Keep the economic crunch from biting your practice

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Keep the economic crunch from biting your practice

Financial negotiations with your patients should be delegated to a trained financial coordinator.
Sally McKenzie, CMC

Sally McKenzie, CMC

Thu. 27 August 2009


As many of us have observed or experienced firsthand, the economy isn’t doing so great these days. Patients are delaying treatment. They are looking for lower cost options. If patients perceive an appointment isn’t particularly necessary, chances are they will find an excuse to cancel or reschedule. Consequently, practices are scrambling to fill cancellations, and no-shows are on the rise. 

This is all the more reason why patients need to understand that dental care isn’t a matter of personal preference, nor an option to be exercised when they have a little more discretionary income. Rather, oral health is essential to the patient’s overall health and well-being.

It’s up to the dental team to use every opportunity to educate patients that dentistry isn’t about just brushing and flossing; it’s about controlling diabetes, helping to prevent heart disease and respiratory ailments, as well as helping to ensure that pregnant women carry their babies to term.

First, check the messages that you are sending to patients. If you are minimizing the need for care, you are doing your bottom line no favors. Hygienists must take the time to verbalize exactly what they see clinically.

In addition, at the end of the appointment, remind the patient about the findings, such as the pocketing on the lower left that is more of a concern now than it was at a previous appointment.

In turn, the dentist must be singing from the same songbook. If she/he walks in and says, “Everything looks great. See you in six months,” not only will both of you lose credibility, you’ll virtually ensure production shortfalls for both dentist and hygienist. If everything does not look great, emphasize the importance of addressing concerns.

Follow up or fall down

Follow up with patients who delay care. In too many cases, patients forgo or delay treatment because they really do not understand the importance of pursuing treatment.

In between appointments, continue to educate patients.

Too often dentists will tell a patients something once or twice and believe they’ve done their part to educate them on the matter. Take a page from McDonalds’ — everyone in the country knows what a Big Mac is, but that doesn’t mean they stop telling us, at every opportunity, how delicious they are.

Patients are inundated with hundreds of competing messages every day, which means that for the message to have impact, it must be repeated multiple times and in multiple ways. You can’t just send out the newsletter or the postcard and expect to have to increase hygiene days.

You have to continue to reiterate the message many times and on multiple levels. Telling patients something once or handing them a brochure isn’t ongoing patient education.

What’s more, patients need to understand how they will benefit, so make that an integral part of your message. It’s essential that patients recognize that the dental practice is an essential stop on their journey toward overall good health. It’s up to you to bring them along.

Pursuing treatment should be easy

Next, make it practical for your patients to pursue treatment. This may be a good opportunity for you to review your financial policy and guidelines. It should be neither too lax nor too severe. A policy that is too lenient can create undue financial strain on your practice. A policy that is too strict can cause patients to forgo necessary and elective dental procedures.

The plan should encourage patients to pursue dental care and pay for that care promptly. Consider these possible options:

  • If you choose to allow patients to make installment payments, determine how long you are willing to wait for payment. For example, perhaps you will allow all patients undergoing procedures that cost over a specific amount to pay for the treatment in three installments over a three-month period. The timeframe can be longer or shorter depending on your own preferences. However, it must be finite and it should only be extended to patients undergoing more costly treatment.
  • Accept all major credit cards, and in lieu of allowing patients to carry large balances on their accounts, encourage them to pay with credit cards.
  • Explore the availability of patient financing companies, such as CareCredit. Some patient financing companies will allow patients to pay over 12 months or longer; however, the dentist receives payment immediately.
  • Encourage patients to build a credit on their account before the treatment begins. Consider offering those patients who are pursuing more costly and more comprehensive dental care a slight adjustment in the fees, such as 5 per cent, if they pay for the procedure in full upfront. Expect patients that have insurance coverage to pay their portion of the fee at the time the dental care is provided.
  • Provide a limited number of specific options from which patients may choose, and avoid the urge to make too many exceptions to the policy.

Many patients appreciate payment options because they have a means to pay for procedures that are necessary, but can become costly. Certainly, options can and should be provided, but they should never compromise the fiscal integrity of your practice or cause accounts receivables to exceed more than one month’s production.

Always ask for payment

Even during challenging economic times, business staff must continue to ask for and expect payment from patients at the time of service. Keep a few points in mind at the time of collections to ensure that patients fully understand the level of care they have received for their investment.

When asking for payment, explain the services provided and make it easy for the patient to pay. For example, t

Avoid asking patients if they would like to pay today. Rather, ask patients what form of payment they would like to pay with today — cash, check or charge? This reinforces the payment expectation and enables patients to determine which form of payment will be best suited to them.

Be prepared with specific scripts that the staff can use when discussing payment options.

For example, if the patient says, “I can make monthly payments for the next 12 months,” the front desk person should say, “Mrs. Jones, we would be unable to accept monthly payments for that duration because this is a small business and we are unable to extend credit for that amount of time.

However, we do have a relationship with a patient financing company (provided such an arrangement exists) that will offer you an interest-free loan. I just need a little more information.”

This approach helps patients understand why the practice cannot extend no-interest loans, yet it provides a reasonable financial option for patients to pursue.

If the patient says, “I forgot my checkbook. Can you bill me?” respond with, “That is no problem at all, Mrs. Jones as we take Visa, MasterCard and Discover. Which would you like to pay with today?”

If the patient says that she/he doesn’t have a credit card and asks that a bill be sent, respond with, “Mrs. Jones, we can do better than that. I can give you your bill right now along with a printout of the services Dr. Smith performed today.”

Give the statement to the patient along with a self-addressed, stamped envelope. Smile at the patient and say, “Thank you Mrs. Jones, and if you would drop your payment in the mail to us when you get home, we would greatly appreciate it.”

Financial negotiations should be delegated to a trained financial coordinator. The dentist is the clinician, the primary income producer and the chief executive officer.

However, he/she is not the financial coordinator, and engaging in this role is often both inefficient and awkward for dentist and patient alike. It also can undermine the profitability of the practice.

Delegate financial discussions to trained members of the team. Those individuals most capable of succeeding in this position are typically assertive, tactful, confident and goal-oriented.

You may have excellent members of your team who are loyal, kind and truly dedicated to your practice. However, they may be entirely too passive or very uncomfortable asking patients for payment. It is not a job that just anyone can step into.

Some people are simply not suited for this responsibility. Pay attention to the personality type of the individual responsible for collections and secure training to ensure maximum success.

From time to time, as the dentist, you will feel that certain exceptions should be made to the policy for specific cases. Certainly, as the business owner, that is your prerogative.

However, be judicious in making those exceptions. Special arrangements that become common practice usurp the role of the financial coordinator and can quickly render financial policy useless.

Educate patients fully so that they understand the health care impact and the overall value of the care you provide. Review your collections policies, train those who discuss financial arrangements with patients and ensure that patients fully understand the options available.

Before long, we’ll be well past the current economic crunch, and you will have kept your patients in your practice and your bottom-line intact.

About the author

Sally McKenzie is CEO of McKenzie Management, which provides success-proven management solutions to dental practitioners nationwide. She is also editor of The Dentist’s Network Newsletter; the e-Management Newsletter; and The New Dentist magazine. She can be reached at +1 877 777 6151 or


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