The Final Close

"Well, Doctor, I'd like to go ahead with this treatment. I know I need it. But it just costs too much! I can't afford it right now. I'll just have to wait."

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By Cathy Jameson, PhD

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photo Tipp Howell/FPG Intl.

"Well, Doctor, I'd like to go ahead with this treatment. I know I need it. But it just costs too much! I can't afford it right now. I'll just have to wait."

Have you heard this before? Do you get too many of these responses directly after an outstanding case presentation? Do you get discouraged? Do you wonder what you can do to deal with the objections, the barriers, and the fears of cost?

Certainly, communicating with your patients about their financial responsibilities and payment options is one of the most challenging conversations you will have. If you have given a convincing presentation, and patients want to proceed, yet indicate they will not, the reason, more than likely, is cost.

If the doctor or treatment coordinator gets the "go ahead" from the patient, don't be too confident. Closing on the clinical aspects of treatment is the "pre-close." The final close comes when the patient agrees to the financial responsibility and schedules that first appointment.

Let's look at two aspects of financing:

  • Establishing equitable and comfortable financial options
  • Learning to communicate those options.

Get out of banking
Financial assistance exists for patients who need help paying for treatment, whether for a small case or a major one. The dentist does not have to provide the money — only the financing vehicle.

Consider this goal for your practice: make treatment financing affordable for the majority of your patients without doing the banking yourself. Get out of the banking business and stay out!

The cost of carrying accounts
Consider providing more dentistry per patient on fewer patients per day with fewer visits, and get out of the banking business.

In terms of stress control, quality control, and profitability, doing more dentistry on fewer patients per day, and seeing the patient for fewer visits makes good sense. Being busy — having a patient in every chair all day long — is not necessarily the answer to increased profit. In fact, many practices are too busy.

Can you be too busy? Yes. If you feel you aren't giving patients the time and attention they need; if you can't see patients in a timely fashion because you are too heavily booked; if you feel you lack the time to carefully orchestrate and deliver a quality case presentation; if you are so exhausted from the day's work that you have no energy left for your family when you go home, then you are too busy!

What do you do? First, give some careful study and practice to improving your case presentations. Then, revamp your scheduling techniques.

Finally, provide the financing that will make it possible for patients to receive quality care. The financial options I recommend will let you schedule longer appointments based on need and quality rather than on how much a patient can pay per appointment. Giving patients a chance to have as much work completed in as few visits as possible is a win-win scenario for all.

Ask your patients the following question: "If you have decay in four areas, and you want to become healthy and save your teeth, how would you like to schedule that treatment? Would you rather come in for four different visits? Or would you rather come in for two visits?"

Nine out of ten people will answer, "Get me in, get it done, and get me back to work." Even so, most patients seldom choose this scenario. Why? Because the amount of treatment they receive per visit is usually dictated by the amount they can afford to pay at the time. Therefore, you must:

  • Work on your case presentations and scheduling so that your patients will accept treatment.
  • Make your appointment book work for you. You must schedule longer appointments, and you must expedite treatment once patients decide to proceed. Remember: The time to sell is when you have a willing buyer. If you put a patient off because the schedule is too full, you risk losing their motivation to proceed.
  • Analyze the cost of carrying accounts. Most doctors discover that carrying accounts costs so much in time and money they quickly decide to stop. In fact, if you carry an account for more than three months, the total cost is approximately 42.2 percent. Various data show that the average overhead for a general practice today ranges from 60-70 percent. If your overhead is less than this figure — good job! However, the average practice either loses money by carrying accounts, or, at best, breaks even.

Get out of the banking business. Leave it to the professionals — people who have banking and collection expertise and can afford to loan money.

Turn your time, money, and attention to doing what you do best — dentistry. Spend more time on new patient experiences and consultations.

Patient financial options
The following strategies work to help more people accept your dentistry and keep you out of the banking business. Your production will increase significantly; so will your profit margin.

Discount: Offer a five percent reduction for payment in full before treatment begins. This option should be offered only for those cases over a designated amount. This gives those who can afford it the incentive to make full payment. Advance payment puts the practitioner ahead. Plus, patients who pay for their treatment in advance are guaranteed to show for their appointments.

Payment by the appointment. Take the total investment, divide it by the expected number of appointments and collect those equal amounts per appointment. Payment by the appointment ensures that the patient's financial responsibility to you is complete by the time the treatment is finished. Patients can pay cash, by check, or by bankcard.

Bank cards. Bank cards are terrific. Don't let the service fees concern you. The benefits of getting payment and avoiding statements and collections far outweigh any service fees you will pay.

Promote bank cards to your patients as a payment option. Use newsletters and special mailings, and mention bankcards with every case presentation.

Health care financing programs. These include revolving payment plans, minimum payment plans, interest-free payment plans, and extended payment plans.

Health care financing programs
Promoting a health care financing program is one of the best services you can offer your patients and your practice. Instead of delaying or foregoing needed treatment, patients can receive quality care without compromise.

The practice also wins. Cash flow, and therefore the profit margin, increases because of a higher level of treatment acceptance. The costs paid by the practice to the financing company are significantly lower than the costs of running a banking business within your practice.

Get involved with these programs. Learn how to present these options. Learn how to address the common objections patients present. Learn how to promote the program. Both you and your patients will benefit.


Establishing financial options
Financial assistance exists for patients who need help paying for treatment, whether for a small case or a major multi-thousand-dollar case. The dentist does not have to provide the money — only the financing vehicle.

Consider this goal for your practice: make treatment financing affordable for the majority of your patients without doing the banking yourself. Get out of the banking business, and stay out! I often poll my audiences and ask:

1. "How many of you have had professional banking training?" Most of the time, out of an audience of 500 to 1000 people, I will get one or two hands raised.

2. "How many of you have had professional training in collections?" Usually, the same two hands will go up.

3. "How many of you are doing credit history checks on your patients prior to carrying their account on your own books?" Usually, five or six hands go up with this question.

4. "How many of you are charging some kind of a finance fee for loaning your patients money?" Usually, the same five or six hands go up.

I then ask, "Are you saying that you are loaning your patients money without a credit history check and without a finance fee? Are you asking team members to run a bank, even though they haven't received training in banking, loaning money, or collections?" Of course, heads nod in affirmation.

Then I ask my final question: "When was the last time you received an interest-free loan without a credit history check?" Their hands, of course, stay down.

I have had the privilege of studying with banking and financing experts, and with the professionals who first originated the concept of patient financing. As dentistry has evolved, so has the patient-financing concept. However, only a small segment of the dental profession utilizes patient financing; those that take advantage of such programs usually do so on a limited basis.


How payment programs work
The patient fills out an application in the convenience of your office. The finance company extends a line of credit, you do the dentistry, and get paid. Patients receive monthly statements from the financing company.

There are numerous types of programs available. Different types of programs have been developed due to both patient and practice demand.

Revolving payment plans. The finance company extends a line of credit that patients utilize much like a bankcard. You will see more people agreeing to full treatment rather than doing one crown a year. More family members will proceed with treatment and will follow through with regular check-ups and hygiene visits. These revolving payment plans have two options:

Minimum payment due. Spread out as long as is necessary.

Interest free. The patient must charge a specific amount with these programs and must be able to conclude payments by the predetermined time allotment. However, they can extend their payment and will then fall into the category above.

Extended payment plans. Two-to-five year financing with specifically determined payments (much like a car loan), with low interest rates, and low service fees for the doctor.

These are great programs for larger cases such as implants, full-mouth reconstruction, and cosmetic cases. They also offer a higher maximum credit line, typically as much as $25,000.

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