Written by Jennifer de St. Georges Sunday, 31 October 2004 19:00
As I wrote in the August issue of this magazine, a doctor is judged on everything but his or her quality of care. The only thing patients really have the knowledge to buy from a dentist (and physician) is “confidence and trust.” So, building and maintaining strong, positive relationships with your patients is an integral part of practice success. Satisfied patients who trust you and feel as though they are a part of your extended dental family are the best ambassadors a practice can have. Out in your community each day, these patients share their positive experiences at your practice within their sphere of influence. When someone says, “I need a good dentist,” it is perfectly natural for these ambassadors to respond, “I’ve got just the dentist you want to see.” In fact, 70% of the time when a new patient contacts a dental practice, it is the direct result of a referral from a friend, relative, neighbor, or coworker who is a patient of the dentist.
In this article, I would like to share with you how to get the most out of your patient relationships by developing a more patient-centered practice. I’ll discuss an often-overlooked resource to increase practice production, the best way to manage your patient charts, and some of the most common reasons why practices lose patients. I’ll also share some tips on how you can keep your patients healthy, happy, and in your chairs for a lifetime.
’TIL DEATH DO US PART: BUILDING LIFELONG PATIENT RELATIONSHIPS
I often tell dentists that in theory, you should lose a patient for only one reason—and that is when the patient dies. And I mean that! Every other reason is simply the symptom of a problem that can be fixed. Many practices today have patients who come from all over the country, even internationally, just to have dentistry done at that practice. So an excuse like, “Well, doctor, I’m moving a few exits further down the freeway” is just that—an excuse. It is usually not the real reason why the practice is losing the patient.
Here are the top reasons practices lose patients.
(1) Your reputation in the community. They say good news travels fast—and bad news travels even faster. The way in which you treat your patients is no exception. If you develop a bad reputation in your community, it can literally kill your practice and stop patients before they even walk through your door. Remember those ambassadors out in the marketplace that we talked about earlier? Well, they can say wonderful things about your practice and drive patients in, or they can say naughty things about your practice and drive patients away. Make no mistake—how you treat your patients will get out into the community.
(2) The patients’ expectations were not fulfilled. When patients perceive the services or treatment to be less than they had hoped for, you have a problem. For example, if a patient goes to a plastic surgeon with a picture of Nicole Kidman and says, “Make me look like her,” and the patient ends up looking like anything but Nicole Kidman—you’re going to have an unsatisfied patient. The solution here, as I’ve said over the years, is to “inform before you perform. No surprises.” Every single patient for whom you perform a procedure should have clear expectations about the services being provided and the results of treatment.
(3) The patient doesn’t perceive the benefit of treatment. There is a phrase I like to use that was coined by lecturer Clyde Schultz, DDS, in San Francisco. He has always said, Until the patient buys the problem, he or she cannot buy into the solution. We buy 95% on emotion and 5% on product knowledge. So, when patients says no to recommended treatment, they’re not actually saying that at all. What they are saying is they don’t perceive the benefit of the treatment. If they don’t perceive the benefit of the treatment, even if it’s only a dollar a tooth, then in their eyes it’s a dollar too much.
(4) Dental insurance limitations dictate level of treatment. Patients often perceive the limitations of dental insurance as justification for overruling necessary treatment. And a whole group of dentists buy into the philosophy that when a patient says, “If my insurance isn’t going to pay, then I’m not going to do it,” the conversation should end. I think that’s a cop-out, a smoke screen. When a patient says, “I’m not going to have that bridge because my insurance won’t pay for it,” that patient hasn’t bought into the program. He or she doesn’t see the benefit or value of the care you’re recommending. It’s time to stop and educate dental insurance patients about the total financial responsibility they have when utilizing their dental insurance benefits.
(5) The patient perceives that they don’t have the money for treatment. The majority of dentistry performed today is elective. Often, dentists are competing for discretionary income that patients would rather use to take a trip to Hawaii or a 2-week cruise to the Panama Canal. They may need the bridge, but they want the cruise. So, dentists really have to do a good job of communicating and educating their patients on the value of the treatment and then give them a financial solution (eg, CareCredit monthly payment plans). The American economy is absolutely geared toward the monthly payment. We pay for almost everything—our house, car, and even our bills—on a monthly basis. In fact, if you watch television commercials today, they don’t even tell you how much the product actually costs. They talk about how easily it can be yours for a low monthly payment. So programs like CareCredit give patients a financial solution that is familiar, manageable, and comfortable for them.
(6) The patient is scared of real or perceived pain. In my opinion, the No. 1 thing a dentist needs in order to have a successful practice is a painless injection. I think it is absolutely the most important thing. There is a perception in the world that dentistry hurts. If a patient receives an injection that is painful, it can really place the dentist/patient relationship in jeopardy. Of course the patient may experience some pain after the procedure is over, so the dentist must be sure to set the proper expectation. You can do the simplest extraction and say to the patient, “Gosh, that was a really tough extraction. You are going to hurt tonight so you better go home, take 4 aspirin, and get into bed.” Once the patient has taken the aspirin and is in bed relaxing, most likely he or she will feel very little (if any) pain. But even if experiencing a slight twinge, because the proper expectation has been set, the patient’s reaction to it should be minimal.
(7) The dentist is intimidated by technology. Many dentists invest large amounts of money and time learning new procedures and technology but may feel intimidated to take the first step and actually utilize the learned technology. The majority of dentists are perfectionists—they don’t want to make a mistake. But until they take that step and move to the next level, they will continue to miss an opportunity to help their patients and maximize their investment of time and money in learning the new procedure.
(8) The patient leaves for reasons out of your control. When a patient chooses to leave your practice, at times it is a legitimate or perceived legitimate reason out of your control. Whatever the cause for the departure, it is to your benefit to find out why. I recommend using exit interviews whenever possible. The exit interview should always be conducted by a senior administrative staff member and usually over the phone, assuming you can make contact with the patient. You begin simply by stating you received a call from another doctor requesting x-rays. Then say, “May I ask why you are not returning to our practice?” The patient may just come right out and tell you, but sometimes patients don’t want to explain. So, you go to the next level and say, “The reason we’re asking is it would appear we’ve obviously done something to make you feel uncomfortable and we would like to establish what it was. We are not asking that you come back, because obviously you’ve already made the decision not to return. But if you can share with us what it was we did that made you feel uncomfortable, then we can make sure we don’t do that to any other patient.” Nine times out of 10, this approach is going to get the information you need.
Once you get the patient’s input, be sure to document it in a patient exit log along with any other pertinent information that can be used to enhance the way in which the team interacts and communicates with patients. Your log should include the date, the patient’s name and account number, along with the reason for the departure and the situation in which it occurred. Ideally, your exit log should be on your computer so you can create a report that will detail the number of patients lost. For example, for the month of August you may have lost 3 patients: 1 died, 1 left the state, and 1 declined treatment and left the practice because of insurance limitations. Your team should review the log on a monthly basis to analyze and determine the best way to handle any issues that may be having a negative impact on your patient relationships.
WANT MORE PATIENTS? LOOK IN YOUR CHARTS
To create a thriving, patient-centered practice, obviously you need patients in the chair. You also need those patients to say yes to recommended treatment and to have a way or a desire to pay for it. And finally, you need those patients to remain loyal to your practice. Fortunately, through referrals and marketing, most practices do a good job of attracting a fair amount of patients. But once the patient has sat in the dental chair, far too many practices proceed literally to “lose the patient in the files.” What do I mean by this? A patient who is lost in the files is a patient who has either refused the diagnosed treatment or in fact accepted the doctor’s recommendation, but for whatever reason, the practice has dropped the ball and not followed up with the next step. The patient’s chart has been neatly tucked away into the general file cabinet, and in essence the patient has completely dropped out of the loop. When this occurs, it means lost production for your practice and a patient who is still in need of dentistry.
Zelda Weiss, who was a well-respected Southern Californian consultant (now deceased), once conducted an experiment where she went into 3 dental practices and added up all of the diagnosed but uncompleted treatment just sitting in their charts. She found almost a million dollars! My sense is the average dental practice could probably go for nearly a year without seeing any new patients if it would just get the patients who came in to actually change the no to a yes, or take the “let me think about it” to a “let’s get started.”
In the early 1980s, I was doing a considerable amount of lecturing in Alaska. You may recall that during this time a major fuel shortage was going on, and the Alaskan economy was really suffering. As I was conducting my seminar, the dentists in attendance were virtually crying as they lamented that no new patients were coming in because they could not afford treatment. So I said to these dentists, “Why are you waiting for new patients to come through your doors? Why don’t you focus on the patients who have already entered the practice but who have not said yes to your treatment recommendations? Go back to these patients and look at where you failed to turn a ‘No, I can’t accept treatment right now,’ into a ‘Yes, doctor, go ahead and do what needs to be done.’”
The following year, I went back to Alaska, and during my seminar a well-known dentist by the name of John stood up. John said, “Jenny, you were here last year and told us what to do to deal with the economic issues that were affecting our business. I just want to say I followed your advice, and as a result my dental practice has just had its best year ever. During that time I saw no new patients. I simply went back and contacted every single patient that I had seen over the years who, for whatever reason, did not go ahead with treatment. And I did a better job of talking to them and educating them on the benefits of the treatment I had recommended.” Remember, it costs 5 times as much to bring in a new patient (customer), than it costs to re-educate and/or remotivate an existing one.
PROPERLY MAINTAINING PATIENT RECORDS: THE DAILY CHART AUDIT
One of the best ways to ensure you don’t lose patients in your charts is to maintain and handle patient records properly. When a patient leaves the dental office after an appointment, the average practice takes the patient’s records and places them into a general filing area without determining the chart’s status or implementing the follow-up action that may be necessary. As a result, almost every office in the world does what is called a yearly purge in an attempt to make sure as many files as possible are up to date and current. They start with A and pull every record. They get to E or F and then just run out of energy. The following year they try again, this time starting at XYZ. They work backward and may get to about P before they run out of energy again. A better solution is to do a 10-second audit on every chart before it is placed back in the general file. If your practice follows this simple procedure, then you will never have to complete another yearly audit.
I recommend performing a daily chart audit for several reasons. While the patient is walking to the car and you’ve got his or her chart in your hand, now is the time to make sure the patient has the next appointment scheduled and the records reflect what treatment or procedure was performed that day. The daily audit also helps ensure that you are not losing production or patients by filing charts away before the proper follow-up action has taken place. And of course, the biggest benefit is that it will eliminate yearly purges. Here’s how the procedure works. Mrs. Smith comes in for her appointment. Once Mrs. Smith leaves the practice for the day, her chart should be placed on a special shelf labeled “To Be Analyzed.” The shelf should have dividers from A to Z. Place Mrs. Smith’s chart under S. Several times during the day, your daily chart auditor will go up to the “To Be Analyzed” shelf and pull the charts to see if the following analysis has been completed:
(1) Clinical Concerns:
•Continuing care appointment made?
•Next appointment made for needed treatment (and noted in the patient’s records)?
•Follow-up treatment has been rendered (Endo/CAOH/post-op x-rays)?
(2) Insurance Concerns:
•Completed treatment needs to be submitted for insurance payment?
•Diagnosed treatment needs to be submitted for predetermination?
•Maximum benefit allowances have been reached? (Phase treatment.)
•Eligibility problem or question?
(3) Record-keeping Concerns:
•Written post-ops correct and agree with Tx plan? (Only doctor can change post-ops.)
•Medical history updated and medical alert stickers are correct?
•Consent forms are signed? (Especially for minor patients.)
•Insurance stickers are correct and updated?
•Attached notes handled and removed from plastic pocket?
•Changes of address, telephone numbers, etc, handled?
•Referral out to specialists?
Once the auditor gets familiar with it, this entire process should take no more than 10 seconds per chart. When the analysis has been completed and the appropriate concerns have been addressed, the file should be placed on the next shelf labeled “To Be Filed.” Now anyone can file it away without having to look at it again.
If the auditor finds the chart is still incomplete, it gets passed on to someone who will take care of the issue. Before moving your practice to the daily chart auditing system completely, you should perform one last total audit to clean up your files and retrieve all of the patients who are lost in your charts. If you would like a worksheet to help you conduct this final audit, visit my Web site: jdsg.com/auditchart.
At this point, it is appropriate to acknowledge those practices that have gone paperless. They are still very much in the minority, but the numbers are growing slowly. These practices will need to adjust the daily and total chart audit to accommodate their specific needs. The vast majority of readers of this material, however, are still handling patient charts and other paper records.
As you can see, losing patients in your chairs and your files can have a profound effect on your practice’s productivity and success. By proactively addressing these issues, you can build and maintain strong and positive relationships with your patients that will last a lifetime and have a huge fan club that will act as ambassadors in your community, helping you attract even more patients and fill more chairs.
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