Do Not Let Another Unclosed Case Walk Out of Your Office

Here's a shocking truth about dentistry today: dentists are sick and tired of patients saying yes.
Yes to expensive, painful treatment.
Yes to all of the dentist's recommendations.
Yes to scheduling appointments.
Actually, the "yeses" aren't the problem. The problem is that as soon as patients leap from the chair, they change their mind...about the treatment, about the appointment, about the cost, even about you.
What can a dentist do to keep an instant "yes" from turning into a permanent "no"?
When it comes to closing prepaid cases, Dr. Kathy Jacobsen and her team have the Midas Touch. The Gilbert, Ariz, dentist directly booked $92,139 in restorative and cosmetic treatment last month into her schedule. Carol, Dr. Jacobsen's treatment coordinator, is very proud of her consistent 67% treatment acceptance ratio, with more than 50% of the treatment she presents being prepaid.
What makes this so significant is how far Dr. Jacobsen and her team have come. Rewind just 6 months ago to when I first came into her practice. She, like most dentists we work with, thought she closed at least 80% of her cases. "It was a real eye-opener to learn that the real, live reality of our case acceptance was a dismal 7 percent," Dr. Jacobsen expressed. "It seemed like all patients were saying...yes. What I learned was they were saying yes to get out without anyone really discussing their condition, talking about the cost, and dealing with all the questions, concerns, and issues people have when they purchase anything." How did Dr. Jacobsen's team transform its effectiveness in a matter of weeks? The answer is in the system.

Photo by Nathan Zak

THE KEY TO CLOSING CASES

Dentists always want to know the key to closing big cases. The simple fact is that you can't close big cases if you don't present them. I often ask dentists what the biggest case is they ever closed. The typical response is $15,000 to $20,000. "How did you do it?" I ask. Invariably, it turns out that the dentist didn't do anything. A patient simply came in and said, "Do my whole mouth."
So then I ask the dentist, "What's the most you've ever presented, educated about, and closed?" The answer is in the $3,000 to $5,000 range. Dentists who don't have a method in place for presenting comprehensive cases cannot close them.
The key to closing big cases is to know how to have your entire office involved in the selling process...so you can be chairside, doing the work that's the most interesting and lucrative for you, all day long.
Most dental teams despise anything to do with the concept of selling. They see themselves, and correctly so, as health professionals, and they regard selling as dirty, disreputable, and somehow beneath them. The problem is that if you don't sell, you don't work. Most dental practices plod along in a mediocre fashion because the dentists simply don't realize how important it is to know how to sell.
Alternatively, some dentists take an overly aggressive approach to sales. They hammer their patients and annoy them so much that the dentist is the last person on earth the patient ever wants to see. Some hygienists tell me that their patients want to avoid any contact with the dentist while they are getting their teeth cleaned. The patients actually ask the hygienist to sneak them out of the office before the dentist gets there. That shows you the extent to which dentists who are overly aggressive in their sales practices upset their patients and lose sales.
I want to propose a happy medium, a situation in which you feel comfortable enough with the sales process so that you are able to generate huge amounts of treatment like Dr. Jacobsen. Ironically, if you put the process in this article into place, you won't have to do much-or any-of the selling. Your team will be doing it for you, allowing you to practice the kind of dentistry you want to practice, while making the kind of money you may never have dreamt that you could make.
Most dentists-and most people, for that matter-think about sales as a process of forcing other people to do things that are against their will and not necessarily in their best interests. That's a form of sales, certainly, but unfortunately, the entire world of sales is tainted by that perception. Those tactics may be appropriate on a third-rate used car lot, but the fact is that you can sell with dignity and respect for yourself, your patient, and the practice of dentistry. Let me show you how.

GARY KADI'S 6-STEP CASE ACCEPTANCE METHODOLOGY

Let's set the foundation before we get into the tactics. First, let's take the word "selling" and replace it with "education." Dr. Jacobsen and her team learned 2 fundamental reasons why patients did not accept the treatment she was presenting: most of the time patients did not perceive they had a problem, and even if they did, they did not feel a sense of urgency in treating the problem. In general dentistry, if it doesn't hurt or look bad the patient's motivation to take action is low. This is the reason patients tend to be insurance-driven. Therefore, the primary cause of low case acceptance is that patients do not understand. They do not understand many things: your motivation, that they have a problem, that it needs immediate attention, that payment options are available to fit their budget, and that the solution is not worse than their condition. This is all solved by the following team approach to patient education.
Step 1. Your recare coordinator will be making sure that your hygienist has a completely booked schedule. If you do not have a recare coordinator, hire one part time to work Monday, Tues-day, and Wednesday from 4 to 7 PM to make uninterrupted outbound calls to fill holes and turbo charge the hygiene schedule.
Step 2. Your appointment coordinator makes sure that the schedule is adhered to, and that if patients cancel at the last moment, other pa-tients from the "wish list" or short-call list are called and take those appointment times that otherwise would have gone empty. This is a full-time, dedicated position with what we call a daily primary outcome (DPO) that focuses on meeting and ex-ceeding doctor and hygiene daily goals.
Step 3. The hygienist gets a full hour with each patient in order to perform work to the highest professional de-gree, and then he or she educates the patient in terms of what problems are seen and what dental services are necessary to treat those problems. The hygienist will be putting up at least 4 pictures on the monitor so that the patientóand youócan see exactly what needs to be done. It is vital to leverage your hygienist's trust with the patient. Most of the time (unless there is high trust), when the doctor presents treatment, the patient thinks he or she is doing it to buy a third beach house.
Step 4. When you are invited, or as we see in many cases, you are pulled, coerced, and pushed into the hygienist's room, you simply confirm the work that the hygienist has suggested. Your patient will hear the hygienist ex-plain the problems to you a second time, enhancing the patients understanding and trust. You'll confirm the hygienist's findings, answer any questions the patient might have, and then you leave the room. Think of a hygiene check as a 3-minute visit to put thousands of dollars into your bottom line rather than an intrusion on your day. Utilize the relationship your hygienist has with the patient and his or her ability and availability of time to educate the patient. Be aware of a major pitfall hereÖwe often have to rehabilitate the hygienist's willingness to present treatment to the patient, because the minute you invalidate your hygienist in front of the patient, he or she retreats into a shell and never comes out again. Your primary source of having your case acceptance go through the roof has dried up. To prevent this from happening on an ongoing basis, we have a workshop with the entire team to agree on a healthy mouth baseline and standard-of-care guidelines.
Step 5. With you moving on to do more important things with your time, the hygienist finishes up the session with the patient and turns the patient over to the treatment coordinator, who will go over the nature of the treatment, address concerns and questions, and make agreements with regard to time and money. How much selling did you have to do in that paradigm? Not much at all.
Selling really isn't your business. Setting up a system in your office by which sales can happen easily through effective patient education-that is your responsibility. 
The key to this process working is to allow your treatment coordinator to have a dedicated space in which to hold these extremely important conversations with the patients. This point is so important that I want to repeat it, because I don't want you to miss it. You must give your treatment coordinator a dedicated space where he or she will do the selling for you, in a dignified and entirely honorable manner.
By now, in our new process, the hygienist has walked the patient from the hygiene room to the treatment coordinator's office. At this moment, the patient's emotional attachment to getting the dental treatment completed is at its highest. Keep in mind that people buy based on their emotions and then justify their purchases based on logic. If patients leave before they have made agreements about the nature of the treatment to be performed, the time or times when that treatment will be performed, and the cost and method of payment for that treatment, their emotional connection to getting the treatment done will diminish rapidly...and then you've lost them.
I'm not suggesting that you hammer people, or have your treatment coordinator hammer people on your be-half. I am suggesting strongly that your closing ratio will collapse if you are not getting agreements at the time when emotions are the strongest. When the patient gets home, if these agreements have not already been put in place, the spouse might say, "It's not worth that kind of money; that dentist is a scammer. I don't want to spend it. It doesn't hurt, does it?" And other sorts of things will intervene to diminish the likelihood that the patient will return to get the work done. If the patient must go home and talk with his or her significant other, then send the patient home with intraoral pictures to present.
So, it's the role of your treatment coordinator to get agreements while the pa-tient's emotional attachment to getting the work done is at its peak. The treatment coordinator will first go over the nature of the treatment with the patient. The treatment coordinator needs to recognize that patients often don't listen to dentists, because when dentists speak, patients are dealing with their own fears about pain and expense. On top of that, dentists often use terms that make a lot of sense to the dentist, but make no sense to the patient. So it's up to your treatment coordinator to explain the nature of the treatment in layman's terms, go over the questions, concerns, and fears of the patient, and make sure that the patient understands exactly what is necessary.
For example, the dentist might take a quick look in the patient's mouth and say, "You need root planing and scaling." First, this language is frightening to the patient. It sounds painful, it sounds unpleasant, and it sounds ex-pensive. What the dentist has doneóand dentists do this all the timeóis skip the nature of the problem and instead proceed directly to the proposed solution. Why do dentists think primarily in terms of solutions? Could it be because they think solutions put money in their pockets? Patients perceive it this way.
By the way, the hygienist and the dentist should never be talking about money and insurance. Remember that the patient is in a very vulnerable situation in that dental chair and won't be able to focus on the information about money and insurance at that time. In any event, money and insurance are the wrong things for hygienists and dentists even to be thinking about. Your focus, and your hygienist's focus, should be on educating the patient about his or her condition and getting the patient healthy. If the patient asks you about the cost of treatment, your only response should be, "My duty and obligation is to tell you what's happening, and it is completely up to you if you  choose to accept or decline my recommendation. My treatment coordinator will discuss with you everything to do with money." 
The treatment coordinator therefore needs to remember that the doctor was probably speaking in a language the patient could not comprehendóor probably even hear straight. The treatment coordinator also has to recognize that there is a lot of fear going on in that hygienist's room. To put it simply, everybody's afraid. Dentists are afraid that if they don't close the case, then they will get a feeling of rejection or won't be able to meet their many financial obligations. The patient is afraid that the treatment is going to hurt and cost a lot. The hygienist is afraid that he or she will lose credibility with the patient if the dentist contradicts the suggestions that are based on the office's agreed-upon standard of care.
At this point, the treatment coordinator has demonstrated to the patient the value of the particular treatment the hygienist has proposed and the dentist has agreed to. Now you've got the patient saying, "I understand exactly what the treatment is! Get that nasty stuff out of my mouth!"
Step 6. This brings the treatment coordinator to the next task-to assist the patient in paying for the treatment. Only when the patient understands the value of the treatment should the investment necessary for the treatment be presented. If not, you must start over and re-educate the patient.
The treatment coordinator has established the value of treatment in the patient's mind, and the patient has a very strong emotional attachment toward getting this situation handled right now. The next thing for us to discuss is the role of insurance in paying for dental care.
Before the patient has even entered the treatment coordinator's office, the treatment coordinator should determine exactly how much the patient's insurance (if the patient has insurance) will cover. You want the treatment coordinator to get the patient to think of dental insurance as a benefit, not as a cure-all for the high cost of dentistry. The treatment coordinator has to get the patient away from the mindset that says that "insurance" covers everything. Instead, you want the patient to view insurance like getting a discount. You will certainly have people saying, "What does my insurance cover? That's all I want to pay." Instead, your treatment coordinator should say the following: "The treatment we are discussing costs $6,000. Your insurance pays $1,000. So your out-of-pocket cost is only $5,000. Everybody else who comes in the office who doesn't have your quality of insurance has to pay $6,000."
At this point, it's time to share with your patient 4 payment options. I'll share each of them with you right now, but make sure that your treatment coordinator understands that he or she is not to move on from one option to the next until the patient has thoroughly declined the offer currently on the table.
"Now let's talk about that $5,000," your treatment coordinator says. "If you want to pay for it in full today with cash, check, or a credit card, we'll be happy to give you a courtesy of 5 percent. So if you pay in full today, instead of paying $5,000, you would only have to pay $4,750. How does this sound?"
Wait and see. People with cash love to get the discount. Whatever the patient's re-sponse, you're starting off by establishing your best-case scenario: you get paid in full right now. Do not move on to the next option unless and until the patient rejects this first approach.
The second option is to offer third-party financing on an interest-free basis. Yes, you'll have to pay a fee on that money, but it's truly worth it to you, because you get the whole payment immediately from the third-party provider. Otherwise, you get it piecemeal, and you'd have to bill to get it. If the patient defaults, you still have the money and it's no longer your problem. It's up to the third-party finance provider to try to collect. And your patient isn't going to have to make a buying decision every time he or she walks into the office.
Here's what your treatment coordinator tells the patient: "We have another option. How about having the work done interest-free for a year? Can you afford $400 a month?"
Again, wait and see what the patient has to say. If the patient can handle the $400 a month, make the agreement. I have clients who use Care-Credit (9.9% fee  to the doctor), and Sullivan-Schein's clients save by using Citi's patient financing (8.65% fee to the doctor).
Your treatment coordinator can actually have your patient preapproved online for third-party financing even before the patient steps out of hygiene. You can discuss that with your third-party finance provider.
Let's say that your pa-tient does not want to spend the $400 a month. Then and only then, proceed to this third approach, which you will offer only to your most trustworthy patients. Here's the script for your treatment coordinator: "We could do it this way. You could pay half today, and half before we complete your case."
If the patient agrees, then the patient writes a check or gives you a credit card for $2,500. You then make a written agreement with a specific date for that second payment, and then you hold the patient to that agreement when the patient returns for the treatment. Again, only offer this approach to pa-tients who are reliable, trustworthy individuals. 
Let's now turn to the last resort so that you don't lose the patient in the event that he or she turns down all of the previous payment op-tions. Have the treatment coordinator go back to you. The treatment coordinator will say, "The patient can't handle the case; it's way out of their budget. All of the treatment we have proposed is urgent, but doing something is better than doing nothing at this point. Can we split this case up over a year? Can we do $2,500 through CareCredit, do this tooth and that tooth, and let the rest wait for a year?"
In this case, the patient's monthly outlay would be $200 instead of $400. If your patient continues to object, don't coerce the patient. Go back to the original point that we made in this article-you are in the business of educating patients as to the problems they have and the consequences they face. If the desire not to spend the money truly outweighs the need for the dentistry, and if they don't want to get the problem solved, let them go. Allow the patient the freedom to accept or decline the treatment you present. You'll have plenty of other patients for whom you can practice the kind of dentistry that you want to practice. You no longer have to come from a sense of scarcity and work with people who simply do not want to pay for the quality you want to provide.
You - and your team - can experience a paradigm shift. Instead of selling dentistry, you will have the patient wanting to buy it.
When you've got a dedicated treatment coordinator working in a dedicated treatment coordinator space, a lot of wonderful things happen. First, your bottom line soars, because you are now educating patients effectively, handling objections and misunderstandings, and getting written agreements with patients as to the nature of the case, the nature of the cost, the nature of the payment method, and the specific time or times when the work will be performed. All of my clients - and I mean all of them - experienced skyrocketing gross income as a result of the changes I am proposing  in this article.
You'll be getting written agreements from your pa-tient, unlike 99% of your fellow practitioners. They don't have true agreements with their patients, so it's not surprising when their patients break appointments and payment arrangements. Also keep in mind that you are allowing your patients to have their intimate conversations about medical care, emotions, and money in a private area. Again, this room always has to be ready to receive the next patient coming out of hygiene. We started off this article by saying that most dentists don't like to sell and don't know how to sell. My clients who install the procedures I've outlined in this article are in the fortunate position of not having to sell. Their team does that for them with the use of a system that consistently delivers 70% conversion rate.
Once you learn and install this new system, you, your team, and your patients will never want to go back to the old way. Think about it: your patients will get educated and will know exactly what's necessary. Your hy-gienist and assistants, and the rest of your team, will feel fulfilled. They're getting to help people, which is exactly what drove them into dentistry in the first place.
And coincidentally, you're going to enjoy the benefits of more money, less stress, and more freedom that Dr. Jacobsen and her team now experience on a daily basis.


Mr. Kadi transforms successful dentists into highly successful dentists - financially secure, professionally respected, and deeply satisfied with their practices and their lives. He innovated the Next Level methodology and is one of America's leading dental practice developers. His 12 years of transforming and developing dental practices are captured in his newest book, Million Dollar Dentistry. He can be reached at (480) 361-9955, This e-mail address is being protected from spambots. You need JavaScript enabled to view it , or by visiting nextlevelpractice.com.