Most dentists would agree that acceptance of their recommended treatment plan and payment at time of treatment can be challenging and stressful for the doctor, the team and often the patient.
Most patients want to achieve optimal oral health. Yet, on a daily basis, patients who want care walk out without receiving treatment. I’ve found these two challenges are interconnected and most often occur when the practice owner has failed to establish effective systems and provide the team with the necessary skills through ongoing training.
If a doctor wants to have predictable outcomes, the team must have exact protocols laid out and be consistent with their actions. Without consistent actions, treatment acceptance and subsequently practice revenue are likely more of a roller-coaster ride, up one month and down the next.
Treatment acceptance starts with patients understanding and valuing the benefits of care. This can end when the patient isn’t able to pay for the dentistry—but only if the team is unprepared to provide payment solutions that can work for most families. If the team is unprepared, they may accept the patient’s objection as a final decision. This doesn’t benefit the practice or patient. Luckily, there are two primary protocols that can help solve both challenges: the treatment presentation and financial protocols.
Treatment presentation protocol
We have seen practices average less than 40 percent case acceptance, which means 60 percent of diagnosed treatment is not being done. Presenting treatment plans is a critical system in every practice and it’s a team responsibility. The doctor is responsible for providing the patient with clarity on their oral condition, recommended solutions, the benefits of treatment and the consequences to delaying dentistry.
Once the doctor has discussed these topics with the patient, he or she is handed off to the team. Before any financial conversation happens, the team must ensure the patient understands and agrees with the benefits and consequences, so team members should feel confident talking to patients about needed treatment. This confidence is attained when the doctor invests time to train the team on the most common treatments and, during the handoff, clearly communicates the information the team needs to have an informed conversation with the patient. Then, a simple question confirms the patient’s mindset and understanding.
“Mrs. Jones, do you have any questions about the benefits of treatment as the doctor has discussed and is this something you want for your oral health right now?” If the answer is yes, then it’s time to move to the financial protocol. If the answer is no, there is either a lack of understanding that must be addressed, or the patient perceives that dentistry is expensive, especially if they’ve neglected their oral health. When the patient responds with, “No, I don’t think I can afford it,” the team needs to understand that’s a request for solutions and a signal to move forward to the financial protocol.
Since office collections keep the practice viable, it is one of the essential systems in the practice. The financial protocol should be created so the natural result is the desired outcome. If your protocols give patients the opportunity to pay you as they like, you will find yourself with unhealthy accounts receivables. Your practice offers an essential service to patients, but we all know they would rather see a concert, buy that new pair of shoes or write that college tuition check than pay for dental treatment.
As you start to organize the financial area of your practice, consider appointing a financial coordinator and let them know the monthly collection goal is 98 percent of office production. As you create the financial system, you’ll need to write and train your team on the following:
- A financial policy.
Verbal skills for presenting fees.
How to send statements.
How to enter charges and make adjustments.
How to close out the day and prepare deposits.
How to handle past due accounts
When the patient expresses cost or affordability as a barrier, it’s time for the team to better understand what that patient means by “can’t afford” by asking, “Mrs.?Jones, I understand that dentistry is an investment in you and your long-term oral health. When you say ‘can’t afford,’ are you more concerned with the total cost or how to fit paying for care into your other family financial priorities?”
For many, it’s often a budget issue, not a cost problem. If that’s the case and the patient replies, “Fitting it into my budget,” then confirm the patient wants a solution by asking, “If I could give you a way that you could afford to do your dental work, would you be glad about that?” Patients will almost always say yes to that question.
It’s important to have the payment policy in place and in writing to help ensure consistency in the practice. Patients should be able to choose how to pay for the dental services offered. Everyone’s situation is different. So, the ideal payment policy would take patients’ differing financial responsibilities and priorities into consideration and provide a variety (not too many, which can be confusing) of payment options, so patients can choose what’s best for them. Let’s look at the four most common payment options.
Patients often expect their insurance to cover all of their treatment and are surprised when you ask for a co-pay, deductible or the portion not covered. You need to have options for them to make payments after the insurance pays to avoid a growing out-of-control A/R balance.
If patients can pay with cash prior to treatment, it’s the ideal option. But it’s important to avoid tying a cash payment to an appointment, which can result in cancellations and no-shows. Instead, cash payment should be collected at the time of scheduling and you may want to offer a 5 percent courtesy accounting adjustment.
3 General-purpose credit card
Another option that allows the practice to get paid at time of treatment is a general-purpose credit card. The only drawback is that not every patient has the available credit and may rely on their credit card for household and unplanned expenses, so they prefer not to use their credit cards for health care charges.
4 Health care credit card
A health care credit card payment option offers something general purpose credit cards rarely can—promotional financing. This option can be convenient for patients who have an out-of-pocket expense for their dental needs, don’t want to tap into savings and want to pay with convenient monthly payments while avoiding interest. Being able to pay monthly may make it easier for patients to choose dentistry and other needs/wants because care fits into their monthly budget.
If the desired outcome is to receive payment at time of treatment, paying a transaction fee when a patient chooses to use a health care credit card or providing a 5 percent accounting adjustment for cash are both good investments in increased treatment acceptance.
Organization is key
Organizing your practice, training your staff on ways to help increase treatment acceptance and providing multiple payment options are great ways to grow your practice and increase your collections. There’s nothing magic about efficient, well-run practices. It’s all a matter of deciding that you are ready for more predictability and taking the necessary steps.