Reality Check - Does Your Practice Suffer from Neglect?
It’s no secret that over the past few years, many dental practice owners have had to take a good hard look at how they do business. The problem, however, is most either don’t know what to look for or really don’t want to pull back the curtain and face the nasty mess that lies behind it. Instead, they promise themselves: “We’ll get through it. We’ll be okay.”
For practices that have been in operation for 15-20 years, owner neglect is not uncommon. The doctors went into dentistry to treat patients. They managed to squeeze out a pretty decent income over the years. They tolerated the staff challenges. They did their best to stay enthused. They knew things weren't perfect, but they were good enough - until the last few years. These dentists can no longer bury themselves in the dentistry and let the rest of the practice operate on autopilot.
They are facing serious challenges today, unlike any they have seen in their careers. They don't know what to do, so they pretend the problems aren't that big. Essentially, they check out from reality. But eventually, the doctor finds him/herself standing toe-to-toe with serious concerns - be they with practice finances, staff, or other - and something has to change.
What can you do when you've allowed your practice problems to multiply to the point that you are completely overwhelmed? Get help. In the meantime, take a good close look at the critical systems that feed the business, starting with the manner in which your staff handles telephone calls.
With all of the focus on customer service and creating a positive experience for patients/customers, I continue to be utterly and completely amazed by the numbers of dental employees that think quality customer service is something that everyone else should provide, except them. Or they are convinced that the mediocre or poor service they are delivering daily is actually good!
One of the most eye opening reality checks for doctors who seek help for their struggling practices is listening to the phone conversations that take place between their employees and prospective patients. The ultimateirony is that in many instances, the doctor acknowledges that if s/he were the calling patient, s/he would hang up and never call back again. In others, the doctor listens in disbelief as patient after patient after patient slips away. Staff rattle off their best guesses on fees for services, provide advice on insurance, yet never make the effort to schedule the caller or reschedule a cancellation.
McKenzie Management’s telephone skill training helps doctors better understand how truly critical this “front door” to the practice is in maintaining a full schedule and a steady stream of patients. Consider this actual exchange:
Patient “Mary” calls the practice of “Dr. Casio.” Business employee “Tina” answers the phone, states the nameof the practice, identifies herself, and conveys a helpful attitude. The call is off to a good start. Mary explains thatshe has a 3 p.m. appointment today, but “something” has come up and she cannot make it. Tina, nice as canbe, says: “Okay, doyou want to just call back when you can reschedule?” Mary, of course, says “yes.” Click, the call ends, and the opportunity is lost.
What's wrong with this exchange? Tina makes no effort to convey to the patient the importance of keeping the appointment. She does not emphasize that the time has been reserved exclusively for Mary, or that the doctor will be very concerned, or the importance of receiving treatment so that the dental problem does not worsen. More troubling is the fact that Tina doesn't even try to reschedule the patient. Certainly, the tone is warm and friendly, but it is also one that conveys the appointment is not important, last minute cancellations are no big deal, and the patient can just call back when she's in the mood for dental treatment.
There is a very good reason why this practice is not meeting daily production targets. Cancellations and no-shows are rampant, and patient attrition is clobbering the bottom line. Yet, Tina - who has not received a day of training - is doing her best. The doctor hears Tina’s friendly tone and believes that she’s doing a “good job” until he listens to both sides of the exchange and hears for himself the sound of patients slipping away, one friendly phone conversation after another.
Next week, practice feeders can't be ignored.
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How to Get "Yes" Instead of "I'll Think About It"
If I were to ask you, the doctor, what is the one thing (I know there may be several) that you would improve in your practice, what would it be? And if I asked your Schedule Coordinator the same question, what do you think that she would say? You may find that the answer would be the same - “I want patients to schedule their next appointment with the doctor!”
This is quite a concept, because in many cases, we are expecting the patient to “eat the whole elephant” - when in reality, we would be thrilled if they took the first bite.
Let's review this scenario:
A new patient calls in to “get their teeth cleaned.” The patient was referred to you by an existing patient that loves you and your team. She indicates on the phone that she has no chief complaints or concerns. She just wants to change dentists. During your charting of existing restorations (which I suggest that you do opposed to your assistant or hygienist, because it allows you to build trust and rapport with the patient), this is what you observe and call out to your assistant or hygienist so that the patient can also hear.
Etc. You see the picture. Praise them when something is nice or doesn’t need treatment. Speak at a 3rd grade level so they understand what you are saying and can “co-diagnose” with you. The patient understands words such as “old, cracked, cavities, silver, mercury, tooth-colored,” etc. They don’t understand “lesions, decay, alloy, amalgam, composite, PFM,” etc. Your “dental-ese” dialogue will sell no dentistry for you. It will cause the patient to ask your assistant or hygienist exactly what it was that you just said!
OK so you have charted existing restorations for your new patient, and amazingly enough, she has some dental needs, even though nothing is hurting.
#4 Needs to have the old silver filling replaced due to a cavity - tooth-colored MOD filling
At this point, the patient is hearing what you are saying and has an idea that she has some cavities, and a cracked tooth. Let’s estimate that this treatment plan is valued at $2,500. You may be thinking that this is not a large treatment plan and the patient will easily accept this. What you may not recall is that she indicated “nothing is hurting” and she just "wants to get her teeth cleaned.”
The Treatment Plan Presentation
If all clinical concerns are equal, which tooth would you start with in her treatment plan? Why? When I ask the doctor and the team this very question with the same scenario, I receive many different answers, and they are all correct. However, let’s think about it from a marketing standpoint. Where is the easiest and least painful area to give an injection? Upper? And which of the upperteeth is the easiest to say “yes” to from a financial standpoint? #4 - that is where I would start.
“Mrs. Jones, as you heard and as we have discussed, you have dental needs in all 4 quadrants (areas) of your mouth. With your permission, I would like to start on the upper right side with the tooth-colored filling. When you return, we will decide where you would like to go from there. How does that sound? Do you have any specific questions about my findings and what we have discussed? Are you ready to get started?”
Most of you do not like to probe the patients to see if they have questions. I think it is because you are afraid that they will! It is much better to answer their questions clinically so they are knowledgeable about what they need, as opposed to asking several questions to the Schedule Coordinator, who was not in the treatment room when you presented to the patient.
Your Schedule Coordinator will ask her how her visit was, maybe thank her again for coming to see you, and then ask her if 10am on Tuesday will be convenient for her. She does NOT ask, “Would you like to schedule this now?” We always assume that the answer is “yes” until the patient says “no.” The financial arrangements are made for this upcoming visit and the patient is dismissed. We have a “yes!” We’ve achieved our goal.
If the Schedule Coordinator had presented the $2,500 treatment plan - even though she may have said that the patient can work through it in phases - all the patient might have heard is $2,500 and she only wanted her teeth cleaned.
Let’s just get to “yes!”
Scripting for Periodontal Maintenance
As Business/Financial/Insurance Coordinators, we are constantly asked questions in regards to billing dental insurance for preventive teeth cleanings (prophylaxis) versus periodontal maintenance. Clinicians know the difference between the two services and are relied upon to relay the information to the patient. Often the patient’s next response is “Does my insurance pay for it?” At this point, the patient is transitioned to the front desk for answers and for scheduling. Before the patient is transferred to the desk, the clinical team needs to make sure that the education process is complete and that the patient understands the consequences of not complying with recommended treatment protocols. The uninformed patient that has had scaling and root planing often thinks they can go back to regular cleanings.
Unfortunately, patients with a low trust of dentists or with the belief system of eventually losing their teeth look to the insurance company to validate whether their care is “necessary” or not. Being prepared by anticipating this question is your best defense. Know enough about the differences between a preventive service such as a “regular” cleaning and a therapy treatment, as in the periodontal maintenance visit. To be convincing to motivate the patient is important as patients tend to ask for information they have already received from the clinical staff.
Some suggested scripting would be as follows:
“Mrs. Brown, I know it is important for you to have coverage for your care. I have been able to communicate with your insurance provider and have found out that the periodontal therapy maintenance visits are covered. Your contract allows an 80% payment for our fee. There is a $50 deductible applied to this service once a year. In other words, they will pay 80% minus $50. We will provide the necessary documentation of your condition along with the claim to the insurance. Each year, your plan will pay for 3 periodontal maintenance visits. Our recommendation is 4 visits, so one will be your responsibility for payment.
The early stages of periodontal disease is the best time to halt and manage its progression. Our dental hygienist uses special instruments to clean where your toothbrush and floss cannot go to remove debris and toxins causing the gum disease. Losing teeth is not an option at this point. We must protect your oral health, which is essential to your overall physical health. We cannot ignore a bacterial infection simply because of insurance limitations.”
Another scripting scenario would be the following:
“Mrs. Brown, as you know, our goal is to provide excellent dental care to all of our patients, regardless of whether they have dental insurance or not. The information that I have obtained from your insurance company is that they will pay for two dental hygienic visits per year, whether they are preventive or periodontal therapy in nature. This is a plan limitation and not a judgment on the type of care that you need. According to Dr. J and Dee, our hygienist, you have a bacterial infection that needs to be treated. After the treatment, you will be placed on a maintenance program so that we can monitor your healing and bone loss. Dr. J recommends 3 periodontal maintenance visits a year for which two will be covered by your insurance company.”
Some patients don't think it is harmful to change codes or alter treatment notes in order to get more benefits from their insurance company. The patient may even report that the insurance company has instructed them to tell you to bill for another code so that they get coverage. This is the time when a three-way phone conference is in order between the business coordinator, the patient and the insurance company representative. Put on the spot like this, the representative must tell the patient that the doctor has a legal obligation to code services correctly by choosing codes which most accurately depict the treatment rendered. The plan representative may not understand the risks for the doctor in falsifying claims to gain benefits.
In order to get better benefits in the future, patients should be encouraged to communicate with their employers to increase the dental benefit coverage, or to negotiate for better coverage on specific services such as periodontal maintenance.
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