Who wants to talk about money with patients? No one!

Feb. 1, 2009
Who likes to talk about money with patients?

by Nate Booth, DDS

For more on this topic, go to www.dentaleconomics.com and search using the following key words: discussing finances with patients, offering financing, Checkbook Chills, Dr. Nate Booth, The “Yes” System, financial coordinators, no-interest financing.

Who likes to talk about money with patients? Do clinical assistants? Nope. Hygienists? Not usually. Dentists? You must be kidding. In most offices, the only people who enjoy discussing money are good financial coordinators.

Whenever patients ask questions even remotely related to money, clinical assistants, hygienists, and doctors usually use one of their well-rehearsed escape mechanisms, such as, “I don't know,” even when they do, or “Our financial coordinator will explain all that to you later.”

After escaping the dreaded M-word conversation, they think, “Whew! I almost had to talk about money.” So what's the result of this ongoing evasion? The discussion of money is perpetually delayed until it pops up (explodes may be a better word) at the end of the treatment conference.

Where's Milton?

Here's an example of what I'm talking about. Milton is a patient in Dr. Avoidit's office. He needs several implants and accompanying restorative dentistry. He is treated extremely well by everyone in the office. At the first visit, the doctor does a thorough examination. Milton sees a very impressive video on the advantages of implant dentistry and the various types of implants available. He's excited to return for the treatment conference in a week.

At the treatment conference, Dr. Avoidit does a masterful job of presenting the best implant care available. Milton is even more enthused. He says, “Looks great, Doc. How much is all this going to cost?”

Dr. Avoidit immediately selects escape mechanism No. 2 (his personal favorite) and says, “Our financial coordinator, Judy, will explain all that to you in just a few minutes.” He then wipes the sweat off his brow and does a flawless handoff to Judy as she enters the room.

Judy is a very pleasant and extremely knowledgeable financial coordinator. She asks if Milton has any questions about the treatment the doctor recommended. Milton answers, “Just how much the dentistry is going to cost.”

Judy takes a gulp of air and announces, “The fee to do all your implant and restorative dentistry is $10,800.” There is silence as Milton tries to grasp the figure. Judy wonders how she will do the financial arrangements and CPR at the same time.

Milton mutters, “Boy, that's a lot more than I thought it would be. My insurance will cover most of it, right?”

Judy proclaims, “I'm afraid your insurance will only cover $1,000.”

Is Milton prepared to make a decision right after he has been figuratively hit over the head with a two by four? He's dazed, disappointed, and discouraged. So he gathers his thoughts and says, “I'm going to have to think about it.”

Two weeks have gone by. No one has heard from Milton. One day, Dr. Avoidit stops Judy and asks, “When's Milton coming in to get started? He was really excited to get going when I talked to him. What happened?”

Judy feels like saying, “Nobody in this office would talk with Milton about money, financing, and insurance so I had to whack him over the head with a two-by-four at the worst possible time. He was nice about it, but we'll probably never see him again.” Instead Judy tactfully says, “Milton is still thinking about it.”

I'm guessing there are hundreds of Miltons in your practice right now who are “thinking about it.” What a shame. They aren't getting the care that will enhance their lives, and you aren't receiving the income that will improve your bottom line.

Empowering beliefs about financing

When your team and you learn to talk about money early in the conversations you have with patients, their reaction to a quoted fee should be, “That's about what I thought it would be.” I call this process “massaging money.” To effectively massage money, your team needs to hold the following empowering beliefs about financing:

1 It is professional to offer financing for dental care. I've seen dentists' attitudes change on this one during the past five years. An increasing number of dentists now realize that their competition isn't the dentist across the street. It's the Best Buy store down the street. I can guarantee you Best Buy offers financing (often no-interest financing) on most purchases. The question you need to answer is, “Is the dental care we provide just as important as a new flat screen television?” If the answer is yes, your office needs to offer financing.

2 I have little idea who's going to accept financing. So I offer it to everybody. It's virtually impossible to tell which of your patients need financing. Many patients are embarrassed to ask about financing and won't discuss it unless you bring it up. Assume everyone is a candidate for financing. Offer it to everyone. Doing so will increase case acceptance rates by 10% to 25%.

3 Offering financing, even no-interest financing, doesn't cost me money. It saves me money. At the end of the month, some dentists look at how much it cost them to do business with a finance company. They would be better served by seeing how financing added to their bottom line in the following ways:

  • You will do fewer removable partial dentures and more dental implants. The amount you net per hour on implants is vastly higher than with members of the Partial Denture Club.
  • You won't be the bank. It doesn't pay. If your patients have 36 different kinds of bills to pay, you will be number 35 on their list. The average dental office collects 96% of their production. That's 4% that wouldn't be lost if you used financing and got paid the day you started your procedures.
  • You won't send as many (or any) statements. Numerous studies have shown it costs you $10 per statement sent. How many do you send each month? Multiply that by $10.
  • Your patients won't get the Checkbook Chills. Here's a short story that explains what I mean: It's Monday evening. Your patient, Maria, has an appointment for the next day to seat a crown. She knows she must bring in a check for $600. She looks in her checkbook and notices her balance is $132.27. She begins to shiver and comes down with a bad case of the Checkbook Chills. She calls your office at midnight, informs you of her condition, and says she will call you when she's feeling better.

The moral of the story: Don't combine an office visit with a payment. They don't mix well.

4 Money is the problem. Have you ever heard a dental practice management guru say, “When it comes to case acceptance, money isn't the real problem? If you build enough value for the care, people will consistently say yes to your treatment plans.” I'm certainly in favor of building value for dental care, but there are limits. Statistics show at least 60% of patients are unwilling or unable to accept treatment plans because of financial constraints. Just accept that money is the problem and follow the suggestions in my next column.

5 I'm booked solid now. I can be booked more effectively with patient financing. Some offices don't use financing because they're booked solid. I'm guessing they're booked solid with lots of small restorative procedures, which cause everyone to frantically rush around the office trying to keep up. With patient financing, you will be booked solid with longer visits doing more high-end dentistry.

6 Phasing care can be more expensive for my patients. When it comes to financing, realize that patients are going to pay for their comprehensive care over time whether they finance their care and have it all done immediately, or whether they phase their care. If they finance their care with a no-interest plan, it can be less expensive to have everything done now because the cost of care will increase each year and there will be fewer emergency situations. In other words, phasing care can be more expensive than financing!

7 Financing leads to better relationships with our patients. In general, what do people think of those to whom they owe money? There's often a weird form of resentment when a borrower writes a check. And how is the relationship affected if the borrower is late with payments? It puts a strain on both parties, doesn't it?

The holy passion of friendship is of so sweet
and steady and loyal and enduring a nature
that it will last through a whole lifetime,
if not asked to lend money.

— Mark Twain


In my next column, I will give you 16 times and ways you can discuss money before you offer solutions to patients. In the meantime, don't hide from the discussion of money. Massage it.

Dr. Nate Booth is a speaker, consultant, and author who provides dentists with the information and systems they need to thrive in their dental practices. Dr. Booth teaches at the South Beach Dental Institute and is a practice management advisor for ChaseHealthAdvance. Dr. Booth is the creator of the in-office, DVD-based program, The “Yes” System: How to Make It Easy for People to Accept Comprehensive Dentistry. For more information, go to www.theyessystem.com, or call (800) 917-0008.

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