Converting Emergencies: Give the Gift of Comprehensive Exams
This time of year, they are everywhere. No I’m not talking about patients, unfortunately. I’m talking about advertisements. Turn on the television or the radio. Open a newspaper or a magazine. Visit a few online sites. Wherever there are consumers, there are ads for products. And this year, retailers are pulling out all the stops to get recession-weary consumers to splurge a little. We’re flooded with recommendations that we purchase that new super-size TV at an “unbelievable” price. We must get that cool gadget now because “supplies are limited.” Whatever the item is, right now there is no shortage of so-called “must haves” in the marketplace and so-called “great deals” to get consumers to buy them.
For most of us with a modicum of restraint, many of these blaring messages are simply relegated to background noise. They are snippets of information that we quickly cast off or never even see because we’re not ready to consider them or are simply not interested. But when the time comes and we begin to consider a purchase, then we start to open ourselves up to the messages around us. We pause to consider the appliance promotions. We might click the link on that cool new gadget that pops up on the web page. We want to find that unique gift for someone special. It is then that we are open to learning more.
Such is the case when the emergency patient sits in your chair. Up until this moment, that person may not have been interested in what you have to offer. However, their current situation has prompted them to consider not only immediate treatment, but quite possibly comprehensive care as well. Yet dental teams miss this opportunity time and again. According to the industry standard, 80% of all emergency patients should be converted to comprehensive exams. If your percentage is lower, it’s time to develop a plan to maximize one of the best practice growth opportunities you have, starting with team attitudes.
Sadly, emergency appointments are viewed as negative and potentially problematic by both the patient and the staff. Consequently, practices commonly send the wrong message to these patients. The person is squeezed into the schedule. Although it’s not necessarily intentional, the emergency patient is frequently viewed as an annoyance and an interruption to the day, rather than an opportunity.
When the emergency patient calls your office, what’s the reaction? Irritation? Frustration? Increased stress? Depends on the time and the day? Here’s what happens in many offices. The scheduling coordinator takes the call and scans the already full schedule. With a labored sigh, she tells the patient it’s going to be very difficult for the practice to work them in, but they will. Oh, and the doctor expects payment upfront. Within the first 60 seconds of contact with that emergency patient, your practice is laying the groundwork for conversion to comprehensive exam …or not.
No matter what the circumstances - full schedule, stressful situations, etc, emergency patients must be treated with compassion and understanding. Each day the dental team should identify where emergency patients are to be placed in the schedule. This ensures that there are no surprises for the clinical staff, the scheduling coordinator knows exactly where emergencies are to be placed, and these patients can be happily welcomed.
Next, increase awareness among your team. Business staff, who tend to be more task oriented and are much more comfortable when the day runs according to a specific plan and schedule, occasionally need to be reminded that emergency patients are likely to require more empathy and concern than they may typically convey in their day-to-day patient communication. The emergency patient should feel that your practice is one that is understanding and helpful - not punitive.
Listen to how the emergency patient calls are handled. Are these conversations warm and welcoming? How would you feel if you were an emergency patient calling your office? Would you be glad you chose this practice, or would you feel that the practice’s primary concern is the payment rather than the patient?
I recommend dental teams develop phone scripts to help them effectively communicate with emergency patients from the very first word. The script provides a general guide to assist all staff, no matter who picks up the phone, in gathering necessary information, conveying essential details, and continuously expressing a helpful and caring tone and attitude throughout the exchange.
Next week, creating the very best emergency patient experience.
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Did Julie Schedule Her Dental Appointment?
As the dentist and “salesman” in your practice, do you often wonder if John scheduled the appointment for his crown today or if Julie made her appointment for the quadrant of fillings? Many clients will express their concern relating to whether their patients are scheduling or not scheduling at the front desk. “Did I spend all that time discussing treatment options just to see the patient walk out the front desk with no appointment card in their hand?”
Why Is This Important?
I know that you are thinking - my practice management software tracks this - not exactly. If all the I’s are dotted and T’s are crossed, it will give you treatment acceptance, outstanding treatment plans and other pieces of information that are not always helpful. This report, however, tells you exactly who scheduled and who didn’t and if they didn’t, why. Accountability is vital to the management of your practice. This is accomplished by monitoring tasks that are measurable.
A tracking form also indicates how many perio, removable, fixed, oral surgery, endo, etc. categories have treatment presented and what percentage of these patients scheduled their appointment. If there is a pattern of restorative procedures being scheduled and fixed or crown appointments not being scheduled – there is a problem. Could it be that the patients can manage their financial obligations for this type of treatment but not for higher dollar items? If so, this means that the financial options in your office are not effective. It could also mean that the patient does not have a full understanding of what the benefits are for a crown versus a filling. As a result, they elect the more affordable option, just to be safe.
Follow Up with Non-Scheduled Patients
Your patient wants to talk with their spouse first before they make an appointment. My guess is that it is about finances. I have a question for you - how well do you feel your patient can go home and “talk to” and educate their spouse on their dental needs? Probably not well enough for their spouse to say “yes,” in many cases. These patients need tools to take home to help support their plea. Tools such as a photo of their tooth/teeth that require treatment, a color-printed periodontal chart with the areas circled that are of concern, a pamphlet relating to their specific dental needs, etc. should be offered to the patient.
The Schedule Coordinator would be appropriate in responding to this comment from the patient with a “Mrs. Jones, I can understand that this is a difficult decision. Do you have any specific questions that I may be able to help with?” or “Mrs. Jones, I appreciate that this is a big decision for you. Would you like for me to speak with your spouse about your dental needs?” or “Mrs. Jones, I know that this is a big decision. I also know that Dr. Brown is concerned about these teeth. If I don’t hear from you in a few days, may I call you and see how I can help?”
“I need to think about it!” I love this one. What exactly are they going to think about anyway? My guess is: what’s for dinner - what’s on TV tonight - what will I wear to the party tomorrow. You know - those important questions. This response simply means that the patient was not “sold” chairside and is not committed emotionally. Maybe options were not offered or not enough questions were asked to determine if the patient is ready to commit to the treatment. The doctor should have inquired - “Mrs. Jones, does this sound like something that you are committed to in order to save your tooth?” It is necessary for the patient to indicate that they are unclear about their dental needs in the treatment room opposed to making this statement to the Schedule Coordinator. However, should it happen, the Schedule Coordinator would ask the probing questions as mentioned about to determine exactly what the hesitation is - financial? Understanding exactly what is needed and why? Will it hurt?
Information is powerful. Information also assists you, as the doctor, to hold your team accountable for their required tasks relative to their job descriptions. Find out what your appointment scheduling percentage is and improve it for increased production and collections.
Managing the Flood Waters of New Patients
There is no cookie cutter plan of action that fits all practices. Each has its own uniqueness, and those differences dictate how to set up and monitor systems. Starting up a new practice without a patient base can be frightening, and the expenses to operate coupled with the payback on loans can seem overwhelming. Attracting quality new patients is one of the top fears new dentists have when opening a new practice.
Demographics and psychographics play an important role in determining if there will be a large enough population and a population that seeks the care your practice will provide. Investing in the right marketing plan, branding your practice and getting the word out everywhere that you are there to serve the community is high priority.
General advice would include signing up for select Preferred Provider Networks of insurance companies. The practice of Dr. J thought it reasonable that if you accept all plans, you will have more than enough patients to treat. This really depends on the saturation of dentists accepting the PPOs in the area of the practice. What it does do is control what you can charge and collect for services. What about management of these patients when you are trying to control operational expenses?
Dr J’s practice showed favorable demographics and psychographics, but he decided to sign up for every PPO network available. Because this was generally a fee for service area, it seemed like a good idea. Some of the plans paid from a limited fee schedule and not the UCR or the usual contracted plan. The practice was writing off so much that there was no profitability in the patient’s visit.They made up for some of this loss by participating in the plans that paid from the UCR for the area. The doctor looked at the production reports on a daily basis and was pleased, but was shocked when he saw the adjustments on the end of the month report. Cramming more patients into the schedule seemed like the way to make more money.
To control overhead staffing issues, the practice had one business coordinator whose job was all front office duties and also presenting treatment and financial arrangements. There were three open phone lines that rang regularly. Since they could accept just about everybody, they did -and there was a “flood” of new patients wanting to get in for an appointment. Accepting so many plans called for checking eligibility and verifying benefits before the patient’s arrival. This was priority, as was fielding all the phone calls and making sure to collect all co-payments and deductibles at the time of service. The business coordinator’s main focus had become insurance driven, and the effort to educate patients and spend the time building relationships was replaced with booking treatment that the insurance would pay for, as it was easier and fit into the time restraints of a “busy” practice. Some patients got out the door with “I will bill your insurance and if there is a balance, I will send you a statement” from the business coordinator, who was too busy on the phone.
Monthly business meetings were thrown by the wayside because the patient demand outweighed the value received for the team to discuss practice goals. There were no goals, just get them in wherever you can. Morning huddles also became a thing of the past as the practice became focused on finding any open time to see a patient.
The demand to stay on time with a schedule that was impossible to manage caused the doctor and the team to drop the niceties that many patients expect, such as offering a cup of coffee, water or at least pleasant verbal exchange upon arrival. They often fell behind schedule when the opportunity arose to do more treatment that was covered by the insurance. Being seated late and with poor customer service was not acceptable to some patients, who soon left the practice.
After a few years operating at this pace, the practice had reached an adequate level but not close to its potential. There are staffing issues of burnout and the doctor spends less and less time communicating with the staff, causing an absence of teamwork. There is turnover among the staff and the “hiring panic” had caused the doctor to hire without verifying experience or references. The new hire was a problem, as he did not have the basic computer skills that were necessary to put in patient notes and treatment plans.
Upon looking at the practice reports, it was noted that the unscheduled treatment report was quite large, and no one had called the patients to follow-up. The practice had become insurance dependent, and the skills to motivate patients to accept treatment were rusty with neglect. Dr. J admitted that it was not the practice he envisioned, but he did not know what to do to change things.
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