On your mark, get set ... don't go!

Oct. 1, 2001
You've just sold a big case. Now, a week later, it's Monday morning and you've scheduled three hours to start your big case.

by Paul Homoly, DDS

"Knock, knock."
"Who's there?"
"Ellen who?"
"Don't go through Ellen and high water to collect your fees."

You've just sold a big case. Now, a week later, it's Monday morning and you've scheduled three hours to start your big case. The first half of her fee — $4,000 — is due, and you're ready to go. At 8:15 a.m., the patient calls and cancels because "she's sick." Now you're sick! Your staff runs and hides from you, and you feel like you're all dressed up with nowhere to go. Know the feeling?

Nothing is worse than a false start because you lose time and money. "On your mark, get set ... don't go" is no way to live. If you want to preserve your mental health and collection goals, learn to structure the preoperative appointment.

The preoperative appointment
The preoperative appointment is part of the case-acceptance process. It's a short, usually 20-minute appointment, following case presentation. The preoperative ap-pointment is designed to provide informed consent and simple initial care, as well as collect the first portion of the fee.

The preoperative appointment confirms that the patient is going to begin treatment. Just because patients have agreed at the case-presentation appointment to begin treatment does not mean that they'll follow through. But you already know that, so why are we surprised or disappointed when patients "don't go"? Usually, it's because we find out it's "don't go" when they cancel their initial long appointment. Why do they cancel? Money usually is the issue — they haven't set aside the dollars for the first part of their fee. So when they cancel, you lose the money and the time. You can make up the money, but you can't get the time back. The solution? Don't attach a big fee to a long appointment.

Set the stage
A big part of the success of the preoperative appointment comes from setting the stage at the previous appointment. Here's an example of a dialogue between you; the office manager, Ginger; and the patient, Wanda. Wanda has just agreed to go ahead with a few veneers. You, Ginger, and Wanda are in the consultation area. Your goal is to tie up all the loose ends related to fees and financial arrangements. This helps make Ginger's job easy, and eliminates unpleasant surprises at the next appointment.

"Ginger, Wanda has decided to go ahead with fixing her front teeth. Her total treatment fee is $6,000. Wanda, our normal financial arrangements request that one-third of the fee be paid at the next appointment, another third would be due during the middle part of treatment, and the last third would be payable when we're done. Ginger, it will take us about two months to complete Wanda's care.

"Give Wanda the information about consent for treatment, and her next appointment will be for 20 minutes. Wanda, Ginger is going to give you information about the risks, benefits, and alternatives to care that state law and dental ethics require me to do. Next time, we'll review this material, I'll answer any questions you have, and we'll start your care. Read this information and if you have any questions, just underline the items or call me. Ginger, Wanda understands that she'll pay us directly and her insurance company will reimburse her. Wanda, do you have any questions for me while Ginger is here? (Respond to questions.) Ginger, do you have any questions for me?" (Respond to questions.)

Now, leave the room following this dialogue. Ginger then confirms Wanda's understanding of the treatment and its costs, gives her consent forms to sign, answers questions, and sets the preoperative appointment.

At the preoperative appointment, review consent information, collect the first portion of the fee, and provide simple noninvasive care — shade selection, photographs, etc. Now that you have the first portion of the fee, set Wanda's next appointment as a long, productive appointment. You'll rarely have a patient cancel a long appointment that has been prepaid.

Having problems with "on your mark, get set ... don't go"? Never attach big fees to long appointments!

Dr. Homoly coaches dental teams to implement reconstructive dentistry through his continuing-education workshops, private consulting, and seminars. This column is an excerpt from his new book, Isn't It Wonderful When Patients Say Yes? — Case Acceptance for Complete Dentistry. Dr. Homoly can be reached at (704) 342-4900 or via email at [email protected]. Visit his Web site at www.paulhomoly.com.

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