Your article, "Why Lower Fees Mean More Work," was extremely timely and accurate. Just this week, I facilitated a staff-meeting workshop for a new client and I used the Eastman Kodak Company research. As you so concisely and practically described the different scenarios, this particular client is working harder and enjoying it less. And, yet, he provides outstanding care and service to his patients. Prior to leaving private practice after 18 years to pursue my passion, business creation and development, I also anguished each time I raised fees - only to notice that my practice continued to grow, referrals increased and the quality of dentistry improved.
It took me until I left private practice, and some collaborative efforts and support from consultants outside of health care, to understand that just because people complain about fees and prices does not mean they will stop "buying" from you. Unfortunately, it is the only thing they have to measure and, right or wrong, price is the torchbearer of competitive advantage if you position yourself in the cost market. On the other hand, what the questions about costs may mean is that the patient-consumer is questioning the value of the service for them, not necessarily that you are overcharging. They may feel what you recommend and provide is extremely valuable, but not their priority at this time.
Cathy Jameson, in a subsequent article, "Do Your Patients Bemoan Fee Hikes," gives the example of a patient asking, "Haven`t you guys gone up since my last visit?" I always appreciate Ms. Jameson`s outstanding articles and advice, but I did feel her answer, and one that I typically read and hear, is much too defensive and possibly does not reflect the patient`s reason for asking. It assumes that the patient is complaining.
Communication always is the key to success. But good communication does not mean having an art for gab. More importantly, it is the art of listening. Maybe the patient actually has a budget, strange as that may seem for our society, and cannot afford the few extra dollars. Maybe this patient likes to pay his or her bill at the time of service and did not consider the increase and is embarrassed that he or she did not have enough money to pay it in full. Maybe it was just a question and did not require any special answer, certainly not a defensive one.
And, maybe, this was an indication that this particular patient was not receiving the value he or she expected and this was a unique opportunity to listen to this patient. Explaining your costs and overhead increase does not improve the relationship. When was the last time someone explained to you that their overhead was too high and you willingly wanted to pay their price? The problem isn`t the fee, it`s the perceived value.
Effective communication and education are more than just providing answers and asking question. It is listening and understanding and saying the right things. I suggest that before doctors and staff script a defensive response, they consider asking a question like, "Mr. (or Mrs.) Patient, our fees did go up. It sounds like we may not have done a very good job of explaining how we determine the fees for such services. What additional questions can we answer for you?"
By asking better questions, you will get better outcomes. If the fee question is more a question of perceived value than cost, then this is an excellent opportunity to listen to your patients and enhance the relationship. If the question was merely a point of information, there was no need to justify the increase with an explanation of rising costs when this wasn`t the intent of the question. In fact, it may irritate the patient that you were not listening to what he or she was saying. He may wonder why you felt you had the need to justify it in the first place.
Finally, I agree that patients must understand "what you do and why you do it before they can value it." However, telling them is not educating them. Convincing patients that any service is worth a certain amount of dollars is futile unless you understand what they value first. Rather than talk to your patients, listen to them. Instead of telling them your view of managed care, ask them what managed care means to them.
Just taking the time to ask questions and listen without judgment is so unique in the delivery of health care today that this competitive advantage in a private practice will be remarkable.
Ira S. Wolfe, DMD, FAGD
New Holland, PA