Ownership Suite: Treatment Planning for Lifetime Health
Ownership Suite: Concepts and Tools
(To the right you can download this as a pdf e-book)
Treatment Planning for Lifetime Health
Key Concepts: Patient Budgets and The Treatment Year
Objective
This document outlines a treatment planning method and supporting practice policy that results in optimal lifetime oral health outcomes for all patients.
Background
Dentists and hygienists are highly trained medical professionals. But trends in healthcare require us to add another topic to our repertoire: money. As medical treatment is increasingly made into a consumer transaction like any other, learning to talk with our patients about strategies to help necessary care fit into their budget is necessary to help them achieve optimal oral health outcomes.
Treatment Planning for Lifetime Health
Key Concept: Patient Budgets and The Treatment Year
Consequences: The 40% Conundrum
We see dentistry through a medical practitioner’s lens. What seems like a simple, rational fact to us is not to our patients. When they hear that they need treatment they can’t afford, and we don’t step up to stabilize the situation affordably, many patients take that as a cue to wait until pain forces them to value treatment in the clearest way possible. This flips them from a long-term mindset to a short-term one, and an overall loss of their perceived subjective value of dentistry, according to the ADA.
Many take it as a cue to forget about proactive dental care altogether. In fact, the ADA has noted, with alarm, that some 40% of insured patients do not go to the dentist. Our misunderstanding the importance of affordability, and hesitating to follow the evolving demands of the dental marketplace have resulted in a reversal of earlier positive trends in oral health outcomes and patient interest in prevention.
Demonstrating Value By Acknowledging Cost
As we can see, improving patients’ perceptions of the value of dentistry is a now a crucial task to be undertaken, and it falls on clinicians and their individual practices.
Luckily, the path forward is clear. By addressing affordability and explaining treatment needs within this context, the patient-consumer is brought back in line with the true value of dentistry which, after all, is apparent only when they accept and receive needed care.
The Treatment Year
The key to helping patients get the care they need is in doing some work in helping them afford it. With insured patients, their coverage is a given budget each year that they feel they have already earned and paid for, and are eager to use it to fulfill treatment needs. Beyond this amount, they are forced to consider factors beyond their oral health, and to make judgements about what they want to spend based on what they can afford and what they believe is valuable.
Coverage Limits Start the Conversation
Where some providers see insurance coverage limits as a creating a limit or barrier to what care is possible, this perception is faulty. In fact, this amount should be seen as the dollar figure we have to work with, and provides us with a structure to work within to discuss diagnosis in terms which treatments can be completed now versus later.
What the patient is covered for is a courteous and objective starting point for what would otherwise be a difficult conversation.
The Affordable Dentistry Toolbox
This practice believes that dental care should be affordable, and has policies in place to make this possible including:
- discounting or writing off out-of-pocket fees
- discounts for bundling same-day procedures
- flexible fees
- guarantees that we will stabilize all diagnosed areas until they can afford permanent restorations
These, within the context of their coverage and ability and willingness to pay any out-of-pocket fees, are the tools in your treatment planning toolbox. By using these tools to solve the affordability problem creatively, we ensure that patients get the treatment they need.
In doing so, we communicate unambiguously that our priorities are in doing what is best for them. This is the right thing to do, and it is the most certain way to build patient loyalty and prove that we are worthy of referrals.
Patient Perspectives
Patients are not dental experts. Their perceptions are different from ours. Meeting their frame of understanding helps them feel respected, empowered, and oriented within the decision-making process. These build confidence in their knowledge as a dental consumer, trust in you as a practitioner, us as a practice, and supply a positive experience of getting something out of dentistry that they understand and value. All of these outcomes help to make them a lifelong partner in their treatment.
Money is the gravity of consumer physics. We are letting them know we live in the same universe with them when we put the topic on the table. Once they feel comfortable with the financial aspects of proposed treatment, they will open up when asked about their concerns and fears about pain, inconvenience, and having to make decisions they don’t understand. Only when money has been addressed with each patient can we talk to them meaningfully about treatment.
Talking About Money to Get to What Matters
When present treatment, we are asking the patient to make judgements about what they want to spend based on what they can afford and what they believe is valuable.
By starting with money, we move their decision-making process into the rational zone and away from their emotions and fears.
Once the financial comfort zone is established, what they believe is valuable comes down to whether or not the money, time, and discomfort they are concerned with will result in the completion of all necessary treatment.
The Treatment Presentation Algorithm
Once you have made your diagnosis, present prescribed treatments within the context of what they can afford. To do this, you will need to know the patient’s coverage limit going in to the conversation.
Look at the budget. If their coverage limit will not pay for all of the major restorative, do not present an all-or-nothing treatment plan. Instead, look at the diagnosis, look at the budget for this treatment year, and make the money work.
If they came in with an active concern, look at taking care of that first. Then look at the urgent major restorative they can afford. Then, using the tools in your affordability toolbox, make the money work. Mentally assemble a treatment plan that handles their urgent needs and major restorative first, and stabilizes everything else to the degree that they can afford. Visualize a few options to prepare for what they will tell your their ability and willingness is to pay out-of-pocket.
Think: What must be done ASAP, what can be done this treatment year, and what can be stabilized until permanent treatment in the next treatment year?
Minor and Temporary Procedures and Patient Value
When we’re looking at making the money work, we will inevitably have to perform minor and temporary treatments.
Patients don’t have the training to fully appreciate that your crown prep, which took 90% of the visit, is 5 times harder than the four small procedures you did while they were already anesthetized. All they understand is that you did more in a visit than they expected, and they have completed a significant portion of their needed care.
When we bundle small procedures, we use their time and money more impactfully. Instead of thinking “Ugh, they took and hour for one tooth,” they will leave your chair saying “They did five teeth and I was only here an hour!”
Getting to “Wow!” means you did something right.
Bundling Quadrants and Sides: The Secret Weapon Against Fear and Resistance
When assembling this plan, think also in terms of the efficiencies that come from same-day treatment. This not only allows us to provide pricing flexibility, but it maximizes patient comfort and it’s a mutual scheduling convenience.
For some people, time is their strongest barrier. To them, offering this convenience can be even more attractive than offering a discount.
Further, those with fear of needles and pain will not want to be injected and prepped more than absolutely necessary. It may not be immediately apparent, but some people’s preference for “just getting it over with” comes down to their self-defined threshold for coping with their discomfort towards needles, drills, or other aspects of treatment. Bundling is exactly what these patients want.
Bundling Quadrants and Sides: Continued
Even for patients who prefer to have absolute minimum time-in-chair, bundling treatment is a win-win. For these patients, the amount of time necessary to complete minor and temporary restorative is negligible when added to the time required for anesthetic and prep on major restorative. An extra five to ten minutes to finish four more teeth while you have them prepped for another procedure will most likely be attractive even to those with this preference, after all, it saves the rest of the time a separate visit requires, and it allows the patient to achieve significant and memorable progress toward completing their necessary treatment.
A Completed Quadrant is Medically and Psychologically Significant
So parse what needs to be done in terms of quadrants or even sides of the mouth. A completed quadrant or full side means that they don’t need to worry about a significant portion of their mouth. You have demonstrated value at this point. They have seen before and after pictures, and can feel with their tongue and with their bite that everything is taken care of and better than before.
Patients are happiest to undergo treatment that they believe makes progress toward a 100% clean bill of health. We need to facilitate that goal. We do that best when we use their time and money to make progress they understand as significant.
The Presentation Conversation
Once you’ve mentally prepared your treatment plan with a few variations, present the full plan and cost. Ask how it sounds to them and gauge their reaction.
Go through the conversation with everything you know and with full awareness of the Four Fears and their implications.
By connecting your understanding of their fear, needs, and expectations to your clinical expertise, you are removing the barriers that prevent patients from getting the care they need.