Libran

Libran aims to maximise your net profits by reducing wastage in both your time and practice management costs. Libran is different because we actually become part of your practice team for a mutually agreed time and only charge a fee for the services we supply.

From past experience, as far as practice management is concerned there is no one magic answer to a well run efficient practice. However, there are some sound ground rules, which if followed, can make a world of difference to the profits you make. Sometimes when meeting new clients they try to impress me by telling me about the gross income of the practice - quite often when I ask how much they take home, the bottom line, it's quite a different story.

There are three main areas that Libran identifies:

Your fees - provided you are certain that you are offering the best service you can - put your fees up and stop comparing them with the NHS fees. If you must compare look at others professionals fees and what they charge and remember most of them don't have the high overheads that dentistry warrants. It's not just my opinion that dentists have seriously slipped down the income scale over the past 20 years and the present confusion of the future of the NHS hasn't helped anyone. During the last 7 years I have met very few dentists that are charging a fair fee for their services, many compare their fees to the NHS and say 'my patients will never pay more'. Put your fees up 5% across the board and wait for a reaction from your patients, my bet is that there wont be one. In three or six months time put them up again and again I bet again it will pass unnoticed.

One important thing you need to remember is if you are currently considering leaving the NHS don't sell yourself short by introducing too low a fee scale. Provided you introduce a realistic pay scale and offer the best service you can, patients don't leave, and they appreciate your situation of having to, rather than, wanting to. With all the publicity re NHS dentistry very few patients are unaware of the fact that most dentists are leaving because they cannot sustain their service at the fees the are getting and rather than lowering their standards they choose to go independent.

Independent doesn't have to be overly expensive

Your time - STOP WASTING IT - by doing things you don't need to do you are - most administration can be delegated. Introduce systems into your practice that minimises the amount of time you spend on non-dental tasks. By this I mean anything that doesn't involve actual dentistry. By doing this you are left with time to get on with what earns you money i.e. dentistry - with well organised managerial systems you'll earn more.

The wasting of time is as much of an extravagance as the wasting of money.

Your practice overheads - to make sure your practices running costs are the most cost efficient, you need to regularly review them. AN ADDED BONUS of doing this is by improving & organising the daily running of your practice it creates a much happier place of work for both you and your employees because everyone knows exactly what they are supposed to be doing.

It is a well known fact that principal dentists are put under huge pressure when it becomes necessary for them to manage their practices as well as provide quality dental care. How many of you remember those carefree days as an associate? How many of you thought it was so easy running a practice, do you remember when reality struck and you realised it's not easy and you are supposed to do dentistry as well!

It is also a fact that considerable strain is put on your practice team through lack of communication and guidance from 'the boss'. How often do you really discuss the running of your practice with ALL your team? Do you actually put time aside to discuss the management of the practice. I am sure some of you are saying, we already do this, we already have systems in place, and we've done it for years. When did you last review these systems? Are you absolutely sure they are the right systems and that you are not wasting time & money by using out dated and inappropriate ones.

No dentist, no matter how adept, can see what is going on in reception while operating in his surgery and no member of staff can work efficiently unless given clear guidelines as to what is expected of them.

IN OTHER WORDS -

COMMUNICATION -

AND IT'S A TWO WAY STREET

One of the principal services Libran offers is a review or an audit of all your current managerial systems. This is a service tailored to each individual practice and basically goes through everything that relates to the running of the practice. It is, in my opinion, the best way to find out exactly what is going on or not as the case may be. It gives you & all your team an opportunity to talk about the practice. Having an arbitrator (Libran) to manage the meeting enables you and your team to concentrate on the matters in hand and not the running of the meeting. I also ensure that everyone has an opportunity to talk. Invariably there are members of your team who are more confident than others and talk more, this doesn't necessarily mean that they know more.

Apart from fees, reducing wastage and time management it also gives,

the opportunities to introduce systems to encourage teamwork
to share the actual costs and concerns of running a practice with your team.
It gives your team the opportunity to make suggestions on improvements - to share the opinions they have on the practice.

Just one example for you to think about - how do you feel about holiday rotas - how many of you have problems here and some of you even hire an agency nurse for holiday cover? Expensive aren't they? It can also be disruptive? In many cases this isn't necessary. Understanding & utilising your team to the maximum is probably the most beneficial outcome from an audit both personally & financially. It can help to solve existing problems that appear to be impossible to solve and create new ideas for the betterment of the practice.

None of what Libran does is rocket science...

There is no reason why you can't do this yourself...

So why don't you?

NOT ENOUGH TIME...

Call Lyndsay on 01792 510112 or 07721 622 765 for further details

ARE DENTAL CAPITATION COMPANIES ESSENTIAL?

On being asked this question a short while ago my first response was a firm and unhesitant " NO". My enquirer was so taken aback that I felt obliged to justify my view and to focus on my reasoning. This led me to seriously look at the concepts for and against dental capitation companies and just how essential they were in the past and are for dentists today.

Having done this I have come to recognise the many benefits that have followed on from their introduction, but equally question their relevance today. Time has moved on for many of you.

Let us consider the exact nature and function of such companies.

This question has been asked many times and in essence their role is a very simple one; they collect and distribute money for a fee.

They collect a predetermined monthly fee from your patients, hold on to it for several weeks deduct their administration fee and (in the vast majority of cases) deduct an accident and emergency insurance premium before paying the balance to you the dentist.

As I write I can hear protest from the companies. What about the support we give the dentist? They cry. Well yes, some do have regional 'consultants' who offer support and details of developments within dentistry. However, I question how the practices would be affected if these visits stopped. Other companies do not offer such a service and one does question the real role of them at all.

I'm sure the views of dentists using such schemes vary and that in many cases the support is appreciated and valued in what can be an insular life, professionally speaking, in which dentists work without the input from colleagues such as lawyers or accountants etc.

However I still return to my basic premise, which is, are such companies essential or have they outlived their usefulness.

Such schemes are limiting. A capitation company allows you to offer their scheme and no other, their administration procedures, accident and emergency cover their terms and conditions, notwithstanding local considerations and needs. What may well be ideal in Esher would not necessarily work to the advantage of neither the dentist nor the patient in the valleys of South Wales. If you introduce your own plan, independently of the capitation companies, you are in control of all these things but you are alone.

Moreover capitation companies are in control of how much administration charges you pay, they can increase or decrease them as they see fit. Whilst you may cancel your agreement if you wish the inconvenience is overwhelming. To my knowledge few other ventures enjoy such control. If you introduce your own plan admin charges are reduced to a bare minimum.

Nor does it rest there. Most are in control over the service you offer your patients, over the insurance cover and most importantly themselves. They can and do a 'sell out', merge with another company, take over others and even possibly go bust. Where does this leave you? If you introduce your own plan these concerns do not exist.

However, in fairness they have introduced a new method of practicing dentistry to the UK independent of the Health Service. This was seen by some dentists as more patient friendly than the 'fee per item' world of private dentistry. It is fair to say that the initial introduction of the capitation system was seen as an excellent one for the dentists by way of regulating their income and providing A&E insurance cover to patients for a moderate sum. They have relieved dentists of an uneven cash flow and encouraged better practices by encouraging preventative rather than restorative dentistry. It is true that ten years ago the direct debit systems were not available to dentists as they are today. The A&E insurance is still not available to individual practices, however there are companies who will offer this service for a single fee. There are companies who will support you through the design and introduction process, again for a single fee. By using these companies it frees you from any on-going administration charges incurred when you join a capitation company and enables you to introduce the exact service you wish into your practice. However, there is not the continual support offered by these companies but support is available on an hourly basis from them if and when you feel you need it.

The question is 'can you deliver the same benefits whilst avoiding the drawbacks of a one scheme fits all approach'? Today I think you can. I accept that it does involve the dentist in a more hands on involvement in the administration of what would be their individual scheme but the financial benefits are apparent.

So on balance I think the true answer to the initial question is 'No they are not essential but different horses favour different courses' and one needs to consider carefully the course best suited for you.

To that end I would suggest you consider your answers to the following;

Do the capitation companies and their support make a significant difference to your practice, your patients and you?
Could you survive without a capitation company?
Could you survive without the current support you are getting from your present capitation company?
Do you consider capitation companies essential for the future of dentistry and you?

If you were given support during the creation and initial launch of your own plan,

Could you introduce a payment plan yourself?
Do you know the exact service you want to offer your patients?
Is it the service you are offering now?
Do you feel that the on-going administration charges are good value for money?
Is the support you get essential to your everyday running of your practice?
Could you administer a payment plan in your own practice?
Could you arrange the necessary direct debit system necessary to introduce your own plan?
Could you acquire the necessary A&E insurance cover independently of a capitation company?

Before you scream 'NO' to the majority of the above questions and turn to the next page, pause, stop and think -

In my opinion capitation companies are essential if a dentist feels they are an advantage and benefit to his practice. They, too, are essential if the dentist is convinced he cannot achieve the same quality of service without them. They are essential if it means that the dentist is going to loose something, which he feels, is essential to his practice if he introduces his own payment plan.

However, if the dentists doesn't feel this way, they are not essential providing the dentist is prepared to do some research into becoming independent from the capitation companies. They are not essential if the dentist has a good managed practice with a supportive team. Independent direct debiting system and accident & emergency insurance cover are available if you are prepared to look for them. At the end of the day the choice is yours, after all, whose practice is it?

And so in conclusion I think the real question should be

Are Dental Capitation Companies Essential For You?

And you are the only person who can answer that.

DOES INTRODUCING YOUR OWN PATIENT PAYMENT PLAN INVOLVE A LOT OF HASSLE AND DOES IT REALLY INCREASE YOUR PROFITS?

Libran, a management company that supports dentists in the introduction of independent patient payment plans would like to take this opportunity to discuss the 'pros' and 'cons' of such a venture and acknowledge them in a realistic light.

PROS

Once you have introduced your own plan the only monthly costs incurred are direct debits and A&E insurance. This works out at around half the admin charge you would pay any company currently involved in the dental patient payment plan market. It is far more cost effective to have your own plan, no hidden costs or excessive admin charges that are increased on a regular basis without warning.

As an example - if you count the number of patients on your present scheme, your profit usually will increase by £1 per patient per month (£12 per annum per patient) when your introduce your own plan. For an average sized practice this can result in an increase of profit of several thousands of pounds every year.

The Accident & Emergency Insurance cover which is seen as attractive by many dentist is available and is arranged between yourself and the Insurance Company upon registration. No intermediary is used once you are registered.

The Direct Debit facility is also introduced independently of any external agency. The service is very similar to what the capitation companies offer, with monthly printouts and easily accessible staff to help you with any concerns you may have. Once the direct debits are instigated the company does the rest for you apart for any amendments, which is the same when using a capitation company.

The Admin System once the patients are signed up the admin is very little, certainly little more than if you used a capitation company. This can be easily designed to fit in with your daily admin system and takes very little time to manage.

There is no more hassle in introducing your own plan than when introducing a company plan, the procedures used are very similar. Indeed there can be far less because you are totally in control of the entire exercise. Nothing can be instigated until you are 100% confident and clear as to what is going on.

You have the freedom to offer the exact plan/service you think is right for you. You are not obliged to introduce a plan which 'sort of fits' into your practice. Your plan can be customised to compliment your practice and the environment you live in. What fits nicely into a large city doesn't fit quite so easily in the countryside.

Your plan can't be changed, bought out, sold or go bust, any company plan falls under one or all of these threats.

CONS

The 'fear of the hassle of going it alone' does appear to be a main reason that deters dentists from doing what, in their heart of hearts, they know is best for them. Smoke screens, fear of the unknown -

'There is no greater fear than fear itself '.

You do need to invest when you introduce your own plan. You will need to invest in a one-off fee to Libran. You will also need to invest in the registration with the direct Debit Company. The insurance cover needs to be paid initially, however, you only pay these fees once whereas with the companies you pay every month for as long as you use their plan. There is no end to it and over several years can run into a huge sum of money.

Another main concern is the lack of support given after the plan is introduced. As I write I can hear protest from the companies. What about the support we give the dentist? Well yes, some do have regional 'consultants' who offer support and details of developments within dentistry, other companies however do not. How difficult would it be for you if these visits stopped? Any future support can be acquired and paid for on a fee per item basis from several independent sources. If you don't need any support you don't have to pay anything.

Patient's concepts - some dentists are misguided to think patients will leave if they change to their own plan from a capitation company. This simply doesn't happen, especially if you explain to them that you are designing your own plan to enable you to offer the service you consider best for them.

NECESSARY SUPPORT DURING THE INTRODUCTION

Let's address these one by one.

Direct debits - most banks offer some form of direct debit service. Some are far better than others. However, if the service your bank offers is not as attractive as it could be it can be arranged with an independent direct debit company that will manage the d/d's for you at a very fair rate. Once the plan is introduced all the practice has to do is inform this company of any changes which have occurred affecting the d/d's from month to month. In most practices these are very few, unchanged d/d's go through automatically. Some practices are computerised some are not, all can be managed in a way to be relatively stress free.

Administration - the daily administration can be incorporated into your admin system with necessary forms and procedures designed and introduced as part of Librans service. Again these are individually designed to fit in with your practice management and not as an additional task.

Support during and after the introduction of your plan is given by Libran. We give as much support as you and your team feel is needed. Some practices need a lot more than others do but we remain in touch until you say you are ready to be independent.

Accident and emergency insurance cover - Libran has an exclusive contact with an insurance company for accident & emergency insurance cover similar to the cover offered by capitation companies.

NECESSARY SUPPORT AFTER THE INTRODUCTION

I appreciate that it is easy for me to tell you I don't believe there is hassle in introducing your own plan as I do it all the time. The support needed after the conversion is really a very personal one. There are several independent companies in the dental world that will be able support you in any concerns you may have for a single fee. These need not necessarily be about your payment plan.

In my opinion, capitation companies are only needed if a dentist is convinced he cannot achieve the same quality of service without them. If the dentist doesn't feel this way, then they are not essential providing the dentist is prepared to trust his own instincts and invest in his future.

At the end of the day the choice is yours, after all,

Whose practice is it? Whose patients are they? Whose profit is it?

July 2003

WHY NOT DIY? - GO ON - INTRODUCE YOUR OWN CAPITATION PLAN

The Libran Management Company is currently in its third year of trading. During this time clients of the company repeatedly asked director, Lyndsay Lucocq, if they could introduce their own capitation scheme into their practices. The reasons they gave were wide and various, some noted what they saw as unduly excessive administration costs, others had failed to achieve what they saw as best for their practices. Some simply wanted to introduce there own because they were unable to find what they were looking for with any of the existing capitation companies. All wanted the freedom of 'doing there own' yet, thought they recognised the need for support to achieve their goals.

The concepts are simple and the more the possibility of introducing an independent in-house capitation scheme was researched by Libran the clearer the picture became and the more convinced Libran became that dentists were more than capable of achieving this themselves. There are no great mysteries about introducing a capitation plan; it is not complicated or difficult to understand. There is no need for pages and pages of literature to explain the concepts and workings of a capitation scheme to confuse and dissuade dentists from accomplishing their aims. It can be made straightforward, easy to implement thus dispelling any fears surrounding the introduction of your own plan. Recognising the benefits and dispelling the fears Questions asked by dentists:

Have I the time?

No, not really but if you make the effort now and spend a reasonable amount of time and effort for no more than two months, you can achieve your ambition and be in control of your independent practice capitation plan.

Do I have the skills to do this?

Yes, you just are not aware or have time to appreciate that you have.

How much do I save?

The saving of all the admin charges deducted monthly by existing capitation companies. This can be a substantial amount with many dentists questioning the value of this service.

Can patients save as well? Yes, when you design your own scheme you are in the position to make up your own terms and conditions which could dispel of the registration fee which is at present charged by most existing capitation companies. Who is in control?

You are, you have the freedom to design, with Libran's support, your own scheme and introduce services to your patients, which you feel would be beneficial to patients, your practice and you.

What happens if I think that the service I am offering at present is acceptable but want to be independent and save money?

Some clients who already had a capitation scheme in place chose to convert like for like, thus saving the admin charge immediately and introduce changes as and when they became apparent at a later date.

Is there support for me to administer the financial side of the scheme myself?

Most of the High Street banks have services available for you to implement direct debits / standing orders. Libran supports the you in deciding which avenue is most cost efficient for the practice at this time but inevitably the decision is yours.

What benefits are there for administrating the scheme in-house?

By administrating the scheme in-house it means that you are in control of the financial aspect and not in the hands of a holding company. If errors occur you only have yourself to blame rather than being seen by patients as inefficient if errors occur which are totally out of your control when implemented by an outside company.

How are the fees paid?

The fees the patients pay go directly to you and are not held by a capitation company, which could be up to 21 days every month, the interest incurred goes to the dentist and not the capitation company and nothing is deducted at source.

How much do I pay Libran once the conversion is completed?

Nothing, if you want Libran to work with you on other managerial aspects of your practice you pay on an hourly basis. The fee paid for the conversion is subject to the number of principle dentists in the practice.

What if I do not know how to introduce an in-house capitation scheme?

You think you don't but you know far more than you think. It is not over complicated to introduce your own capitation scheme once you know how, Libran has information on all aspects of a conversion to support you.

What if I do know how to introduce an in-house capitation scheme but can't get the accident and emergency insurance plus out of hour's cover?

Libran is prepared to offer an insurance package only if this is the only aspect of their service you are interested in.

I am unable to get the insurance cover offered by the capitation companies?

Yes, it is highly unlikely that a single practice will get this cover. However, Libran has secured competitive insurance with The National Dental Plan at the costs of 64p per patient per month, this is included as part of their package.

What about out of hours cover?

Practices converting have arranged cover with other practices in their facility, it has been noted that most of the practices were already doing this.

What about cover away from the practice?

The accident/emergency insurance with NDP is world-wide

I have been told that there is excessive admin work involved?

There is far less than in an average NHS practice, Libran can support you in the introduction of this into your practice before the conversion if you feel it is necessary but an average size practice, once converted, should take no more than a few hours per month.

To achieve a successful outcome;

Believe in yourself and your team that introducing and administrating your own scheme is easily within your capabilities. Recognise you are in the position to design your own capitation plan or offer the same service as you are now and save on the admin charges. Think about what service you would really like to offer your patients by designing your own, you are free to do this. Once you have agreed your plan the insurance plus any necessary literature, i.e. Terms and conditions, patient's costs, pamphlets and information sheets can be designed and produced. Training can be given to your team if you feel it is necessary. This results in:

One of the most rewarding conclusions of 'doing your own' results in the knowledge that you are in control of your practice scheme. You say what is offered to your patients and when, your gain the maximum income, you decide on the service you give, you offer excellent world-wide insurance cover at a competitive price. Your patients know that you have designed your scheme personally and independently to compliment your practice and assure them they will receive the service you feel is right for them.

Once your scheme is in place, if at any time you want the support of Libran for any aspect of the managerial side of your practice all you have to do is pick up the phone and they are there for you, until then you pay them nothing.

January 2001

WHO SAYS INTRODUCING YOUR OWN PATIENT PAYMENT PLAN INVOLVES A LOT OF HASSLE?

Not Libran, a management company that supports dentists in the design and introduction of in-house patient payment plans for a single fee.

Once introduced the only on going costs incurred are direct debits and A&E insurance and this works out at around half the admin charge you would pay any company currently involved in the dental patient payment plan market.

Nevertheless it is the 'fear of the hassle of going it alone' that appears to be the main reason that deters dentists from doing what, in their heart of hearts, they know is best for them.

In fact, there is no more hassle in introducing ones own plan than when introducing a company plan, indeed there can be far less as you are totally in control of the entire exercise. Nothing is instigated until you are 100% confident and clear as to what is going on.

Clients of Libran have openly admitted that when they introduced a capitation plan they went along with it without really understanding the concepts or its workings.

The main areas of concern lies in the prospect of hassle on introducing the plan and the in-house administration necessary once the plan is up and running.

Hopefully by the end of this article you will appreciate that this is just a myth.

Let's address these one by one.

Direct debits - most banks offer some form of direct debit service. Some are far better than others. However, if the service your bank offers is not as attractive as it could be Libran has an arrangement with a company that will manage the d/d's for you at a very fair rate.

Once the plan is introduced all the practice has to do is tell this company of any changes which have occurred affecting the d/d's from month to month. In most practices these are very few, unchanged d/d's go through automatically. The admin of this is incorporated in an admin system designed by Libran to fit into the daily running of your practice. Some practices are computerised some are not, all can be managed in a way to be relatively stress free.

Administration - the daily administration is incorporated in to your admin system with necessary forms and procedures designed and introduced by Libran as part of their service. Again these are individually designed to fit in with your practice management and not as an additional task.

Patient's concepts - some dentists misguidedly think patients will leave if they change to their own plan from a capitation company. This simply doesn't happen, especially if you explain to them that you are designing your own plan to enable you to offer the service you consider best for them.

Support during and after the introduction of your plan. Libran 'holds your hand' very firmly right from the concept through to the delivery. We give as much support as you and your team feel is needed. Some practices need a lot more than others do but we remain in touch until you say you can go it alone. You are free to call after this to discuss issues arising from your plan at no extra cost.

Accident and emergency insurance cover - Libran has an exclusive contact with an insurance company for accident & emergency insurance cover equivalent to the cover offered by capitation companies. Part of our service is your registration with this company when you introduce your own plan.

Additional benefits offered by Libran -

a) Libran is in the position to offer you the opportunity to introduce a finance facility to patients as part of your plan. b) Libran has an additional insurance cover for implants to cover accident and failure, this too can be incorporated as part of your plan. c) Libran has the facility to offer a much higher rate of A&E insurance which can be offered as well as or instead of the basic A&E cover already mentioned.

The advantages of introducing your own plan are numerous.

You have the freedom to offer the exact plan/service you think is right for you. You are not pressurised or persuaded to introduce a company plan which 'sort of fits' into your practice, your plan is customised to compliment your practice and the environment you live in. What fits nicely into a large city doesn't fit quite so easily in the countryside.

It is far more cost effective to have your own plan, no hidden costs or excessive admin charges that are increased on a regular basis without warning. Your plan can't be changed, bought out, sold or go bust, any company plan falls under one or all of these threats.

The disadvantages in my option are very few. The main one I recognise is the support given after the plan is introduced. As I write I can hear protest from the companies. What about the support we give the dentist? Well yes, some do have regional 'consultants' who offer support and details of developments within dentistry, other companies however do not. How difficult would it be for you if these visits stopped?

Smoke screens.

Fear of the hassle - ' There is no greater fear than fear itself'.

I appreciate that it is easy for me to tell you there is no hassle in introducing your own plan as I do it all the time. However, in my opinion, capitation companies are only needed if a dentist is convinced he cannot achieve the same quality of service without them. If the dentist doesn't feel this way, then they are not essential providing the dentist is prepared to trust his own instincts.

At the end of the day the choice is yours, after all, whose practice is it? Whose money is it?

Why don't you call me and try to prove me wrong?

Lyndsay - Office - 01792 510112, Mobile - 07721 622 765