Doctor, Put Those New Practice Fears to Rest
Fear is an interesting sensation. On the one hand it is a profound motivator in all of us to take swift action when necessary. On the other, we can be paralyzed by our fears. Some of the world’s great leaders and philosophers have tried to help us look at fear rationally. A few centuries ago, French Renaissance writer Michel de Montaigne summed up our tendency to create worrisome imaginary scenarios pretty well. “My life has been full of terrible misfortunes most of which never happened.” Franklin Delano Roosevelt’s immortal words from his 1933 inaugural address remain true today, “The only thing we have to fear is fear itself.” And Dale Carnegie’s words remind us that fear is something we create, “Fear doesn't exist anywhere except in the mind.”
For dentists, fears often come down to the day-to-day challenges of running a practice - such as patients saying “no” to recommended treatment, or patients leaving for the dentist down the street, or not being able to pay the bills, fund retirement, etc.
We talk to dentists about their fears regularly, particularly newer dentists enrolled in our Practice Start-Up Program. We find that virtually all of them have similar fears. While some of these worries are warranted, others are a waste of energy.
What are the top five fears for dentists? Read on.
# 5 - Insurance Dependent
Making insurance work for the new practice requires that it be treated as you would any other practice payment system. Co-pays and deductibles should be collected from the patient at the time of service. Additionally, once a year the fee schedules must be updated for each preferred provider organization that the office is affiliated with. If the fee schedules are not updated in the practice's computer system, then over time the practice is billing the insurance provider for less than what it could be. For example, XYZ PPO had an exam reimbursement rate of $55 in 2010, but in 2011 that rate was increased to $60. Yet a practice will continue billing the insurance for only $55 because the business team hasn't updated the fee schedule, the years go by, the fee schedules change, and the practice loses money it can never recoup.
#4 - Paying the Bills
What's more, it is common for new dentists to be treating family and friends when they open their practices, and many feel pressured to give freebies and discounts. Freebies and discounts will not pay for staff salaries, taxes, or supply and equipment purchases. But they will give you many sleepless nights worrying about how the bills will be paid. Nothing in the new practice should be given away for free. Fees must be set at a level that is appropriate for the area, and, most importantly, patients must be charged.
Additionally, now is the time to begin educating patients about the value of care that you are providing. Talk about what is involved in the procedure; explain the instruments on the tray, the many steps in the process. Very quickly the patient begins to realize that a so-called “simple” filling is a highly detailed procedure that requires numerous steps, a multitude of instruments, and a variety of materials that must be precisely applied. Too often dentists at every level - new and experienced - minimize the care that they deliver. Remember, dentistry requires a level education, training, and skill that most people simply don’t have.
Next week, the top three fears for new dentists.
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New Patient Visit - With or Without the Hygienist?
A couple of weeks ago I wrote an article about establishing a focus for your practice to assist in determining the type of new patient visit you will offer. This article is intended to focus on the “general dentistry” practices, opposed to the specialty practices.
Two Types of New Patient Phone Calls
Call #1: “Are you taking new patients? I would like to make an appointment to get my teeth cleaned.”
Call #2: “Do you have any appointments available today? I have a toothache and would like to see the dentist?”
Emergency NP Visits
Should you elect to “fit them” in the schedule, this decision will have a detrimental effect on the appointment time for your already scheduled patients - possibly jeopardizing your ability to always provide 100% customer service.
Second - how much time should you allow for a new patient emergency visit? 30 minutes to evaluate, diagnose and present the recommended treatment without actually treating the patient? 60 minutes because history has shown that the emergency patients usually need a simple extraction or the first step of a root canal procedure?
Either decision is correct, depending on your practice focus. The key is to have the information that you need in order to make an educated decision on how you will manage your emergency visits, in order to provide 100% customer service to all your patients.
There are basically two philosophies or “camps” on how to schedule NP visits. The objective is to provide you with information so you can make an educated decision about what works best for you. Let’s visit both scenarios…the first being that the patient visits the doctor first for a 1-hour comprehensive exam without seeing the hygienist at the same appointment.
Non-Emergency NP Visits without the Hygiene Visit
It is also possible that you instruct your assistant to take intraoral photos at this time or perhaps you prefer to take them yourself along with your comprehensive exam. Maybe a blood pressure screening is performed by your assistant at this time, as well.
Upon your return, having pre-reviewed the radiographs before re-entering the treatment room for this new patient, you will conduct your exam, including an oral cancer screening, periodontal evaluation screening, and treatment plan.
It is vital that the treatment plan be entered in your software by your assistant (especially if you are chartless) so your Schedule Coordinator has a mechanism to follow-up with your new patient should they elect not to schedule an appointment to address their needs. This is an example of how important it is to track appointment scheduling in order to maintain the dental relationship with the patient and confirm that you have a treatment acceptance rate of at least 75% for their next appointment.
Statistically, you also want to know if your new patients are returning to hygiene after their initial visit with you. Create an “in-office for their first hygiene visit” identifier code and post it along with their hygiene treatment. Monthly, compare the # of new patient exams vs. the # of new patient hygiene appointments. Your goal would be 100% of the new patient exams are also being seen in your Hygiene Department in the next week.
Non-Emergency NP Visits with the Hygiene Visit
To accomplish this, time must be set aside in conjunction with one another for you to conduct your exam and the hygienist to have time for her appointment. Should it be determined that the patient is in need of periodontal treatment, this allows her the opportunity to educate the patient, possibly start the treatment or provide other services, depending on their needs.
One very important advantage of the new patient visiting with the hygienist is their opportunity to support your treatment plan for the next visit, answer any questions that the patient may have and add continuity to the patient’s visit with you. It is often observed during a consultant’s visit that the doctor has lower than average treatment acceptance and is not scheduled out a minimum of 1-2 weeks due to the “ball being dropped” between the exam visit and the hygiene visit. The hygienist focuses on the hygiene care for the patient and fails to “re-sell” the restorative treatment that was recommended weeks prior to their appointment with them.
Know your practice and your statistics to determine if you are making good decisions about your practice. There is no “right or wrong” as long as your practice is profitable and successful!
Are Computer Treatment Plans Scaring Your Patients?
Dr. J did a terrific job of communicating the dental needs to his patient, Joe Tee. The intra-oral photo showed the fracture lines and the open margin of the ancient three surface amalgam filling on tooth #3, and Dr. J explained the need for the build-up to support the new crown. Dr. J also demonstrated to Joe Tee the need for 4 quadrants of scaling and root planing with the follow-up periodontal maintenance visits. Replacing the missing teeth, #30 and #14, with implant supported crowns was included in the discussion and the favorable prognosis for the end result. The implants would be surgically placed by an oral surgeon, whom Joe had never met but who came highly recommended by Dr. J.
Joe Tee was impressed with the digital display and the new technology. He was amazed with the information about implants and the prospect of having new teeth to chew on. His new insurance plan through work would pay for some of it, so he was motivated to get started. Joe just wanted to know more because he was concerned with down time from work, recovery, and of course, out of pocket costs.
Joe Tee was escorted to the business area by Dr. J, who told Joe that he looked forward to getting started at his next appointment. Bee, the business coordinator, was processing the treatment plan and printed it to present to Joe. He looked at the document placed in front of him. “You are going to have to explain this to me because I don’t know what I am looking at,” said Joe. The document was a print out of procedures that had been discussed in lay terms and were now on a list with ADA codes and procedure descriptors that only trained eyes could decipher. Going down the list, one by one, Bee explained what the code and descriptors meant and what appointments would be needed to accomplish the treatment goals. A referral form from the oral surgeon’s office was handed to the patient with instructions to call at any time to arrange for a consultation. “Does this surgeon charge for the consultation?” asked Joe Tee. Bee replied, “I don’t know, you will have to ask them.” “Do they take my insurance?” asked Joe Tee. “I don’t know the answer to that one either, sorry,” said Bee.
With so much technology in the clinical arena, there is no reason not to use it in the business arena - where it is going to make a difference in whether your patient has the treatment in your practice or not. Intra-oral photos should be included in your treatment plans because they are dramatic to the decision making process for the patient. Printing a treatment plan or emailing a treatment plan with the photos is a continual reminder as to why the treatment needs to be completed. You can accomplish this with most software programs, and if not, you can check out Treatment PRO online for customized treatment plans. In a Word document, spell out the treatment in appointments and what will take place, how long the appointment will take and if the patient will need recuperation at home and for how long. Include estimations for insurance coverage and payment options for co-payments. Extended payment plans or interest free programs through CareCredit should always be part of the presentation.
Many patients fall through the cracks after being referred to a specialist. To prevent this, call the specialist while the patient is at the desk and ask them the questions the patient wants to know. Better yet, find out the referral protocols for all of the specialists that you refer to. If you are a network provider for any plans, find out if the specialist you are referring your patient to is also in the network. Many patients assume that they are, and are angry later about large unexpected out of pocket expense. If your referral sources are not signed up for CareCredit, then motivate them to sign up. It will ensure that both practices can help their patients get treatment with a payment plan. Offer to call the specialist's office to schedule the consultation when the patient is in the office. This ensures that the patient will not postpone calling and also shows a higher level of care on your part.
A treatment plan discussed and handed to a patient that does not result in an appointment requires follow-up. A patient that is scheduled to see a specialist requires follow-up. Demonstrating the extra level of care beyond the printed treatment plan is the key to higher treatment acceptance in your patients.
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