Increasing Practice Profitability with Large Cases

The dental overhead monster has an insatiable appetite. There is always new technology to buy, and new or replacement staff are hard to find at any price due to a strong economy and low unemployment rates. Like an old-fashioned taxi meter, the cost to open the door to your practice continues to click up. Your schedule is full, but your mailbox is also full of bills that you have to pay, month after month.

To get ahead and increase practice profitability, you need to increase your average case fee (by doing more large cases) and therefore raise your per-hour production rate. There is more profit in large cases, both in terms of dollars and percentage, than there is in small- or medium-sized cases.

Here are ten ways to handle more large cases in your practice:

1. Contact leads immediately.

Patients often contact the practice after office hours by sending an e-mail or leaving a phone message. When someone decides to contact your practice for the first time, especially if you are marketing a high-end procedure such as dental implants, you have a marketing success. The interested person not only found you, but they took action by reaching out. This person could have contacted so many other offices, but you are the chosen one. It is amazing how many practices let precious time go by without contacting these potential patients. There are systems in place that send an automated e-mail response indicating that the patient’s message has been received and someone will make contact during business hours. It is vitally important for a team member to contact these leads promptly. If they do not hear from your office by the next business day, they will continue their search for care by calling someone else.

2. Establish a texting relationship.

Many people get behind on responding to e-mails, they lose messages, or they delete messages that they suspect are advertisements. The bottom line is that e-mail has lost much of its cache and immediacy. Text messaging, however, is more popular than ever, and people read them. Once you have spoken to a patient on the phone, ask if you can text them a link with more information about the practice. You can follow up with a text to ask if they received the link, have any questions, or would like to appoint. As you go back and forth with someone via text, you develop a texting relationship. If someone says, for example, they would like to come in for an exam but are so busy they will have to call you back, you can text them and let them know that an opening just came up in the schedule on a particular date and time. Whether they take that appointment or not, you are still in active texting mode. That dialogue is essential, because it allows you to keep in touch and work toward getting them to come in for their first visit or ask questions following a case presentation.

3. Know how to answer the cost question on the phone.

In the old days—just a few years ago—practices were very reluctant to quote fees on the phone. People are now used to price shopping on the Internet. Most people want to know dental fees upfront, even though it may not be possible to quote a final fee until after a comprehensive exam. The solution is to give the patient a range. For example, a patient contacts the office and says she is missing teeth and currently wearing a partial denture. She wants to know what implants will cost. The answer is, “There are various options to replace missing teeth, such as a complete, conventional denture, a removable implant-supported denture, or a fixed implant solution. The fees range from $5,000 to $25,000 or more depending on many factors and the choices you make. My recommendation is to come in, meet the doctor, and get all your questions answered. The doctor will explain all your options to you.” This response answers the question in terms of various solutions to the problem of missing teeth, but it does not commit the office to a specific fee or treatment plan.

4. Keep the conversation positive—don’t say no.

There are times when it is tempting to say no to a patient. Some patients ask if their insurance will pay the full cost, if Medicare will cover the fee, if they can get a substantial discount, or if you can do the procedure for the price that they saw advertised somewhere else. Instead of a litany of no’s, keep the door open to additional conversation. A good response is, “We want to work with you. I am sure that by working together we can provide a solution.” You can explain, for example, that insurance will not pay the full cost, but you will give them all the information so they can decide which option is right for them. The patient may not be able to afford or may not want to spend the money for the costliest treatment option, but they came to your dental office with a dental problem. You are committed to helping them find a solution, which may mean phasing treatment. In this situation, the patient still has a big case, but one with various treatment milestones that occur over a period of time.

5. Ask the patient why and when.

A patient called a periodontal office to say he had been missing teeth for years and wanted to talk to someone about dental implants. After establishing that he was not having any discomfort, the team member who answered the phone asked him a question: “Why are you interested in replacing teeth that have been missing for a long time?” The patient said he thought he would likely lose more teeth in the future, and he wanted to be able to “feel whole again.” In another instance, an adult patient called an orthodontic office to inquire about braces. The astute team member asked, “What prompted your call today?” The patient said that she had spent years taking care of her children, but now the children were grown and she thought it was time to take care of her needs. In yet another case, a patient contacted a general dentist’s office and said he wanted to have his significant dental problems corrected because he was going on a cruise in six months and wanted to be able to enjoy the food on the cruise and smile for the photos. In all cases, team members’ understanding of patient motivation, expectations of benefits, and sense of urgency are important pieces of information to consider when discussing large cases. The goal is always to meet the patient’s needs.

6. Use financing options.

Most people choose to finance large purchases. CareCredit and other fine companies offer many options. I am continually struck by how many practices try to avoid financing because the financing companies charge a fee. That fee is the best marketing expense ever in terms of return on investment because you do not have to pay it unless or until you have a patient who is ready to accept treatment. Financing companies are part of the cost of doing business. For larger cases, especially, the ability to offer the patient attractive financing will often make the difference between case acceptance and rejection.

7. Show testimonials.

Take a close look at commercials on television by national providers of dental implant services. Notice they do not go into step-by-step details about the procedure. Instead, they focus on success stories. In just seconds, they tell the story of someone who had been self-conscious about their smile and is now totally confident, enjoying life with a beautiful smile made possible by dental implants. Whether you are offering dental implants, orthodontics, veneers, or other services with a cosmetic benefit (among other benefits), solicit written and video testimonials from patients. For videos, keep in mind that most new smart phones have very sophisticated cameras. With an inexpensive tripod and some attention to lighting and background, you can get short, effective testimonials from patients. (Be sure to position the camera horizontally for the best “television look” for your videos.) Finish the project with some basic editing and you have a powerful, persuasive tool to aid with case presentation and acceptance.

8. Assume the answer is yes.

Without proper planning, there can be awkward moments in a case presentation. Once the team member has reviewed the fees and answered questions, there can be an uncomfortable moment of silence. Will the patient accept treatment? If you go into a case presentation with great confidence and enthusiasm, you can assume that the patient will say yes. At the appropriate point in the conversation, talk about scheduling. “We can see you on (date) and (time) to get started, if that works for you.” Once you have agreement on the appointment, you can then go back to your earlier presentation of fees and options and ask the patient which payment option they would like to choose—for example, using a financing service and spreading out payments for a certain amount of time. Remember to ask open-ended questions. Do not ask, “Do you want to have this treatment?” That is a closed question and the answer might be no. Instead, ask open questions such as, “Which treatment option would you like?” or “Which of these payment options do you prefer?”

9. Follow up with patients who are thinking about treatment.

Some patients are not in any hurry to accept treatment. They are intrigued by the potential benefits, but feel no sense of urgency to move forward. Stay in touch with those patients. Send them the occasional text message. Ask if you can check back with them by phone every few months or at whatever interval the patient finds agreeable. Send them additional information about the procedure and alert them when you post a new video testimonial to your website concerning the treatment that interests them. There are patients who may take many months to decide to accept treatment. When they are ready, you want them to feel comfortable calling or texting you to continue the conversation—not start all over by contacting another dental office.

10. Set a goal.

Dentistry is a business—it is not immune to good business principles. While it is true to some extent that simply educating patients and running a patient-centered practice can lead to good case acceptance, you cannot afford to just see what happens. If you do orthodontic cases, an initial goal could be to start an average of two additional cases per month. For offices that do full arch dental implant cases, a good goal is an average of one additional case per month. If you do complex restorative cases, your goal can be an average of one additional, five-figure case per month. There are so many patients out there who need your services. The goal you set simply reflects your commitment to sharpen the patient education process in your office and encourage more patients to accept treatment. As a bonus, when you put your goals in writing, you are more likely to meet and exceed them.

You have a choice. You can spend a lot of time on smaller cases, or concentrate on more advanced, interdisciplinary cases that challenge you, give you the opportunity to do your best work, and ultimately provide the greatest benefits to your patients. Those larger cases also keep the overhead monster at bay by increasing practice profitability.

Click here to play a two-minute audio postscript.