Jenny’s Blog – In My Opinion!

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Dental Practice Management: Financial Policies

dental practice management

Q: Our practice is located in a small town. Isn’t a formal written financial policy inappropriate in that sort of community?

A: On the contrary, it’s particularly important to have a written policy in a setting where business and social lines intertwine. If you try to treat an entire community like members of a giant extended family, your accounts receivable management is almost certain to face disaster. Additionally, having a written policy that you adhere to will ensure that everyone will be treated the same. You certainly don’t want patients who know one another to have any feeling that some patients get different treatment than others.

Q: We take forms of third-party payment in our office, including fee for service, HMO and public aid. Why are the HMO [health maintenance organization] patients so disrespectful to the doctors and staff? Because of this disrespect, we are seriously considering dropping all HMO programs. These patients expect to be seen immediately and break appointments without notice. We have extreme difficulty collecting payments from them. We’ve even had patients use profanity to the doctors and staff when disputing HMO policies. Although public aid patients tend to be unreliable as a whole, they don’t expect the doctors to work for free. HMOs are terrible, and every day we ask our doctors to drop them, I think they’re starting to listen.

A: Working with HMO programs has both strengths and weaknesses. When the practice is well managed and the practice’s enrollment in HMOs is held to 30 percent or less, there’s potential for a successful relationship between a practice and HMO programs-if the desired goals are met. However, research has shown certain companies who sign up with HMOs attract a certain level of short-term (less than one year) employee. I believe that we need to look at the quality of the HMO and the companies they sign up. This background information will give a practice an idea of the caliber of patients they will receive in the practice. Also, have a full practice analysis to understand fully the implications your particular HMOs have on the practice.

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Dental Practice Management: Customer Relations

dental practice management

Q: Consultants recommend sending a welcome package to new patients.  What kinds of things would be included in such a mailing, and what are the benefits?

A: I appreciate you focusing on one of the most underutilized marketing and management tools in dentistry.  An effective welcome package consists of seven specific items:

  1. Welcome letter, which welcomes the new patient to the practice.  The letter needs to be positive and upbeat.  It is not appropriate to use this letter as a vehicle to state your policies on confirming appointments, no-show charges, charging interest on overdue accounts, etc.  The letter is a wonderful way to make the initial visit less stressful for the patients by sharing with them what they can expect on the first visit.
  2. Practice brochure is a professionally designed and printed educational piece.  It sets the tone of the practice, helping the patient get a sense of the doctor’s and practice’s philosophies.

Key items include:

  • Map and Location Details
  • How emergencies are handled during and after regular office hours
  • Continuing care (maintenance) program
  • Team approach to patient care, including the important role that staff play in dentistry
  • Picture of doctor with brief CV

Information not included because it might change:

  • Office hours
  • Staff Photos

Form, filled out at home carry complete answers to questions asked.  Forms completed in the reception room, prior to being seated, are usually void of several important details.

  1. Medical
  2. Dental
  3. Patient registration forms

There’s a staff perception that so many patients will forget to bring the forms with them on their first visit, that staff feel mailing forms to the patients, in advance, is a waste of time.  My personal research shows that a practice can expect to have about 99% of the forms accompany the new patients!  The secret is for the practice to telephone each new patient the day prior to the visit.  Use this call to confirm that, in fact, the patient has received the welcome package.  Ask the patient if any help is needed with directions to the practice.  Thank the patient, in advance, for taking the time out of their busy schedule to complete the forms.  Finish the call with “Mrs. Patient, we’re really looking forward to seeing you and your completed forms tomorrow, Thursday, at 4:30 p.m.”

  1. Completed appointment card
  2. Two Business cards: one for office and one for house.

The whole package needs to be professionally designed, printed, and assembled.  Image is extremely important.  The impression created will set the tone for the patient’s initial visit to their practice.

Q: I asked a patient recently if she had seen the doctor before. She became very upset that I had not remembered her name. How should I have handled her so that I do not upset a patient of record?

A: Luckily, this is such an easy problem to solve. The following solution reduces stress for the staff on the telephone and ensures that a well-established patient is never upset again.

Patient: “I’d like to make and appointment to see the doctor.”

Staff: “Mrs. Patient, may I ask when you last saw the doctor?”
(came in, had an appointment)

If the patient is a patient of record, the answer will be along the lines of “two weeks, two months, etc.” However if the patient is new, the answer will reflect that.

Patient: “Actually I’ve never seen Dr. Brown before.”

Q: Is it best for our office to call and confirm appointments?

A: My personal research over several years shows, without a doubt, that practices that confirm appointments have a higher no-show rate than practices that do not confirm. There are two specific negatives why this occurs.

  1. The confirmation call provides a patient with the opportunity to “cancel short notice.” The patient will comment to the staff, “I am so glad that you called; I have been meaning to call you for days. I don’t think that I’m going to be able to keep my appointment tomorrow.” If the practice had not called, the patient would not have been offered this wonderful opportunity to cancel.
  2. When a patient can rely on the practice calling to “remind” them the day before, the patient puts the responsibility on the practice to “chase” the patient around town rather that recording the appointment details and making the commitment to keep their appointment without telephone call.

Q: “I’ve heard that one should thank patients for referring patients to the practice. We feel uncomfortable doing this. Any suggestions?”

A: There is a proven system, which totally allows you to thank your patients of records in two specific ways for their referrals, while, hopefully, remaining very comfortable in the process. Each day, Doctor needs to put out the last five to ten minutes to write a very brief thank you to patients who have referred their friends, neighbors, relatives, and co-workers to your practice that day. Such a note can be limited to two to three sentences i.e.

“Mrs. Smith, I’d like to thank you for the confidence you’ve shown in me by referring your sister, Susan, to my care. We will enjoy taking care of her dental needs. Sincerely…”

Be sure to capture each referral source in your computer system. The icing on the cake is to follow up on this note to patients by actually thanking them again, in person, on their next visit to the practice, (even if it is several months later). Patients constantly express amazement that you actually remembered, thereby encouraging them to continue their referrals. It works.

Q: “I scheduled a patient for a new patient exam. However, during the visit, Doctor found that the patient had quite a serious emergency. As a result, we ran very late. How can we prevent this happening in the future?”

A: Unless the administrative staff, that take the telephone call, take the proactive stance on questioning the caller about any potential emergency needs, you’re destined to repeat this scenario. The solution is to offer patients the opportunity to advise you of any potential emergency problems that they may be experiencing, without inviting them to build the problem into a perceived emergency, when it is not.

Staff: “Mrs. New Patient, may I ask are you experiencing any discomfort?”

The key word here is discomfort as it allows the patient to accurately describe their current needs. With these specifics at hand, you’re now able to ascertain whether the appointment should, in fact, be for an examination or an emergency. Most practices prefer to divide these two procedures into two separate appointments for all the obvious reasons.

Q: “We find that patients often comment on the fact that they have to wait two to three weeks for their new patient exam appointment. We find, that in many cases, they then miss their appointments. How can we solve this problem? Our schedule is full and we can’t schedule them to see the doctor any sooner”

A: I’m glad to see that you are concerned about asking patients to wait. The #1 reason patients miss their initial appointment is because of the wait involved. We need to remember that (other than a true emergency) the majority of patients make examination appointments because of either perceived emotional needs or interest in elective procedures. Therefore, a patient, who is motivated to call into the practice to schedule an appointment, must be handled promptly.

I have espoused, for over twenty-five years that all new patient exams need to be scheduled within seven days of the patients calling. Therefore, I believe that you problem is a scheduling problem and easy to solve. By incorporating a system of blocking out certain times each day/week, allows new patients to receive immediate service. This will solve your problem. (Remember any blocked out time in the schedule, still unused 24 hours out, is released and booked with another patient needing care.

Q: In our orthodontic practice, we have 35-40 patient cancellations or no-shows every month. How do we reduce this number? We schedule about 25-30 patients a day. Should we charge for broken appointments?

A: The secret here is to be proactive not reactive. Assuming many no-shows are pediatric patients, experience shows that the parents probably are aware of the appointment.

The last thing they probably said to the child that morning before school was, “Don’t forget your dental appointment.” The problem? The patients get caught up in the school day and school activities and they forget the appointments.

The solution is to include a very strong verbal and written policy on no-shows during the financial consultation: “There will be absolutely no charge as long as we receive at least 24 hours notice of your need to change your appointment. If we do not hear from you and do not see you (or your child), there will be a charge of $45 for the missed appointment.

While an orthodontic adjustment may not be a long appointment in itself, when you experience several no-shows a day you have a major problem.

Q: I feel uncomfortable asking people for money. Is there a way to get payment at the time services are rendered without actually asking the patient?

A: There certainly is, and here’s what I recommend.

First, make sure the patient’s chart is at the counter five minutes before the patient returns to you after seeing the doctor. You can accomplish this by having the assistant bring it to the front at the end of the visit but before the patient is released from the clinical area. This five-minute period is the critical time when you look over the chart and familiarize yourself with the patient and the treatment plan.

When the patient arrives at the counter, you take out an itemized charge slip or walkout statement from the plastic pocket on the outside of the chart. While the patient watches, look at the charge slip and enter an amount on the calculator. Tear off the tape and lay it next to the charge slip. Smile and set the charge slip in front of the patient.

Most patients, faced with an efficient staff person who obviously assumes they are going to pay on the spot, will pay on the spot.

Q: When patients come in with serious health care problems, I feel like I’m putting additional stress on them by pressuring them to pay their bills on the spot. How can I avoid feeling guilty about this?

A: Keep several things in mind. Remember that your practice is helping to correct on of the patient’s most urgent problem. If patients lack the resources to pay cash at the time that service is rendered, then by offering them the CareCredit payment plan, you’re providing a manageable solution to their financial dilemma.

Also keep in mind on of the quirks of human nature – namely that the longer a person owes money, the less he or she is likely to appreciate the service for which the fee was incurred. Having a written payment policy that promotes immediate attention to the patient’s financial obligations should insure that the patient deals with those obligations when he or she will most appreciate what they got in return.

Want to learn more about customer relations in your dental practice? Click here to check out Jenny de St Georges Dental Practice Management seminar.
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TOPIC: Dental Practice Management

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Dental Practice Management: Patient and Dentist Communication


Q: Where does a practice being to tighten up patient communication in an all-around manner if it never had any Dental Practice Management or Marketing Focus?

A: Written communication with our dental patients is essential and is done for three reasons.

  1. To educate your dental patients:  As Dr. Clyde Schultz, international lecturer from San Francisco espouses, “Until patients buy the problem, they cannot buy the solution.”
  2. Positive Reinforcement:  Written confirmation of a point not only raises the patient’s dental IQ (as noted above), but also is an integral part of dental practice internal marketing.
  3. Negative Reinforcement:  The patient who has fallen into a negative relationship with the dental practice, for whatever reason (a series of no-shows or a past-due account) must be contacted in a professional and positive way by letter, and, if necessary, by telephone.

Educating your dental patients

A natural follow-up with a new patient who has recently received a full diagnosis, necessary x-rays, and consultation would be to send a letter confirming the conversation held between the doctor and patient.  Summarize the key points to be considered.  This communication is a very personalized one that can vary from dentist to dentist based on the philosophy of the practice.

It is a positive reinforcement for a patient to receive such a letter within 24 – 48 hours of this first important meeting.  Although Periodontists have made this part of their initial consultation series for some time, general dentists have been quite slow to pick up on this very personal “internal marketing” tool.

Positive Reinforcement

A wonderful idea that springs to mind is the “end of current treatment letter.”  It should portray the “caring attitude and concern” of the dentist, as well as the express the need for the patient to accept responsibility for the maintenance of his own dental health.  When new patients who have joined the dental practice leave the office at the end of their initial series of appointments, they should receive this letter.  The administrative staff prepares the letter for the doctor to sign personally and should be received by the patient 2 or 3 days after the last visit.

Other positive reinforcement letters could cover home care of recently cemented crowns or bridges.  For the specialists, the letters would be customized as needed.  The majority of dental practices do give patients written as well as verbal postoperative instructions.  Many offices will call patients who have received invasive treatment.  The dentist or an auxiliary may make this call.  Then, a follow-up letter coming a few days after the appointment shows professionalism, caring, and concern.

Only and office “in control” has the ability to send the “right letter.”  This, if I were the patient, not only would I be touched by the concern and interest, but also by the “management and organization.”  Such professional management, I believe, reflects very positively back on the dentist himself, it also allows the patient to digest the information for a second time at his own speed.

Negative Reinforcement

Even though you should “inform before your perform” some dental patients will fall by the wayside.  Accounts do become delinquent and patients do miss a series of appointments.

Collection agencies will tell us a telephone call is much more effective than a letter, mainly because this allows instant feedback.  However, collection letters are still necessary for those times, when telephone contact is not possible.  Such collection letters can be arranged in a series so that Letter#1 is positive and Letter#2 becomes a little more formal.  Letter#3 goes into a different level of collection mode.  There are several benefits to this series-type correspondence.

Letters can be critiqued by several people other than the writer.  The attitude in the letter should still be positive even though it is a “collection letter.”

Prewriting the series prevents the employee in contact with the patient from writing a letter in an emotional state, which might be counter to the image and overall professionalism of the practice.

Such a series makes record keeping and follow-up very easy.  Records may show, for example, “Letter #2 sent 2/1/13.”

Have more questions about Patient Management and Patient Communication? Click here to learn more about Dental Practice Management from Jenny de St Georges.

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TOPIC: Dental Practice Management

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