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Raising your Fees

Many Doctors have hesitated to raise their fees. Whether it was fear that lower priced competitors would take their potential patients or that they “could not raise fees in this economy”, fees have remained the same since 2009 for many practices. Other practices feel they should “maintain the status quo” because they will only take a bigger write off from an insurance plan.  Some doctors have gone so far as to  “negotiate” a lower fee with some patients, thinking that if they could get this patient and the case, it would fill the book. Somewhere in this belief is the idea that more patients will offset lower fees, and will lead to higher profitability.

We look at profitability numbers each month with our clients. Our busiest practices are not the most profitable, and the practices that do the most large fee cases are not as profitable either. Why is that? In a word, overhead. The more patients you see, the higher your overhead. The more large cases you do, the greater the likelihood of not pricing the case right for the amount of time it takes and more likelihood there is of providing one or more of those crowns in a multiple unit case, for only the lab fee.

Overhead has not stopped increasing because of the economy.  You and your team would like raises, the lab wants to be paid, supplies are costing more – you cannot not raise your fees.  We recommend raising fees on an annual basis.  Many teams struggle with raising fees because of the anticipated reaction from patients. We hope you are subscribed to Words Matter for some suggestions on how to handle this challenging topic.

Raising your fees is one of the best steps you can take to improve profitability.  The chart below shows the relationship between a specified percentage fee increase and the effect this increase will have on profitability.

% Fee Increase

3%

5%

10%

80%

15%

25%

50%

75%

12%

20%

40%

Overhead

70%

10%

16.6%

33%

%

65%

8.6%

14.3%

28.6%

60%

7.5%

12.5%

25%

55%

6.7%

11.1%

22.2%

50%

6%

10%

20

When is your next fee increase?

 

Dental Fees are on the Web for your Patients

There are websites designed to help consumers estimate what dental services will cost them. One for you and your team to check out is:
http://www.fairhealthconsumer.org
On their website they state: “Fair Health is a not-for-profit organization whose mission is to help consumers understand the out-of-network reimbursement system and estimate out-of-network medical and dental costs. Our free website has an easy-to-use cost estimator tool to help with your health care expense planning. We also offer clear and unbiased educational articles and videos about the medical and dental reimbursement system.”

Fair Health was formed in 2009 as a result of a fraud investigation by then NY State’s Attorney General Andrew Cuomo. The ADA granted access to the CDT codes in February of 2011. They will have medical information available in August of 2011.

We have always recommended that you submit your full fee to the insurance company on a dental claim form. It now becomes even more important to not submit contractually discounted fees.  Not only because this will skew the maximum allowable fees determined by carriers based on data submitted by practices but it will skew the costs posted on websites like Fair Health. This will cause consumers to question the fees you are charging when they have a “non-biased” resource about what your fees “should” be.

Have a team meeting and make sure everyone knows about this website and how your fees compare to what is posted on the Fair Health website. Talk about how to deal with patient’s concerns and what to say. As always if you need help, don’t hesitate to get in touch with us.

Benefit Language

Situation:

You are struggling to get your patient to want the treatment that they need.  The patient puts off or makes excuses about beginning treatment.

Desired Result:

The patient to go ahead with your treatment recommendations. To willingly schedule and make a financial commitment to proceed with treatment.

How To:

So that your patients want the treatment that they need, train yourself to use benefit language. Benefit language is a learned skill. It requires the ability to create benefit/feature statements that link the patient wants to their needs. Benefit/feature statements let another person know the advantage(s) of taking action. It helps people be open to concepts or ideas they may be otherwise closed to.

The formula for a benefit / feature statement is:
BENEFIT + PROCEDURE + FEATURE

They are used:

  • To motivate others to see value in a request or guideline
  • To help someone be open to listening to information
  • To personalize advantages the patient will receive

It is critical that the benefit be stated first, prior to the procedure or the logical features of your recommendation. This feels awkward initially, as we are accustomed to stating our request and then justifying it with facts. Try using the “WIIFM” (What’s In It For Me) technique. Visually tattoo WIIFM on your patient’s forehead as you present treatment. Using benefit/feature statements and answering the What’s In It For Me question for your patients, allows them to understand why this treatment solves their problem.

  1. Listen for the patient “want” (benefit). Common benefits are to save money, save time, improve their appearance, and to avoid pain.
  2. Match it with the recommended dental procedure.
  3. Now, state the logic or features that support your choice of dental procedure. Answer the question “Why / How does this treatment achieve the benefit the patient wants?”
    Example: So that we can help you maintain the youthful appearance that is important to you, I would recommend whitening your smile.  Whitening would be perfect for you since it will give you the brighter, younger looking smile you want
  4. Many people also find that stories of other patients or your own personal experiences help increase understanding and give the patient time to process the information you are providing. In this case it might be something like; “We had a patient, Mary, who told us that after she had whitened her teeth she was out to lunch with her sister who commented she looked much more vibrant. Her sister was certain she had tried some kind of procedure at her dermatologist and could not believe it was whitening that made such an immediate difference!”

The Patient is Denied Credit by Your Financial Partner

Situation:

You offered your financial option of working with an outside partner such as Care Credit, to provide long term interest free payments on their dental treatment and the patient’s application was denied.

Desired Result:

The financial administrator feels confident discussing the denial process.  She/he is able to offer assistance and an explanation without causing embarrassment to the patient.

How To:

Although we all wish that every patient qualified for patient financing, the reality is that some applications are not approved. When that occurs, patients typically want to understand why — and that may make team members unsure of how to respond. Here are some points of information you can use to confidently talk with patients in a positive, helpful manner.

  1. Patients will receive a letter within 10 days from the issuing bank, regarding the reasons for the decision and the source of information used.
  1. The credit decision is based on a number of factors, and applicable law limits what the financing company can share with your practice. If your patient wants to speak with a representative, refer them to the Cardholder Support Center and provide them with the toll free number.
  1. Sometimes an application is not approved simply due to a “typo” or missing information on the application.
  • Review the application with the patient to check for any data entry errors, such as misspellings.
  • Make sure the patient has included a complete street address, not a post office box (P.O.) number.
  • Check that the patient has included all sources of income.
  1. You can also suggest that the patient re-apply with a co-applicant or have a family member apply on their behalf. In many cases, this may result in an approval.

How to Say It

Here is a sample script to use as a guideline when talking to a patient about an application that was not approved:

“Unfortunately, our financing partner was not able to extend you credit at this time. You will receive a letter from the issuing bank within 7 – 10 business days, indicating the specific reason for the decision. Applying with a credit-worthy co-applicant is a good way to increase your chances of approval.”

Preventing and Handling Late Patients

Situation:

The patient arrives more than 10 minutes late for a scheduled appointment.

Desired Result:

The patient receives the care that they need and the practice does not inconvenience another patient by running behind.

How to:

Before we can address the late patient issue, we must first make sure that we as a practice are not training our patient to arrive late because of regularly running behind and not seating patients within 10 minutes of the scheduled appointment time. If we do not respect our patient’s time, it is difficult for us to address the late patient arrival effectively.

As a team, analyze your procedure times and identify causes of running behind. You must make staying within the scheduled time frame a priority. If you are 10 minutes behind or more acknowledge the delay, and give the patient an approximate wait time. The more cordial and caring you are in addressing this with the patient, the more likely the patient will be considerate with you.

“Mrs. Jones, I am aware that your appointment today was for 11:00 am. Unfortunately, Dr. Robert’s assistant just informed me that he will need some extra time with his patient. We should be seating you in about 10 minutes. Can I offer you something to drink while you wait?  Thank you so much for your patience!”

As a good will gesture, follow up with the patient by sending a handwritten note thanking them for graciously waiting to be seen. If you feel it is appropriate include a gift card to a local coffee shop as a token of your appreciation.

When a patient is late:

  • Notify the clinical team to determine if the patient can still be seen for their regular appointment.
  • Try to at least see the patient for a quick check, even if they need to be re-appointed for the original procedure.

“Tina, we were worried about you, I’m glad you’re here.  I hope everything is o.k.” Empathize with the patient’s reason for being late.  “I’m sorry traffic was so terrible, I know it can really get bad at this time of day.  Let me check in back to see if they have the quality time that they need for this procedure.”  If the answer is no… “Tina, in order to devote enough time to what we had originally scheduled for today, we will need to schedule another appointment.”

  • Once you see a pattern developing with a late patient, say something like the following:

“Tina, we need your help.  We would like to discuss how you could help us stay on schedule with your treatment, as well as your patient appointments. Can you tell me what might be preventing you from being on time?  Maybe you and I can come up with some solutions that could work.”

  • When a patient is late and they are too young to be responsible for getting themselves to the office, it is important to communicate directly with the responsible party. Many children are embarrassed and have no control over the situation.

Gathering Patient Testimonials

Situation:

Everyday we work with patients we hear compliments about the dentistry, the doctor, the team or the facility. Use these opportunities to gather testimonials and build a library of quotes and stories about your patients’ experiences. These can go a long way in helping others decide to choose you for their dental needs.

When a patient says something nice about the practice ask them “May I quote you on that?” and then inform them that you are gathering testimonials to use on your website and in your practice brochure. You may also want to prepare a reception area testimonial book and include them on any video presentations you may play in the reception area or in the operatories.

Target patients that would be good candidates to give you a recommendation and ask them if they would be willing to share their story with your potential patients. If they agree to do so, inform them that you’ll send an email with a testimonial request. Download a Microsoft Word Testimonial Authorization Form .

How to:

  • Sample email to a patient whom you’ve asked to write a testimonial:

Dear [Patient],

Working with patients like you makes my dental practice a great joy! Thank you for agreeing to provide a testimonial. Your story will help inform our potential patients why it’s good to work with us and how they can benefit.

To help you get started, I’ve included a few questions, but please feel free to write whatever you like.

(Include some questions, using the list below as a guide.)

Thank you for your time and kind support. We value your business and look forward to caring for you again in the future. Please let me know if there is anything further I can do for you.

  • Sample email to a patient asking if you may quote them for a testimonial:

Dear [Patient],

Thank you for taking the time to express your kind comments to me. Your praise brightened my day and patients like you make everything I do worthwhile.

With your permission, I would like to share your thoughts with potential patients. Your words will help them to understand how they can benefit from working with us, and why they should do so. Do I have your permission?

Thank you again for your business, and please let me know if there’s anything further I can do for you.

  • Sample email asking for a testimonial:

Dear [Patient],

I hope all is well. Because I value you as a patient, I would appreciate your feedback. With your permission, I would like to use your comments as a testimonial on our website and in our practice brochure.

To help you get started, I’ve included a few questions, but please feel free to write whatever you would like.

(Include some questions, using the list below as a guide.)

Thank you for your time, and thanks again for your business. Please let me know if there’s anything further I can do for you.

Of course, most of your patients are busy people who don’t have much time set aside for tasks like this. That’s why it’s your job to make it easier for them. One way to do this is to provide them with a few sample questions in your testimonial request email. Here are a few that you might want to put to use:

  1. How do you feel about your dental work? How does this compare with dental work you’ve had in the past?
  2. How do you feel about the way you’ve been treated here in our office? How does this compare with other offices you’ve been to?
  3. What problems were you experiencing before you came in? How were these resolved? How do you now feel about your dental health?
  4. How affordable are our services? How does this compare with other offices you’ve visited?
  5. Do you have any other comments about your dental care or our office?

Whenever a patient provides a testimonial, don’t forget to send them a kind thank-you note. A personal handwritten note is best and a thank-you gift may even be a good idea in some circumstances. The goal is to make your patients feel that they’ve done a good thing, while also keeping your business in their minds so that they’ll provide referrals in the future.

Part 2: What Questions to Ask when Networking. More low cost ways to market your practice

When networking you want others to feel good about themselves, and, to feel good about being in a conversation with us.  We want to ask questions that make others feel good about us as people, even though we have just met and they hardly know us.

 

Here are our top 10 questions that are not sales oriented in any way.  They are friendly and fun to answer and they will tell you something about the way a person thinks. In one conversation you will not use all these questions.  We recommend knowing them well enough to ask the ones you feel are appropriate for the conversation and the time frame available at your networking function.

 

Here are the 10 questions:

 

1.  How did you get your start in your business?

  • People like to share their story

2.  What do you enjoy the most about your profession?

  • The people you want to associate with will love to answer this question

3.  What separates you and your company from your competition?

  • Gives them permission to brag

4.  What advice would you give someone just starting in your business?

  • Mentor question

5.  What one thing would you do with your business if you knew you could not fail?

  • What are your dreams question

6.  What significant changes have you seen take place in your profession through the years?

  • Mature business owner question

7.  What do you see as coming trends in your business?

  • Be a speculator question

8.  Describe the funniest (or strangest) thing you’ve experienced in your business?

  • War Stories question

9.  What have you found to be the most effective ways to promote your business?

  • All small businesses market in some way

10.  What one sentence would you like people to use when describing how you do business?

  • Customer service question

 

These are questions people will enjoy answering.  You are not being nosy.  Again, don’t plan to ask all 10 questions in one meeting. This is not an interrogation, these questions are meant to establish initial rapport.  When someone answers a question use genuine curiosity, try saying “tell me more”.  Learn as much as you can about your fellow business owners in your community, there may be opportunities to cross promote your business or create a small business breakfast group.  The more people you know, the more people who know you, the larger your practice will become.

 

What is one networking event you could attend in your community?

Part 1: Networking at business functions or social events. A low cost method to promote your practice

Chamber of commerce, or other business functions, and social events, are excellent sources of networking if used correctly.

Follow these 10 tips for successful networking:
1. Adjust your attitude. Realize that the purpose of attending this function is to work and build your network.

2. Work the crowd. Be pleasant and approachable.

3. Prepare a quick 30 second introductory “elevator” speech to help others understand what you do for patients and how your services benefit others.

4. Introduce yourself to someone new. If possible have that person be a center-of-influence person or someone who is in a complementary profession. Look for cross-promotion opportunities.

5. After the introduction, invest 99.9% of your time asking the other person about their business. Refrain from talking about you or your business.

6. Ask for their business card. (Never attend a function without your business cards)

7. Introduce this person to other people you know at the function.

8. Follow up with a “nice to meet you email”

9. Follow-up regularly with articles or information relevant to their business or your shared business concerns.

10. Give referrals to others.

Keep in mind networking is first about what you can do for someone else, not what they can do for you. If you help others, you will receive help in return, it may not be an immediate payback but it will come with time.

Always remember people find it irresistible when you recognize them and know their name (not just their teeth or dental challenges). This quote says it all:

We are all so vain that we love to have our names remembered by those who have met us but once. We exaggerate the talents and virtues of those who can do this, and we are ready to repay their powers with lifelong devotion. The ability to associate in the mind names and faces is a tremendous asset to a politician, and it will prolong the pastorate of any clergyman.          William Lyons Phelps

Embezzlement: Dentistry’s dirty little secret

Here is an article from DrBicuspid.com that suggests that over 60% of dentists will be victims of fraud.  Read about Dr. Gordon Christensen’s experience.  Make sure that you have embezzlement safeguards in place in your practice! Not sure? Contact us.

Embezzlement: Dentistry’s dirty little secret

By Donna Domino, Associate Editor

April 29, 2011 — Sometimes it’s a spouse, girlfriend, relative, accountant, or business partner.

Unfortunately, more often it’s a trusted, longtime employee who has an insider’s knowledge of your bookkeeping practices and access to your bank account.

Maybe their spouse has been out of work for months and, desperate for money, they begin embezzling from the practice and “cooking the books” to cover their tracks.

But experts say it is often just a matter of greed.

Dental practice embezzlement is not an anomaly; in fact, it’s shockingly pervasive. Some fraud investigators say that 60% of dentists will be victims of fraud during their careers, while others put the figure as high as 90%.

Even Gordon Christensen, DDS, MSD, PhD, and his wife Rella Christensen, RDH, PhD, have been victimized — not once, but twice — by employees who stole from their nonprofit research group, CRA, now called the Clinicians Report.

“It’s often the most trusted employee,” he told DrBicuspid.com.

The first theft involved a woman accountant who seemed extraordinarily dedicated to her job: She came in early and left late. She was also intent on being the only one in the office who made financial entries. She was eventually discovered after the office’s door activator recorded her coming into the office at 3 a.m.

“This is usually a person that you think is working hard and is the most trusted employee.”
— Gordon Christensen, DDS, MSD, PhD

“She was rigging the numbers and embezzling an enormous amount,” Dr. Christensen said. CRA took the case to a state job court, where the bookkeeper/accountant somehow twice avoided being held responsible. Finally Rella filed a civil lawsuit against her and won, but the situation took a toll on the Christensens — especially after the accountant’s husband, who worked for an explosives company, threatened them and even tried to run down Rella with his SUV.

“We did win, but I don’t know if it was worth it,” Dr. Christensen recalled. “The endeavor cost many thousands of dollars and lots of time, effort, energy, worry, and grief.”

The second embezzlement involved a young man, a former missionary, who was responsible for depositing funds from German subscriptions for the Christensens’ research group into German banks.

Despite growing subscription levels, revenue was mysteriously going down, which made Rella suspicious. The Christensens eventually discovered that he had embezzled more than $200,000 over several years.

“At first it was deny, deny, deny,” Dr. Christensen said. “He finally admitted it and brought his parents in, who apologized and wanted to repay the money.”

While many embezzlers involve people who’ve had a run of bad luck, these individuals had no extenuating circumstances that motivated them to steal.

“It was simple greed,” Dr. Christensen said. “It’s just appalling that people do this.”

Should you prosecute?

David Harris, who runs dental fraud investigation company Prosperident, investigates up to 100 dental fraud cases per year using four forensic examiners, but he says he could keep 15 inspectors busy. In the U.S., 5,000 to 6,000 dentists per year will be fraud victims, he told DrBicuspid.com.

“It’s just so endemic in dentistry,” he said.

Most embezzlers steal about $100,000, but Harris said the biggest theft he’s uncovered totaled $612,000. Insurance only covers so much. Most policies have a fraud coverage maximum of $75,000, he said, adding that some dentists have no insurance to cover thefts.

Office managers, receptionists, and anyone with front desk access are usually the culprits, Harris noted, and the majority of frauds are committed by people who’ve been with the practice more than five years.

Often, normally honest people are driven by desperate circumstances to steal from their employers, he said.

“Something happens that puts their back to the wall,” Harris explained. “A spouse loses their job or dies, or narcotics or gambling problems threaten their basic financial existence.”

Only about 20% of dentists prosecute the embezzlers, he said. In Harris’ experience, several chose not to because the thief was a relative, girlfriend, or a staffer they were having an affair with and they didn’t want their wives to find out. Some dentists don’t prosecute because they are engaged in illegal activities themselves, such as insurance fraud, he added.

In one case, after Harris uncovered a staffer’s theft, she warned Harris that the dentist should think twice before pressing charges because she “had the goods” on him.

“She knew the dentist had been inflating procedures on insurance claims,” he said.

Harris described the dentist’s reaction to the embezzler’s ominous threat. “He sort of turned pale and said, ‘I didn’t think this would be an issue.’ ”

Not surprisingly, the dentist decided not to report the theft.

But sometimes practitioners decline to file charges because they’re embarrassed. A periodontist who lost more than $100,000 to an employee decided to drop the matter. “If this becomes public, all the general practitioners will think I’m an idiot and will stop referring to me,” he explained to Harris.

While checking references is a good idea, it does little to prevent theft because in most cases, the potential embezzler is already on staff, Harris said.

“The thief isn’t going to quit and go someplace else to steal. They’ll just find a weak spot in the system,” he said. “They need money and their ethics become pliable. You trust them and they know what you look at on a monthly basis, so they have all the advantages.”

Like Dr. Christensen, many dentists have been victimized by fraud more than once. One periodontist Harris worked with was the victim of embezzlement three times. “He had a big office with about 15 staffers,” he said. “It’s the law of numbers.”

And even if the thief is successfully prosecuted, few ever serve jail time, Harris said. Generally, it’s a first offense, they usually have no criminal background, and there are mitigating circumstances. Embezzlers will plead hardship, telling judges that they were forced to steal to pay for their son’s kidney transplant, he said, which in one case was true.

Initially, many dentists who’ve suffered thefts are reluctant to file charges against employees who they’ve known for a long time. But insurers require that dentists file a police report if they want to file a fraud claim.

“They feel bad for the employee and say, ‘She was like family. I don’t want her to go to jail,’ ” Harris said. “The majority say they don’t want anything bad to happen to the person. But as the dentist sees what the person has done to him, they get mad.” After the investigation is over, more are inclined to prosecute, he said.

Usually, embezzlers are caught when something unforeseen occurs. One woman’s stealing came to light when she broke her leg skiing and couldn’t come to work after not missing a day in five years. “The dentist brought in a replacement worker who, after a few days, said, ‘Something doesn’t make sense here.’ She had gotten questions from patients who had paid by cash but had received statements that looked like they paid by credit card,” Harris said.

Dentists who’ve been defrauded by longtime employees understandably feel betrayed, Harris said. “They’re mad, hurt, confused,” he said. “They feel they can’t trust anyone afterward.”

“The thing that hits me hardest,” Dr. Christensen noted, “is this is usually a person that you think is working hard and is the most trusted employee.”

Handling Emergency Patients

Situation:

Caring for emergency patients and not causing the scheduled patients to run behind or feel like they are not the priority.

Desired Result:

Emergency patients seen on the day they call and the patients on the schedule that day feel a consistent high level of care and excellence.

How To:

  1. Identify the type of emergencies commonly seen in your practice.  Sensitive to Hot or Cold, Broken Tooth, etc…
  2. Determine the provider coding of doctor time and assistant time for each type of emergency.  For example: the patient may be seated and the assistant will spend the first 10 minutes of the appointment taking an x-ray intra-oral photos of the problem tooth, and interviewing the patient.  The doctor spends 10 minutes getting the patient out of pain and prescribing the needed appointment.
  3. The dental assistant reviews the daily schedule and determines the best place to work in emergency time at the morning huddle, one in the morning and one in the afternoon. These are the natural breaks in the schedule or where you know you have an operatory available and the Doctor is able to modify the schedule to accommodate the emergency patient.
  4. Do not hold or block emergency time unless you routinely see 3 or more emergencies per day. You may want to hold time on Monday after the weekend or a vacation, or Friday before the start of the weekend or a vacation, if you see more emergency calls on these days.
  5. Provide palliative care whenever possible, do not “over treat” the emergency, unless you have open time in the appointment book you are trying to fill. Analyze the situation, prescribe any additional needed radiograph(s) or photos, get the patient out of pain, prescribe any medication necessary and reschedule for the needed treatment or refer the patient to a specialist.
  6. When a patient calls with an emergency, offer the two times that have been determined:

    Mrs. Smith, I am sorry to hear you are having a problem. Doctor will want to see you right away. He has emergency time today at 10:20 or at 1:50. Which would you prefer?

  7. If the emergency time has already been taken by other patients, ask the patient to come right over, so that you can work them into the schedule:

    Mrs. Smith, I know that the doctor will want see you right away, please come right over and I will do my best to work you in to the schedule. We do have a full day of patients so please understand that there will be a wait.

  8. Avoid offering the patient the end of the day as an option. This trains your patients to say that they have an emergency to get a “prime time” after work/school appointment.