Maximizing Treatment Plan Case Acceptance

Beginning the clinical exam, the Dentist will confirm any missing teeth, teeth with recent treatment. The Dentist will next address the patient’s Chief Complaint if there is one. If stated, this is why the patient is here. It may be a less critical matter in the eyes of a dental practitioner, but it must be given attention to assuage the patient. The issue will be brought into prioritization with education as the exam and treatment plan are developed. Many practices lose the patient by skipping over the Chief Complaint because they dismiss it as not a priority. Clinically, perhaps it is not. Emotionally for the patient, it is (emotions trump everything).

Many dentists skip around in the mouth during the exam. Even experienced clinicians miss things by doing this. Begin with the Upper Right Quadrant. Address each tooth. Move to the Upper Left. Then Lower Left, then finish at Lower Right. This sequence allows your Advocate to follow and chart in a complete, systematic method, being completely inclusive. With each tooth, diagnose ideal dentistry, as if the patient were a loved relative. Assume patients want the best care, because everyone does. Don’t worry about money right now—your Advocate has you covered. Note options for teeth. Give your Advocate some room to compare and contrast options when they later go over the treatment plan with the patient. Include notations—or verbal notes to the Advocate—as to “Why” you are mentioning certain treatments. This will assist the Advocate in presenting the advantages and benefits. It will also have you thinking about any narratives you may be needing to explain diagnosis.

Note all the options for any missing teeth.

Have the mindset of looking for items to enhance, not just fix. Think occlusion. Think pre-emptively. Assume the patient wants the best. Your Advocate will be “cueing” both yourself, and the patient, to remind everyone as to the earlier stated objectives of the patient, usually including “keeping my teeth for a lifetime, having my teeth problem free and looking their best, etc.”

The following is a basic order and checklist for Diagnosis:

Diagnostic Exam Quick Checklist

The Dentist never begins an exam without Advocate or Assistant in operatory
Assistant and Advocate reiterate the items that patient and they have discussed so patient sees dentist is really listening and understands their situation
Health history reviewed and signed.
The Dentist spends one minute or less in personal bond with patient (must show sincere interest)
Chart existing teeth using standard procedure listed above.

Begin exam with,
1) Chief Complaint addressed
2) diagnosis from UR to LR
3) note all options for problems and why you prefer one over another

The Advocate should interact verbally with the Dentist, referring to treatment options discussed earlier with the patient. The best statement: “Dr. Smith, what could possibly happen if Mrs. Jones does not have that crown placed soon?”

Notate what was done previously in mouth—when, why, where, and what happened?

The Dentist performs initial periodontal probe. Let patient know what the numbers mean, and why its important. Tell them what numbers to listen for.

Review intraoral photos and x-rays with patient so they see for themselves what you see.

Address patient’s chief complaint again, and tie it into what you just reviewed.

The Advocate looks for conclusion from the Dentist and asks patient if everything made sense, and if they see how the dentist’s plan addresses those factors important to patient. The Advocate asks the patient if they have any more questions for Dr. Smith. Advocate directs patient to schedule appointment and review finances.

Diagnosing Periodontal Problems

Stop using the word “cleaning.” There is no such dental term.

The Dentist will reiterate the need for the periodontal probing. The patient should hear the need to have the soft tissue checked. The Advocate will have pre-briefed the patient as to why the practice does not automatically perform “cleanings” upon patient request. In fact, patients who insist upon “a cleaning appointment” without an exam, films and probing should not be seen. Undiagnosed periodontal disease has been one of the largest litigated issues in dentistry. It happens when practices give in to patient requests for “only a cleaning.” Refer to Recall and Hygiene Section for more information.

Both Dentist and Advocate should realize the disconnect that patients may have between a simple cleaning (healthy mouth prophy) and a non-healthy mouth gingivitis/perio approach. Many patients leave practices because this disconnect has not been addressed correctly. Patient education is key here, and the Dentists initial diagnosis and confirmation of a non-healthy situation is paramount to case acceptance. The Advocate will know from the Intake Interview as to the patient’s dental IQ regarding perio. Graphical charts and aids of the disease should be ready as needed. Phrasing like “this is an infectious disease” and “this is a communicable disease” and “this is similar to flesh-eating bacteria” and “you have infection causing pus you can actually see under a microscope” is language an un-educated patient must hear in order to get a real comprehension (and case acceptance) for perio control (again, please refer to the Recall and Hygiene Section on Periodontal Control).

For new patients who have a non-healthy perio condition, most practices prioritize the periodontal treatment as the first step. For that reason, it is critical the initial diagnosis comes from the Dentist, with the Advocate’s help. The Hygienist will really educate the patient further when the treatment begins.

Transferring Diagnosis to an Acceptable Treatment Plan

Areas that you have discussed and decided are in need of attention will be brought up on the intra-oral camera. Dentist, patient and Advocate will focus in on these areas. The Advocate will know that these are the areas that will be included in the forthcoming Treatment Plan. This is the time for all questions, concerns, objections, feelings, options, etc. to be spoken for all to hear. The patient must acknowledge the facts of the findings. The Advocate must have the Dentist answer the question, “Dr. Smith, what could possibly happen to that tooth if Mrs. Smith does not have that addressed now?”

The patient must hear all the potential consequences of non-treatment. This is the time. If the patient does not feel their will be any impact on them by not scheduling at this time, they will not schedule. If, at any time during this pre-summary of findings is being discussed, the patient is not agreeing to the basic needs as being discussed, the Advocate must go back to earlier discussions with patient to find a common agreement. This is where the Patient Advocate can go back to notes from the New Patient’s Intake Interview, and voice, in front of patient and Dentist, those items the patient stated as being important to them. The patient really cannot refute what they told you was important 30 minutes ago. The Advocate and Dentist must correlate their proposed preliminary treatment plan to those items that the patient said were of most importance to them.

Emotions carry the day with patients. The F-A-B exercises will help the Advocate and Dentist to present clinical treatment and care and show any particular patient the advantages and benefits to them by accepting the proposed care. Not just for their dental health. But for their overall health, their peace of mind, and overall sense of satisfaction and well being.

Patients are making purchase decisions every day based on how well those needs, wants and preferences are being met. Most of the time, they are emotionally based. Many times, purchases are merely wants and preferences being indulged. Dental practices have an advantage: we have a health-based imperative that should outweigh other purchase options for the patient. Our task is to always demonstrate that is what we believe. If presented in the above format, it is difficult for patients to refute the priority of their own health.

Close it. Case Acceptance is a Win for the Patient and for You. Now is the Time to Get Commitment.

The final step for the Advocate when in the operatory with Dentist and patient is to ask for the acceptance. It is important to gain an affirmation by the patient in front of the dentist. The question should be, “Mr. Patient, do you see how Dr. Smith has addressed your reason for coming in, and more so, addressed those items that you said were important to you for your dental health?” The patient should say “yes.” The Advocate responds, “Well, let’s go figure out a way to get this started!” What you have is a conditional acceptance of treatment. If there are no other questions of the Doctor, then exit the operatory.

If the patient is hesitant, or answers negatively to the above question, you must isolate what it is that the patient has not understood, or agreed with. Unless you overcome the sticking point right here and now, it will become the sticking point when you are asking them to agree to the treatment and get it scheduled. Either overcome or move on to something else in the treatment plan to get patient agreement. The dentist is the ultimate objection solver. The Advocate must get the dentist to focus on a solution the patient agrees to right then and there.

Stage Three: The Advocate and the Patient Scheduling for Case Acceptance

After exiting the operatory the Advocate will escort the patient to a private area. Ask the patient if they need to use the restroom, make a call, have a refreshment, etc. The Advocate will be spending critical time with the patient. There should be no interruptions. And the private area should be not within sight of the front door. The perception should be that it is time to take the courage of the convictions that have been demonstrated to the patient. It is time for the patient to accept the treatment plan, make financial payments and arrangements, and schedule for treatment. For all this you want a venue that is quiet, relaxed, uninterrupted, and business oriented.

Case Closed

The last statements that were made prior to exiting the operatory were to the effect that we all understood what needed to be done, and why. That is the supposition the Advocate will continue with. All that is needed now is to go over financial obligations and scheduling. The Advocate may even want to re-affirm what a great feeling it will be for the patient to have their concerns addressed and taken care of. Make the patient feel they have made a really smart decision in getting things taken care of now before they got worse and more expensive. This is all stated even before the final treatment plan with finances has been presented.

The Advocate will begin to review the written treatment plan with the patient, explaining again the treatment and why we are doing it. Do not assume the patient remembers what had been said. Bring the patient back to phrases and benefits that you underscored when in the operatory with the Dentist.

The Financial Presentation

All that is needed is to determine what the patient can afford on a monthly basis.

Show the patient several columns of fees. The first one should be the UCR—usual, customary and reasonable fees—for the area.

The next column shows the fees for what the patient is being charged (PPO’s and any other reduced fee schedules will be here).

The next column shows what the insurance should pay.

The final column shows the patient’s out-of-pocket expense.

What to Show When Presenting Fees to a Patient

(The fees listed are just a sampling in one market. Your fees may vary, but the ratios between the three columns would be similar)

Procedure: Crown (PFM)
For a patient with a reduced fee plan, show them these columns:

Code	Patient Pays	A Reduced Insurance Fee	What UCR fees are
2750	$375	$750	$1,300
2950	$85	$125	$300
3120	$45	$55	$75
9971	$55	$55	$55
9951	$55	$75	$75
4231	$175	$175	$175

	$790	$1,235	$1,980

The presentation verbiage to the patient would be, “Mrs. Patient, because of your great insurance plan, you’re saving over $700 over what you would pay without insurance (show column 2 versus column 3). And your portion of that reduced fee is only $790. You are paying less than half the amount for the care than if you did not have any insurance. That’s quite a savings!”

By showing these columns of fees, the patient sees how their share is a relatively reduced share of the all the other columns. The Advocate is showing the patient the benefit of having any type of dental benefit—even a cash discount, or senior citizen fee can be shown.

After showing the patient their share column, the Advocate states the different payment options for the patient co-pay, and asks the patient their preferential method of payment. The goal is to get the patient to give you any answer as to how they would prefer to pay. Any answer is an affirmative for case acceptance. The goal is to proceed as if there is no question as to them accepting treatment. Often, the patient will answer as we desire if we have followed the entire Advocate methodology.

When a patient hesitates to answer affirmatively, a pause and silence by the Advocate is needed. Do not speak too quickly and let the patient off the hook. The patient knows they need the care, the Advocate knows, the Dentist knows, everyone knows. It is all about sticking with the conviction that has been demonstrated. If the patient does state that the finances are a problem, the Advocate needs to find out how much of a problem. The Advocate will proceed with options to assist with financing.

The next step would be to break the treatment into phases. Present those phases, and ask the patient the same questions. This step may have to be repeated a few times, but the key is to persist until a point is reached where the patient has had to agree to some part of the treatment plan.

Typically, any type of periodontal treatment is usually scheduled first, so that may become the initially phased treatment and signed financial agreement. If so, the Advocate should get the patient to acknowledge the additional phases, and even get a preliminary date for the beginning of the second phase.

Whatever is agreed to, obtain a written signed acceptance for the treatment. This should be with a Truth in Lending disclosure statement on the bottom of the signed sheet. The Advocate will help the patient select the appropriate appointment time, and ensure all the reminder notes are written and posted. Here is a basic outline of tasks for the Advocate when affirming the plan of action with the patient:

Confirm treatment acceptance, and congratulate patient on addressing those important items. Reaffirm the wisdom of saving money and aggravation in the future by not letting this go any longer. Collect the fee agreed upon. Always get a deposit before the first visit.
Get patient signature on treatment plan/financial arrangement form.
Give any periodontal informed consent to sign, and get patient signature.
Make initial appointment. Address the patient’s chief complaint by stating when that would be addressed.
Let patient know they have your business card and they can call you any time with questions.
Continue to reaffirm the positives of accepting the treatment plan, such as:

— “You have a nice smile now, but wait until this treatment is over, you will absolutely love the way you look.”

— “Feel great about stopping this infection now. You will really appreciate it when you hear about other people who let it go and what they will have to face.”

— “You’re going to happy with Dr. Smith. He/she is very gentle. And his/her results will have you smiling all the time.”

There are excuses, rationalizations, confusion, etc. that can arise when the patient is asked to accept a treatment plan. There are a series of verbal arguments that have been successfully used to counter patient excuses, protests, etc. Look for future webinars that demonstrate how to counter patient objections.

The Advocate’s Role if the Patient Does Not Schedule

Not every patient will schedule every single time. The critical position to take is to not let the patient forget all the advantages, benefits, and possible consequences of non-treatment.

The longer the patient is away from their last practice visit, the more they will forget. Therefore, it is critical to understand why the patient did not schedule, and build a bridge for them to overcome their objectives as soon as possible.

Who better to build a dossier of information, educational contacts and follow-up than the Advocate? After all, the Advocate’s job is to build a “win-win” relationship with the patient. That means case acceptance. The practice wins by performing treatment. The patient wins by getting the best dental health care.

The Advocate has many tools and resources with which to influence a reluctant patient.

The Advocate must keep accurate notes on the nuances of the patient interaction, as well as the clinical notes of the treatment plan. As emotion rules the patient, the Advocate must stay tuned in to the patient’s overall life situation. The Advocate will use personal greeting cards, when appropriate, to deepen the personal bond with the patient. The Advocate will use e-mail to send notes to the patient that may further the patient’s dental education. The patient’s name will be in the practice’s computer “pop-up”, or note section, so the Advocate will always be reminded to follow-up with the next contact with the patient. All these reminders will be notated with the patient’s information in their records.

There may be days or weeks that are particularly slow and unproductive in the practice. This will be the time the Advocate may offer a special fee inducement to the reluctant patient. The offer should be for a particular time period only, so the patient’s visit helps the practice when it needs the patient appointment, even at a reduced fee (refer to Section Scheduling for Productivity).

Passive and Observational Factors that affect Case Acceptance

The factors that impact Treatment Plan Case Acceptance have been delineated in the above section. One of the final factors is really a composite of how patients “feel” about their overall experience. You may have implemented the recommendations we have discussed for other factors, but the patient may still walk away from your practice not accepting treatment because of other negative, impactful impressions.

All the sensory and experiential impacts a patient has at your practice will define their New Patient Experience. It is difficult for a dental owner and team to objectively assess how their practice will deliver these impacts. You are essentially too close to the experience to be objective—the sights, sounds, smells, information, and people have become comfortable and accepted by all of you. You need an objective source to provide you with honest feedback about all the factors. More so, you are really competing with other practices who may have better, or worse, impacts in each or many areas. You may not know how good, or bad, you are presenting yourselves. To assist you in evaluating all the factors in the new patient experience, please have yourself, your staff, family members, trusted patients who are friends, complete the following survey. Have everyone do it anonymously.

New Patient Experience Survey and Assessment

Answer each question on a scale from 1 to 10, with 1 representing the most disappointing new patient experience and 10 representing the best. As your benchmark, use the best service you have ever received by any organization in any industry.

1) How would you rate the quality of the new patient telephone call in your practice for each area?
a. Pleasantness | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
b. Answering initial patient inquiry| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
c. Educating the patients about this practice, and why it benefits the patient
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
d. Securing a visit to the practice | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
e. Obtaining critical information about the patient | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
f. Preparing the patient for the first visit | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |

2) How would you rate the first visual impression of your facility?
a. Ease of finding your facility | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
b. Ease of access to facility and parking | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
c. Initial visual impression of front entrance to practice
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
d. First impression of facility upon entering the practice
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
e. A closer inspection of reception area | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |

3) How would you rate the first greeting and team-patient interaction?
a. Eye contact, initial greeting warm, friendly | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
b. Proper name and title introduced, use of patient name and welcome | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
c. Asking the patient what we can get them upon arrival | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
d. Soft introduction to the advocate’s role and intake interview | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |

4) How would you rate the intake interview?
a. Relaxed, controlled, attentive | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
b. Bonding for trust | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
c. Gathering of data | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
d. Overview of visit | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
e. Explanation of practice philosophy & DDS background | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
f. Requesting of information about the patient | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
g. Beginning of the advocate process | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
h. Patient compliant, open, relaxed and ready to receive and give information | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |

5) How would you rate the “hand-off” of the patient after the intake interview?
a. Movement throughout the practice controlled, professional | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
b. Personal introductions done | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
c. Comforting dialogue reassures patient | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
d. Patient knows what’s happening, why, who is involved | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
e. Assistant demonstrates care and comfort | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
f. Introduction of the DDS | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
g. First impressions of the DDS | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |

Download the New Patient Experience Survey and Assessment | Get Acrobat Reader

For a real, objective analysis of the new patient experience in your office, you should retain a dental advisor to become a “secret shopper patient,” and call as a new patient. It is almost impossible to remain objective when assessing your own situation. You have seen and heard the same things in your practice every day. How can you rate it against anything? What is the standard for comparison? Of course you will be biased in favor of certain items that perhaps others dislike. Remember, this entire experience is to favorably pre-dispose the patient towards case acceptance, repeat visits, and referrals to their friends. It’s all about the patient, not our own likes and preferences.

Overcoming Patient Resistance

The preceding scenario shows a fairly straightforward new patient visit to a practice. In each scene there could be many different responses, requests, objections, etc. by the patient. Our purpose is to provide a framework for the steps that should be included in a new patient visit. The timing, the team members, the specific areas of where dialogue is exchanged would be consistent no matter what the specific language was between patient and practice member.

As we have indicated, there are scenarios between patient and practice that are complicated beyond the one portrayed. Patients sometimes have objections, questions, and challenges to every simple statement we make. Similarly, treatment options may be very complex. And financial arrangements can be a long, drawn out negotiation.

For these reasons, Dentistry Simplified will be providing our subscribers with different, more complicated situations that require varied approaches. These special solutions will be e-mailed to your practice regularly, and be made available through timely webinars.

In the meantime, should your practice be challenged by on-going patient resistance to case acceptance, you may e-mail your questions and concerns to us for a prompt reply.

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