The Last Thing Your Patient Hears

Many times in life, great experiences are completely erased by what occurs in the last few moments.  How often have you loved a movie right up until the predictable (or incomprehensible) ending? Or gone to a fine restaurant, recommended by your friends, and had a fabulous meal.  Great service, unusual dishes, worth the money, terrific atmostphere, and then you waited 35 minutes to get the check!  It wiped out the whole positive experience.  Now when people ask you about the place, you say, “Yeah, great food, but…” It’s that “but” that changes everything.

If you’re aware of the fact that most patients are evaluating your dentistry by the experience of being in your practice as much or more than they by your clinical skills, then you should be thinking about what the last thing is that the patient experiences in their visit.  There are two critical times in any service experience: what happens first, and what happens last.  I speak at length about the first experience–how you answer the phone, how you greet new patients–and those moments are very important, but I want to talk now about what happens last.

The problem is we make this mistake all the time in dentistry.  The last few minutes of the appointment very often involves someone trying to get the money out of the patient, and even worse, having to explain why the insurance doesn’t cover it.  Or trying to get the next prophy appointment scheduled while they’re trying to run out the door to get back to work.  You can have the sweetest people working in your office, in a fun environment, with great technology and wonderful chairside manner, but then the last taste in the patient’s mouth is money issues, and insurance confusion, and your scheduling needs.  Tainting everything.

My point is, take care of all these things sooner. Get the money chairside.  Do the explanation of coverage ahead of time.  You have to do it anyway, so slide it forward.  We love to put off things we don’t like to do until last–it’s human nature.  But you need to override that tendency because it’s tarnishing the experience of the patient visit.  There are thousands of practices who get all the money dealt with chairside, as soon as the diagnosis takes place.  It’s just a matter of changing procedure, and using the right words.  Don’t say, “It’s our policy,” say, “We like to take care of all of this ahead of time, so that you can just leave the office when your done and not worry about it.  We have to take care of it anyway, so let’s do it now.”  Then you know if they have sticker shock about the treatment.  Or if they actually don’t have the money to pay for it, because then you’ll be trying to collect your fee, and hoping to get some percentage of it.  Get all your money, or don’t start treatment.  It’s just a change in procedure.  You are in business to make money, right?  There’s nothing mercenary or unprofessional about it.  You completed an expensive education and set up a facility that is costly to equip and operate.  You should be paid for the services you provide.

And do schedule their next appointment chairside as well.  Most people have smartphones with their calendar right there, and you have computer access.  Get it done.  Slide it forward.

So now, instead, the last experience of the practice is you giving them a little goody bag of some floss, toothpaste, a travel toothbrush, maybe a pack of Advil and some home care instructions.  And maybe, just maybe, it’s the dentist giving the patient a call later, or sending a text, asking how the patient is doing.  Now that’s a great way to end the visit, and make it a positive experience right through the finish.  Whatever it is, be conscious of what you’re doing, knowing that it is your last chance to make a good impression.

When It Comes to Self-Financing Dentistry, Shakespeare Was Right!

When the economy shifted a few years ago, many dentists I know starting giving their patients a break and accepting terms, financing treatments themselves on patients who had lost their job or their homes, or who were just tight on money.  And I applaud their generosity.  But the most common experience was they ended up losing both the patient and the money.  Many of these people couldn’t make the payments, so rather than come back they went to another dentist, and often times paid the second dentist to finish the work the first dentist started essentially for free.

Accounts receivable is bad business, to be sure. But self-financing is also bad marketing. Statistically, if you have payments more than 90 days overdue, you can be 90% sure you will never see the money.  So why do dentists do it?  To be a nice person?  Because the patient had been a good patient for a long time?  Because the need of the patient was so extreme they didn’t feel they could ignore it?  All good reasons, but the unintended consequences are most often negative.  As Shakespeare said, “A loan oft loses both itself and friend.”

Sometimes there’s a deeper reason, that dentists are so overwhelmed by the constant whining about the cost of dentistry that they devalue it in their own minds.  And that’s where the unconscious marketing message comes in: when you agree to self-finance, you’re telling the patient that even you don’t believe you deserve the money, that you’re too expensive.  That’s why they’re so comfortable not paying you.  You think you’re building loyalty, but instead you’re compromising on your value position.

I’m going to make an absolute statement. There should be no accounts receivable in your practice.  No more than there are with your  dry cleaners, or any restaurant in town, or your supermarket.  If you are not paid at the time of service, you guarantee a percentage will be written off.   Because when it comes to bills that patients feel required to pay, you don’t make the list.  They pay their rent/mortgage, their car lease, their grocery bill, and their credit cards.  I could add ten more items to the list and you still wouldn’t be on it.

So why not only work on patients who will pay you?  That shouldn’t be a radical concept.  What you offer is valuable, worth every penny, and a better long term investment than almost anything else your patient is spending money on except food for their children.  And that’s the marketing message you want to communicate.  You communicate that very effectively when you insist on full payment for your work at the time of service.

So what should you do when you have a good, long term patient, someone who has been with you for years, and he lost his job?  He comes to you with a broken crown or a cracked molar and simply has no money to fix it.  Instead of financing him yourself, just do the work for free.  Say to him, “Look, you’ve been a good patient for years. This would cost $1000 to do this, and I know you don’t have it.  So I’m going to fix it at no charge.  But there are two conditions: first, you don’t tell anyone that I did this.  And second, the next time you need work done, you’re going to have to pay.  This is a one-time thing.”

You’ve made it clear what you’re willing to do, why you’re willing to do it, but it’s not the way you’re going to continue doing business with this person.  They will appreciate it, and instead of them owing you money and not being able to pay you, you’ve added one more experience that makes this person a loyal patient, and most likely they will soon get a job and continue as a paying patient.  Not all the time, of course.  Nothing works 100% of the time.  But the odds are a whole lot better than when you self-finance and hope to get paid.  Best of all, you’re not devaluing your dentistry.  You’re choosing to be generous with something extremely valuable.  Whole different message.

The rest of the time, I say get the money chairside.  This isn’t a fantasy.  I can tell you a hundred practices that do it with every procedure, every case.  They simply say, “This is what the treatment will cost, and this is what your insurance covers. How would you like to handle the rest?”  Don’t save it for last, when they’re leaving the office.  I’ll discuss this concept in more detail in my next blog, so stay tuned!