SmileMakers Dental Blog

For many doctors, the ultimate test of self-confidence comes when a patient questions your fees. You may feel that they are questioning your personal and professional integrity, your technical competence, and/or the value of your services.

You have invested years of education and financial sacrifice to master your craft. Yet, invariably, you continue to encounter patients who question your right to be adequately compensated.

In addition, the patient is making you feel that you are overpriced for the marketplace and can’t compete. You worry about losing the time you’ve invested in preparing the treatment plan, if the patient goes to another practice that’s willing to cut fees to compete.

While all of these thoughts and emotions may come to mind, the reality of the situation may be entirely different. In reality, the patient is setting the stage to negotiate. The reality is that the patient hasn’t the slightest clue of what it costs you to provide the treatment. When a patient makes this type of statement, she is really making her opening move to negotiate a lower fee. She is “bottom fishing” for the best deal.

The first thing you must understand is that caving in and cutting your fee is never acceptable. Cutting your fee is cutting your throat. It is tantamount to telling the patient that your craftsmanship is overpriced and your fees are negotiable.

On top of that insult, you are adding injury to the basic economics of managing your practice. It costs money to deliver quality health care. Inadequate compensation can only lead to a reduction in qualified support staff, the use of lesser materials, and reliance on inadequate or obsolete equipment.

Your best choice is to play the game, understanding that you and the patient are really negotiating on the quality of the patient’s health care. You must structure the negotiation so that both you and the patient can win. Remember that in the psychology of negotiating, the person who blinks first often loses. You just have to say that you feel good about your fees and that they are correctly calculated. At this point, eighty percent of the patients will stop negotiating and accept treatment.

It is rare that a patient will persist in questioning your fees. The implication to the patient is that if you want your treatment performed with lesser quality materials or by a less experienced doctor, you are welcome to go elsewhere. In any case, you have made the statement in such a way as to reinforce your personal and professional integrity without embarrassing the patient.

In developing financial strategies for our consulting clients we are often asked, “What should my fees be?”

Our answer is invariably, “Whatever you feel confident in charging.” There is essentially no limit to what you can charge for your services. (Except for insurance fee schedules, of course, but that’s another issue entirely…) The basic premise is that you are confident that your fees are representative of the quality of the materials you use and your experience in performing the treatment. The key word is confident. Any lack of confidence or hesitation will be detected by the patient and exploited in the negotiation.

One of the most successful doctors we know accepts no insurance and requires all fees be paid in full prior to beginning treatment. The cost to a patient for a single gold crown ranges from $950 to $1,250.

He presents his treatment plan by saying, “My fee for performing this treatment is $950. I will attach a copy of the lab bill detailing the materials and their preparation cost to your bill.” Now, in case you missed it, the lab bill was separate and added to his fee for the crown. His case acceptance level is in the 90% range.

Patients immediately perceive that this doctor knows his worth. I must also add that every stage of the patient’s interaction with the doctor’s staff, facility and post-treatment care are of the very highest quality. This high level of quality supports the 90% acceptance level and reinforces the sense of value the patient perceives in the doctor’s capability to deliver the treatment.

The best confidence-builder to help you feel comfortable with your fees is very simple. Just remember that quality treatment must be supported by commensurate fees.

Dentists frequently tell me their top New Year’s resolutions for their dental practice is to attract more new patients. Well, January is traditionally one of the best months to acquire new dental patients for your practice! Three completely different types of patients are all coming into the market at the same time.

1. People who have put off their dental treatment plans until after the November-December holidays.

2. New Year’s resolution patients who have decided to clean up their dental act as part of their new physical fitness program.

3. Patients who have put off their dental treatment until their dental insurance benefits are renewed in the New Year.

Group number one, the procrastinators, are already in your practice. All you need to do to get them in the door is to follow through on your normal Chart Audit of patients with uncompleted treatment plans. This means a call from your dental scheduling coordinator to remind these patients that the new year is the right time to complete their treatment.

Patients from group number two are generally not in your practice. These people will be out looking for cosmetic, implant, sedation and orthodontic dentists in droves! Most of these people will look online to find a local dentist who can meet their particular dental needs.

If you don’t already have a comprehensive Internet marketing plan (multiple dental directory listings, email newsletter program, team training on how to convert Internet patients and multiple targeted high-value new patient websites), there’s no time like the new year. Sign up with a dental website provider. and they’ll do the work for you!

Group three, those patients who have been putting off treatment until their dental insurance benefits are renewed, can be quickly converted into active treatment plans with a simple letter that should be sent to ALL your insurance patients. Here is a sample letter:

Re: Dental Insurance Benefits in the New Year

Dear Valued Patient:

I would like to take a moment to discuss your dental insurance benefits.

Almost all insurance companies renew your dental benefits with the New Year. That means that you can take advantage of possibly $1,000 or more of benefits for yourself and your family.

So if you’ve been postponing dental treatment, now is the time!

Many insurance patients neglect to take full advantage of their insurance benefits. These benefits, often part of an employer’s insurance program, are typically lost if not used. What are you waiting for? Call today to ensure your best dental health - particularly if you’re due for your regular check-up and cleaning!

As always, please do not hesitate to call our office or email us should you need anything at all.

Sincerely,
Dr. Dentist

P.S. If you have friends or family who you feel would benefit from our preventive approach to healthy gums and teeth, please send them our way. We’ll take good care of them!

P.P.S. Be sure they mention your name so that we can thank you personally with a token of our appreciation.

To send online newsletters to your entire patient base, and gain access to pre-written dental patient communications letters that can kick-start your dental marketing in the new year, just sign up with a dental email newsletter company.

We all know how many insurance patients wait until the end of the year to use their benefits. All it takes is a simple reminder from you to bring them in earlier!

The Hidden Costs of a $40 Dental Crown

The relationship between dentists and their dental labs is a close one - but is it close enough?

Dental labs have been in the spotlight due to the recent scare over lead apparently finding its way into dental restorations such as crowns and bridges. Dentists are realizing that they are ethically (and possibly legally) responsible for the quality of their dental lab’s work. Doctor, you better have your story straight when you patients start asking you where your lab work in being done.

Start at the beginning

Once upon a time, would-be dentists studied alongside would-be dental technicians. The two professions are inextricably connected, and each would do well to understand the needs of the other. How better to foster this relationship than by educating students together?

Today, however, that is certainly not the case. At most schools, dental students and lab students have little to no exposure to each other. The communication gap that begins in school tends to continue into the working world.

“Most dentists don’t meet a technician until after they graduate and that’s criminal. The pre-clinical students and dental laboratory technology students are able to learn from each other, which helps them hone the skills they have and build new ones.”
- Bob Schneider, DDS, University of Iowa Hospitals and Clinics Professor (Journal of Dental Technology, June/July 2006)

Bridge the communication gap

One of the biggest complaints dental lab technicians have about dentists is that they often don’t give the lab all the information they’re supposed to. A proper prescription for a dental prosthesis includes detailed information about the materials to be used in its construction. When the dentist doesn’t provide all the details, it’s up to the technician to make these important decisions.

“Most dentists rely on the dental technician to choose the materials needed for the fabrication of the prosthesis. With lack of adequate information, all too often the design, fabrication, and completion of the case is left up to the technician. Therefore, our results indicate an apparent trend to which technicians are left to make crucial decisions for dentists.”
- Z. Afsharzand, DMD et al. (from the Journal of Prosthodontics, Vol 15. No 2 March-April 2006 pgs 123-28)

Know your partners

One dentist will have been working with the mom-and-pop dental lab down the street for thirty years. Another will use a major domestic lab after personally visiting the premises. Another will prefer the US-based chain with the lowest prices. Another will go online to find a Chinese lab that offers crowns for $39.95.

The dentist’s relationship with his or her lab isn’t something the patient can see. It’s not even something most patients would think to ask about. But even if it’s invisible to the patient, it’s likely to be the factor that best predicts the quality of the dental work they receive.

Patients deserve disclosure

In the US, dentists are not required to tell patients if their dental prosthetic was manufactured outside of the country. In fact, dental labs are not always required to tell dentists where the device was manufactured. (And since many US labs use partners overseas, a domestic return address is no guarantee.)

However, expect the laws to start changing soon. A number of states are already considering legislation mandating that labs inform dentists and/or dentists inform patients of work fabricated outside of the country. In Canada, for example, patients must sign an informed consent form before receiving any foreign dental work.

Keep on working

It may be a long time before the ADA announces the results of their testing. Perhaps it’s a big fuss over nothing; perhaps we’re all slowly dying of lead poisoning. I can’t predict what the science will say. But I can definitely predict this: you, the dentist, are going to be held responsible for your dental lab work. Here’s hoping you can be proud to stand by your restorations.

There is an old saying in business: “It’s not what the cockroach eats that matters… it’s what he spoils for others.” Just imagine you’ve worked closely with a patient to put together a major long-term treatment plan involving a full-mouth reconstruction over an eighteen-month period. Eight months into the plan, both you and the patient are happy with the initial results. So far, so good.

Your patient then visits a local heath fair, stopping at a dental information booth run by a competitor. As she starts to tell him about her treatment plan, he volunteers to do a quick look-see. Of course, he comes up with half a dozen better ways to solve the problem. Your patient comes back to you with Dr. Cockroach’s list of treatment recommendations. This is what we call “Cockroach Competition.”

There is no easy way to defend yourself from this type of competitor. They are just taking pot shots at your treatment plan with little understanding of your history with the patient. Even worse, they may use a self-made diagnostic check-off sheet designed to make their approach look great and anything you might be trying to accomplish look second-rate. Basically, these types of doctors can’t compete on the value of their own services. They need to attack their colleagues’ work to recruit patients.

I recently ran into another version of Cockroach Competition with my Internet dental website business. One of our competitors decided to run an unsolicited automatic analysis of some of our doctors’ websites, claiming that we were doing a poor job because each doctor’s “assigned Google Page Rank was too low to be competitive.” Just for your information, page rank is one of those interesting buzz words that a cockroach can easily fall back on when trying to knock the competition.

Even worse, I recently had several website subscribers attend a seminar held by what I had always thought of as a reputable consulting company. Like the health fair example above, our clients were offered a no-charge analysis of their websites. Lo and behold, they all received a highly critical analysis of their sites, accompanied by a full list of services and how they could do better… another “Cockroach Competitor.”

So what is the solution to these kinds of competitive attacks on your patient base? Patients aren’t stupid, but they can become confused when a cockroach starts throwing a lot of technical jargon at them. Talk with them and, most important, listen to them too. Then bring them back mentally to when they first came to you with their problem. Review how you have worked together to map out just the right treatment plan for them. Remind them of all the things you have accomplished together and, hopefully, how happy they have been with the results.

I’m a fanatic about signage, specifically dental practice signs. I actually carry a digital camera when I travel just so I can snap pictures of a great dental practice sign that I may see in my travels. Why is this so important to me? Signage is the least expensive way to acquire a new dental patient!

Recently I got a question from a doctor asking me if it was worth a 100% premium to add an electronic digital reader board to his new sign. The addition of this feature literally doubled the cost of the sign from $7,500 to over $15,000! He wanted to know if it was worth the extra expense.

For those of you who aren’t familiar with digital reader boards, these are essentially programmable digital displays with changeable moving messages and basic images. They are usually attached just above or below your standard practice sign.

The answer depends on three questions.

1. How much drive-by traffic will your sign have?
2. Are you willing to spend the time changing the programmable message on a daily basis?
3. What is the average value of a new patient in your practice?

First, for any dental practice sign to be successful, it must have great drive-by traffic. If you haven’t got significant drive-by or foot traffic visibility, do not invest heavily in signage.

Second, digital reader boards are involvement tools. Yes, you can program them with the time and temperature and let them run on their own. But for maximum return on your investment, you should change the message daily and turn it into a community bulletin board.

This works especially well if your office is near a high school or college and you program your sign to tie into sporting events, honors programs, community events, plays, etc. People will always look at your sign to see what’s new. If your market is more urban, program your sign with short quotes from famous people.

Third, consider the average net contribution of a new patient to your practice (after the cost of providing the dentistry). For example, if each patient nets you $500, then you only need an additional fifteen new dental patients over the entire life of the sign to pay for the additional cost of the programmable reader board. This falls into the “No-Brainer” category of dental practice marketing decisions.

Click here for more information on dental sign design and positioning

Search Engine Optimization (SEO) is a hot topic online these days - it’s all about making sure that your dental practice website ranks high on search engines. If you’re an orthodontist in Omaha, you want to be at or near the top of the list when people go to Google looking for “Omaha orthodontist.”

If you don’t know much about SEO, there are lots of people willing to take your money in return for (hopefully) improving your page rank with the major search engines. But there’s more to the internet than just your homepage. It doesn’t take a lot of work on your part to get yourself and your practice in the news - and that’s free publicity for you! Consider the power of press releases.

First off, you need to start with a newsworthy item. Some examples:

• You or your practice has received an award or honor.
• You’ve gotten new equipment or introduced a new service.
• You’ve done or are going to do something for the community
• Your practice has moved.
• You’ve hired an associate.

In creating your press release, think locally. Be sure the text includes your city, state, and zip code. Including information about where you’re located makes the local media more likely to notice and pick up on your story. You’ll also want to send copies of your press release to the local media - they are your friends! You’ll pick up more clients from a spot in your local news than from any national media.

Make sure your press release is long enough to look respectable - that means at least 150 words. In fact, your release can be as long as 500-1000 words. Keep in mind, however, that most news outlets won’t reproduce the whole thing. That’s why most press releases are written in the inverted pyramid format, which means that the most important information is at the beginning of the document. That way, it reads smoothly even if paragraphs are lopped off the bottom. Remember the old adage: who, what, where, when and why.

Finally, if it’s an option, consider scheduling your release in advance. This gives the local media time to read your release and research your practice beforehand.

Press releases can seem daunting at first, but they’re pretty simple, and they’re a great avenue for publicity. There are lots of sites for press releases out there - a quick internet search will show you hundreds. And don’t forget to include the local media - not just newspapers, but TV stations, radio stations, and popular local websites.

To understanding dental marketing, you must start with this phrase: “If you don’t ask, you don’t receive… However, beware! You may get what you ask for.”

I’ll tell you a story about a client I worked with years ago. She came into my office and said, “Jim, I just built an outrageously beautiful new practice facility downtown. It’s just absolutely fantastic! But what I want from you, as fast as I can get it, is as many patients as you can possibly get me!”

“Are you sure?” I asked.

“Yes. I’ve got to have patients to pay for that office,” she said.

I said, “Fine.”

Three and a half months later, I got a phone call: “Jim, I’ve got a problem.”

“What’s the problem?” I asked.

“I’ve got 57 new patients a month!” she said.

“But you asked for all the new patients you could get!”

“I can’t service 57 new patients a month! I’m doing nothing but examinations. I don’t have time for operative!”

Okay… Remember what I said about being careful what you wish for? Because if you market yourself using the principles I talk about, you could find yourself overwhelmed by the response you get. So let’s start with an important question: How many new patients do you really need a month?

But is that the REAL question? Or is it: On how many new patients can you do a full diagnosis and case presentation? You have an ethical obligation to your community to take care of the patients you see. You can’t just cherry-pick through 57 new patients a month. You won’t have time to do a good job on any of them.

So on how many new patients can you perform full diagnosis and case presentation in one month? The average number of production days in a month for a normal doctor is about 16. On a consistent basis, the number of new patients that a doctor can generally see is about two new patients a day and still maintain a productive operative schedule. That means, allowing time for operative, you’re going to want to see two new patients every day in a steady stream. That means the maximum number of new patients that you can handle in a given month is about 32.

Some will be children, some will have perfect teeth and some, God forbid, will not accept your treatment plan. Depending on your style of dentistry, even 32 could be too many. But remember, the REAL question is: “On how many new patients can you perform full diagnosis and case presentation?” Is anything more… ethical?

The master of system design and technology, W. Edwards Deming, famously said, “94% of success is the system, 6% is creativity.” After WWII, Deming went to Japan to rebuild industry using systems that target quality. He practiced it, he preached it, and it’s now become accepted truth in business.

A good program for marketing includes straightforward, step-by-step systems, and it’s important that you follow them.

I’ve seen lots of marketing problems over the years. Sometimes a doctor will say, “Hey, I got this great idea from one guy, and another from another guy, and I kind of combined them together into this one big great idea.”

Guess what? It won’t work. To be successful in your dental marketing, you must preserve the integrity of the system. I don’t care what system you use. The key thing here is to use one system consistently because it is designed to work as a whole. When you take bits and pieces of different ideas and put them together, you can defeat the entire system. So stay with your system.

First, choose systems that compliment your personality. I can’t stress this enough. It’s important! For example, I know one doctor who has an elephant. A literal elephant. And this doctor would go on late-night TV in his jeans, flannel shirt, and cowboy hat, riding his elephant. He’d say, “Come one, come all, and come on down and see the biggest teeth in town!” He was comfortable with that style of practice marketing.

Now, the question I’ve got to ask you is: would you be comfortable sitting on the back of an elephant telling everybody to come on down to your dental office? Perhaps not. What works for one doctor is not necessarily going to work for all doctors. This is what you’ve got to be careful about when you’re selecting your marketing strategies. You’ve got to make sure that they complement your personality.

Next, we want to start with strategies that have the lowest cost of acquisition. Why spend a dollar more than you need to before you have to? So start with the strategies that cost the least to acquire, then build up as needed and as new patients join the practice.

The third thing to remember is to choose systems that target the types of patients you want and screen out undesirables. We all know who the undesirable patient is: it’s the patient who calls you at 11:30 on Saturday night with a toothache and wants you to prescribe drugs over the phone.

And finally, we want marketing strategies that preheat the patients for case acceptance. And what does it cost you to get these referrals? Absolutely nothing other than treating your current patients correctly.

Not long ago, I got a letter from a doctor’s spouse complaining about the amount of time it took to set up an Internet marketing program - about 2 hours. This included a teleconference to customize the doctor’s Internet directory program with a practice profile and geographic markets, a complete email newsletter and patient communications program, and the selection of their dental Web site options.

Wow! Two whole hours to set up a comprehensive Internet marketing campaign targeted at cosmetic patients - each worth about $3,000 net to the bottom line at a cost of just $280 a month. Has there been a mental disconnect here?

Even if this doctor’s time was worth $1,000 an hour net, one new cosmetic patient a month will net him $30,000 by the end of the first year. These people didn’t want a marketing campaign - they wanted a magic bullet!

I’ve seen this magic bullet syndrome before, and not just in marketing. For years, we used a software program in our dental consulting business to manage practice statistics and team bonus programs. The time commitment? Two hours set up by the doctor and 45 minutes of team time a month. Net average increase in income? About $45,000 a year - and we still got complaints that it took too much time to administer.

The truth is that dental marketing and management are part of the doctor’s job description. Often a minor investment of your time in either can generate an outrageous increase in your bottom line.

In marketing, you are either pregnant or you’re not. There is no gray area. If you are going to professionally market and manage your practice, make the commitment or don’t. But if you do, follow through with it.

Think about it for a second - if you were the prospective patient, where would YOU look on the Internet to find a dentist? You’d probably use a search engine to accomplish that task. This means that your dental practice website will need to use Search Engine Optimization (SEO) principles in order to gain maximum search engine presence.

Visibility is the name of the game if you want to be found on the Internet. It all comes down to the search engines and SEO technology and research. If you think ‘Cosmetic Dentistry’ has become a buzzword of sorts over the past few years, look into Search Engine Optimization - it’s a multi-billion dollar industry in and of itself. Yes, that’s billion.

Then there’s the age-old question: When will I see a return on my investment? Do you honestly expect some arbitrary date in the near future when you will magically begin to recoup your investment? Sounds a bit strange, doesn’t it?

I can give you average dates all day long, but they don’t mean anything to YOU and YOUR practice. I’ve had a practice in Texas getting a full ortho case in less than 30 days and another in California get a major implant case in just a week from their dental practice websites.

Rather than you asking me when you will see a return on investment, I’m asking you; “How well prepared are you to deal with the requests that come through the Internet?” Up to 50% of all new patient appointments requests are lost at the front desk. We don’t want to see this system generating lots of appointment requests each month for your practice and having them lost due to poor follow-up, weak appointment setting skills, or worse yet, because of an apathetic, ill- trained receptionist.