after construction begins have a long lead time or are on back order, forcing the contractor to put your project on hold until the items arrive. This time constraint may force you to accept less desirable alternatives.
Contractor
Tenant improvement costs will likely be the single biggest expense you will incur when opening your new dental office. They are also the expense that can fluctuate the most from the beginning to the end of your project, often wreaking havoc on your budget.
Hire a contractor who has experience building dental offices. An inexperienced company may underbid the project, not fully understanding its complexities and underestimating the time necessary to complete your project. If you live where experienced contractors are unavailable, it becomes even more important for you to get everything on paper to avoid expensive change orders.
Ask contractors for a bid that includes a full-time superintendent. A salaried employee of the construction company that you hire, the superintendent is the most important person involved with the construction of your project. He or she is responsible for ensuring that all the tenant improvements are built according to your plans and making sure that none of the subcontractors deviate from the plans to save costs. The superintendent coordinates all the various subcontractors and makes sure they show up as scheduled. He or she is the person who works closest with your dental equipment consultant/ supplier to make sure your equipment requirements are met. Warning: When a construction company takes on more projects than it can handle, the superintendent will often end up being assigned to several projects at once, leaving you with only a part-time manager. Inevitably, less supervision over the numerous subcontractors involved means more mistakes and delays during tenant improvements.
Hire a contractor who has experience building dental offices. An inexperienced company may underbid the project, not fully understanding its complexities and underestimating the time necessary to complete your project.
Avoiding change orders saves significant backend construction costs. You can also save additional costs on the front-end of your project. When you and the architect made decisions during the design phase of your plans, many may have been based on esthetics, without you really knowing the total cost. If even the lowest bid ends up being higher than your budget, value engineering can play an important role in bringing that cost back in line. When value engineering, the contractor will make suggestions about what you can substitute in place of the design decisions specified in your plans and tell you the resulting lower costs involved. Most contractors are familiar with the cost of materials. A contractor who is good at value engineering can save you a lot of money, and it only costs the contractor a little bit of time. Of course, for this to work, you are going to have to make concessions with your previous design decisions.
Sometimes a dentist will already have a relationship with a contractor he or she likes, or has the name of one highly recommended by a trusted colleague, and may elect to bypass the traditional bidding process. This can be to the dentist’s advantage, but only if the contractor is willing to attend all the design phase meetings with the dentist and the architect. If the dentist clearly states a budget for tenant improvement costs, the contractor can concurrently value engineer the project as the design phase progresses, guiding the dentist and architect in making decisions that keep final costs on target. In the construction industry, this process is called a negotiated bid.
One other tip for protection against financial catastrophe: Insist that your contractor purchase performance bonds and payment bonds that guarantee contractor performance and shield the dentist from contractor default. The American Institute of Architects (A.I.A.) has standardized performance bonds and payment bonds that guarantee contractor performance and shields the dentist from contractor default. Insist that your contractor purchase these standardized bond forms used by the A.I.A., which have repeatedly held up in court and passed the test of time.
When you and the architect made decisions during the design phase of your plans, many may have been based on esthetics, without you really knowing the total cost. If even the lowest bid ends up being higher than your budget, value engineering can play an important role in bringing that cost back in line.
Technology Specialist
The technology specialist has the biggest learning curve of any of the vendors you will need to hire for your project. “Plug-and-play” results can be realistically expected only if all the pieces of this complex puzzle have been judiciously planned, designed, and implemented (installed). The value of dental experience in this arena cannot be overestimated.
Planning for technology installation in your new office takes a great deal of research and due diligence. The first step should be to understand the practice management software and capture (imaging) software, the foundation of any digital office. The design stage consists of determining where the technology equipment and devices will be located in your office, and what they require to properly function. A critical element of the design phase also involves validating all the individual components as to how they need to be integrated, programmed, and set up. This validation process is a key step towards ensuring a problem-free installation, and demonstrates the value of experience. Trial and error can be very expensive and frustrating. The specialist’s previous experience with a variety of digital and radiology equipment will also be a huge advantage to both you and your staff during training, an important element of the installation phase.
Should the specialist purchase your computer hardware from a large reputable company or custom build your CPUs (central processing units)? CPUs from large, reputable manufacturers come in a variety of sizes, ranging from large to very small, to fit every possible situation. A custom-built CPU starts with a “white box,” which generally comes in two sizes, large or medium. A white box won’t have a manufacturer’s name on the outside, because it is typically made up of components (such as the processor, hard drive, and video card) from a variety of manufacturers. A technology specialist may build their own CPUs to gain a pricing edge over the competition. He or she can piece together various components that may be on sale or discounted to produce a less expensive CPU. If these components are compatible — and that’s a big if — another concern involves warranty issues. If a technology specialist who builds their own computers goes out of business, you have no warranty coverage for these CPUs, while CPUs purchased from a reputable manufacturer still have applicable warranty coverage.
If you purchase custom-built CPUs, your technology specialist must get involved with the custom cabinet design throughout your new office to ensure that these CPUs fit inside the cabinets where indicated, with adequate room for air ventilation.
Be sure your technology specialist offers adequate backup support. Is someone available to either immediately fix your problem from a remote location or send service people to your office on short notice?
If your practice is a HIPAA covered entity, you will require a business associate agreement with your technology specialist if he or she will have access to patient information. Work with a qualified attorney to develop appropriate business associate agreements with any outside individual or entity who will have access to protected health information (PHI) as defined by HIPAA, which can include dental records, images and radiographs, billing records, and insurance information such as explanations of benefits (EOB). HIPAA requires covered entities to safeguard PHI in electronic, hard copy, and spoken form.
Planning for technology installation in your new office takes a great deal of research and due diligence. The first step should be to understand the practice management software and capture (imaging) software, the foundation of any digital office.
Accountant
Your accountant should be a certified public accountant (CPA) who has lots of experience with dentists. One who has served dentists opening a new practice is an even bigger plus, especially when you are in the process of developing a business plan for your lender. Ask several of your colleagues who they use and if they’re happy with the firm’s service. Don’t focus solely on cost because a good accountant can save you a small fortune in tax savings over the years.
Dentists who open a new