Re-starting Your Practice – How Will You Handle Fees?

April 29, 2020 North Shetter DDS

We are “all in” on getting ready for our office to re-open. We have been in dialogue with our team members, reviewed our cleaning, asepsis, OSHA protocols, and worked out client and staff management protocols that follow the ADA guidelines. We are ready to go! However, our governor may prevent us from starting for another month. If that happens, we will have lost a full three months of production – one quarter of the year. 

We can never regain that lost revenue. Like the car salesman who does not close the sale, the money that was going to pay our fees is now gone forever as it has been spent somewhere else. If you want to understand a bit more about the mathematics of loss, take a moment to read this letter from Steve Blumenthal. The letter is old, but the math still makes sense and it is not pretty.  

“The New Normal” 

Like many of you, we have been “Zooming” into a variety of web-based CE on how to manage the new normal. The new normal to us looks like less productivity and higher overhead. The new normal also looks to us like a time when our clients and staff will feel a sense of increased vulnerability, so it is imperative that everything we do at every touchpoint is focused on active listening, positive messaging, and mutual respect.  

The Question of Fees 

This leads to the question of fees. Some presenters are suggesting adding charges for PPE or raising fees in general. Our opinion is that, as a nation, we are about to enter a period of deflation. If our clients are worried about maintaining their jobs, they are not going to spend discretionary dollars. We are very unlikely to see a V-shaped recovery. Our government has poured a great deal of money into the economic system, but fearful people will not spend if they are not sure of a paycheck.  

Most of us will have to eat the added overhead in our practices. In fact, many practices will look at staff costs and decide to run with less people. You can count on insurance carriers to use the pandemic to push on dentistry to accept lower reimbursement.  

Our Plan 

We know we will lose production until we refine our new systems. We are asking our team members to consider flex time until we can ramp up and have everyone working effectively. We are asking team members to multi-task so we can avoid adding extra people for the increase in sanitation needs. We are revamping scheduling and hours to get maximum productivity with patient flow that will be less than the old normal.  

We have mapped out projected production and can meet reasonable goals under the new model with no fee increase for now. We plan to hold the line for four months and then we will have a fee increase. How much? We do not know yet, but we project at least 3 – 5%. We believe that amount will be accepted by clients and will cover most of the cost of increased overhead. We do not foresee the fee increase dropping the bottom line. If you want to share what you are doing, feel free to do so in the comments section of this blog. 

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North Shetter DDS

Dr Shetter attended the University of Detroit Mercy where he received his Doctor of Dental Surgery degree in 1972. He then entered the U. S. Army and provided dental care at Ft Bragg, NC for the 82nd Airborne and Special Forces. In late 1975 he and his wife Jan moved to Menominee, MI and began private practice. He now is the senior doctor in a three doctor small group practice. Dr. Shetter has studied extensively at the Pankey Institute, been co-director of a Seattle Study Club branch in Green Bay WI where he has been a mentor to several dental offices. He has been a speaker for the Seattle Study Club. He has postgraduate training in orthodontics, implant restorative procedures, sedation and sleep disordered breathing. His practice is focused on fee for service, outcomes based dentistry. Marina Cove Consulting LLC is his effort to help other dentists discover emotional and economic success and deliver the highest standard of care they are capable of.




Top 5 Clinical and Career Tips of 2017 for Dentists

December 31, 2017 Pankey Gram

The end of 2017 is wrapping up a solid year of incredible dental blogs from our talented Pankey contributors. Our posts featured everything from techniques for occlusion and orthodontics to practice management and leadership.

There are tons of useful tips and plenty of information for dentists at every stage of their career on the Pankey Gram. Here, we’re compiling five pieces of sound advice from blogs in 2017 that are sure to get you excited for another year of practicing dentistry your way.

As Pankey dentists, we continue to strive for greater learning and growth in our professional and personal lives. Revitalize your hunger for education with these thought-provoking tips:

5 Clinical Tips From 2017 Pankey Blogs

1. Consider physiologic changes that occur over a lifetime when planning restorative dentistry.

In his blog on ‘Adult Growth of the Dental Arch,’ Dr. Roger Solow explored the slow craniofacial growth that can affect dentistry throughout a patient’s life.

2. Set splint therapy fees in such a way that you can actually make money off them.

In his blog, ‘How to Set Splint Therapy Fees,’ Dr. James Otten described how to individualize splint therapy fees and more accurately estimate therapeutic time.

3. Think like an orthodontist when advising patients on post-ortho care.

In her blog, ‘How Long Should Patients Wear Their Retainers Post-Ortho?’, Dr. Lee Ann Brady laid out important considerations for dealing with questions about retainers.

4. Recognize when patients are in denial and practice empathy toward them.

In her blog on communication, ‘From Denial to Acceptance and Action,’ Mary Osborne RDH enlightened with a description of patient denial in dentistry.

5. Improve you protocol for restorations by adding another dental assistant.

In his blog, ‘6-Handed Bonding,’ Dr. Mike Crete made his case for why an extra dental assistant can benefit dentists dealing with adhesive dentistry and tricky restorations.

And there you have it folks. Best wishes for 2018! 

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How To Set Splint Therapy Fees

September 1, 2017 James Otten DDS

Splint therapy can be one of the best services we offer our patients, but plan poorly and your headaches will greatly increase as you decrease your patient’s.

We all want to provide our best stuff for our patients, yet sometimes we can find ourselves in a quagmire of complexity and not getting reimbursed for our efforts.

Through the years I’ve seen this scenario play out in my own practice and many others because we lack structure around our fees for splint therapy. If ever there was an example of the failure of unit fees to provide appropriate care and reimbursement, the one size (fee) fits all approach in splint therapy will leave you clenching and grinding.

How to Individualize Splint Therapy Fees

To be equitable for patient and practice, fees for splint therapy must be individualized. To do this, you’ll need to have a good idea of what your production per hour goals are and utilize that as a basis for your fee.

For example, if I have an anterior deprogrammer that requires very little follow up to simply protect the dentition and calm muscle, the fee would consist of a lab fee (I charge this fee even if I make it in house), the time for insert, and the amount of time for follow up, usually one or two short appointments.

For more complex TMD therapy I like to look at it this way: take the same basic fee structure illustrated above and add time for insertion (allow yourself enough time, knowing mandibular/condylar position is likely to change as you adjust), then add for follow up appointments based on your diagnosis and complexity.

Estimating Therapeutic Time

Here are some of the factors I consider when estimating the “therapeutic time.” I’ll routinely add time and/or appointments based on whether it involves:

1) an occluso-muscle disorder

2) an intracapsular disorder

3) the amount of degenerative change in the condyle disc assembly

4) the chronic or acute nature of the problem (acute problems I feel are generally harder to manage)

5) the presence of pain, both quantitative and qualitative

6) the duration of pain and complexity of pain pattern (pain emanating from multiple sources)

7) the behavioral and psychological dynamics involved with the patient

In closing, I’d remember to under-promise and over-deliver in direct proportion to the complexity of the problem. Evaluate, diagnose, and treat wisely and you’ll achieve pain reduction and stability for both you and your patient!

How do you structure fees for splint therapy in your practice? We’d love to hear from you in the comments! 

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James Otten DDS

Dr. James Otten, is a 1981 graduate of the University of Missouri-Kansas City School of Dentistry. He completed a one-year residency in hospital dentistry with emphasis on advanced restoration of teeth and oral surgery at the Veterans Administration Medical Center in Leavenworth, Kansas. He taught crown and bridge dentistry as an Associate Professor at UMKC before entering private practice in 1982.He has completed the rigorous curriculum at two prestigious institutions – The Pankey Institute for Advanced Dental Education and the Dawson Center for Advanced Dental Education. Dr. Otten lectures nationally and internationally. Dentistry’s most prestigious organizations.