Doctor, That’s Not a Treatment Presentation
As patients are winding their way back into the dental office for necessary and desired treatment, dental teams are seeking to maximize every patient interaction. The days of being too busy to worry about the efficiency of practice systems are long gone. The recession taught many practice owners that in lean times, system efficiency is the make it or break it factor. Above all, practices are taking a much closer look at treatment presentation and acceptance.
In working with practices, we consistently find that doctors misunderstand their role in the treatment presentation process. Let me explain. Consider the typical doctor/patient scenario. The doctor diagnoses treatment for the patient and, in his/her mind, thoroughly explains why the patient needs the treatment and what the doctor is proposing. From there, the patient is dismissed and goes to the front desk to schedule the next appointment for treatment. Or so the doctor thinks.
At least 7 out of 10 times, the front desk employee becomes the default treatment presenter. The patient goes to the front desk where the phone is ringing and other patients are checking in/checking out, and they start asking questions about the doctor’s recommendation. The patient sheepishly looks at the business employee and says, “I didn’t want to sound stupid, but I didn’t really get what the doctor was telling me. Could you please explain this to me? Now why do I need this bridge? How’s this going to work? How much is this going to cost me? Do I have to do this now?”
Did I mention that the phone is ringing and other patients are standing there waiting to check in and check out? The doctor’s production now hinges on how well the busy business employee, with no treatment presentation training, answers the patient’s questions.
The other common scenario is the patient has lots of questions, but they don’t ask them. They make their way to the front desk and say, “I’m going to think about it; I’ll call you back.” They leave and likely don’t schedule the appointments necessary, largely because they don’t have enough information to make an informed decision. They have no clear understanding of why this treatment is important. They have no idea how much it will cost. They don’t know how many appointments will be required, or how much time those appointments will take. Most importantly, they have virtually no appreciation for how pursuing the recommended course of treatment will benefit them now and in the long-term. They can’t make an educated decision, so they make no decision.
Dentists like to think that they are the ones presenting treatment. In actuality, what most are doing is introducing treatment to the patient. The doctor plants the seeds where many questions grow, and if they remain unanswered then the recommended treatment withers on the vine.
As Belle DuCharme explains in the McKenzie Management Educational DVD Treatment Acceptance Tactics, dentist after dentist thinks that his/her treatment acceptance is much higher than it actually is. They commonly believe that because they have introduced a particular course of treatment to their patients, those patients have scheduled and are pursuing that treatment. Dental teams seldom look at treatment acceptance as a system. Rather, they look at the schedule and if the schedule is full, they assume treatment acceptance is right on track. It’s an illusion. They are stunned when they actually look at the unscheduled treatment report and discover that treatment acceptance is well below the 85% benchmark.
Treatment acceptance is one of the most critical systems in the practice. And as a system it requires specific procedures, a designated person responsible, proper training, measurement of its effectiveness, and accountability. Achieving the 85% goal for treatment acceptance is essential in helping the practice move forward, grow, and meet other established goals and objectives. It is the cornerstone of the business. If patients are not pursuing recommended treatment at a certain level, the practice stagnates.
Next week, move beyond the treatment introductions to achieve treatment acceptance.
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Your Production Is Down and So Are You!
My schedule is full and I am busy, but at the end of the month I am lucky to break even. What is wrong with this picture?
Dear Dr. Shortnsorry,
There are several practice systems that affect the profitability of the practice. Have you delegated tasks to licensed dental assistants to free up some time on your schedule for productive services? Doctors who continue to fabricate their own temporary restorations lose about an hour or more out of every day that could be spent producing more billable dentistry. How much time do you spend in casual conversation with patients? Of course it is good to connect and share a little sports news, car bragging and child news, but when it causes you to run over or alter a patient’s treatment plan to get finished on time, you have lost production.
Are procedures scheduled according to the actual chair time required? If you find yourself with time to surf the net, perhaps a clinical time and motion study is in order to become more efficient in procedure times. If you are running over every day for some procedures and patients are left waiting in the treatment rooms while you try to catch up, you may want to reschedule procedures that were planned for that day.
Are your treatment rooms set up to allow for easy and quick access to materials and supplies you use daily? If not, your assistant will be running back and forth to retrieve instruments and supplies from the sterilization area, supply storage or the other treatment rooms - causing you to lose time at the chair.
How about your overhead management? Are costs out of control for dental lab and dental supply costs? Out of control overhead can cause the productivity of your practice to fall short of the goal because you are spending more than you are making. Don’t know if you have healthy statistics? Call McKenzie Management and talk to a consultant who can give you information on the standard overhead costs of a dental practice.
If you haven’t raised your fees each year for fear of scaring patients away, that could account for production goals falling short. Have a fee analysis completed to find where your UCR fees fall in your demographic. If they are low for the area, then raise them to be competitive in your neighborhood. Most people do not shop around for cheaper fees if they feel you are fair and bring value to the services that you provide. It’s about trust, not fees.
Discounting fees is a way to make you feel like you are making your services more affordable to your patients who want care, but struggle to pay for it. This is wrong thinking and detrimental to the profits of the practice, unless you have a margin of profit after the discount. If you internalize that your fees are too high and you feel sorry for your patients, it will result in poor treatment acceptance because patients will sense that perhaps you aren’t fair or that your services are below par to other dentists in the area. If your fees are middle to low for the area and you give discounts on top of this, you may be giving your services away. The same applies to daily no-charge visits to patients for viable billable visits. The patient may or may not appreciate the gesture, and may develop a sense of entitlement and expect no charge visits each time they come in for adjustments or limited evaluation appointments.
If you schedule without consideration for hygiene exams, you may be passing up the opportunity to present treatment again to a patient that just might buy it. Studies show that 65-85% of your repeat dental business comes from the hygiene department, so make sure you do the exam sometime within the hour that the hygienist has the patient in the dental chair.
Lastly, consider the adjusted production/collections that are necessary for being a preferred provider on the PPO network. Because this is discounted dentistry, it is imperative that you collect co-pays and deductibles at the time of service and carefully manage your schedule for efficiency.
Carefully monitoring these systems and making the right changes will result in higher production and collections every month.
Scripts for Everyday Dentistry
One of the more widely requested solutions that consultants are asked about are scripts. Apparently, doctors hear comments, questions and statements made by the business and clinical team that make them cringe, but they don’t want to address their concerns directly to the team member.
Explaining simple dental procedures in a manner that the patient can understand can be challenging. How many of your patients will be dismissed to Suzie at the front desk, only to ask her, “Why do I need this crown?” It is not the job of the Financial or Schedule Coordinator to review the dental needs of the patient. Rather, it is their job to assist in financial arrangements and make the appointment. Please don’t misunderstand. It isn’t that Suzie isn’t capable, but rather, that these clinical questions should be answered chairside.
Here is a dialogue that I hear often:
Doctor: “Mrs. Jones, it appears that you are going to need a crown on this tooth. The margins around the old amalgam are deteriorating and there is recurrent decay under the alloy. The integrity of the tooth structure is jeopardized, requiring a PFM. Suzie will answer any questions that you have. See you soon.”
I can promise you that Mrs. Jones has no idea what the doctor just said. All she really knows is that she came in for her “regular cleaning” and nothing is hurting. Now she needs something, but has no idea what it is or why she needs it.
Every staff member including the doctor needs to be able to express to patients in simple language, that anyone can understand, why they need dentistry. If patients don’t understand what they need, when it comes time to make an appointment their response is “I need to think about it.” You tell me what they are going to think about when they walk out the door? Dinner, their golf game tomorrow, picking up the kids, etc. I don’t think it is going to be their teeth, as much as we would like to believe!
So, how can you create scripts for the dentistry that you do?
A suggestion: Place a whiteboard in the staff lounge. When someone hears a statement from another team member that could be said in a more “patient friendly” manner, it is written down. The intent is not to hurt someone’s feelings but to help the entire team be on the same page with their dialogue. It is a learning experience for everyone. Review at least one procedure at your next monthly meeting and develop an easy to understand explanation.
Another suggestion: At your monthly meetings, establish 3 typical procedures that are performed in your office and tell the team that next month, 3 names are going to be drawn, along with one of the procedures. The person whose name is drawn will explain, on a 3rd grade level, the procedure that is also drawn. Everyone can chime in after the initial presentation and continue to simplify the definition until the entire team feels that the explanation is easy to understand.
Focus on getting your explanation to achieve a visual image and correlation of something that they can relate to so it makes sense to them. Also remember that in many cases, they must be able to “re-explain” this to a spouse or other family member at home.
In addition to a verbal explanation, give them a tangible object, such as a brochure, periodontal chart or intra-oral image that you have drawn on that “personalizes” it. Avoid handing them a brochure on periodontal disease and instructing them to “read it.” The results are not the same.
For all of us working in the field of dentistry, understanding dentistry and why and how we do what we do is a given. For patients, all they really know is that you practically lay them back on their heads, they keep their mouth open for a long time and you stick them with a sharp instrument. Seriously, this is true, and it has nothing to do with their level of education. Granted - there are some patients that don’t want to know and don’t want to see intra-oral images of their condition. Always ask permission to show them, as well as ask permission to share with them their dental needs.
For example: “Mrs. Jones, as you have heard, I gave my assistant quite a bit of information about what I have seen in your mouth. May I have your permission to share this with you?
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