Discretionary Dentistry

Sept. 1, 2007
More and more dental procedures are becoming purely discretionary purchases. For today’s sophisticated consumers, there are educational and financial resources available to help them move forward with treatment.

More and more dental procedures are becoming purely discretionary purchases. For today’s sophisticated consumers, there are educational and financial resources available to help them move forward with treatment.

by Raymond "Rick" Willeford, MBA, CPA, CFP

It’s an exciting time to be in dentistry. Twenty or 30 years ago, the vast majority of dental procedures were “need”-based - patients only went to the practice when they were in pain or to prevent disease or decay. Today, more and more procedures are purely discretionary “want”-based purchases, which is good news for those doctors anxious to balance the managed-care portion of their practice or get out of managed care altogether. Because dentistry is trending toward a discretionary purchase, more and more resources are available to both doctors and patients, making both groups better educated and more sophisticated.

Dentistry’s new sophisticated patients

Recently, I had the opportunity to discuss patient trends with Dr. Robert Vassey, who has a thriving practice in Georgia. Dr. Vassey has found patients’ dental IQs are much higher and their perception of insurance benefits is changing.

“Patients are much more educated and sophisticated than they used to be,” he said. “They come to the practice with a good idea of what they want for their oral health and smile. And, more and more realize that insurance companies are not basing their coverage on what the patients need, but rather on the minimum amount of coverage they can provide and still motivate patients and employers to pay the premium. We are helping our patients to understand that dental insurance is simply a supplement and is not intended to cover their entire treatment. But, the bottom line is that because insurance does not pay for the cost of dentistry today, patients have to come up with the money and it’s putting a drain on their discretionary income.”

>When patients have a better understanding of the limited role insurance plays in their oral health, they become more receptive to treatment recommendations that will allow them to achieve the healthy and beautiful smile they want. To gain a real-world perspective, I spoke with Dr. Juan Arrue, who runs a successful general practice. Dr. Arrue agrees that patients are more savvy when it comes to understanding their insurance benefits and is finding even long-term patients are proactively requesting cosmetic procedures.

“Yes, I agree that patients are more sophisticated today,” Dr. Arrue said. “We’re still doing fillings and crowns, and these types of procedures are a big part of my practice. But, it’s the big cases that make the difference between having a good month and having a great month, and it seems we’re doing more and more of them! What’s intriguing is that even patients we’ve had for 15 years or more are proactively asking for procedures that will give them both a healthy and beautiful smile.”

Dentistry’s new sophisticated dental teams

Because an increasing number of dental procedures are considered discretionary purchases, dental teams have begun to realize they are now competing with luxury vacations and flat-screen televisions for this portion of their patients’ income. As a result, they are enhancing their verbal skills, business skills, on-going training efforts, and scheduling.

Dr. Vassey observes, “Teams are learning how to work smarter, not harder. They are becoming experts on how to communicate the value of the dentistry to patients, using technology such as an intraoral camera, visual tools to help patients literally see their dental needs, and verbal skills to help them want their dentistry and have a sense of urgency.”

Dr. Arrue has also found that using sophisticated technology and appropriate communication skills can significantly impact the acceptance of comprehensive dentistry.

“Our team uses technology to get patients to begin thinking about their dental condition and the possibilities even before we present our treatment recommendations. We use an intraoral camera on every patient in our practice. We want them to see their teeth. Only then can they understand the treatment plan we are recommending, which is the first step to ownership and acceptance.”

Providing financial options for today’s patient

Doctors are beginning to report that fear of pain is no longer the primary reason patients do not get treatment - it’s now cost concerns. This shift validates the trend toward discretionary-based dentistry and the challenges so many doctors are experiencing. Insurance benefits continue to cover less and less of the dentistry they diagnose, resulting in higher out-of-pocket costs for patients. When you consider the top two barriers to treatment acceptance, we know that technology and education can go a long way in overcoming fear. But if a patient has cost concerns and the practice does not effectively address those concerns and offer a way to make treatment fit his or her lifestyle and budget, the patient may choose to delay or decline treatment, jeopardizing his or her oral health.

This dilemma has been addressed by the simultaneous evolution of payment arrangements in practices over the past decade. Dr. Vassey explains, “Twenty-eight years ago, I was fortunate to work with a consultant you recommended, Rick. She helped me clearly see that I could work a lot more efficiently and effectively. Her method for optimizing treatment acceptance was to first and always present a total treatment plan, not phased dentistry. Second, educate and illustrate to patients their problems, the solutions, and the consequences of delaying or declining care. Then give them options - not options on treatment, but options on payment. So I began offering financing plans and I’ve always had more dentistry than I can do. Luckily today, we no longer offer financing through the practice. We gladly handed that portion of the practice over to CareCredit six years ago.”

“It’s best for both patients and our practice if we can help them make the decision to move forward with dentistry before they leave our practice,” confirms Dr. Arrue. “That’s why five years ago we added CareCredit to our payment options. Some patients are really floored when we tell them the cost of complete dentistry, but we immediately let them know we have several payment options designed to help them comfortably pay for care. It takes away cost as an obstacle.”

A recent ADA member survey indicates that 64 percent of members now offer outside patient financing, validating the trend toward larger out-of-pocket expenses and discretionary dentistry. CareCredit reports that it has financed treatment for more than 6 million patients, verifying it’s a value-added service patients appreciate. As the demand for dentistry continues to push patients’ out-of-pocket expenses up, the practice’s responsibility no longer ends at diagnosis. Instead, practices must use the resources available to them to help patients get the dentistry done.

Over the past decade, dentistry has experienced significant advancements in technology, materials, and procedures. It is highly likely that insurance benefits will continue to play less and less of a role in dentistry, and the cost of dentistry will continue to increase. The good news is, today’s sophisticated consumer is educated and motivated. And there are more resources available to help patients move forward with treatment.

Raymond “Rick” Willeford, MBA, CPA, CFP®, is president of Willeford Haile, CPA, PC, and Willeford CPA Wealth Advisors, LLC. As a fee-only advisor, he has specialized in providing financial, tax, and transition strategies for dentists since 1975. Willeford is the president of the Academy of Dental CPAs, a consultant member of AADPA, and is available as a speaker nationwide. Contact him by phone at (770) 552-8500, or by e-mail at [email protected].

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