My Patients Aren't Paying - Now What?!
Certainly, there can be many reasons why a patient delays or disregards their payment obligations. It's likely that the root causes of collection problems have been quietly chiseling away at many practices' financial footings since well before the recession. However, the current times have made the consequences of weak financial systems all more obvious.
Typically, we find that delinquent accounts are the result of a number of factors, including:
The practice sees a disproportionate number of emergency cases. These patients tend to be in a crisis situation before they will take action. They may suffer from dental phobia. Lower income adults may forego dental care for themselves in order to pay for care for their children, until there is a problem. Whatever the circumstances, all patients must be given the practice's financial policy and informed of the payment options up front.
Doctor routinely performs treatment that the patient did not expect. It is a dentist's responsibility to inform patients as to the treatment options available and risks associated with treatment. Part of that discussion involves the fees for recommended treatment and what is or is not covered by insurance. It is a thorough and detailed conversation to ensure that the patient is fully aware of his/her options and able to make an educated decision as to whether s/he wants to proceed.
The doctor rarely engages in treatment planning. Treatment planning enables the doctor to have a much clearer understanding of the patient's dental priorities and develop a plan for how those priorities can be addressed. Moreover, with treatment planning, the entire dental team can reinforce the need for care and continually educate the patient on why addressing dental needs is critical to maintaining overall health and wellness.
The practice does not have a trained financial coordinator. A trained financial coordinator is well prepared and comfortable explaining the financial policy and payment options to all patients. This person politely and diplomatically educates patients about what the practice cannot do, and most importantly, what it can and will do to help them proceed with necessary and desired treatment.
The practice sends out statements monthly. Statements must be sent daily. Additionally, it should include a practice-addressed envelope and a date by which payment is expected.
Even if all of the above issues are addressed, there will be some patients who do not pay. These are the delinquents - virtually every practice, except those demanding cash up front, occasionally has to chase down these financial greased pigs, some of whom can be more slippery than others.
Delinquent accounts must be addressed promptly, and the first follow-up phone calls should begin one day after the payment is due – not 60 days and definitely not 90 days later. As the weeks drift by, so do the chances of collecting on the account. Like it or not, you can't afford to let these accounts sit.
Follow a strategy for addressing delinquent accounts and avoid the tendency to just run down the names. Instead, focus first on those individuals that owe the most money and are most likely to pay. Those are the calls more likely to reap the greater collections successes. Be prepared before placing the call:
Every contact with every patient should be professional. I recommend this approach: “Our records indicate we have not received a payment for your account since (date). We wanted to make sure you received the statement.”
If the answer is “No,” state the balance: “The amount you owe from the treatment performed on (date) is (amount). I can take your Visa or MasterCard number now.” STOP TALKING. If they want to pay by check, verify address. “Let me go ahead and send another statement today, however, I need to know when we can expect your payment.”
Do not hang up until you get an exact date. Send statement now confirming promise of payment. If check is not received on promised date…CALL AGAIN!
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The Challenges of Employee Grief
At one time or another, every organization has to deal with grief and loss in some capacity. If an employee experiences a death in the family, a serious illness, a traumatic or life-changing event - it is next to impossible to keep those feelings out of the workplace. Expressing sympathy may be easy at first, but it can be difficult when that staff member returns to work following an absence. You're likely to feel unsure of what to say or do. Loss impacts the person directly experiencing it, and it also can be challenging for you.
Effective leaders have empathy… the ability to understand and respond to others, to see the world from someone else's perspective, to step into their shoes. Perhaps you believe that work and personal life should be separate. You may have been told to keep a healthy distance from employees. Be careful, because the work environment has changed.
Work is more than a job and a paycheck. It is a place where people spend 30, 40, 50, 60 or more hours together a week. Good leaders know more about their employees than just the work they do. And employees expect some compassion from a boss and co-workers. They need personal validation. Being impersonal signals disinterest and a lack of caring, and is as risky as being overly involved. Certainly it is important to balance your concern for employees without getting too deeply into their lives. It requires good judgment and tact.
In his book, Primal Leadership, Daniel Goleman describes empathy as the key to retaining talent. Although a positive relationship with a boss is not enough to produce worker productivity, it can significantly contribute to it. And the absence of sensitivity can lead an employee out the door. At the same time, you need to strike the right note in your interpersonal relations with your staff. It is important to be approachable and friendly, yet fair and firm.
Those statements minimize a person's pain and convey a lack of interest on your part. The impact is negative and potentially damaging to your relationship. So how should you handle the situation? It is important for the employee to feel supported by their co-workers and by you. This will aid in their recovery.
1. Express your condolences and be understanding. An emotional wound is really no different than a physical problem. Think about how you would respond if your employee had a broken ankle or a surgical procedure.
2. Acknowledge their grief and listen to their story if they want to tell it. Be patient. Refrain from interrupting. Nod appropriately. Maintain good eye contact and display interest in your facial expression and posture.
3. Expect them to be different and sad. Be concerned without becoming a therapist. Don't get into the counselor role. Avoid giving advice or probing for details. Simply expressing concern is greatly appreciated and often enough.
4. Recognize that the person's performance may be diminished temporarily and offer the appropriate assistance. It may be time off, some degree of job sharing for a period of time, or guidance to community resources.
5. Be caring but objective. The office is a place of business. If your employee becomes too self-revealing or rambles, manage the time by gently redirecting the conversation to a close. For example, “It sounds like you’ve gone through a lot and it will take time to heal. Let me know if I can help in any way. You’re an important member of our dental team and I want you to continue to feel better. Welcome back. (Pause) I’ll let you get back to your patients now.”
6. If productivity and/or office behavior doesn't improve over time, it's important to follow-up. Meet with the employee informally and talk about your observations. Seek mutually agreeable solutions to improve performance.
7. Respect confidentiality. Some subjects are not matters of public discussion in the workplace. These include situations such as your employee's psychological struggles.
In today's increasingly complex world, even rock-solid workers are likely to have times when their lives are affected by a personal crisis. At some point, you probably will be faced with an employee's grief. The skill and humanness exhibited by you, the leader, will be important in the final outcome.
Dr. Haller provides training for leadership effectiveness, interpersonal communication, conflict management, and team building. If you would like to learn more contact her at firstname.lastname@example.org
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The Late Patient
Mrs. Smith's appointment is at 2:00 and she called the office after receiving a message to call, confirming that she will be there. It is now a little after 2:00 and the hygienist is on the telephone trying to contact Mrs. Smith to make sure she is on her way. Nobody answers the cell phone or home number, so she tries the work number. They tell the hygienist that Mrs. Smith has stepped out of the office. It is now 25 minutes into the appointment and Mrs. Smith walks into the office.
Now what? Many people will be quick to scold the patient for being late. “You are too late, we need to cancel your appointment and reschedule.” Or, “The doctor is waiting” with some very negative non-verbal communication. The hygienist is standing or pacing in wait, tapping her foot with a scowl across her face, and the first words out of her mouth are, “well come on back and we will see what I can do. I am not going to be able to probe, or get the x-rays. I will just do the cleaning.” Of course the voice she is using has just a little attitude also.
We have all seen this scenario. Maybe it has happened to us the one time in our life we were late to an appointment. This is not a good way to encourage patients to return for future appointments. This may even be a reason that patient retention is not as good as it should be in your practice. Nobody knows what is going on in this patient's life that made her late. It may not even be our business. Whatever happened, she has done whatever she needed to in order to make the appointment.
There are many things to consider when patients show up late. Here are the two to always keep in the front of your mind.
This is one way we would have liked to see this scenario play out.
The hygienist did perfect by calling the patient even a couple minutes after the confirmed time was missed. The sooner she gets the phone call made, the more likely you are to save the appointment. Even if the patient has not left their house, they may only live five minutes away and the appointment is saved. If the hygienist waits 10 or 15 minutes after the appointment is originally scheduled, it may be too late to save the appointment.
When Mrs. Smith walks in the door already looking like a truck has run her over, the last thing she needs is to have the staff jump into another truck and back up over her. Greet her as you normally would. Have her come back to the chair. Most patients at this time are already profusely apologizing. You're not going to say it is all right, because really it is not. You are going to say nothing at this time. Continue to guide them to the operatory.
Once the patient is in the chair, ask them to take a deep breath, they are here now. This will lift the entire world off of their shoulders. Giving a patient just a minute to stop, breathe, and relax will make a difference in the rest of the appointment. If the hygienist were to get the patient in the chair and start hurriedly, then you would have two people dealing with an unnecessary stress for the remainder of the appointment.
Go ahead and review the health history, and begin the appointment as if you would any - do blood pressure, ask the patient what problems, concerns, or changes they have. Make the notes in the computer, look in the mouth to check for decay, and evaluate the work that needs to be done. Once you have actually evaluated the patient's mouth, this is the time to decide what will and will not be done during that appointment. Even if you have seen this patient for years and you know they have a trash mouth, at least look in the mouth.
You always want to provide the quality of care that is in your vision. With this particular patient, you may be able to complete the hygiene appointment in the time remaining. This is where teamwork will make a difference. The assistants may be available to do the x-rays, the doctor or another hygienist may be available to do the probings.
During the 20 minutes the patient was late, the hygienist should be looking at the appointment book with another staff member, determining how the appointment may be saved. Arrangements made with the individual staff members or doctor should be set up during this time - rather than standing, pacing, and lying in wait to pounce on the patient when they walk in the door, risking lost production (and possibly a lost patient).
If the patient does have a concern, and if time permits, at least address their concern - get x-rays, and even probe if that is all you have time for, and reschedule them for the specific time required to complete the cleaning.
If there is no way at all to save the appointment, after the hygienist has looked in the mouth, inform the patient by saying something like, “Mrs. Smith, in looking at the work that you require and the quality of work we like to provide, it would be in your best interest if we reschedule your appointment.” Now you are canceling the appointment with the patient in mind, in private.
You may also want to have Mrs. Smith stay in the office long enough to make sure the next patient is going to show.
Of course we would prefer that our patients never be late and always make their appointments. However, life happens even to the best of us that are “NEVER late.” Try to consider the patient first and what they may have gone through to get to you at the time they did, instead of thinking only of your schedule.
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