9.30.11 Issue #499 info@mckenziemgmt.com 1-877-777-6151 Forward This Newsletter

The Patient Wants a Discount?
By Sally McKenzie, CEO

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It's a disconcerting sign of the times. I recently had a doctor contact me because a patient was insisting on a 10% discount. More troubling is the fact that a portion of this patient's procedure was covered by insurance. If the doctor were to grant such a discount, he would be in violation of state insurance regulations. It is a reminder that since 2008, when the world's financial troubles began affecting many dental practices, doctors have felt pressured to make concessions on treatment recommendations, hold the line on fees, abandon established financial policies, and cut corners wherever they could.

Yes, things are slowly improving, but we are seeing too many practices that are routinely disregarding their financial policies. While I understand that practices need a certain measure of flexibility, and the policy should be reviewed annually, it is critical that every member of the team respect and uphold the policy. Moreover, all new patients should be given a copy of the policy along with other office procedures and information, and existing patients should receive a copy periodically - particularly if changes are made.

mailto:info@mckenziemgmt.comSo now the question is: what should be included? It goes without saying that a financial policy should reflect your practice philosophy, but remember, yours is a small business and you simply cannot afford to give no-interest loans or other financial breaks.

I recommend that you consider the following options:

  • Offer a 5% discount if the case is over $250, paid in full, and will not be submitted to insurance.
  • Divide fees for more involved cases over a specific number of appointments.
  • Ask patients to pay 50% at the start and 50% when treatment concludes.
  • Establish a relationship with a treatment financing company.
  • Allow patients to build a balance on their account before beginning major treatment.
  • Make arrangements to bill the patient's credit card on a recurring basis until the dental work has been paid in full. This is ideal for larger cases. Orthodontic practices often do this routinely. This system streamlines payment and posting while eliminating billing for your practice.
  • Accept cash, check, and charge.

Remember that if you accept checks, you cannot accept post-dated checks. This is a practice that had been all but eliminated, only to be revived during the recession.

In addition, spell out what you expect of your patients. For example, if a patient's insurance will cover 50% of the cost of a crown and the patient's portion is to be paid in full upfront, they need to know this. Make your financial policy clear. Don't assume that displaying the policy on the wall or showcased in your brochure is enough. It is critical that the financial coordinator review the terms of the financial arrangements with each patient for each procedure or treatment plan.

Verifying that everybody's on the same page will go a long way toward improving your practice's collection success. Which brings me to my next point in a practice's overall financial policy, and that is collections.

Practice collections should yield 98% for treatment currently being performed. I do not disregard the fact that you must be sensitive to your local economy. Just understand that each time you make concessions and exceptions, you chisel away at your financial policy and further risk the fiscal solvency of the practice. The exceptions and concessions add up much more quickly than you realize.

Business staff must know the fees for each procedure, and at no time should a business employee say to a patient, “Did doctor tell you the fee for this procedure?” S/he simply states, “The fee for the crown is $xxx. Our financial options for payment include the following …”

Financial policies are only as effective as the person in charge of collections is at upholding them. Certain people just cannot bring themselves to ask for payment from patients, no matter how low the fee. They simply are not cut out for the position. Effective collections require someone who is assertive, tactful, confident, and goal oriented. “Stacy” may be a wonderful member of the team, but entirely too pliable when it comes to collections. If Stacy is your only option, train her. If “Meredith” is better suited for the position, assign the responsibility to Meredith and train her.

Next week, patients aren't paying, now what?!

Want more of me? Click here to visit my blog, The Lighter Side, for more Dental Practice Management info.

Interested in speaking to Sally about your practice concerns? Email her at sallymck@mckenziemgmt.com. Interested in having Sally speak to your dental society or study club? Click here.

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Belle DuCharme, CDPMA
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Who Is Presenting Treatment Plans In Your Office?
By Belle DuCharme, CDPMA

The typical scenario in a general dental office includes the dentist presenting the diagnosis and explaining the treatment options and recommended course of treatment to the patient. Next on the scene is the transition from the clinical to the treatment coordinator or financial coordinator to offer payment options and get the patient scheduled for treatment.

If the patient and the doctor have forged a trusting relationship and the patient is motivated to have the treatment started, it is much easier to then agree upon a method of payment and schedule the appointments. If the patient is wavering and not convinced that the treatment is something they want or can afford, there will be more of a challenge for the treatment coordinator or financial coordinator to get them appointed. It is at this critical moment that having someone trained and experienced in presenting treatment will make the difference to patient acceptance. Also important, and somewhat undervalued, is someone presenting treatment who personally values good dental care.

JB, a treatment coordinator for Dr. Ad’s office, was attending a McKenzie Management dental training course when the question was raised: “Do you think dental work is expensive?”  He and a couple others in the room said “Yes, I think dentistry is expensive.”  He went on to explain that he had spent thousands of dollars on dental work in another office and that his bite had been severely off since then. His teeth did not meet correctly enough to bite through a sandwich, yet he presented thousands of dollars in treatment to patients daily. He had not told his current employer out of embarrassment.

Another person said that she felt the fees were high in her office, and when she knew the patient had financial challenges she felt that she should offer them discounts or only have them do the treatment that was the least expensive option, even though the result would be less than favorable. Her own teeth had not had regular care and she had some broken fillings and a missing tooth on the lower right side of her mouth.  “I feel sorry for our patients that don’t have the money and I think they probably can wait until they get more money to have the treatment done.”

When considering long-term value, dentistry (done correctly) is a good investment. A crown in a healthy well maintained mouth should last 5 to 20 years. Implants are 99% successful and offer patients an opportunity to eat anything again and look many years younger. Even a professional cleaning to prevent future problems is good for six months. A haircut is about every 3 to 4 weeks and costs about the same. A haircut you could do yourself, but not a professional cleaning.

Having a fee analysis to establish your fee baseline is crucial to determining where your fees place in the local marketplace. If your fees are on the low end in the area, then giving discounts would not be recommended. It would also be prudent to raise your fees to the level of the local usual and customary fee level. Correct pricing of products and services is necessary for any business seeking to be successful and competitive. Raising fees yearly is required for a business to stay current with rising costs associated with doing business, and paying close attention to costs of some items which may have recently been driven up dramatically - like the cost of gold and other metals.

If team members, who are critical to treatment acceptance, don’t understand and accept the long-term financial value and the benefits to a healthy mouth and body, it would be difficult for them to communicate these values to patients. Every team member should value dentistry and its relationship to total health. Have an open discussion with your team about their values and feelings in regards to dentistry. Take an interest in the dental health of the team and see to it that everyone gets regular examinations, preventive maintenance and corrective care. There is nothing better than a testimonial from a team member to a patient about receiving care in your office. Hearing “Dr. Ad did this beautiful crown for me and now I can chew on the left side of my mouth” can make a difference to a patient wondering about your skill level or the results of the treatment.  For training in Treatment Acceptance for you or your team, give McKenzie Management a call today to schedule training that will make a difference to your patients and your team.

If you would like more information on McKenzie Management'sTraining Programs  to improve the performance of your team, email training@mckenziemgmt.com

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Nancy Caudill
Senior Consultant
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New Patient Visits Depend on Your Practice Focus
By Nancy Caudill, Senior Consultant McKenzie Management

At McKenzie Management, one of the many strengths we have is the ability to tailor our practice management recommendations to “fit” the practice that we consult with. We observed over 30 years ago that each and every practice is unique - sometimes in very obvious ways and others in only small and subtle ways, but different, none-the-less. For this reason, to McKenzie Management “one size fits all” does not fit all sizes.

The topic of “what should happen on the first visit?” is always a topic of discussion with our clients. As consultants, our job is to share information with clients to help them make an educated decision about the direction of their practice. The concept runs parallel with you presenting treatment to a patient. Your job is to help them make an educated decision about the dental options and find what works best for them - a bridge, a partial or an implant to replace missing teeth. Is one option better than another? Depends on the patient, their financial means, their tolerance to having something in their mouth that they must take out to clean, how many other missing teeth they have, etc.

Hygiene To address the question, “What should I do on the first visit?” let’s discuss areas that need to be evaluated in order to make an educated decision.

Question #1 - What is the Focus of the Practice?
Many dentists have never really given this any thought, believe it or not. Their website and business card says “family and cosmetic dentistry - walk-ins welcome.  All insurance plans accepted.” This is quite a potpourri of services! Is this a “clinic-type” practice where walk-ins without appointments are encouraged? Okay, but the practice is also a cosmetic practice providing cosmetic-type procedures such as veneers, full-mouth rehabilitation for a new smile, anterior bonding, whitening, etc. It’s a family practice as well. Children are welcome… and all insurance plans are accepted.

In order to efficiently and effectively (and profitably) be able to offer all the above, it's going to take quite a juggler at the front desk - as well as a dentist/dentists that are able to wear many hats at the same time.

Your cosmetic patient in the middle of having their 10 veneers cemented will now have to wait while you visit with the walk-in emergency that needs an extraction. In operatory #1 you have a sweet 5-year old who would much rather be playing outside than having her fillings done, and she's just as vocal about it, as well. There are two hygienists waiting for their exams and they are already running 5 minutes behind as it is… and it is only 10:00 in the morning. I feel the stress just writing about this scenario.

It is very difficult to be “all things to all patients” and do it well. Each of the descriptions of the practice could easily be a practice focus in itself: Family or Cosmetic or Emergency-Focused.

Question #2:  The New Patient Visit - What Now?
Each of the focused examples above would be best served with a variation of the New Patient Visit. Examples:

Family: Carol Jones calls the office to make an appointment “to get her teeth cleaned.”  She saw your practice while driving by and your office is convenient to her work. She also has other family members that she would be interested in making appointments for, as well. What is important to Carol? My guess would be a rapport with a dental office that can provide her with good dental care for her family and herself without a lot of “hoops” to jump through. She is a busy mother with 3 children and time is precious.  Asking her to come for only a Comprehensive Exam for 60-90 minutes without visiting the hygienist may not work for her. Her preference would be to see the doctor AND see the hygienist.

Emergency:  These patients are looking for immediate attention and relief from their dental pain as soon as possible. Seeing a hygienist is not important to them at this point, nor learning about all the other dental needs that they have. Would a comprehensive exam best serve their needs on their first visit?

Cosmetic:  A new patient calling about the ad they saw in the local newspaper about veneers is not calling to “get their teeth cleaned” and they aren’t experiencing a dental emergency. They are anticipating a Comprehensive Exam to discuss their options.  Seeing the hygienist is not expected.

The conclusion is that there is no conclusion! The expectations of the patient relative to their first visit with you are dictated by the services that you provide and your practice “focus.” All the examples above are correct, but maybe not for every office… ”one size fits all” does not fit all practices. What is your practice focus?

My next article will address the Family Focus specifically, and how to determine what fits your practice.

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

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