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07.15.05 Issue #175
Create Payment Expectations for Patients and Staff

Sally McKenzie, CEO
The McKenzie Company

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Consumers appear to be having a love affair with credit these days as consumer debt is at an all time high. Have it now, pay for it later . well maybe. Many of those individuals love to buy but hate to pay, and some of them are your patients. They may adore you as their dentist and are fully willing and interested in pursuing your treatment plans, but a percentage of them will be more apt to wish you pennies from heaven than provide you with payment from their own pockets. That is unless you make it clear that this doctor/patient relationship is based on a few fundamental expectations.

Expectation #1 - Patients and staff (including the doctor) should be expected to follow the practice financial policy. Establish a standard operating procedure that spells out how patient financial arrangements will be handled. Every practice, no matter how small, how rural, how this, or how that must institute and follow a clear financial policy. It is in no one's interest to give free money to patients.

Expectation #2 - Patients should expect to clearly understand the fee for treatment. This is best handled by a staff member - not the doctor - who will provide information on the available payment options . Practices that provide care with no mention of the patient's financial obligation can find themselves in a financial tug of war that can become very expensive and very ugly, very quickly.

Expectation #3 - Staff should be expected to request payment according to a well-prepared, well-rehearsed script . For example, the financial coordinator tells the patient that the cost of the crown is $800. She goes on to give the patient two options designed to benefit both the doctor and the practice. "If you would like, you can pay for the cost of the crown today or at the next appointment when we start the procedure." If the patient asks to make smaller payments over several months, the front desk person responds, "Mrs. Jones, we could take the cost of the crown and divide it into two payments: $400 today or when we start the process and the remainder when we insert the crown in your mouth."

Expectation #4 - The practice should be expected to provide additional payment options that encourage patients to pursue treatment and enable them to manage the financial demands associated with pursuing your care. For example, if the patient says "I can make payments of $100 per month." The front desk person says, "Mrs. Jones, we would be unable to accept $100 monthly payments because it would take eight months to pay for your crown. Being a small business, we are unable to extend interest free loans to our patients for that time. However, we do have a relationship with CareCredit which will provide an interest free loan for this period of time. It's just a matter of providing me with a little more information."

This option gives both the practice and the patient a reasonable and cost effective alternative . Offering payment options for patients not only allows the dentist to collect what they produce, but production also will go up if patients have a means to pay for procedures that can be quite costly to most people.

Expectation #5 - Employees discussing payment options should be expected to understand the patient financing process. Few things will kill a treatment plan quicker than the employee who is poorly educated on patient financing options. Too often the staff member will halfheartedly mention the availability of a dental credit card. When the patient seeks additional information, such as the interest rate on the card, the staff member either doesn't have it or fills in with a comment such as, "It's kind of high." Kiss that treatment plan goodbye.

Dentists who choose not to use a finance company but still want to allow patients to make payments should consider having the patient make the installments before the procedure begins . When the procedure is paid for, begin the treatment.

If you plan to change long-established procedures do so slowly and inform existing patients individually. Avoid mass mailings, which often come across as impersonal. Rather, talk to each patient individually when they come in for their regularly scheduled appointment. The vast majority of patients understand and respect the fact that their dentist is running a business and must operate it according to sound business practices.

If you have any question or comments, please email Sally McKenzie at

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Prophylaxis Based Hygiene---A Thing Of The Past

Jean Gallienne RDH BS
Hygiene Consultant McKenzie Management

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So, you are still just cleaning teeth. I am sorry to hear that. Is that because of insurance limitations? Is it because of undeveloped verbal skills and the working knowledge on how to convert your patients? With so much technology out there and so many different approaches to fighting periodontal disease I would hope you had fallen off of that bandwagon.

Where the problem comes in is if the insurance, patient, or operator limits the quality of care you can provide because of the payment that is expected. I am sure there are many of you that have patients you would love to charge more because of the poor quality of homecare they perform. However, because of insurance benefits, you think you are forced to keep them as a prophylaxis. Should they still get the benefit of a more expensive treatment at a lesser cost? You should be asking yourself, is this fair when it comes to the dental office? Is the insurance company, and the patient limiting the money dental offices should be making? Is it the dental office limiting the money the dental office should be making? Who is the health care provider, the insurance company, the patient, or the person performing the task, and diagnosing the treatment?

Now, the sad thing is most patients, no matter of financial wealth, will only do what the insurance covers even though they say they value their oral health. I will use a periodontal maintenance appointment as my example. This procedure is for patients who have completed periodontal therapy and includes removal of the bacterial flora from crevicular and pocket areas, scaling, and ultrasonic scaling with antimicrobial agent, of the pocket area and teeth, periodontal probing, and a review of the patient's plaque control efficiency. This appointment should cost more than a prophylaxis. A periodontal maintenance appointment is typically at an interval of three months. Unfortunately, some insurance companies will only pay for two prophylaxes in a calendar year. Therefore, a lot of patients will only have two appointments per year when they need four. Again, you have to ask yourself why should you work twice as hard on somebody that will only come in two times a year? Why should these people get more for less? The major question is, are you really even helping them by only doing the partial treatment they allow you to do because of insurance limitations?

What you may not know is that some insurance companies actually pay for four periodontal maintenance appointments in a calendar year. Where they will only pay for two prophylaxes a year. Some will alternate between a prophylaxis and a periodontal maintenance appointment. Now, you just need to convert all of those "prophylaxis patients" that should be receiving periodontal maintenance appointments into periodontal therapy patients.

This is done by taking the time to diagnose the treatment needed, treatment planning it, and educating the patient about periodontal disease. Good communication skills are very important. The verbiage used alone may make the difference of the patient accepting treatment or declining treatment. The patients value system and the way they think about insurance benefits will need to be changed.

Americans have become so accustomed to thinking they must have insurance coverage to have dental work done. This way of thinking is actually limiting the quality of care health care providers are able to provide. However, it is not only the insurance companies fault. The patient and operator are also responsible for the way they think about the use of dental insurance. This mode of thinking needs to be changed within the office staff, the patient, and the doctor.

It is a nice convenience that people have healthcare benefits in order to help with the cost. However, patients and dental offices need to look at dental insurance as a coupon in a grocery store . The insurance is there to help cover expenses. It is not provided to dictate the care needed or the quality of care the patient deserves.

If your hygiene department is a prophylaxis-based production wanting to become a periodontal therapy based production, we can help you with skills to enable you to be comfortable with converting your patients. Not only will you be providing quality of care, but you will be getting paid for the quality of care you provide.

Jean conducts 2 day Hygiene Performance Enrichment Programs for The Center for Dental Career Development and McKenzie Management in La Jolla/San Diego, CA. Contact her at or call 1-877-777-6151 for more information on her Advanced Hygiene Training Programs.

Interested in having Jean speak to your dental group? Email us at or call 1-877-777-6151

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The Mirror of the Practice

Walk into a home, a business, a retail store, a physician's office, and without even realizing it you begin to make judgments about the homeowners, the staff, the care or service provided, and the people associated with the space. The physical environment is a mirror - a reflection - of the quality inside.

Dental offices are no different and the environment has a direct impact on how patients perceive your care and how they respond to your treatment recommendations. When was the last time anyone on the staff sat in the waiting room and in the dental chair? Is the space comfortable or uncomfortable? Do you feel welcome or unwelcome? If you were the patient, would the sites, sounds, and smells put you at ease or cause stress? Perhaps it is clean and orderly but stark and unwelcoming. Maybe it is cozy and warm and patients happily curl up in one of the chairs and just enjoy the space.

From colors, to furniture, to smells, to lighting, the feel of the space affects the temperament of the patients, and acceptance of treatment is always easier in a relaxed and comfortable atmosphere. While creating the spa-like experience continues to grow in popularity, fashioning a calm and enjoyable environment for the patient doesn't demand that every practice install waterfalls and offer foot massages. Rather the space can be enhanced merely by looking at the surroundings from the patients' viewpoint.

When was the last time the office was painted? How is the furniture wearing? Depending on the traffic, an office should have a new paint job approximately every five to seven years, and the walls should be washed periodically.

Painting the walls is an easy and inexpensive way to give a fresh look to an office and convey a particular feeling in the space. Primary colors red, yellow, and blue can add drama and life to an otherwise dull area. Used well, they provide brightness and visual bounce. A warm yellow infuses a room with happiness. This is an excellent color for a dental office especially if the room does not have a lot of windows. In a room that has dark leather furniture, you might consider painting the walls in a sage green. It provides the room with balance and relaxes the formal leather pieces. Soft blue walls are very soothing to the eye and create a feeling of calm.

Monochromatic schemes do not fight the setting of the room. The one-color room, especially white, is very effective in offices that lean toward an ultramodern, state-of-the-art look. But it also can be cold and stark if other features in the room don't balance the bright white.

Photographs are low cost, attractive, and can command lasting visual attention. Changed regularly, the effect doesn't become static and provides ongoing interest. One office chose to take black and white photographs of the area. The pictures were then changed with each season. The patients looked forward to seeing what local pictures would be used for a particular season. Black and white photos are particularly striking on a brightly colored wall such as yellow or blue, and they do not fade as quickly as color snapshots.

Another doctor featured flowers from his yard. He showed the flowers starting to bloom in spring, fully blooming in summer, leaves collecting in fall and snow covering the area in winter. The patients looked forward to seeing the changes. Consider partnering with a photography club at the local high school or college. It will provide a steady stream of visually interesting pieces and provide a venue for amateur artists to showcase their work.

Collections are another means to provide visual pizzazz to the space and give patients something to focus on while waiting for the doctor. Some practices create specific themes in the individual operatories from sports, to children's movies, to history themes. The options are virtually limitless, and creating the themes can be a fun and interesting project for the staff.

Look at the surroundings from the patient's eye, from the front door, to the flooring, to the waiting area, to operatories, to the restrooms, to the collection area. The entire environment and physical atmosphere of the space is a direct reflection of the doctor and team. Does this mirror capture your best side?

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Sally's Mail Bag

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Dear Sally,

I work at the front desk part time, doing billing and insurance. I have learned that some of the specialists we refer to have been asking our front desk patient coordinator to leave us and work for them. I find this highly unethical. We all like the coordinator and she has been doing an excellent job for us. But she is flattered by the offers. What should the general dentist do?

To the dentist I have said, "Tell them (the specialists)!" My dentist says, "That will be the last referral the specialist ever gets." But I fear it will be too late when this charming coordinator has left us.

Suggestions, please!

Dear Front Office Employee,

First of all this is all "hear say" on the part of your employee. She could be lying or blowing out of proportion what she thought she heard. Also, the offer could be coming from an employee of the specialist and not the specialist him/herself. I would tell the employee that you are going to call the specialist and see how much she squirms. I am sure it is coming from employee to employee. It is not wise to burn your bridges till you have all the information.


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July 21-24 San Diego, CA IA of Comprehensive Aesthe 702-341-7978 Peak Performer Sally McKenzie
July 28 La Jolla, CA Southern CA Ortho. Symposium 619-656-4646 Top Issues Sally McKenzie
August 13 Topeka, KS Delta Dental Plan of Kansas 800-733-5823 Breakdown Sally McKenzie
Sept. 9-11 San Francisco, CA California Dental Association 916-443-0505 Successes Sally McKenzie
Sept. 22 El Paso, TX El Paso Dental Society 877-777-6151 Breakdown Sally McKenzie
Sept. 23-24 Griffin, GA Endo Magic Root Camp 877-478-9748 Top Issues Sally McKenzie
Oct. 14 Riverside, CA Riverside Implant Study Group 951-279-7847 TBA Sally McKenzie
Nov. 18-19 Griffin, GA Endo Magic Root Camp 877-478-9748 Top Issues Sally McKenzie
Dec. 1 Cincinnati, OH Cincinnati Dental Society 513-984-3443 Breakdown Sally McKenzie

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