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Published by Viva Concepts, 2018-12-07 11:55:19

Hygiene Residual Course Inspiration


The Masters of Marketing Administration is an educational advancement for training of business owners and their administrative and support staff on the Viva System—a system that puts in place the
ideal residual business model for consumer
acquisition, loyalty and retention.
Copyright © 2018 by Gregory Hughes, Viva Concepts, LLC. All rights reserved. This book or any portion thereof may not be reproduced or used in any manner whatsoever without the express written permission of the publisher except for the use of brief quotations in a book review. Printed in the United States of America. Second Printing, 2018.

Overview of the Viva System
Every business in existence operates on precise laws. The laws are the same in every business regardless of the type of business. A hair salon, Starbucks, Victoria Secrets, Macy's or a local donut shop all operate on the same laws. Knowing these laws will give greater understanding of the business side of the practice.
The 4 Business Laws:
1) Consumer Acquisition: Every business will always have to acquire new consumers to continue to expand. Why? Because existing consumers are lost every month from the company’s database.
2) Consumer Sales / Case Acceptance: Once a business acquires a consumer the business has to sell its service(s) or product(s). In the dental office we call this Case Acceptance.
3) Consumer Retention: Once the consumer has purchased something then that same consumer returns for future purchases or services. It means “keeping” the patient.
4) Positive Experience: Positive experience is powerful because referred patients cost virtually nothing to the practice owner while new patients acquired through marketing efforts usually cost around $300 per new patient.
As seen by the arrows of each business law, the successful application of each law increases the size of the active patient database. The active database controls the growth of any business. Its long term increase in both the size of the business and the volume of its revenue.
Consumer Acquisition Consumer Retention
Consumer Sales Positive Experience (Case Acceptance)

The Viva System -- Our Focus: Growing the Active Patient Count in the Database
1) Consumer Acquistion: There are two elements of the Viva System that work to provide the practice with new patients:
a) The Care To Share pack (Vivapak) It is simply handed to the patients in the office and the staff member asks for a referral. "How was your visit today? Great, we would be delighted to have you take this Care to Share pack and pass it a long to someone in your family or to a fiend... we would love to have more patients like you."
The Viva "Care to Share" Gift Pak
b) The neighborhood brochure mailer: This is a direct mail piece designed to let your neighbors know who you are, where you are located and lets them know your purpose. It is a 6 page brochure full of information, photos of your office and staff. It lists your services, and your mission statement. It mails multiple times to a radius of a mile or two around your office to generate new patients.

2) Consumer retention & reactivation: The Database Mailer is the second element of the Viva Program. The database mailer is a mailing piece that is sent to your existing patients along with a gift card and a letter insertinviting your existing patients to make their next appointment and come back for their recall visits.
When a patient enters a practice and receives his or her diagnosis, much of the diagnosed work is done at a future date due to patient limitation of finance, ceilings on their insurance, fear of doing the procedure and so on. This mailer is sent to your patients on their birthday and 4 other times a year, to keep in communication with them to encourage them to come back for their recall visits and complete any incomplete treatment.
The first metric, published by Dental IQ, the American Dental Association and Dental Economics, reveals:
Incomplete treatment in dental offices across the country averages 60-65%.
This equates to 6 out of 10 charts having unfinished treatment. Therefore sending the database mailers is an effective way to keep your patients reminded of the mission of the practice, "to assisst them to eliminate their future dental treatment."
3) Case Acceptance: improving conmsumer retention always increases casse acceptance. In combination with the education of the patient the case acceptance increases remarkably the more the patient understands why he or she needs treatment. The trust factor additionally increases as the patient returns and he or she is more likely to refer family and friends.
4) Positve Experience: You will learn in the materials of this study how these focuses work to make a positive experience for the patient and work to build an expanding practive for the long-haul.

Hygiene Industry Metrics
In managing the hygiene center of any practice it is important to know the average metrics (or numbers) that the average hygienist across the country produces each day, month and year. With proper production figures one can then set up a hygiene center which delivers excellent patient care and provides substantial, residual profit for the practice.
The following charts below show the hygiene industry average days worked, patients seen per day as well as the average daily and annual revenue produced.
U.S. Average Annual Hygiene Metrics
1. Number of days the average hygienist works per week.
2. Number of weeks worked per year.
3. Total working days per year.
4. The average # of patients seen by dental hygienists per day.
5. Number of hygiene visits per year for a single hygienist.
U.S. Average Annual Hygiene Revenue
Average daily hygiene production per day.
4 50
200 8 1,600
Annual Revenue per Hygienist
Average Daily Production
Total Working Days/Year

Hygiene Industry Metrics
Current Hygiene Revenue
Hygiene Days Per Week
Step 1: Write down number of days of hygiene currently in your practice. Enter this in the box provided.
Total Hygiene Days Per Year
Step 2: Multiply number of days of hygiene, from Step 1 above, by 50 working weeks/year. Enter this in the
box provided.
Calculate your current annual hygiene revenue by following the steps below
Total Hygiene Revenue Per Year
Step 3: Multiply the total yearly hygiene working days, from Step 2 above, by the average daily hygiene production in your office. If you don’t know the daily production amount, just give an estimate of
the average. Enter this in the box provided.
Average Production

Residual & Linear Income–Definitions
Residual Income Developes Exponentially over time.
Residual Income: income that continues to be generated after the initial effort has been expended. (Also called recurring income). For a dental practice, patients receiving their bi-annual hygiene visits would be contributing residual income to the practice.
Linear Income: is “one-shot” compensation or payment in the form of a fee, wage, or salary.” The majority of practices in the US operate off of this type of income.

Residual Hygiene Revenue Always Residual Hygiene Revenue Always
Outperforms Operative Revenue Out-performs Operative Revenue
With the Correct Retention System & Disciplines Residual Hygiene Revenue Always Grows With Time
Operative Dentistry from Doctor Always has a Revenue Ceiling
The reason for this is covered later on this course on page 21.
Examples of Linear versus Residual Income:
Linear: A patient comes in for an extraction and never returns. Residual: A patient coming in twice a year for recare.
Linear: Buying an iphone for $800.
Residual: Paying $49/month to a service provider (i.e. AT&T) Linear: Selling a movie DVD for $15.
Residual: Netflix subscription for $12/month.
The Hygiene Department is the "spine of the practice" as the entire focus is on retaining patients which in turn is the focal point of retention and building a residual-based practice.

The Ideal Goal for Hygiene Dept The ideal goal or objective for any business is to generate a higher level of residual
income over linear income!
The Hygiene Department accomplishes this objective.
Annual Hygiene Department Revenue Growth
Year 1 Year 2 Year 3 Year 4 Year 5
Total Residual Income Increases Continuously Over TIME!
Linear income is the work-a-day world for 95% of general dentists.
Linear income is itself part of the working model for dentistry... but as you work and put in the time over the years, it is necessary to build your residual income and invest in your database to raise your hygiene residual income. The above graph illustrates how linear income goes to zero when
you stop working at any time. Residual income continues.
Years go by quickly and your most valuable asset in creating residual income is TIME.
Total Production $
Residual Income Linear Income
Residual Income Linear Income
Residual Income Linear Income
Residual Income Linear Income
Linear Income
Residual Income

• • •

he dynamics and growth ne has to understand the
Increased loyalty from patients
Increased income from the hygiene revenue center
Increase in word-of-mouth referrals is generated due to the increase in people coming in and out of the office.
Less dependency on the owner/doctor being the primary provider for the office and working toward removing the hand cuffs from owner/doctor.
Five Benefits from Residual Income
The benefits or rewards from a residual Income based practice are far greater than imagined. Retention causes residual income and brings about numerous benefits including:
• Higher case acceptance due to patients coming back through routine hygiene visits
Increase Referrals
Hygiene Revenue
Higher Acceptance
Residual Case
More Free Time
Income Security
come is income that continues to be generated
itial effort has been expended. Also called

The Most Important Number Calculating the Active Patient Count
”Less than 5% of all practicing general dentists know what their 'active patient count' is.”
Active Patient Count: We discovered that the dental industry is working with a wrong definition of active database. Some say its 18 months;
others say 2 years.
To illustrate this, the following excerpt is from an article published by one of the major dental suppliers:
“...there is variation between different consultants as to what period this active patient count should be—twelve, eighteen, or twenty-four months. We prefer eighteen months.
“Part of this variation is caused by limitations of various dental software programs. Many programs can only provide twelve or twenty-four month reports.” 1
The CORRECT Definition:
The number of annual hygiene recall visits divided by 2.
If a patient is seen 1, 2, 3 or more times per year in the hygiene department, the number is still divided by 2. While this number is not “perfect,” patients with 3 or 4 appointments (perio patients) and patients with only 1 appointment will average out to give an very close active patient count. The Active Patient Count does not include new patient hygiene visits. New patients are not a recall visit and have not yet entered the retention category of the practice. These patients count upon their first recall visit.
1 Henry Schein Article, entitled, “ e Most Important Number— e Active Patient Count (see full article at end of this booklet)

The Focus of the Dental Industry
Consistently on Acquiring New Patients
The industry of dentistry has been focused on building a practice through new patient acquisition. While acquiring new patients is and has always been a part of any business model, it has never been the most important component!
The most valuable component of any business is its existing clientele (patients). The busi- ness aspect of this is called RETENTION & LOYALTY. Retention, in the dental industry, is the only component that builds residual income.1
1 Residual Income: income that continues to be generated after the initial effort has been expended. Industry Mindset
The dental industry, consultants, marketing companies, website companies, major dental suppliers and the like have flooded the Internet with advertisements geared toward "I need new patients. I need new patients."
Of course every practice needs new patients. However, the existing patient charts is where most of the revenue is sitting in offices across the U.S. At best 35-40% of patient's treatment have been completed as according to the ADA over 60-65% of charts have incomplete treatment sitting in the charts.
Retention, Constant Contact & the Residual System
The value of an existing patient is rarely understood, yet businesses for a millennium have built empires by utilizing their existing consumers to generate word-of-mouth referrals. Your patient database is a marketing powerhouse that you can easily leverage to get more patients in the door and, since referred patients cost you next to nothing to acquire, you also reduce your overall cost of new patient acquisition.
The missing element is residual income. Viva has uncovered it!

The Largest Situation to
Long Term Practice Growth
The loss of the patients from your database is the largest situation to long term practice growth.
Database Leakage
ADA Surveys Show a Minimum of 35% - 45% of Your Practice Database is Lost Every Year.

National Average after 15yrs
650 - 800 800 - 950 700 - 850 650 - 800
450 - 550 200 - 300
0 5 10 15 20 25
Database Peaks Between 12 - 15 Years And Then Declines
The national average database metrics after 15 years of dental practice ranges between 800 - 950 active patients.
Yet after 15 years of being in practice your database should have continued to grow, however it hits a ceiling (as shown above.
60 - 65% of patient files in the dental industry have incomplete treatment.

What the Numbers Should Be
According to the ADA the national average for number of new patients per month is, 30.
The below illustration shows the number of patients the average practice in the U.S. will have at the end of 1 year, 10 years and 20 years, assuming the practice sees an average of 30 new patients per month.
Size of Database After 1 Year
Years in Practice
1 10 20
Size of Database After 10 Years
Size of Database After 20 Years

Watch The Numbers With an 40% Average Loss of Patients per Year
According to the American Dental Association, the average practice in the dental industry loses approximately 35-45% of its patient base each year. The average dental practice in the U.S. obtains 30 new patients per month. The below illustration shows the size of the patient base after 1 year, 10 years and 20 years. At 30 patients per month at the end of the first year the practice will have 360 patients (12 months x 30 patients per month).
The red outlined number represents a 40% loss of patients per year. The purpose of this illustration is to demonstrate the potential size of the database taking into account an average loss of 40%. These numbers are used in the following page to show the potential hygiene revenue if the practice had retained its patients over time.
40% Loss in Database Each Year
Years in Practice
1 10 20

Calculating Your Potential
The illustration below uses an average practice after 10 years in business (taken from the previous page.) If the practice had retained 60% of its patient base, (after 40% of the patient base is lost each year), thereare2160patientsthatshouldstillremaininthedatabase. Eachofthepatientsshouldhavean average of 2 hygiene visits per year (not counting perio patients), giving a total of 4,320 hygiene recall visitsperyear. Theremainingmathshowshowmanyhygieniststhepracticeshouldhaveafter10years (2.7 full time hygienists). These numbers are used in the following page to show the potential hygiene revenue if the practice had retained its patients over time.
10 Yrs
60% Retained
X 2 = Hygiene Appt
Per Year
4,320 Hygiene Appts

Retention & Loyalty
The Average Hygienist works 200 days/year. Hygienists Treat An Average of 8 Patients/day.
The Annual Patients Seen Per Year = 1600.
The Average Daily Hygiene Production = $1,500
4,320 Recall Patients/Yr 1600 Patients/Yr/hygienist
2.7 full time hygienists
Annual Revenue for Hygiene Center
The average industry hygienist produces $300,000 per year. With 2.7 full time hygienist with each producing an average of $300,000 per year would generate $810,000 in annual hygiene revenue.

Calculating the Loss In Your Practice
The following is an excercise that takes you through a series of steps to calculate and give an idea of the loss of patients over a period of time. The time period is different for each practice depending on how long it has been open and the average number of patients seen per month.
Drill: On a separate piece of paper answer the following questions:
1. How many days a week of hygiene does the practice currently have?
2. Multiply the # of days of hygiene X 8 patients per day. This will give you the average number of hygiene patients per week.
3. Using your calculation from step 2 above, multiply the # of hygiene patients per week X 50 weeks per year. Now divide this number by 2, as the average patient should be seen twice a year by the hygienist.
4. The number calculated in step 3 is very close to your active patient count.
5. How many years has the practice been in existence?
6. What is the average # of new patients per month in the practice?
Note: Use the average # of new patients for all years the practice has been open. Give an estimate to the best of your knowledge.
7. Multiply the # of new patients from step 6 X 12 months per year. This will give the annual number of new patients seen by the practice.

8. Take the number from step 7 and multiply it times the number of years the practice has been in existence.
9. Divide the number in step 4 by the number in step 8. This will give a percent of database patients lost since the practice has opened.


The Residual Based Practice
Statement of Purpose
Align all Staff to 2 Products
Full Responsibility Assigned
Execute Database Mailings

F The retention of patients begins with the "Mission Statement" of the office. The most important factor in achieving the strategy for a residual based practice is to drive home a continuous strong mission statement. Your mission statement is the focal point of all activities in the office... as this is the goal being achieved.
E The Mission Statement is an education step for every patient and is repeated many times. The Mission Statement is posted in reception, every operatory, the hygiene operatories, the hallway and even the bathroom. It is handed to them in printed form on your stationery with the end result of every patient leaving the office with a goal to share with patients family and friends.
Statement of Purpose

Changing Patient Behavior
Patient retention is brought about through an educational system put in place in the office. Cancellations and no shows in both the operative and hygiene department are manifestations of a weak internal office structure.
In other words, there is no structured "system" or "established pattern" that every patient goes through when they enter and exit the practice.
A structured "system" or "pattern of operation" is put in place that every employee follows AND every patient follows. It is a non-optional "pattern," the same routine, day in and day out.
Viva puts this "pattern of operation" in place through training of the Office Manager and Retention Coordinator.
= Mission Statement Hung on the Wall
Operative #1
Operative #2
Hygiene #1
Finance Coordinator Dr. Office
Hygiene #2
Hygiene #3
Staff Lounge
Bath Room
Sterilization, Instrument Preps, Supplies

AF lign all staff to 2 products
Completions Retention
Education to the Level of Never Needing Dentistry in the Future

A Focused Team Fully Aligned Around your Dental Wellness Program
All Staff Work On Precise Goals
All Staff Work on Precise Goals
With an established Mission Statement for the office it becomes extremely clear and focused—for all staff are now aligned to two specific objectives in the office:
Completions: This means completions of treatment after diagnosis by the doctor. Once a diagnosis has been performed, the objective for all staff, the office manager, finance coordinator, receptionist, the dental hygienist and the chair-side assistant is to do their part as a team to accomplish the goal of a completed treatment for every patient.
Retention: is the primary focus of the entire office as a returning patient becomes a well patient. The retention program consists of a hygiene education center where the hygiene staff establish a relationship with each patient. They then communicate (and reiterate) the goal of their practice: eliminating the need for future dental care by regular hygiene visits.
The product of retention is stellar and is devoted to the patient. A Dental Wellness Program results in:
• Elimination of gum disease nor future dental treatment. • Patients become "partners" with their dental team.
Most importantly, the office has eliminated or dramatically reduced costly dental services! In conclusion, the office has achieved the product of a patient who is well for a lifetime--and dental treatment is eliminated. He or she is only returning for routine dental cleanings and check ups.

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Assign Responsibility or
Remain Frustrated
The primary reason there is no retention occurring in the dental profession is due to the fact that there is no one individual in the practice that held fully responsible for the retention of the patients of the practice. The position is simply missing within the industry.
You will find an office manager, a finance coordinator, a scheduler or receptionist or both and you will also find a dental hygienist and a dentist with a chair-side assistant. But try to find the person in your office or any dental office who is utterly in charge and responsible for the retention of the patient.
This position is called the Retention Coordinator. Simply stated the Retention Coordinator is the per- son in your office assigned full responsibility for the retention of your patients. Often times this is your Lead Hygienist, or if the office is large enough, someone who is appointed for handling this area. The Retention Coordinator is the single person responsible to increase the number of hygiene recall visits per quarter and annually.
The functions and duties of the Retention Coordinator were researched and developed to bring about a revolutionary business model in the dental industry—it is called:
“The Scalable Practice Model”
Definition of scalable: the characteristic of a system or model that describes the capability to perform an expanding workload while increasing its services with a minimum increase in overhead. The scal- able practice model is explained in the section called "The SAFE Strategy."
Appointing a Retention Coordinator is the single most vital element of the Viva system.

AStrategy EFxecute Database Mailings
This part of the SAFE strategy is illustrated below. The calendar shows mailings that go to the patients in the database, once every quarter as well as a birthday mailer, which is sent in the month of the patient's birthday. These mailings are done to capture the patients to return for their hygiene visits. But more importantly, the business law

Stopping the Leakage
There has been no automated system for database retention and loyalty. The startling facts remain that a practice can get 30 new patients a month, but loose 12 other patients. A thorough study of practice metrics shows a loss of 35 - 45% of its patients.
This led Viva to focus on database growth and the bolstering (increasing) of the patient retention by the Department of Hygiene.
Database Leakage
Steps to Reduce the Leakage!
To dramatically reduce the database leakage, the Hygiene Department must put to into place, a series of steps or actions. The following give an overview of actions that reduce the leakage:
1. Patient Education is the key to changing behavior. The behavior being changed is to bring about an increase in awareness of returning for routing hygiene visits. This education step tells the patient about the "Wellness Program" for the patient and their family. Without an education step, or a mission statement for the patient, there is little to no change in behavior.
2. Asking for referrals with a Care To Share program to get family and friends to come to the office under the Wellness Program of the Hygiene Department.
3. Reducing Cancellations with a protocol and cancellation policy and dialogue that significantly reduces the cancellation rate from the industry average of 20% down to 6-8%.
4. Constant quarterly mailings to your patient database with emphasis on keeping them active on the "Wellness Program" with their next hygiene visit. The concept of a "wellness program" is your mission statement that aligns your staff and your patients as partners in their dental health.

The Dynamics of a growing database
starts with an efficient Hygiene
One of the most important dynamic of any practice database is asking patients for referrals. Throughout the history of the dental profession, the majority of practices have been built upon referrals. Referrals cost virtually nothing. The Hygienist is the focus of the referral program as the hygienist is the one who informs the patient of the mission statement.
He or she lets the patient know about the wellness program and insists that the patient is educated on the goal of the office to work in partnership with the patient, to eliminate future dental work.
As the hygienist is the person most bonded with the patients, he ow she is the one who asks each patient to refer their family and friends to the practice, as "we would love to have more patients just like you!"
To date, the full dynamics and system of leveraging patients for referrals has not been researched or published. The following pages give an insight to the power and impact of a business' database.
Marketing dollars for external marketing are costly and while necessary for any practice to grow, the vital element of any marketing is to keep and maintain patients through a retention program (also called a loyalty program). These patients can then be utilized to generate referrals. Again, referrals are the most inexpensive means of acquiring new patients.
To fully grasp the dynamics (or forces or properties that stimulate growth) let us see on the following pages what the database looks like in any neighborhood surrounding a practice.

Hygiene Dialogue
Distributing the "Care To Share" (Vivapak)
This “script” is a guideline for the dental hygienist in distributing the Care To Share pack. The dialogue below is aligned to the overall purpose or goal of the office. The script can be modified to suit your own personal wording... the most important aspect is to “make it your own.”
At the end of the appointment, after the hygienist has made the patient's next appointment, he or she would say:
"One last thing before you go... as you know our mission (point to the mission statement on the wall in the hygiene operatory) for families, friends and the community is to educate each patient to the level of never needing dentistry in the future.
"I’m in charge of Hygiene Education Center... we call it a “Wellness Program” for every patient. (With a Vivapak in hand) To accomplish our mission we run a community service program called “The Care to Share” program (open the Vivapak while stating this). It is
a new patient cleaning, exam and x-rays to begin their hygiene education program. Our doctor donates the exam and x-rays for each new patient... and we do this so we can begin their education to eliminate their dental needs for a lifetime.
(While handing the Vivapak to the patient) "If you could pass this along to a family member, friend or co-worker, it will help accomplish our hygiene education mission... we would love to have more patients like you. I will be their hygienist and the first person they see!
"Thanks so much... remember you can always call me if you have any questions or concerns about your dental health.
"Have a great day!"

The Dynamics of Referrals
When we speak of the dynamics of the database, we are referring to the action and poten- tial that is a result of just asking for a single referral. According to the United States Census Bureau the average home has 3.2 occupants. This becomes significant for the Hygiene Department as every patient being seen upon returning to their home have an average of 2 additional patients that can obtained as a referral.
The average 3.2 occupants per household however expands greatly upon review of additional consumer surveys. Each of the occupants have 2 close friends, called "confidants" (a person with whom one shares a secret or private matter, trusting them not to repeat it to others).
= A patient in Your Practice
= A potential new patient referral
Guaranteed, nearly every patient standing in front of you in your office, has a couple more family members living right under their roof! Simply ask them, please pass along this Viva Pak to someone in your family or a friend! We would love to have more patients like you!
The average family Home has 3 occupants

This illustrates the vital importance of the database for any practice (or company.) See the below illustration. Every consumer in the practice, upon leaving to go home, enters a household with an average of 3.2 occupants.
And each person in the household has potentially two close friends, giving a potential of 8 additional consumers that can be referred to the practice. This gives an overview of the importance of why the Inspirational Database Mailers are a key component of retaining and building hygiene department.
Each family member has 2 close friends Each household has 8 potential referrals

Hidden Relations & Loss of Referrals
This illustration depicts a typical interaction between friends and family. Remember the diagram on the prior page where each household member has 2 close friends.
This diagram shows a mother in one neighborhood home (who’s husband is a patient in your office).
She goes to coffee with a close friends, finds out about another dentist for her child and ends up in
“I was thinking about getting my son

Without Constant Contact = Lost Referrals
You can prevent referrals being sent to another practice in the area by constantly contacting your database with a warm inspirational message and by providing an introductory offer that your patient can transfer to family or friends.
My daughter just started Invisalign at
ABC Family Dental and she just loves it there!

Lost Loyalty & Retention
Capturing recall patients through repeated database mailings and offering incentives is the single largest business component for revenue growth.
2 New

The loss of 90%+ of all patients is only present due to the lack of application of a retention system and use of the "Business Law" taught in every business school in the countrry.
Business Revenue Law:
The Number of Constant Contacts to the Database determines the revenue growth for any business.
A constant contact to the database is the overiding activity to not only prevent loss of consumers but to improve loyalty with use of communication that can inspire them to do better in life!.
Patients Lost

Creating Retention
Loyalty & Database Mailers Stopping the Leakage

Creating a Continuous Loyalty
Execution of your database mailings is a vital component of your overall retention and residual strategy. Loyalty is created based on constant contact of your database on a routine basis. Viva developed the retention loyalty mailer to make it fully automated due to its critical component of keeping your wellness program in the forefront of their minds. This develops loyalty and referrals of other like-minded individuals.
Branded Quarterly Database Mailer Mailed in Clear Envelope
• Happy Birthday • Happy New Year • Spring Mailer
• Summer Mailer * Holiday Mailer
This is a sample branded database mailer. Every office is branded for their own iconic look and message.

Constant Contact:
The Business Revenue Law
It is the size not the quantity of the database and the number of constant contacts to it, that determines the revenue & growth of any business.
$400,000 $600,000
Revenue growth is always proportionate

The Active Patient Count is your most critical statistic to monitor and control!
Active Patient Count is defined as the number of recall visits per year divided by 2.
(The average patient receives 2 visits per year). The Active Patient Count does not include new patient hygiene visits. These hygiene visits only count when they arrive for a recall visit.
$900,000 $1,900,000
to the number of the Active Consumer Count

Market Research
Building Retention and Residual Practice through Database Mailers
Unfortunately, most business owners focus on finding and paying for new customers and easily forget about the ones they already have in their database. Focusing solely on acquiring new customers can be a costly mistake. Why?
According to marketing metrics, selling to existing customers is about 50% easier than selling to brand new prospects. Therefore, reaching out to customers who have purchased from you in the past and encouraging them to buy from you again is a more cost effective way to grow. And, Database mailers are the perfect way to reach them.
What is a Database Mailer?
Simply put, a database mailer is a mail piece that is sent to your existing customer base, including current and past customers. It builds loyalty. The arrival of the mailer "reminds" your patient to make their next appointment. A database mailer has a softer selling approach than mail pieces that target prospects and relies more on familiarity and customer appreciation.
Why Send Database Mailers?
There is an estimated 60%-65% of incomplete treatment plans sitting in the charts. Your patient files represent a "gold mine". Database mailers also prompt your patients to refer family members or friends by becoming a conversation piece.
What Should Database Mailers Include?
Let your customers know that you appreciate their business by inspiring their day. Inspirational quotes create conversation with the immediate people around them. When your patients talk about you, they are becoming a referral source for your practice. You could also offer them a special discount that is only available to current/past customers. It provides your customers with an incentive to complete
or purchase additional services or not miss their recall appointments. The offers can be costing your practice $4-$15 however saving you hundreds of dollars. Offers should be given to every patient without having attention on whether they were scheduled or not-you are building loyalty.
Most importantly, your database can provide an ocean of referrals if you effectively leverage your

existing patients to refer their family and friends. Be sure to personalize your database mailers with the information you know about them to create familiarity and interest.
Which Customers Should You Target?
Database mailers are always sent to your entire list as a prompter to encourage your loyal patients to make their next appointment. Do not violate the “Practice Revenue Law” covered earlier in this course.
How Often Should You Send a Database Mailer?
It is important to set the right frequency of mailings. Sending a database mail piece once every two months is a good rule of thumb. A minimum of 4 planned mailings plus a warm birthday mailing (done monthly to patients in your database) will achieve a sound retention campaign to build the residual income component of your business.
Rules for Database Mailers
Repetition: Conversation Piece:
Minimum of 5 campaigns/year. Mailed every quarter plus Birthday mailer mailed monthly.
So that your patient would talk about you with their Immediate family and friends (this is achieved by Sending Inspirational quotes).
To incentivize patients not to break their appointments and complete pending treatments, the offer also should be transferable to capture referrals of a family member or close friend.
If you want to lose your patients in your database, simply stop mailing to them.
Most practitioners have never mailed to their database for the entire time they have been in practice. While some "recall" cards or the occasional newsletter may have been sent, the lack of communication and constant contact with your patients is a primary reason why nearly 90% of every patient that walks in the door is lost out the back door!
Put a system in place and keep it in. You're spending pennies on the dollar to build a residual based practice!

Inspiring the Community With "Inspirational" Database Mailings
Mailed in a Clear-Windowed Envelope The above is a sample. Your database mailer will have its own design to match the
brand of your office.
The "Inspirational Message" of the Hygiene Department, in each mailing to the patient, is a message of "Wellness" to educate each patient to reduce and/or eliminate their dentistry for a lifetime! The above image illustrates one of the 5 annual mailings (Happy Birthday).
On the opposite page you can read an example of what the message is to the patient.
A continuous inspirational message creates loyalty and brings about a stronger relationship and bonding with patients to improve and grow the most important business law #3, which is Patient Retention!

The inside "insert" is a Hygiene Inspiration Message of the "Wellness Program" to come to their next hygiene visit & a Message to "Share it Forward" to family or friends.
• Happy Birthday
• Happy Holiday
• Happy New Year • Spring Occasion
• Summer Occasion
A Gift Card for the Patient at next visit
Dear Patient,
Wishing you the most wonderful day on your birthday!
In hopes of lifting your spirits and to quicken your step, we have included an inspirational quote for this special day.
Share it Forward to a family member or friend to spark their day!
Our continuing inspiration for you and those who surround you is to achieve the goal of “Wellness,” of never needing dentistry in the future.
Hope to see you soon at your next hygiene visit.
Our Kindest Regards, Your Dental Hygienist &
The back of the Gift Card contains a New Patient Special to refer a family member or friend. 47

Inspiration: Retention Mailers
As mentioned earlier, there are 5 database mailers each year. They are mailed once a quarter (seasonal) in alignment with the occasion, i.e., Happy Holiday, New Years, Spring and Summer. The 5th mailer is for the patient's birthday month. The database campaign runs for 2 to 3 years, each mailer has a different inspiration quote...below are samples to give a perspective of this retention program.
• Happy Holiday • Happy New Year
• Spring Occasion • Summer Occasion

How it Works!
The Inspiration Mailers to patients improves not only the relationship to increase retention but it works to leverage your existing patients to refer their family and friends.
The power of any business' database is the largest asset the company has...the patients of record are literally the spine of the practice. Here is how it works.
The person happily reads the inspiration quote.
Your patient receives the Inspirational Gift Card.
The family member or friend arrives to the practice as a referral.
ABC Family Dental
The patient "Shares it Forward" to a family member or friend.
The person reads the invitation of the special offer to the practice.

Profitable Hygiene:
Inside and Outside the Realm
Article by Deborah Dopson-Hartley, RDH, Source:
"There are two goals hygiene is held accountable for - daily production and re-care. The scheduled daily goal for production and the next hygiene visit should no longer be the only considerations in a hygiene day.
"Today’s progressive hygiene departments should have daily sales presentations and sales acceptance goals. What are these, and how do we track them?
"Here’s an example. My daily hygiene production goal is $1,500 per day according to my office, but my personal goal is $1,800. I exceed that on most days because I am paid on a 33.3 percentage basis.
"My sales presentation goal (aesthetics, implants, quadrant, or comprehensive dentistry presented from my hygiene chair) is $6,500 per day, and my sales acceptance goal (financial accepted, secured, and scheduled) is $5,000 per day.
"Because there is no definitive way to account for accuracy of these numbers, I made up a way to both establish and track them. These goals are obtained by simply adding my hygiene daily production goals to my doctor’s daily production goals ($1,500 + $5,000 = $6,500).
"Sales acceptance goals from the hygiene chair are more difficult to track because patients must consider and organize their priorities, which are their financial and time restraints.
"But sales presentations are not difficult to monitor if we chart audit prior to an appointment, ask patients leading questions and really listen to their answers, and then document what is discussed.
"To track your sales presentation and the treatment plan that you discussed with your patient, simply write a brief description next to the patient’s name on the day sheet. For example, you discussed restoring the LR (lower right), which consists of No. 31 MOD (on-lay, $1,100), No. 30 MOD (porcelain crown, $1,100) No. 29 MO (inlay, $1,100), and No. 28 DO (two-surface direct, $250), for an estimated total of $3,500.
"You can make it less confusing for the patient by calling everything a restoration. You then say,

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