The Tough Questions

Sept. 1, 2003
Get the feeling patients believe they're draining cold, hard cash right into your hands? Here are some suggestions for handling the financial questions that pop up right after the doctor walks out.

by Lois J. Banta

For years, the dental hygienist has been perceived as someone in her own world, cleaning teeth and educating patients on their oral health needs. Today's dental hygienist is definitely much more. You are the clinician, producer, educator, patient confidant, and team player. Many patients present inquiries to the hygienist that gives you an opportunity to be the "bridge builder" for the dental practice.

Consider treatment planning. You see a dental concern in the patient's mouth. You take diagnostic films, perhaps an intraoral photograph. You document your observations and discuss them with the doctor. Then the doctor makes his or her diagnosis, discusses treatment with the patient, and the visit is finished, right? Wrong!

Frequently, when the dentist leaves the room, the patient asks some very tough questions:

• "What will my insurance cover on this procedure?"
• "How much is a crown?"
• "Can I make payments?"

Even though you may have a financial administrator in your practice who handles these types of questions, your patient is asking you. It will be crucial at this stage to "build the bridge" in communications. I suggest you have a protocol in your office for each team member on how to handle your response. The worst response would be, "That's not my area; you're going to have to ask someone at the front desk." This answer drops the ball, which can lower the confidence the patient has in your office.

A better way to handle this is to say, "Sarah is the expert in our office regarding financial matters. But here's what I know. We have a partnership with CareCredit, a dental finance company, that allows our patients the opportunity to fit their treatment into their budget. The company offers interest-free payments, a revolving credit option and long-term financing for a low fixed rate. As a courtesy, we file insurance claims on your behalf and are dedicated to assisting you in determining your level of benefit with your plan."

Then, you escort the patient to the appropriate individual. They feel well informed and are able to make great decisions about their dental care.

When the entire team gets involved on every level with the patient, then the patient has the opportunity to accept what is in his best interest.

My philosophy is to make the hygienist as knowledgeable as possible about the "business" of running a dental practice. Listed below are some standard financial discussions you may have with your patient.

• "What will my insurance cover on this procedure?"

You have been presented with a perfect opportunity to educate the patient on her needs. A typical response may be: "Your dental benefit plan has been designed to cover basic costs of dentistry. Our philosophy in this practice is to assist you in designing a treatment plan based on your complete dental needs. We pride ourselves in assisting our patients in receiving complete information so that they can make informed decisions.

"Therefore, we partner with our patients in assisting them with their insurance questions. You may not be aware of this, Mrs. Jones, but your employer designed your benefit to coincide with the premiums they pay for your plan benefit. Your written plan benefit guide will outline this for you."

• "That sounds expensive."

Your response may be: "Well, Mrs. Jones, keeping your teeth for a lifetime is an investment, but much less expensive in the long term. It has been our experience that when our patients invest in their dental health and catch problems early, they save money in the long term."

• "Can I make payments on that?"

Your response may be: "Absolutely! We have established a partnership with CareCredit that allows you to make small monthly payments over an extended period of time either through an interest-free option, a revolving credit option, or extended payment option. Sarah is our expert in this area and would be glad to discuss it with you further."

• "Do I really need that dental treatment?"

Your response must duplicate your practice's philosophy, which is typically: "Mr. Jones, our philosophy in this office has many layers. We firmly believe that a patient's level of acceptance of their dental needs is directly related to their knowledge of why treatment is necessary. Therefore, it is our philosophy to educate our patients with why treatment is necessary as well as anticipated fees so that our patients can make informed decisions."

• "I just want my two free cleanings a year as covered by my insurance."

That's a tough one! A typical response can be: "Mr. Jones, fortunately for you we never diagnose your insurance plan. Your dental benefit plan is designed to cover basic needs. We pride ourselves in identifying our patients' dental needs through proper diagnosis and treatment planning. As a courtesy, we assist you in identifying your dental plan's basic guidelines on what they cover. Typically, we see a benefit design that allows payment for basic dental needs such as continuing care (prophylaxis, exams, diagnostic films)."

Make sure you educate the patient on what is involved in her preventive and periodontal maintenance. When you educate the patient on proper terminology, she has a better understanding of her needs, is well informed and can make decisions for the right reasons. For years, we have given our patients permission to think of their continuing care as "just a cleaning or check-up." It is time to re-educate them on what is involved on their preventive visits.

Another great technique in discussing tough issues with our patients is to leave no question unanswered. Therefore, before you escort the patient up to the scheduling and financial experts, say to the patient, "What questions can I answer for you about this proposed treatment?"

We must be prepared to cover all aspects of their treatment experience, even the financial questions. Your patient's confidence and trust in you increases when she feels secure in your response.

New patients have the best chance at staying with a dental practice long term if they perceive that we care. One way to show this is to do a new patient "interview." The most effective way for the patient to feel welcome is to have the hygienist talk with the new patient in a consultation room (or private area) prior to taking diagnostic films. I recommend a brief discussion about their dental history, previous experiences, and identify with the patient's areas of concern.

Listed below is a sample smile evaluation to assess your new patient's needs:

• Why did you leave your previous dentist?
• What made you choose this office?
• What was your childhood experience like going to the dentist?• Did your parents keep their teeth for life?• If you could change anything about your smile/teeth, what would you change?

Patients will tell you a lot about themselves by the way they respond to these questions. For instance, if they left their previous dentist because they were kept waiting, time is a hot button. If they chose your office because their mother, brother, father, or sister come to you, loyalty and trust are important.

"Hot buttons" help you identify how to relate to your patients. It is very important to listen completely to your patients' comments and concerns. I always say engage your eyes and ears. Statistically, 50 percent of patients listen with their ears, and 50 percent listen with their eyes.

Make sure you have visual aids available to help your patients visualize what treatment is in their best interest. Cautious, analytical people tend to need a lot of written information to make a decision: "Can you show me what an implant looks like, and what is the success rate of a crown?" However, high-energy, assertive people tend to make decisions based on feelings or action: "How much, how long, when can we start?"

Remember that it is not what you say to your patient, it's how you deliver the message. Our patients depend on us to work together towards a common goal — dental treatment presented with their best interest in mind. The only way for our patients to make informed decisions about their dental care is for you to educate them on what it takes to keep them healthy. Discussing the health benefits of preventive care is as important as discussing the dental benefits. There is so much information available on the correlation between periodontal disease and heart disease, diabetes, pregnancy issues and more.

Together, with the knowledge we have and the ability for our patient to learn, the opportunities to make informed decisions soars. Our patients deserve and expect the best from us. Let's take this opportunity to make a difference for them!

Know your numbers
The most effective hygienist knows what it takes, financially, to make a practice profitable. Be directly involved in this process and you will achieve unlimited potential. Know how much time you need not only for the procedure you are scheduling, but the patient's individual needs. You may have a patient who grows tartar daily so allowing extra time for these patients saves you in the stress department. Now you're probably thinking, save extra time? Won't my productivity go down? Not if you adjust the fee to match the difficulty of the procedure. These "difficult prophys" become your exception to the rule.

I firmly believe in customizing appointments to meet patient needs. Therefore, "X" scheduling comes into play. What is "X" scheduling? It is a method of customizing how much time you need for each individual patient. For example: An adult patient with exam, prophy, 4 bitewing diagnostic films typically would be allowed 60 minutes. But if this patient is a heavy tea drinker or smoker, they may have a lot of stain. The hygienist will have first-hand knowledge of this and would ask for more time, such as 70 minutes. Your timeframe is documented in the left space of the "X." This technique is a great non-verbal communication technique for your scheduling coordinators. It keeps everyone on the same page and allows for less confusion!

A typical production goal for the hygiene department is 30 to 35 percent of the total production goal. That means if the daily goal for the entire practice is $3,000, the hygiene goal should be $900 to $1,050 per day. In an eight-hour day, that's $113 to $132 per hour. Another important number to track is lost appointments. Typically, a practice will get one cancellation per day that is not re-filled. This can cost a dental practice many dollars. If the average dental appointment is worth $125 and you get one cancellation a day over a 200-day year that amounts to $25,000. Just think of how those dollars could have been used in the practice — for continuing education, bonuses or raises. The possibilities are endless.

When you are able to track statistics, you have a better opportunity to affect the outcome of your profitability and bottom line. Every dental team member needs to monitor the numbers. It helps you take ownership of the practice. Each time you have open time on your schedule, you are temporarily unemployed.

Lois Banta is CEO, president and founder of Banta Consulting, Inc., which specializing in all aspects of dental practice management. Lois has more than 27 years of dental experience. To contact Lois for a personal consultation, or to invite her to speak to an organization, contact her loisbanta, or visit