Since the alphabet soup (HMOs, PPOs, DMOs, etc.) appeared on the horizon, we have introduced "gems," and a philosophy of practice, which will help dentists maintain their direction and exceed their own expectations. With rare exceptions, capitation can hardly stake such claim.

Walter Hailey forecasts that "the middle is hollowing out." At the top will be those dedicated to excellent complete care. These dentists will practice low stress, high reward (emotional and financial satisfaction) fee-for-service dentistry. At the other end will be large corporate-owned, managed care practices, the likes of which, at this point, we can hardly imagine. The majority of "hybrid" practices we see today - the "I'll just sign on with a plan or two to fill those open chairs" will vanish.

These "gems" or ideas, can be read, processed and rapidly put into action. They can help simplify your life, while increasing the quality and profitability of your dentistry.

Deflating False Expectations About Dental Insurance
Setting the Scene for Acceptance
of Excellent Dentistry

How many times have you played out the following scenario? You meet a charming new patient, referred to you by an excellent patient and friend of the practice. You perform a complete and thorough examination. Carefully, you follow the steps of relationship building and creating value. You do everything you are taught to do, and yet the patient's parting words are, "It was certainly a pleasure to meet you doctor. I understand everything you've explained to me this evening and I'd like to get started right away. I'm pretty sure my insurance covers everything pretty close to 100%....and if not, let's at least try to get started on the priorities you think will be covered...."

So where do we go from there? It's already too late. You are way behind the 8-ball and back-pedaling to catch up. I met a very talented dentist in California named Dr. Mark Cruz, who taught me a very valuable gem that helps to deflate false expectations of dental insurance. During the initial interview phase, long before the patient ever sits back to open wide, Dr. Cruz suggests the following:

Take out a piece of blank paper (we've added this right on to our exam form to make it a routine part of the process), and draw the following diagram on the paper:

P____________A___________E

Tell the patient that this diagram represents a continuum of dental care from "P=Poor," to "A=Average," to "E=Excellent." Ask the patient to place an "x" representing the level of dental care they believe currently exists in his/her mouth, today. Most patients will place the "x" somewhere at or just to the left of the "A" for "Average." Then, ask the patient to place an "O" where he/she would like to see his/her level of oral health, five to ten years in the future. Typically, patients will place their "personal expectations" marks somewhere closer to the "E" for "Excellent."

Finally, ask the patient where, on this continuum, they believe their insurance reimbursement pays. Almost every patient, at this point, will tell you that they expect insurance will only pay for average dental care. Since most patients will have chosen excellent health as their goal, the scene is now set for you to begin to discuss how you believe you can best meet the patient's expectations, while recognizing that dental insurance will not play any significant role in achieving their desired level of optimal health.

Remember, it's critical that this takes place during the early phase of rapport-establishment and relationship building, while patient goals and expectations are being established.

First-Class on
Japan Airlines
At Least it Feels That Way

You've been treated to a multi-course gourmet dinner, on board Japan Airlines' overseas flight. Of course, you're flying first-class. As you finish your last morsel of an absolutely delightful dessert, the "hostess" comes by with a steaming hot, lemon-scented white face cloth. You barely notice how long you've been in the chair!

Fascinating concept isn't it? The more you are pampered, and made to feel like the most special person on Earth (Hailey's MMFI=Make Me Feel Important), the more likely you are to want to come back - and, to tell all your friends. After all, who doesn't enjoy this kind of first-class five-star service?

A few years ago, Dr. Bill Dickerson suggested that we complete every visit by offering the patient a lemon scented, steaming hot face cloth. In my practice, we instituted our VIP (Very Important Patient) program more than ten years ago. Our program includes twenty or more simultaneous high-touch nuances, which are consistently delivered. The only reasons we didn't implement the wonderful towel idea was the cost of the steaming oven, the cost of a large supply of face cloths and constant laundering.

Enter my good friend Dr. Ken Ochi. Ken eliminated the entire cost issue. He suggested a trip to one of the large wholesale buying clubs (Sam's Club, Costco, etc.). They had a large "crock pot" (in the cookware and small appliance section), which sold for around $20.00. The same store also had white face cloths, bundled in huge quantities, for less than a quarter each. Laundering is no longer an issue, since all offices now have accommodations to routinely clean uniforms.

Patient reaction? Absolutely incredible. In fact, we recently had a patient comment, "This is just like flying first-class on an overseas Japan Airlines flight!" Tom Peters recommends that we make every effort to achieve a "wow" experience every time our customer (patient) turns the corner. (The Pursuit of Wow, Tom Peters.) Try this gem and you'll have a guaranteed "wow" experience!

That First Critical Recall
The Key to Compliance

A new patient enters the practice. There are many critical steps from the first contact (usually a phone call) to the completion of their treatment plan. But it doesn't end here.

Even the most carefully orchestrated plan misses a key ingredient to long-term success. The first recall! After completion of treatment, continued success (both clinically and from a management point of view) depends on the patients' return!

There is a simple solution. The very last step for every patient's initial treatment plan should be the first recall visit.* Always include the re-exam fee (if they'll be on six month), the prophy, and adult fluoride. The cost of this visit is usually minimal in comparison to the overall fee for the new patient treatment plan. The return, however, will be immeasurable - both for the patient and for your practice.

Often new patients' enthusiasm for their initial plan does not translate into immediate recall compliance. In fact, the new patient is often in the middle of their initial case when the first recall visit is due. Payments on the initial case may still be in progress. If the first recall visit was simply prescribed as another step of the overall plan - and included with the initial financing, compliance is far more likely.

*This idea was given to me by the unknown doctor. He appeared at the podium during a break in a Springfield, Missouri 1000 Gems lecture. Thanks for a wonderful gem!

Skyrocket Phase I Perio
Use the Phrase that Pays

The way it used to be during the new patient exam: "Mrs. Doubtmeyer, the instrument I'm using now is called a periodontal probe. See the black and white markings? These are millimeter measurements. If your gums are healthy, they remain nice and tight around the neck of the tooth. There will be less than a three or four millimeter pocket. And, there won't be any bleeding."

"Oh, my gums never bleed."

"Periodontal or gum disease is a condition of the tissues around the teeth. It affects both the gums and bone. Ah, you see there? That was a six millimeter with bleeding. You know, it's not at all uncommon; in fact, you are in the majority. When bacteria are allowed to collect way down deep inside the pockets, they release acid, which begins the breakdown of the periodontal tissues. Periodontal disease begins when...."

The way it should be done: Doctor gently probes one or two of the most "suspicious" looking areas. Assuming he finds bleeding and periodontal pocketing, he sits the patient up, looks her in the eyes, and says, "Mrs. Doubtmeyer, how long have you had that infection?"**

Note the difference. The way we were taught to explain periodontal disease danced around the issue. The further we get into the explanation, the less convinced some patients become. It's confusing, clinical and not as persuasive as it needs to be to motivate them to accept treatment. In fact, until they buy your story, who owns the problem?

"How long have you had that infection?" clearly puts the monkey on their backs. It's their problem, and they own it. Ten out of ten times your new patient will say, "What infection?!" If you've never tried this technique, give it a shot. It's extremely effective.

One small caveat: remember, this tool is only for use with new patients! Picture your patient of record who has faithfully returned on your recommended recall schedule . . . You get the picture.

**This phrase was the brainchild of Dr. Mac Lee, and Walter Hailey, of Dental Boot Kamp & Planned Marketing Associates.

Your Ace for
Achieving Yes!
Swing Borderline
Presentations Your Way

No, this isn't a panacea. Every case presentation is different. And this won't help you 90% of the time . . . which makes it fantastic! You see, if this gem does work for even 10% of large case presentations, it's worth its weight in gold. Literally.

Just how large the case should be is left entirely to your judgement. There is no right or wrong answer. However, as a general guideline, I'll employ this gem when the total case fee is comparable or greater than the fee for four units of crown and bridge.

You've done a complete and thorough examination. The patient has worked with you to develop the treatment plan. You've done your very best to assess their perceived needs. In addition, you've created a plan that will afford them long-term stability and health.

Too often we do a wonderful job of diagnosis and treatment planning, only to fall flat on our faces when it comes to completing the presentation. We often end on a nebulous note, simply asking if they have any questions. Present the fee, and ask them if there's any reason you shouldn't get started right away.

If the patient asks if there's any way you could reduce the fee, consider it a positive comment! If they have no interest in your treatment plan, they'll likely not ask you if the fee is negotiable.

"Mary, if we could meet your goal of excellent health, and make it fit within your budget, would that help?" If the answer is yes, and creative financing (or "phasing") would help, you're on your way to complete case acceptance.

However, this gem is for the borderline cases when the patient accepts the plan, but "needs" a reduction in fee. In some cases, a slightly lesser fee, without compromising the treatment, may be just enough to make the case for a patient. For others, they may be able to afford the treatment, but they require that feeling of "getting an extra-special deal."

In either case, I decline to "discount" or "reduce a quoted fee." Once you do, you'll forever be cutting fees for this patient, and likely for their family and friends, as well. Referrals will go something like this, "You've got to see my dentist, Dr. E.Z. Markz. He'll always shave a little off and get you a great deal."

So you, too, may be reluctant to "discount" a fee. We do need to see things from the consumer's point of view. Can we meet their needs as well as our own? Yes, in many cases. Offer free recall. How long? The number of free recall visits we might offer will be directly related to the size of the case. Recently we "closed" a $6,000 bridge with the offer of one year's free recall!

In fact, the patient was not only ready to "afford" and commence the treatment, he paid his entire case fee with one check. In full, in advance, that night!

Well, isn't this still giving something away for nothing? Sure it is. But think about the win-win ramifications. A patient presents to your office for examination. She would like you to place a fixed bridge to replace her upper partial. You perform a complete exam and determine that she needs deep scaling by quadrant, an onlay or two, and the bridge in question. Whether she has insurance (and uses it up on the scalings and onlays) or does not, three month recall may be an out of pocket expense she can not afford.

What an incredible win-win situation. You nail down a $6,000.00 case, and your patient gets to return for one year's maintenance, no charge. Note: We didn't say four free cleanings. Rather, we said one-year on three-month recall. Often this tactic will help to ensure compliance with the maintenance schedule best suited for prosthetic cases. Once your patient completes the first year of three-month maintenance visits, there's a high likelihood that she will continue on that schedule. And, a year later, insured patients' benefits have been renewed, affording at least "every-other" coverage.

Excellent case. A committed recall patient. A new referrer. Although we all have our "missionaries" who refer continuously, the bulk of referrals come from patients who've continued to visit the practice on a regular basis, even if it is just for hygiene recall.