05.15.09 Issue #375 Forward This Newsletter To A Colleague


Nancy Caudill
Senior Consultant
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"Something is better than nothing!"

Dr. James Bradford – Case Study #321

“I am not busy……not busy…….not busy!”  Sound familiar?  Unfortunately, we are hearing this expression much more than usual.  Dr. Bradford had the good fortune of enjoying a profitable practice, but now, the number of openings are occurring with greater frequency, and the situation is forcing him to start paying closer attention to his practice production and collections.  “My production is down 10% from last month.”

Dr. Bradford’s practice was established 18 years ago and focused on general dentistry with much of his production in fixed prosthodontics.  The practice averaged 23 new patients and 9 new emergency patients a month.

Low case acceptance
When patients are comfortable with their personal financial condition, it is much easier for them to accept “ideal” dental treatment.  They are not as concerned about insurance maximums and “patient portions.” Utilizing outside financial institutions such as Care Credit for elective services is acceptable and inviting. 

Dr. Bradford prided himself on his high case acceptance of fixed prosthetics, including his in-house fabricated restorations.  Not so, as it seems now.  Reviewing the monthly case acceptance rate for these procedures, it became obvious that his historical approach to treatment presentation and recommendations would need to be altered.

Case presentation
Ideal dentistry to Dr. Bradford was not always what the patient “wanted” or thought they “needed.” Often times it is a perception by the patient and many times it is strictly a matter of affordability.  After reviewing his lower case acceptance over the past two months, it was obvious that his patients were shifting to their wants and needs and not his.  In order to improve case acceptance he was going to need to recommend other options that were more “palatable.”

Note that the objective here is to increase case acceptance, not necessarily to increase dollars accepted.  Understand that Dr. Bradford’s production is down and the number of openings on his schedule is up so it becomes important to get patients in the chair.  An unfilled chair is not adding anything to the doctor’s production numbers!

Dr. Bradford’s approach to case presentations was to share with patients everything they need. The hygienist or assistant would present the entire treatment plan and then the patient was dismissed to the Financial Coordinator to make an appointment.  The dialogue went something like this:  “Joe, it appears that you will need a few ceramic crowns and composite restorations, and let’s replace that missing tooth on the lower right side with either an implant or a bridge.  OK? Great. I look forward to seeing you next time.”

Carol, the hygienist would enter all this into the computer, print out the treatment plan and begin to review it with him.  His treatment plan total is $6,775 but Joe’s primary focus for visiting Dr. Bradford for the first time was to get his teeth cleaned!

Carol escorts Joe to Jane, the Financial Coordinator and says, “Jane, Joe is all finished for today. Good bye Joe, and thanks for coming in.”

Now, Jane is left with the overwhelming task of scheduling an appointment for Joe after she discusses with him his financial options to cover the $6,775 and proceeds with the question, “Which option works best for you?”  Is it surprising that Joe’s response is, “Wow. I didn’t realize that I had so much work to be done.  I have to go home and think about this.”

Not only has Joe not accepted any restorative treatment, but his periodontal concerns have not been addressed ANDhe has also been lost to the myriad of unscheduled hygiene patients because he has no plans of returning.  After all, he just wanted his teeth cleaned!

A Different Approach
Let’s play this out differently without taking into consideration the fact that Carol, the hygienist, has “pre-heated” Joe about potential concerns and revealed these areas to Joe with the intra-oral camera.

Dr. Bradford presents to Joe after his diagnosis, “Joe, as you can tell, you do have some areas of concern.  I understand that you are a businessman that travels for a living.  I sure would hate for you to be on the road and one of those large, broken down silver fillings crack, wouldn’t you?  With your permission, I would like to start by replacing those two old fillings here (and he shows Joe the image) with two beautiful porcelain crowns.  We can complete them right here in the office in one visit so you don’t have to make a trip back.  I know how valuable your time is.  Then we will discuss the other areas when you return.  How does that sound?”

When Joe is escorted to the Financial Coordinator, the hygienist says to Jane, “Jane, Joe did great today.  We really enjoyed having him here as a new patient.  He and Dr. Bradford have determined that they would like to address those two broken down old fillings on the upper left side by restoring them with two porcelain crowns that we will make right here for him.  Dr. Bradford will need about 2.5 hours.  At that visit, we will discuss his other concerns.”

Success!  Jane offers to Joe the financial options for the total treatment of $1,800 and he accepts and schedules.  The treatment plan was much more palatable and not as overwhelming.

What if there is no acceptance?
After Jane’s financial options are presented, Joe is still not comfortable with the fees.  Jane’s approach would be to break it down to an even smaller treatment plan that is more appealing and acceptable to Joe.  Remember that it is not what Dr. Bradford wants but what Joe wants.  Therefore, she presents 1 restoration instead of 2.  If this also fails to get a “yes”, this is the most important question Jane will ask:

“Joe, our goal here is to help you accept and receive the dental care that you want and deserve.  Are you going to be home or at work later this afternoon?  Please allow me to discuss your concerns with Dr. Bradford and see what other options we may offer you to resolve your concerns for these two old fillings.  How does that sound?”

Something is better than nothing. Dr. Bradford does not want to lose a new patient because of options that were presented that the patient was not willing to accept.  He also didn’t want to lose Joe as a hygiene patient.  Even though Joe didn’t accept his restorative options, Dr. Bradford still wants to maintain him as a hygiene patient so he can retain the relationship and keep him in the practice.

After three months of following Dr. Bradford’s “new” treatment acceptance protocol, his rate has climbed from 41% to 67% by offering alternatives that his patients are willing to accept.

If you would like more information on how McKenzie's Practice Enrichment Programs can help you IMPLEMENT proven strategies, email info@mckenziemgmt.com.

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