Take Your Practice to the Next Level

The person who can take you there is the treatment coordinator.

by Cathy Jameson, PhD

A new patient comes in for a comprehensive oral evaluation. The patient has come to you as a personal referral. You identify multiple treatment needs, then schedule a return visit to review the findings. In the meantime, you carefully design a treatment plan and prepare for the consultation. At the consultation, the patient indicates a strong interest in the treatment you recommend, but does not schedule the first appointment. The patient leaves saying that he or she will have to "think about it." Now what?

Do you have an organized system for following up on dentistry diagnosed but left untreated? Do you work as diligently on operative patient retention as you do on hygiene retention? Many doctors and teams are frustrated because they see too much dentistry walking out the door. This is because they don't have a clearly defined system for identifying and following up with patients whose treatment is incomplete.

The result is more dentistry in the charts waiting to be done than you have actually done in your practice. If you don't think this applies to you, and if you're doing comprehensive treatment planning on all patients, give yourself a challenge — do a thorough chart audit. Then, get excited about the opportunities that lie within your own practice. Most practices can double from within by nurturing what they already have — their active patient family.

Treatment coordinator
The role of treatment coordinator may be one of the most productive roles within the practice. Dr. Lee Manser, professor of marketing at Oklahoma State University, says, "The difference between being average and being fantastic is miniscule." He says the difference lies in going the extra mile, doing more than is expected, and being willing to follow-up ... follow-up ... follow-up ... follow-up.

It takes repetitive contact with patients in many cases before they make a "go-ahead" decision. Usually, patients who don't say "yes" right away are not contacted again until their next hygiene appointment. Consider multiple contacts long before that patient's next appointment.

The treatment coordinator can be the person responsible for follow-up on each patient who needs necessary or desired dental care, but who is not scheduled. This person tracks each patient from beginning to end, and can take your practice from average to fantastic.

You don't need to hire a new person to develop this role. Most practices have a wonderful person already onboard who is motivated by challenge, and who is perhaps right under your nose. Put out the word that you want to develop this exciting role, and see who steps forward. For most solo practices, it is not a full-time position. Schedule the working times just like the doctor, assistant, or hygienist.

• Participate in the new-patient experience. Perform a portion of the initial interview to determine patient concerns.
• Take a "tour of the mouth" with the digital imaging system (if available), asking questions to determine perceived needs or emotional "hot buttons." Save or print the images and any notes from the interview. During the evaluation, display the images as well as information and focal points for the doctor.
• Take notes as needed during the doctor/patient interview.
• In some practices, the treatment coordinator is the clinical assistant or hygienist. If so, she would likely join the doctor for the comprehensive oral evaluation, performing the appropriate tasks within the same time slot.
• Schedule the patient for a consultation appointment.
• Join the doctor as he/she designs the treatment plan. Have all data ready for review: radiographs, study models, diagnostic sheets, photographs, etc. If digital images are stored, have them ready to retrieve.
• Review all data with the doctor, so a great presentation will follow your careful preparation.
• After listening to the doctor's explanation, write up the treatment plan on a form or enter it into the computer. This could include tooth numbers, surfaces and materials, extent of work to be done at each appointment, the order of treatments, the amount of time for each appointment, and the time between appointments.
• Have the doctor read the treatment plan for approval.
• Once the treatment plan has been designed, determine the financial responsibilities including expected insurance coverage.
• Know which financial options are available. Have the information ready during the financial portion of the consultation appointment.

• Make sure the room is ready before the patient's arrival. Radiographs should be mounted; intraoral photographs already duplicated or retrievable. Have the patient's full-face photograph up on the screen (if applicable).
• Prepare visual aids for the educational portion of the presentation, such as the treatment plan, models, wax-ups, and financial information. Greet the patient in the reception area and escort him or her to the consultation room.
• Join the doctor for the consultation. The doctor should ask permission from the patient for the treatment coordinator to be present.
• Once the doctor has made the clinical presentation and answered any questions, the doctor departs and the treatment coordinator takes over.

• The treatment coordinator invites clinical questions. Many patients will ask an auxiliary staff member questions they might not ask the doctor for fear of embarrassment or appearing ignorant; or they may not have had time to think of any questions during the clinical presentation. They may ask: 'Do you think I need this? Would you do this if it were you?"
• Refer to the visual aids (intraoral or digital images) to support the doctor's diagnosis and to further the patient's education.
• Once all clinical questions have been answered, discuss the financial responsibilities. This important discussion requires the following abilities:
• 1. Clear knowledge of all financial options
• 2. Excellent verbal skills for presenting the fees
• 3. The ability to identify objections and to overcome them
• 4. The ability to complete any paperwork
• 5. A belief that the fees for the service are equitable for the treatment rendered
• 6. Confidence in the doctor's ability to accomplish the results

Verbal skills
Paul Harvey says, "It's not what you say, but how you say it." He's right, don't you think? The treatment presentation must be accented by excellent communication skills. Say something one way and get a definite "no" or "I'll think it over," but say it a different way and help patients make a decision that is good for them — the decision to go ahead with treatment.

A doctor wouldn't recommend a treatment the patient didn't need or want. Therefore, if someone walks out the door without saying "yes" to the treatment, the patient loses the chance to become healthy or more beautiful.

In a case presentation, you have an important opportunity to educate, motivate, and activate a patient. This cannot be done "off the cuff." Your case presentation should be carefully planned and orchestrated. Case acceptance is the fulcrum of your practice. If a patient doesn't accept treatment, everyone loses. These skills can be learned with study and practice.

Transfer of goodwill
Once the doctor has presented the recommendations, he or she 'transfers" the patient to the treatment coordinator who has been in the room during the presentation.

Here is an example of verbal skills for this transfer:

Dr.: Mrs. Jones, do you have any questions about the treatment that I have recommended for you?

Mrs. Jones: No, I understand what needs to be done. I just need to know how much all of this costs.

Dr.: Are you concerned about the financing of your treatment?

Mrs. Jones: Yes. I need to see if I can afford this or not.

Dr.: I understand how you feel about the investment, Mrs. Jones. That's why I've asked Jan, my treatment coordinator, to join us today. She handles all of the financial arrangements for our patients. I'm confident that she'll be able to find a plan that works for you. If we can work out the financial questions, is there any reason why we shouldn't go ahead and schedule your first appointment?

Mrs. Jones: No. I want to get this done. I just need a way to pay for it.

Now, the doctor leaves and Jan takes over.

Jan:Mrs. Jones, I know Dr. Jameson asked if you had any questions about the treatment he's recommending, and you said 'no," but I thought before we discussed the financial responsibilities, that you might have some questions you would like to ask me.

Jan answers any questions that Mrs. Jones may not have been comfortable asking the doctor. Jan refers to the intraoral photos to back-up her explanation, encourages Mrs. Jones, and makes her feel comfortable with the decision to go ahead.

Please note: All clinical questions must be answered before a discussion of money takes place.

Financial arrangements
When the treatment coordinator has answered all clinical questions, she begins the financial consultation. It may take as long or even longer than the clinical consultation itself.

Preplanning can make or break this entire treatment presentation sequence. If you want to be successful, plan! The treatment coordinator should know all the fees involved, such as the total investment, the investment per appointment, the expected insurance portion, the private pay portion, and the monthly investments, as well as health-care financing options.

Ideally, the patient will agree to a specific financial arrangement, including an acknowledgment of the financial option selected. The close of the financial consultation comes when there is a financial agreement.

Verbal skills for financing
Jan: Mrs. Jones, the fee for your treatment is $1,000. We expect your insurance company to cover approximately 50 percent of the fee, or about $500. At the time of your treatment, you will be responsible for the difference — or the other $500. We will do our best to file your insurance; however, if for some reason your insurance does not cover your services, you will be responsible for the total balance. Be assured we'll do everything we can to help you maximize your benefits.

Mrs. Jones: I need to pay $500 all at once? Can't I pay this out some way? I can only afford a little bit per month.

Jan: How much per month would be good for you?

Mrs. Jones: Oh, I guess I could pay about $50 per month. Would that be OK?

Jan: That would be fine. We have a payment plan available through a health-care financing company that allows our patients to spread out their monthly payments and pay as little as $50 per month. Would this be of interest to you, Mrs. Jones?

Mrs. Jones: Yes. I really want to get this done. I'm sick of this mess in my mouth.

This is just one example of a financial scenario. The treatment coordinator must be prepared for all situations. As a team, list the major objections that might be presented and write scripts of how to handle each of them. Next, practice the verbal skills together until the treatment coordinator gets comfortable with them.

Closing
Once the financial discussion has taken place and an agreement has been achieved, the treatment coordinator will make the close by asking the patient to move ahead with treatment.

If Mrs. Jones has any other reasons why she might not proceed, the following question gives her the opportunity to present them. You can overcome barriers only if you know what they are. Ask questions to discover them.

Jan:Mrs. Jones, now that we have found a financial option that fits your situation, is there anything else you would like to discuss, or shall we schedule your first appointment?

If there are no further questions or problems, schedule that first appointment, and you are on your way! You have a written treatment plan and a written financial agreement. You and the patient are clear and comfortable with both the treatment and the payment schedule.

Practicing
As you begin this process, get the team together on a regular basis to review how things are going. If things aren't going as well as you would like, or if patients are presenting objections that you were not prepared to handle, go back over everything, refine, perfect, and try it again.

Tom Hopkins of Scottsdale, Ariz., says there are four Ps of Professionalism. If you want to master a new skill, all four are essential.

1. Preplan
2. Practice
3. Perfect
4. Perform

Do these, and you will get better at everything you do.

Follow-up
Remember, business and marketing experts say the difference between average and fantastic is follow-up, follow-up, follow-up! Being able to track the dentistry diagnosed and the dentistry yet to be done provides you this opportunity.

On a regular basis, the treatment coordinator will make follow-up contact with patients who have not completed treatment. The treatment plans must be at the fingertips of the treatment coordinator, and there should be no problem accessing information needed to make effective follow-up telephone calls.

Written messages are not nearly as effective as a contact in person or by telephone. If a patient has left the consultation appointment without scheduling the first appointment, ask permission to call in the near future.

Jan:Mrs. Jones, I can certainly appreciate your need to think about this. I'm sure you wouldn't take the time to think about it if you weren't interested. May I ask your permission to call next week to answer any questions you may have?

More than likely the patient will give permission to be contacted again. Set a specific date and time to do it.

On that day, call to touch base and reconfirm the need for the next phase of treatment. If there are any new barriers to moving ahead, ask questions to find them out. This is the opportunity to resolve them.

With carefully planned and excellently presented telephone follow-up:

1. The patients will know that you are on top of your responsibilities.
2. You will be able to answer any questions concerning treatment, finances, or scheduling.
3. You will reinforce the need for the next phase of treatment.
4. You will fulfill your legal responsibility to try to complete treatment.
5. You will schedule more patients, which will reduce the amount of needed dentistry just sitting in patients' charts waiting to be done.
6. You will help more people move ahead with dental care that will benefit them now and in the long run.

How to do it
Keep a three-ring notebook with alphabetical dividers. Keep a copy of each treatment plan in the book by patient name. The treatment coordinator reviews each day's schedule, which keeps each treatment plan up-to-date.

If you have computerized treatment plans, a current record must be accessible. Review the list of incomplete treatments regularly, and call those patients to schedule them. If treatment is completed, remove it from the treatment plan or incomplete treatment list.

When the treatment coordinator reviews an incomplete treatment plan, she calls that person. Double check the patient's record to assure the information is current.

Telephone scripts
Jan: Mrs. Jones, this is Jan with Dr. Jameson's dental office. He was reviewing your records and noticed that we started your treatment but haven't moved into the next phase. He was concerned and asked that I call you today to see if you have any questions about the next phase of your treatment. Do you have any questions that I might answer for you?

Mrs. Jones: No, I know I need that bridge, but I didn't want to do it right now. I'm still trying to pay off my Christmas bills.

Jan: I can certainly understand that! So am I! Mrs. Jones, I know you want to go ahead with this next phase, but I also understand your concern about the financing. Let's discuss the options we have available. We'll find a plan that will be comfortable for your situation. If we can provide comfortable financing, would this make it possible for you to go ahead with treatment?

If Jan cannot get a commitment from Mrs. Jones at this point, she should not press the issue. She should ask Mrs. Jones for permission to call at a later time. Jan records the information and follows up as planned.

The main focus
The key to greater case acceptance is to promote case presentation from being an aside in your practice to being the main focus. It's a "win-win" for everyone.

Through the efforts of a treatment coordinator and the entire team to fully integrate this concept, your practice can advance to the next level. The time and effort invested will be worth much more than you ever expected! You will significantly increase your production and profitability through increased case acceptance. Don't hesitate. Begin your search to identify the right person today!