Patients can be wary of supposed “upselling” tactics when they are faced with treatment plans, but there are ways to assuage their hesitation and ensure they get the care they need.
Many things can get in the way of treatment plan acceptance, including the perception that you are "upselling" patients. International speaker Mark Hyman, DDS, MAGD, shares his best suggestions for helping patients progress with treatment plans.
Dr Hyman says that if you don't know your patient and you don't know what they value, that is where misunderstandings occur. It would help if you discovered the patient's goals for their health, teeth, and smile. Otherwise, he says your solution could be seen by patients as upselling even though you consider it part of upholding your responsibility as a healthcare provider.
For example, people use the term upselling when patients think the treatment is unnecessary. Dr Hyman points out that if you do not have a relationship with your patient, it is challenging to offer an appropriate treatment plan for where the patient is in their life.
"When 'upselling' happens, it comes from misunderstanding and poor communication," Dr Hyman says.
He thinks asking patients what they want for their oral health and taking the time to listen to where they are in life regarding it has become something that many dentists are unfortunately in too big of a rush in their daily work to do.
"As a profession, we have hurt ourselves with the false idea that busy or faster is better," Dr Hyman says. "And sometimes it is, but often it's not. When you have misunderstandings, you're not getting 5-star reviews. You're not getting people paying with appreciation and referring their friends."
Tip #1: Enhance Communication with an Intraoral Camera
Photo documentation helps with the communication part of the equation. Dr Hyman had an IRIS Intraoral Camera (DigiDoc) in every operatory to enhance communication in his practice. No one in the practice would discuss treatment without first showing patients pictures.
Seeing it helps in many ways. First, Dr Hyman says the patient can see the problem, which allows patients have ownership in the diagnosis. Then, the dental team can discuss options with the patient that already accepts there is a problem. Dr Hyman says after showing patients a picture, he could tell if they didn't care or wanted to know their options.
Tip #2: Let Patient Consider Options
The philosophy Dr Hyman's practice used was to provide the appropriate care for the patient at this time in their life. Sometimes, he might buy the patient time to consider moving forward with more expensive treatments later by treating the problem with a "Band-Aid." However, this strategy has its problems, too.
For example, doing a provisional treatment to buy the patient time to think about moving forward with a more permanent treatment might mean the insurance won't cover any more work on the tooth with the temporary solution. As a result, a waiting period might ensue. Dr Hyman encourages dentists to explain this possibility to the patient when offering provisional treatment, so the patient decides with all the information. Otherwise, the patient could blame the dentist when the insurance denial occurs after the patient chooses to move forward.
Another scenario is that the provisional treatment doesn't work, which causes the original problem to worsen. It could be that a partial fracture a dentist fixed temporarily does not hold up. Now, instead of a crown and build-up on a tooth, the patient faces a surgical extraction and bone graft implant with a custom abutment. Again, the dentist should explain these risks up front to mitigate the misunderstandings that can occur.
"If we understand each other, then we can work comfortably together. The whole thing goes south when we haven't formed a relationship," Dr Hyman says. "For my team and I, we had a sensational level of case acceptance because we worked on patients who felt like friends because we had a relationship. We asked patients to make it crystal clear what their goals were for their teeth and smile, and then we gave them what they wanted."
Tip #3: Set Proper Expectations for Patients Regarding Annual Dental Expenses
Dentists could avoid some misunderstandings by setting proper expectations for patients, too. For example, someone whose generation did not have fluoride might need to hear that they can expect to spend $1500 per year on their teeth. Someone who grew up in an era that had fluoride might have less. Dr Hyman says being upfront about this possibility might help avoid some misunderstandings also.
"Sometimes I would say, 'do I have your permission to tell you what I see today, what changes are immediate, and what I anticipate in the next 3 to 10 years? Then, you can tell me how you want to get cared for,'" Dr Hyman says. "If you have the audacity to ask and listen, you will know what they want."
Tip #4: Avoid Letting Insurance Dictate What is Possible
Another contributing factor to misunderstandings is how dental insurance works. Dr Hyman says that insurance denials can make dentists feel foolish. He thinks that dentists and patients should not let insurance dictate the quality of care the individual seeks for their oral health.
"The insurance company, patient, and doctor have created a triangle that should not exist. The patient hired a dentist to care for them. If the goal is to keep the patient's teeth, why would they let insurance dictate the quality of care the dentist can offer?" Dr Hyman says. "I bet no one asked the patient when they were offered dental insurance what their goals were for their oral health, teeth, and smile. That's because insurance is a for-profit business transaction."
Moreover, dental insurers often reduce what they pay for services. Large dental insurance companies make a fee adjustment for the dentist's market and then remind dental practices that as many as 30% of their patients use their insurance company for their dental care. The implication to dental procedures is clear; take our adjusted (read: reduced) fee or lose a third of your patient base. Dentists feel they have no choice but to determine how to keep going with even less reimbursement from insurance.
However, Dr Hyman thinks dentists should not allow dental insurance companies to set their fees. Also, his practice had CareCredit as a financial partner that could help patients find a comfortable number within their budget that they could afford for treatment.
"I want dentists to let go of the limiting belief that they have to dance with the dental insurance companies, or they will lose a third of the practice," Dr Hyman says.
Tip #5: Delegate to Your Capable Team
Dr Hyman realizes that having these conversations about what patients can afford or encouraging patients to move forward with treatment even if they face 100% responsibility could be uncomfortable for some clinicians. However, the dentist can train someone on the team to have the conversation instead. For example, the practice's business or office manager might handle the conversation, or treatment coordinators can address these issues for patients.
"It doesn't mean the conversation won't happen, but it may not happen with the doctor," Dr Hyman says.
Tip #6: Invest in Training or Coaching for the Practice
Also, Dr Hyman says dentists can make it easier on themselves by investing in help from the outside.
He jokes that he bought a bankrupt practice in 1986 and then made it worse. So, in 1990, he started going to the Pankey Institute, followed by the Dawson Academy, and Spear Education over the next few years, which helped a lot.
Later, he moved to a new office with more operatories and hired Cathy Jameson, PhD, founder of Jameson Management and Marketing, to come in and help. The Jameson team implemented systems in the office to address these issues with new patient experiences, documentation, dealing with insurance, and working with patient financing companies. He says the changes were unbelievable for his career. The new processes fixed the chaos, and the practice was profitable.
"We increased $500,000 in 24 months working fewer days per month," Dr Hyman says. "She helped us dream some big dreams of our preferred future."
Tip #7: Trust the Systems
When you don't have predictable systems, excellent communication, and great equipment to facilitate patient education and care, the patients can tell, Dr Hyman says. However, getting the coaching and elements and a well-trained team keep moving you toward treatment plan acceptance.
Furthermore, getting more education all the time and exploring new techniques and approaches to cases means that dentists can present the patient all their options, Dr Hyman says. Making time for regular participation in the continuing education programs available should be part of the dental practice’s systems to keep the practice moving forward to the dentist’s goals. Having this systematic approach to additional training also makes more a more rewarding career, Dr Hyman explains.
"We have so many ideas in dentistry that are antiquated and limiting and create low self-esteem," Dr Hyman says. "When the systems are correct, you will not face the upsell accusation because you'll be offering patients the appropriate level of care they seek."
Popular practice management strategies can get in the way here, too. For example, many dental practices contact patients to remind them they have remaining benefits available before the end of the year. While reminding patients towards the end of the year to use their Flex accounts or remaining insurance benefits can be positive, it can also limit their acceptance of comprehensive, optimal care treatment, Dr Hyman says. Instead, he encourages dentists to work within their values and ethics, asking patients questions about their oral health goals and listening to the patient's answers. Those conversations are essential to have a fulfilling career.
"When there's crystal clear communication to the patient, everybody feels better about their actions. Patients feel they're getting the appropriate treatment, and the dentist knows they are doing the right thing for the patient," Dr Hyman explains. "Long-term successful, happy dentistry is based on excellent communication and relationships."