Ep 1. Four Ways to Increase Case Acceptance
Is treatment acceptance in your office as good as you think it is? No matter how great you are, there’s always room for improvement—for more ideal treatment plans, more completions, more patients with fully restored form, function and aesthetic, and less dependency on insurance coverage. So in this episode, we’ll give you some immediately usable tools for case acceptance, including both the case presentation and the organizational side of case acceptance. Specifically, we’ll cover the biggest determining factor in whether or not a patient accepts a treatment plan (3:03), when to schedule consultations and how much time to dedicate to them (6:29), how you’re making your patients feel dumb and it’s killing your case acceptance (9:55), and why insurance and finances should never influence your treatment planning process (18:19).
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Questions From This Episode
Why does a patient who seemed to understand and agree to treatment still say no?
In most cases it is not that the patient does not care about their teeth. It is that they never actually grasped the significance of what they were told. If a patient truly understood what a problem meant for them, they would act on it. When someone declines, the real issue is almost always a breakdown somewhere in the presentation, not a lack of concern.
How much time should I set aside to present a treatment plan?
Enough time to finish the conversation in one sitting. A skilled communicator given only a few minutes will not close a case that actually needs an hour, while even an average communicator given a full hour can accept a meaningful share of cases. If you do not have time that day, it is better to schedule a dedicated consultation than to start a presentation you cannot finish.
When is the best time to schedule treatment consultations?
First thing in the morning and right after lunch. Mornings are typically primary procedure time, so a consult can fill a same-day cancellation. After lunch works because you are not walking in from another task and can give the patient full, distraction-free attention.
Should the dentist personally discuss the cost of treatment?
Yes. Patients accept a statement about fees far more readily when it comes from the dentist than from anyone else on staff. Handing that conversation off to a treatment coordinator removes weight from the recommendation and, in practice, tends to lower case acceptance.
Should a patient's insurance plan or apparent financial situation change what treatment I recommend?
No. Assuming a patient cannot afford the ideal treatment and quietly recommending something lesser does a disservice to both the practice and the patient. The right approach is to present what is clinically needed and let the patient decide, rather than deciding for them based on appearance or coverage.
Episode Transcript
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Let me paint a picture for you. You have just spent twenty, twenty-five minutes presenting a fairly large treatment plan to one of your patients. Let's say it's six crowns and four root canals. You have explained everything. They have asked you a few questions. They seem pretty engaged.
They nodded their head at all the right times. And then, toward the end, the patient tells you they don't want to do it right now because they're going on a cruise, or they need to buy some new big screen TVs, or they want to think about it, or any other number of excuses you hear on a day-to-day basis.
So maybe you sit back, maybe you're a little flummoxed, maybe you're a little frustrated. You don't show the patient, of course, and you wonder what's going on with this person. Do they have a low dental IQ? Do they not care about their teeth? Here's the truth: the low dental IQ idea is a bit of a myth. Sure, there are people who genuinely don't care about their teeth, but that is the exception rather than the rule. In most cases, what actually happened is the patient just didn't get it. Because if they got it, they would have done something about it.
So this comes back to the subject of treatment acceptance. In this week's episode, our inaugural episode of Dental Business Rx, we're going to tackle treatment acceptance and teach you four ways to improve it.
My name is Jeff Blumberg, and I'm your host. I'm the Chief Operating Officer at MGE. I've run the company since 1998, and I've been on site in over 1,000 different small businesses, primarily dental practices. So I have a pretty good idea of how what we teach clients rolls out in the real world.
We picked this topic first only because a lot of people know us for our sales and treatment acceptance training. I know the word sales tends to get a bad rap, but if you look at what you're actually attempting to do with a patient, it's getting them to want what it is they need. That's really sales, for lack of a better way of putting it.
With that in mind, treatment acceptance as a whole is really the closest thing to a win-win for both you and your patients. You win and they win. It's good for you, good for your practice, good for career fulfillment, and it improves your collections, and patients actually get what they need.
So how would you improve treatment acceptance? Obviously the answer is sales training. You have to be a better communicator, you have to know how to sell. But there's also an organizational side to sales, which is what I want to talk about today, because you're not going to sit and listen to a twenty or thirty minute podcast and come out the other end as a top salesperson.
But I will tell you this: there are a few things you could change right now that would actually improve your treatment acceptance today. If you're listening to this in the morning, you could start doing this today when you get into your practice. With that in mind, let's plunge right in.
When presenting treatment, you want to make sure you have enough time. I can't stress this enough. This is the organizational side I was referring to. You could take the best salesperson, the best closer, and if you give them five minutes when the conversation would really take an hour, they're not going to close it.
Conversely, take someone who's a mediocre closer, and if you give them a full hour, maybe they'll close twenty to thirty percent of the people they talk to, whereas if you give the great salesperson five minutes, they close no one. Time is of the utmost importance. We have a little saying we give our clients here at MGE: don't start a presentation you don't have time to finish.
I can't get into all the reasons why, we teach that in our seminars, but here's one way to see it: a second opinion patient is easier to, quote unquote, sell than someone you're starting with from scratch. The reason is that you've started the sales process before and had a chance to finish it that time.
Let me walk through how this normally works. Say it's a new patient, and let's say your new patients see the hygienist first, we don't have a strong position on whether that should be the hygienist or the doctor, but the doctor will need to do an exam either way.
So you walk in, say to a senior hygienist, and you've got twenty minutes on the schedule for this new patient. You spend fifteen minutes doing the exam, the charting, reviewing the X-rays, and you see this patient needs a substantial amount of treatment. You only have five minutes left.
In a lot of practices, the doctor will start presenting the treatment right then. The doctor says, you need X, Y, and Z treatment, and sends the patient off with a treatment coordinator or financial coordinator to discuss it further. Then the doctor comes to the front desk later in the day and asks what happened with that patient, and hears, oh, they wanted to think about it.
What went wrong is you didn't have time to actually present it fully. In that case, you'd be better off either making sure you and the patient both have the time, or not presenting it at all that day and instead bringing them back to do it properly. Not having enough time is a major reason for lost acceptance.
Here's what I'd do today, and this applies to patients of record too, since plenty of patients on your hygiene schedule need treatment. You do your normal five-minute recall exam, you don't have time to really get into it, answer questions, explain consequences, so you need to block out some time in your schedule for what I'll call consults.
When we hear the word consult, we often think of full mouth restorations, all-on-four or all-on-six cases, ten implants, something large. I view a consult as any sales opportunity, any time you're actually doing a treatment presentation. Even one implant, or two crowns, at two thousand five hundred or two thousand eight hundred dollars depending on where you practice, is enough to require a real discussion. That might take twenty or thirty minutes to properly explain why it's important.
So say you've walked in the room, you've got five minutes with a new patient or five minutes with a recall patient, and either you or the patient doesn't have time. You want to bring them back for a consult. Keep it simple: tell them you want to bring them back, but don't get into what the treatment actually is yet. Just let them know you found things in the exam you want to explain properly.
How might this play out? Say it's a new patient, you've done the exam, you have five minutes left in the appointment, and another patient is already seated waiting for you. You don't have time today, so you're not going to present treatment today. You found a substantial amount of treatment for them to do, so you tell them you'd like to bring them back for a consultation.
When should you schedule these consults? My recommendation is first thing in the morning and first thing after lunch. Why? In a lot of practices, mornings tend to be primary procedure time, placing implants, prepping crowns, and so on, with deliveries in the afternoon. Some practices do this, some don't, but if you do, there's always a chance someone in your primary schedule cancels. If you have one or two consults booked first thing in the morning, when you're distraction-free and can focus fully on that patient, there's a real chance the consult patient could take that canceled slot on the spot. And if there's no cancellation, you can simply schedule them for the next available opening.
First thing after lunch works for a similar reason: you're coming back from a break rather than walking straight out of another task, so there's less chance of distraction. When you present treatment, you want the patient to have your full attention.
As for how to get the patient back for that consult so you actually have adequate time, here's what I wouldn't say: hi Jeff, we found that you need six crowns and four root canals, and I'd like you to come back for a consultation so I can explain it to you. That already starts the sales process by revealing what you found. You're better off saying something like: we've gathered a lot of information today, I found a number of things going on, and I want to make sure I have time to explain this properly and review your treatment the right way.
In other words, make clear this is a big deal, for you and for them. You want to review the case, land on the exact treatment plan you want to recommend, and have time to answer every question. One thing your staff can confirm: the doctor tends to hold more weight with patients than anyone else in the practice, so the fact that you're willing to dedicate twenty or thirty minutes to explaining their treatment plan is usually a very big deal to them.
How long you schedule for the consult depends on the patient and the case. A large case with a patient who seems uneasy might call for a full half hour. A smaller case with an upbeat patient can be shorter. But make sure you have enough time either way. That's point one.
Point two has to do with understanding. You have to make sure the patient not only understands their treatment, but understands why they need it. To show you how bad this can get, I want to read you something. It's from a 2007 New York Times article by health writer Jane Brody, titled The Importance of Knowing What the Doctor Is Talking About. I know it's an older piece, but I think it still applies today.
Here's the line: how often have you left a doctor's office wondering just what you were told about your health, or what exactly you were supposed to be doing to relieve or prevent a problem? If you are a typical patient, you remember less than half of what your doctor tries to explain.
I remember reading that and thinking, half the patients don't understand what doctors are telling them. Read that line again: if you are a typical patient, you remember less than half of what your doctor tries to explain. That means the average patient coming into your practice remembers less than half of what you tell them.
We did a study a few years back looking at negative reviews for dental practices, and found that thirty percent of negative reviews traced back to the treatment presentation and acceptance process. It's the classic, I went in thinking I just needed my teeth cleaned, and they told me I needed four thousand dollars of work. And they always end with, so I went back to my old dentist, which is kind of funny, but beside the point.
Thirty percent of negative reviews come from that process. The patient walks out not really understanding what the doctor told them. You'll sometimes see practice responses to these reviews that completely violate HIPAA, which is a whole other issue, but the underlying story is usually a practice that was earnestly trying to help, and a patient who just didn't get it.
So there are a couple of things you want to do when explaining treatment. You want to make sure the patient understands it, and let's define that word specifically. Understanding means to grasp the meaning and significance of something, to know what something means, and to understand how important it is.
In a lot of cases, like the example I opened with, the patient simply doesn't understand why needing four root canals is a big deal. Yeah, I'll just go on a Mediterranean cruise, what's the big deal, they think, when if they truly understood what was going on, and if this were a dentist sitting across from you being told they needed four root canals and six crowns, they would understand the significance.
I'm not saying the patient needs a dental education. But it has to really land. There are a number of ways to do this, but what you don't want to do is throw out a lot of big words, because that's the fastest way to lose someone. Some people think big words make you sound more authoritative, but really all it does is lose people.
This is something I've battled for a long time. I've lectured to almost 100,000 people over my career, and one thing I've often noticed is someone wants to ask a question but just doesn't. You can see the instant moment of non-comprehension. You tell a patient they have an issue with the mesial surface of their tooth, and you see the eyes glaze over for a second, and you wonder why they don't ask a follow-up question.
Honestly, I don't fully know why. Maybe people don't want to look uninformed, maybe there are other reasons, but sometimes people just don't ask. So if you talk about the buccal surface or the distal surface or some procedure when you don't need to, and they don't ask a question, the only explanation I can land on is that the patient assumes they're supposed to already know, and doesn't want to look uninformed.
That's my assumption. So I wouldn't use a lot of big words. I'd keep the language accessible. But the most important thing isn't just that the patient understands what you want to do, it's that they understand why, and why it matters. That's point two.
Point three, and I wouldn't call it controversial so much as simply underused, is that the doctor has to discuss the fee. I'll say that again for anyone who doesn't want to hear it: the doctor, the dentist, has to discuss the fee.
What does that look like? Using the six crowns and four root canals example again since it's easy to follow: you're the doctor, you have the full treatment plan breakdown with the estimated insurance participation, say it's a thousand dollars, about what it's been since 1992, and you tell the patient, your treatment plan is eleven thousand dollars, we expect insurance to cover about a thousand, so your portion would be ten thousand dollars.
That, to me, is the minimum I'd expect the doctor to do. You might be listening and think, okay, that sounds fine, or you might think, that's horrible, I could never do that, my patients would think I'm all about the money, I don't talk about money, that's beneath me, and so on.
Here's the truth. You own the business. That is your business. You know your fees, and, ask your own staff if you don't believe me, a patient is far more likely to accept something coming from the doctor than from anyone else in the practice. When they hear it from you, it carries more weight.
This can matter more than people expect. We had a client from South Florida, an orthodontist, who went through the MGE program and did the basic sales training. Part of it was simply telling patients, or in his case usually parents, the fee. He went from around 85,000 dollars a month to 170,000 dollars a month, and while that wasn't only from the sales training, there were organizational changes too, it was a meaningful factor.
I saw him one month and asked how things were going, and he said they'd had a bit of a down month. I asked what happened, and he said they'd done 140. I asked if he'd changed anything, and he thought about it and said, I stopped telling parents the fee. I asked why, and he said one parent had given him a hard time about it, asked why he was even bringing up cost since he was the doctor. Just that one person, out of all the parents he talks to and all the presentations he does. So he'd changed his approach, and the numbers dropped. I told him to start doing it again, he agreed, and the next month he was back to 170.
It really is that simple, folks. Just telling the patient the fee. You can take it further, too. Since your job as the doctor is ultimately to get the patient well, if financial concerns are going to block them from getting well, you should do what you can to help them work through it. Some of our clients go beyond stating the fee and will ask something like, how would you normally plan to pay for something like this? I know some people listening might not love that idea, but it isn't as big a deal as it sounds, and it isn't about making the conversation all about the money. It's about getting the patient well. There is nothing wrong with simply telling people what things cost.
Think about how the alternative usually plays out. Patient asks, doctor, how much is all this going to cost? Doctor says, I don't discuss fees, why don't you talk to Bob over there, my treatment coordinator, he'll walk you through it. Then the patient gets frustrated with Bob instead of with you. Something worth trying: start telling patients the fee yourself. The shift can surprise you. That's point three.
Point four, and we'll close with this one: don't let a patient's insurance coverage, or your own assumptions about their financial situation, influence your treatment planning.
Let me explain what I mean. Early in my career, back in the nineties, during the first Clinton administration, so yes, I'm dating myself, I remember sitting down with a doctor and his wife, who was the office manager. I usually start these conversations innocuously, asking what's going on in the office, and she launched right into it. She was frustrated, and she brought up something specific: if a patient came in wearing ripped jeans and clinically needed a crown, the doctor wouldn't even recommend the crown. He'd recommend some kind of multi-pin amalgam restoration instead, and never even mention the crown as an option.
Funnily enough, this was during the era when ripped jeans were actually in style, the Guns N' Roses era, so that added an extra layer of irony. But the real point is this: when you look at a patient and think, they have this kind of insurance, or they drive for a rideshare service, or they don't seem to make a lot of money, and you quietly decide not to recommend the ideal treatment, you're doing a disservice to yourself and to them.
We had a client at one of our seminars recently share a story about a rideshare driver who came in missing his four front teeth. He was getting married and wanted a denture. The doctor said, I can give you a denture, and explained how it would work, then added, or I could replace those teeth with implants. The patient asked how much that would cost, and it was a significant amount, close to the cost of the car he'd driven there in. He went ahead and financed it, and is thrilled with the result.
The point is that decisions like that should be based on what the patient actually needs, not your assumption about who they are or what they can afford. I get asked a related question often: if a new patient has a lot of treatment needed, should you present it in phases? Some doctors will tell the patient about the periodontal treatment first, then come back later with the restorative treatment. When I ask why, the answer is usually, I don't want to overwhelm them all at once, I don't want to scare them off.
But what's so scary about the truth? Tell them the truth. Present it in a way they can take in and process, but I wouldn't soften or delay the actual communication. Tell them what's really going on.
I could talk about this for hours, we run entire seminars on this subject, and we do a lot of sales training for our clients, along with training on just about anything involved in running a practice. But I hope these four things help. To summarize: one, make sure you have enough time, and bring the patient back for a consultation if you need to, or present it that day if you have the time. Two, make sure they fully understand the treatment, not just what it is, but why it matters. Three, the doctor should always discuss the fee. Four, don't let assumptions about insurance or finances get in the way of simply telling a patient what they need.
I hope this helps, and we'll see you at the next episode.