communicate weekly with referring doctors. Reach out to them by email or short informal videos letting them know that you were thinking of them, wishing them safety and health and updating them on emergency protocols. Give them specific contact information and make sure that office phones are answered live every day during normal operational hours so that referring practices feel it is easy to reach the practice, make a request and schedule an emergency accordingly.
  2. Endodontists should communicate daily with their teams. This is a time to stay very close to the team. Levin Group suggest that you contact them daily, again with short emails or informal videos, and that you speak to each team member one on one weekly. This is a time for compassionate leadership which means that the leader is showing interest and caring for other people. Never in our lifetimes has there been a greater need for compassion. The conversations do not have to be about business. They can be about checking in, exchanging stories, answering questions and wishing everyone well. When communicating one of the most important factors in a crisis is honesty. Share what you know, but also be comfortable sharing when you do not know.
  3. Patients may want to contact the endodontic practice directly. If the phone is answered live then a staff member who is trained to handle scheduling or communication will have no problem helping the patient through the process. It will be important to have excellent scripting that includes comments on safety and financial options. Keep in mind that in the COVID-19 crisis we have both a health scare and an economic downturn. There are patients who will be seeking help from endodontic practices but may have anxiety about their health or financial challenges. Each practice will have to make an individual decision about how it will handle financial options going forward.

What can practices do to help maintain or preserve cashflow during uncertain times like these?

As we emerge from COVID-19 all dental practices will be facing a classic business turnaround. Fortunately, there is excellent academic science on how to successfully work through a business turnaround. Cash or cash flow maybe the single most important factor that will allow any business including endodontic practices to survive and move back into profitability. Unlike other practices in dentistry many endodontic practices have seen a higher number of daily patients as most root canal procedures can be deemed emergencies.

It is still important to recognize that all practices, including endodontic practices, will be facing a business turnaround. In a business turnaround the single most important factor is revenue. If the practice generates enough revenue it will lead to the accumulation of cash. And cash means survival and profitability. Levin Group is now recommending that practices, upon re-opening, gradually accumulate four months of cash over 12 to 18-month period. The rationale behind this recommendation is that we do not know if COVID-19 will re-emerge or any other factors will have a negative impact on the endodontic practice. Businesses and practices with cash will survive and be successful. Those without cash will either have doctors reaching into their personal savings or will not be able to continue if expenses cannot be covered. Keep in mind the cash that is placed into reserve and never used can be converted into income later. This is a very likely scenario for many practices.

There is an old expression that cash is king. It may be old, but it is also as true today as it was whenever it was originally stated. Businesses with cash will be fine. They will have cash to cover expenses. They will have cash to pay their team. They will have cash to invest in the resources that will help them through the recovery. It will come as no surprise to any endodontist that as we emerge from the COVID-19 crisis that general dentists will be treating more root canal cases in order to generate revenue for their practices. Many will be in very challenging financial positions. As this occurs there will be fewer referral referrals to the endodontic practice. We estimate that for some endodontic practices this could be as high as 20%. Cash will be the key factor that will allow endodontic practices to move through the recovery.

What steps can endodontists and their practice take to help ensure they recover? If they’re not currently open or limited to only treating emergencies, what can endodontists expect when they reopen their practices?

When practices reopen it will not be business as usual. In order to understand the recovery for endodontic practices we built specific models that can be applied to the recovery. Levin Group has identified 3 phases of a practice recovery timeline that almost all practices will go through. The three phases are:

  • Phase 1: months 1-2 – characterized by  pent-up demand
  • Phase 2: months 3-5 – characterized by decreasing production
  • Phase 3: months 6-12 – recovery

Each practice, upon re-opening should experience significant pent-up demand. Unfortunately, this will be followed by decreasing production in almost all practices as the pent-up demand is completed. The reason for the decrease will be patients who are afraid to come to the practice, patients who are financially challenged and in the case of endodontic practices referring doctors completing more root canal’s in order to generate revenue for their own practices. We saw evidence of this in the 2008-2009 recession.

The single best strategy for endodontists is to launch comprehensive referral marketing campaigns. These need to focus on three components of a successful referral marketing campaign which include recognition, relationship building and referring doctor success. The last one is a new component where endodontic practices can contribute specific education and tools to their referring practices to help them recover faster. Not only will this increase referrals, but as those practices increase production they will tend to refer more endodontic procedures. Start to think of referring doctors as primary customers of the endodontic practice. Customers are also one of the most important factors in recovery. Do you want to enhance your relationship, but we are possible contribute to their recovery and success. Great companies know that if they make their customers more successful they will be more successful as well.

One of the best actions you can take is to complete a one-page COVID-19 Strategic Recovery Plan. This is one page broken into four quadrants. The quadrant categories are Practice, Staff, Patients and Financial. You then select a maximum of four high-value strategies per category. These are the strategies that will ensure the practice has a strong reopening and recovery. I believe this is the most critical exercise to have ready and review every day upon reopening. It is the best friend of a business turnaround. For more information, and a template, go to levingroup.com and into the COVID-19 Recovery Resource Center to learn more about the one-page COVID-19 Strategic Recovery Plan (all resources are free).

When practices reopen, do you see physical, structural or behavioral pattern changes? In other words, will waiting rooms or lobbies need to remain reconfigured to fit social distancing guidelines? Will patients be limited to how many guests they can bring with them? Etc. ...

At the time of answering these questions nobody knows exactly what new regulation will be emerging for dental practices. There are many rumors ranging from air filters to negative pressure environments to wearing full disposable gowns. There are rumors about how many patients will be able to be seen at a time, how much time will be required in-between patients per chair, how many patients will be allowed in the reception room and so on.

In order to be responsible I have gone out of my way not to comment on what we don’t know. Most of the above we don’t know. But here are what I believe the trends may be…

  1. The cost of PPE will be higher. We are encouraging doctors to charge infection control fees of approximately $15 unless not allowable by a specific insurance plan contract. There are a few plans that are currently covering a PPE fee during the COVID-19 crisis, but it is undetermined how that will play out once practices reopen.
  2. There will be fewer patients allowed in offices in a given time. This means that the volume of patients for some practices will be lower. This will put pressure on production and revenue making the recovery possibly more challenging or longer. New management systems designed with high efficiency and excellent scripting will be essential to drive revenue and cash.
  3. Teledentistry will become more integrated into day-to-day activities. It may have many uses, but one of the most common will be for postoperative patients, where appropriate, in order to avoid having them come to the practice and  reduce unnecessary chairtime and overhead that can be dedicated to more productive procedures. Each office will have to make its own choices and there is no consistent pattern of state by state approval or insurance reimbursement.
  4. The time, training and cost of all infection control will increase. Staff members will need to be trained in new methodologies of infection control practices based on new guidelines and we do not yet know what they are.

There will be other changes beyond these, but these seem to be the most common. Will we be asking patients to wait in their cars until they are called into the office? Will we be attempting some level of diagnosis, even preliminary in endodontics by teledentistry? Will it be necessary to work evenings and weekends long term in order to accommodate patients who have used up their vacation time and PTO? These and many other questions are yet to be determined.

As I’ve stated in many webinars over the last six weeks: “we don’t know at this time more than we do now.” That is still the case, but gradually will get more information and be able to react to it appropriately. The only thing we can be sure of is that it will not be business as usual.