How to profit from . . . Fee Surveys

You`ve just completed your case presentation. But, as soon as you quote the fee, you can tell by the patient`s facial reaction that the classic question is about to be asked. You steel yourself as the patient says:

Do your patients bemoan fee hikes?

Your high standards of excellence should mirror your fees.

Cathy Jameson, MA

You`ve just completed your case presentation. But, as soon as you quote the fee, you can tell by the patient`s facial reaction that the classic question is about to be asked. You steel yourself as the patient says:

"Haven`t your fees gone up, Doc?"

This question from numerous patients - regardless of whether your fees have actually increased - can be upsetting. Many doctors and staff members are nervous about in-creasing their fees, simply because they don`t want to face this question.

That`s why a careful analysis of fees needs to be done every six months. Why? To determine if any of your costs of operation and/or costs of a procedure have gone up. If your costs go up, but your fees don`t, profits are reduced. The one who usually takes a cut in salary in this instance is the doctor, right?

When you analyze your fees, you may find that they are just fine. However, if they need to be adjusted 3, 5, 10 percent or more - just do it. Then, as a team, know that your fees are equitable and that they are "in line" for your area and reflect the quality of care you are offering.

When we first go into a practice to consult (and at every visit thereafter), we do a thorough analysis of the practice. We analyze each "system" and all of the statistical data. Before we go in - as well as during the first consultation - the doctor and the team members begin setting goals for each of these systems.

Once we know where they are at the moment (and where we want them to go), then we begin designing and teaching a plan of action to help the doctor and staff accomplish those goals. Oftentimes, we see practices that are so busy that they can`t even imagine putting in the necessary time to "clean up" their systems. They are seeing huge numbers of patients and have a hard time seeing people expediently. New patients have to be "put off" much too long; hygiene patients cannot be seen in a timely manner; major procedures are put off too far, because the appointment book is stuffed full of smaller appointments - lots of them!

Can You Be Too Busy?

Being overly busy can begin to squeeze patient time, increase overhead, and produce stress. The doctors and team members need to orchestrate a plan to increase revenue, while decreasing both the cost of operation and stress.

Improving case presentation will bring about a higher acceptance rate for treatment recommendations. Focusing on high-quality patient care will lead to more comprehensive care, longer appointments, and less stress for patient and provider.

Doctors must get out of the "habit" of thinking that seeing a high number of patients per day is the only way to be productive. It isn`t! To spend more time with patients and on certain procedures, you may need to see fewer patients in each day, but do more dentistry per patient. Remember, you do not want the profit margin of the practice to drop.

Noted dental consultant and lecturer Dr. Charles Blair has proven to me, beyond a shadow of a doubt, that the single, best way to increase practice productivity is to increase fees. If a practice is full of patients, increasing fees by 10 percent might cause a small percentage of patients to go elsewhere.

However, according to Dr. Blair, the practice would have to lose 20 to 25 percent of its patient family before "bottom-line" profits would be impacted negatively. If the practice increases fees by 10 percent across the board without adding other, additional overhead items, the bottom-line profits increase over 25 percent for practices with overheads in the 60 to 65 percent range.

If you want to boost profitability by increasing your fees by 10 percent, you must be prepared for possible negative response by your patients. You must be strong - and ready - for a few patients to leave your practice for a lower-priced competitor. (However, I`ve rarely seen this happen.)

Everyone on the team, including you, must agree that seeing fewer patients in a day, doing more dentistry per patient, and seeing the patients for longer visits is a desirable goal to strive for in the practice.

It`s How You Say It!

It is very important to develop good verbal skills in responding to a patient`s objections about fees. You do not want patients to leave you, and you don`t want people to feel hostile about your fees. So, how you handle the "very normal" fee complaints makes all the difference in the world.

Remember, effective communication is the bottom line when it comes to your success with anything, including discussions about fees.

For example, a patient may say, "Haven`t you guys gone up on your fees since my last visit?"

Your team member could respond, "Yes, Mr. Jones, there has been a slight increase in our fees. Our costs of operation have gone up and, as a result, our fees have done the same. We refuse to compromise the quality of our care, and so we carefully position our fees to reflect our commitment to the best."

The patient, in turn, may say, "Well it seems like every time I come in here, it costs more."

The staff can address this concern by pointing out, "No, not every time. But I can appreciate what you are saying. When the cost of doing a procedure goes up, we increase our fee in order to cover those costs. We prefer to do this, rather than use cheaper materials. Cheap materials produce average dentistry and the last thing in the world that we want to do is put average dentistry into your mouth, Mr. Patient."

Those Hated Insurance Letters

I don`t think a doctor hates anything any more than the classic letter from the insurance company, telling your patients that your fees are above the "usual and customary." Wow! It makes doctors angry that a third party is coming between their relationship with a patient. Most doctors also are concerned that a patient may have a misperception about the legitimacy of the fee presented, as a result of receiving such a letter.

One other issue can arise. If letters from the insurance companies are sent to the patient and if the patient calls or make a scene in the office, the team members can become "gun shy" real fast! They begin to think, "Hey, maybe our fees are too high," or "Our poor patients can`t pay for that treatment if the insurance company doesn`t pay, so maybe we should drop our fees."

That kind of mindset and attitude on the part of the doctor or team members can lead to financial suicide. I tell practices I consult with to take the following attitude: "Be insurance aware, but not insurance driven!"

The answer to complaints about high fees is not to lower them. If you re-evaluate your fees, your patient flow, your cost of operation, and your desired mode of operation, more than likely you will find your fees are just fine - or, if anything, still a bit too low!

For the most part, dental fees are equitable and fair.

The following steps need to be taken, however, so that you can professionally deal with the complaints that you are going to get from time to time:

- Have the entire team practice the verbal/communication skills needed to handle patient objections.

- Create a letter that can be sent to patients when a protest about "usual and customary" fees occur.

- Place a letter in the practice armamentarium to send to insurance companies, protesting intrusion into the relationship between doctors and patients.

There isn`t a doctor in America (or anywhere else in the world) who likes to lose a patient. It kills you ? and I wouldn?t want you to feel any other way about it! But, do not Olet the minority rule the majority.O Don?t think that because one or a handful of patients protests your fees that you are going to go Obelly up.O Not raising your fees when your own cost of operation goes up will make you go Obelly up.O

And then, who wins? Not the patients, because you aren?t in practice anymore!

Put a mirror up to your practice. Are you epitomizing quality? If not, make adjustments. Visualize the patient?s experience with you and make sure every visit matches your idea of excellence. Then, set your fees accordingly.

Study communication skills, so that you can present fees and overcome objections. Provide care to be proud of, and let your fees be a clear indication of your standard of excellence!

The author is president of Jameson Management Group, Inc., an international lecture and consulting organization. For further information, call (405) 369-5555, or write to P.O. Box 448, Davis, OK 73030. To order Great Communication Equals Great Production, call PennWell Books at (800) 752-9764.


Letter to insurer questioning fees

Dear ______________________:

I recently have been informed that your company has taken the liberty to inform a number of my patients, who are insured under your program, that you think that my fees are above the "usual and customary" or average rate for the community in which I practice.

I have verified my fees with the National Dental Advisory Service fee profile for this area, and can show that my fees have proved not to be in excess of those of my peers. I do believe that you are entitled to communicate with your policyholders. I further believe that you also have an obligation to communicate the truth. Your company has determined, in its adjudication policies, that it is unwilling or unable to pay for the quality and standard of dental care that my insured patient has chosen.

Therefore, I would like to request that you seriously consider rephrasing your communication to more accurately reflect your company`s ability to reimburse. Otherwise, please cease and desist with your present communications, which are inaccurate and intrusive in the doctor/patient relationship.


________________________, DDS

cc: Insurance Commissioner


Explanatory letter to patient

Dear Patient:

It has come to my attention that your dental insurance company has sent you a letter, stating that my fees are "above usual and customary." I can understand how you might be confused and upset by this letter. Therefore, I am happy to give you some information that may shed some light on this issue. I have sent a letter to your insurance company, a copy of which is enclosed.

We appreciate dental insurance, and we believe that it is a wonderful supplement to a person`s dental-health care. However, it is not meant to be a "pay-all," only a supplement. As such, the amount paid for the premium determines the amount of available benefits. The more paid, the more received; the less paid, the less received.

Another point of confusion is about how an insurance company determines "usual and customary." Their fees do not reflect any standard of care, but rather are a median fee, based on fee schedules from all doctors in a designated area, which can include several zip-code areas. Again, this "median" fee does not take into consideration an individual practitioner`s own costs of operation or standard of care. Therefore, the fees established in this manner are arbitrary and average, rather than carefully determined.

We provide above average care to you and to all of our patients. Our fees express an equitable exchange of value - i.e., a fair fee for excellent services.


_______________________, DDS

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