If you feel uneasy fees with patients,
you're not alone. It's often downright uncomfortable to broach the
subject. Sometimes team members even sound apologetic when
discussing office fees. Likewise, patients feel discomfort in
questioning the fee and discussing payment of the fee.
This has been a challenge since
early-recorded time. More than once the bible refers to "filthy
lucre" in relation to payment for what might be given willingly ...
the idea being that exchange of money may contaminate a
relationship. This is certainly controversial in healthcare, yet the
impact has colored relationships between patients and practitioners
throughout history. This may partially explain why patients feel
more comfortable discussing fees with staff members than with the
doctor. Patients do understand that healthcare is a business. They
don't expect clinicians to be so altruistic as to operate at a loss!
And they want their doctors to be successful. But they also want the
doctor-patient relationship to remain "pure" and unsullied in
relation to money matters.
Patient preference for this
approach to financial matters is affirmed to us often in our focus
groups. As one patient put it, "I don't want the doctor talking to
me about money. I want the doctor to put all effort into my
condition and treatment and leave the business matters to the office
business people." We hear this verbalized repeatedly. The preference
may be not just a matter of the doctor focusing on the clinical, but
patient reference to keep that relationship pure.
When it comes to financial
discussions, the doctor is wise to maintain a healthy distance.
Therefore it is crucial that the dental team include a highly
competent financial person. This person must be able to both balance
the books and balance relationships ... being professional and
empathic to encourage patients confidence in discussing fees. This
frees the practitioner from the worldly matters of money to focus on
treatment.
Some may argue it's time for
this paradigm to shift to the practitioner taking more
responsibility in financial discussions. Some doctors do handle this
function. Matters of insurance an HMOs may also require doctor
involvement in patient discussion. However, the practitioner who
does discuss fees could be creating discomfort for certain patients
and must be sensitive to patients in these discussions. Because the
doctor is comfortable does not necessaril y mean the patient is!
If the patient DOES ask the
doctor about fees, the doctor must be prepared for a response. The
ideal response is, "Nancy (the financial person) totally understands
the treatment. She's going to discuss with you your investment for
the treatment and will be able to answer all your questions about
this."
THE UNSPOKEN QUESTION:
"How expensive is this going to be?"
A significant number of new patients and patients of
record ponder this question as you present a treatment plan to them.
They may feel awkward about asking the question, but you can bet
they're concerned. In focus groups we conduct, the issue of fees and
fee increases inevitably incurs heated discussion. Everybody has an
opinion and is eager to put voice to these thoughts. When it comes
to the "money issue", we have found that patients fall in 3 camps:
1. New patients or prospective
patients who may be suspicious of the dental team they don't yet
know
2.
Patients of record who have had some type of unsettling experiences
with their present dental practice
3. Patients of record who are
highly pleased with their practice and are truly practice advocates
Here are some of the concerns
expressed by each of these groups:
1. THE
NEW OR PROSPECTIVE PATIENT
They want to
know:
-
You will not overtreat
them
-
You will be fair with them in
clinical and financial matters
-
You will discuss financial
matters openly and honestly ... and in private!
-
You will provide more than one
means of payment option to enable them to accept treatment
They are often concerned that
you'll pitch an elaborate treatment plan that they may not need and
couldn't afford. They want to know your office is going to be fair
in treatment, fees and payments. You won't get a lot of questions
from them but they will be sizing you up. It is here where staff
members play a significant role instilling confidence in the
clinical skills of the practitioners. Auxiliary team members have a
great deal of credibility with patients.
2.
PATIENTS OF RECORD WHO HAVE HAD QUESTIONABLE EXPERIENCES WITH THE
PRACTICE
What is "questionable" to the patient
may not be so termed by the practice. Anytime a patient's faith has
been shaken it can have an impact on perception of value received in
the practice. If a patient is disgruntled you may not even know
about it. However, the next time you discuss treatment or fees, the
negative memory will rumble in the belly of this patient. These are
the ones that are "at risk" of leaving the practice.
They want to know:
* You are
not going to pressure them, but will provide them with the time and
information to make an informed decision - partnering with this
patient is crucial to treatment acceptance
* That your fees are
fair and substantiated - you must educate these patients well
3.
SATISFIED PATIENTS OF RECORD
The easiest group
to deal with is also the one that is most easily ignored. Be sure
you maintain the level of communication with them that has kept them
in your practice.
They want to know:
-
You will be equitable on a
consistent basis.
-
You will not take them for
granted, but will continue to address fees and treatment in a
comprehensive manner.
THE
COST OF FEE INCREASES
No patients want you to
raise fees. No patients will be pleased when you do. And don't think
they won't notice significant fee increases. They will. It might not
be noticed immediately, but if a sizable increase shows up on each
successive statement, you can bet eyebrows will rise. This is a
challenging time in healthcare and patients are consumers. Their
loyalty is easily tested.
Patients have to feel that a fee
increase is justified. That justification must be patient-worthy and
reasonable. It is understandable that fees must rise in relation to
the general cost of living. Dr. Hugh Doherty is a financial
consultant who works with practices nationally to develop a healthy
bottom line. He helps practices maintain financial control while
providing quality dentistry to patients. Dr. Doherty stresses good
communication between the financial person and the patient. "The 3
key terms that should be emphasized to patients are: affordable,
reasonable and fair. If patients
question fees, they need to be
told that the most patients in the practice feel that the fees are
affordable, reasonable and fair." He advises that this should be
closely tied to the quality of dentistry provided by the office. If
pressed by the patient, the staff person may respond that the
practice must make adjustments based on the cost of living, and that
they strive to keep fees as low as possible so patients can accept
the dentistry they need.
Patients also understand fee
increases when periodic requirements like heightened infection
control procedures are necessary. They appreciate when you purchase
new equipment that positively influences their experiences in your
office by decreasing pain, improving diagnosis and/or improving
insurance coverage. But they do need to have these advancements
explained to them, if only briefly. It's when they either can't
justify increases, or the increases are perceived as unnecessary
that the red flags go up.
Here are a few of the red flags
patients have talked about. These can lead patients to questioning
treatment fees. Before you raise your fees be careful about the
following:
-
Fee increases that fall on the
heels of office remodeling or office relocation
-
New extravagant collateral
materials and/or an increase in promotional mailings to
patients
-
Expensive or ostentatious jewelry on
doctor
-
A
marketing campaign that requests referrals from patients of record
and is conducted at the same time as a fee
increase
occurs
-
Highly visible advertising campaign
When you prepare to make
significant fee increases, you may stand to lose some patients. If a
patient has had some type of
dissatisfaction in the practice, the
fee increase may be a pivotal factor in the patient's departure.
There's no question that the issue of managed care feeds this issue.
Because of this, excellent customer service is crucial. If the
patient can't see or feel a difference between your office and
another office that is less expensive, many will question the sense
of staying with you. Every staff member must maintain the highest
level of service possible with each patient. This establishes a
rock-solid foundation for the times when you increase your fees.
TIPS TO INSTILL CONFIDENCE IN YOUR
FEES
-
Educate patients on a
consistent basis. This influences perceptions of
value.
-
Ensure privacy for any
financial discussions. Patients intensely dislike and will avoid
discussion of finances in
earshot of others. A separate
consultation area is far more effective than a busy front desk
area.
-
Offer a written treatment plan
with fee disclosure. Itemize and date it.
-
Encourage patient questions
about proposed treatment, fees, payment options. Privacy, poise
and empathy go a long way to
getting the patient to open
up.
-
Provide an itemized statement
with each appointment. If patients leave and don't know what they
paid for, it's more
difficult to place value on the
treatment.
-
If you provide a complimentary
exam or treatment, provide a statement with the regular fee
listed. Cross off the fee and write "N/C" (no charge) on it. Be
sure the patient understands the value of what was
provided.
-
Dependent on the condition,
offer alternative treatments and address the fees. Discussion of
the pros and cons instills a sense of caring and partnering
between patient and practitioner.
-
Provide information in print
about your payment options. Ensure that each new patient knows you
offer a variety of
payment methods to enable them to accept
treatment needed. Patients want to know you recognize possible
financial
challenges in accepting treatment.
-
Address issues related to
"usual, customary and reasonable" directly. Ensure that all
patients who have insurance understand your approach to UCR before
any misunderstandings can occur.
-
Don't joke about money matters
with patients. Regardless of flippant remarks patients may make
about money, they're
serious about it. They won't appreciate
humor at their expense ... literally and figuratively speaking!
RANTS AND RAVES FROM THE PATIENT'S PERSPECTIVE
-
"I overheard 2 staff members
in the next room discussing a patient's fee and whether that
patient could afford the
treatment or not. I was horrified that
they might talk about my finances in earshot of other
patients."
-
"I like this doctor's brochure
because I can read his payment and insurance policies before I go
there - I think the guy's
up-front and honest."
-
"She had a written list of the different ways that I
could pay for the procedure. It gave me something I could take
home and think about."
"I liked the 5% discount I got for
paying in full. I thought that was very fair."
-
"I
know the doctor does some pro bono work for a local agency. I
respect that and it increases my trust in
her."
-
"She [the business manager] told me ahead of time
that I'd be working with her on the treatment schedule and the
payments.
-
It
took some of the pressure off me when I was listening to the
doctor talk about my condition. I felt confident I could ask her
the questions I didn't want to ask the
doctor."
-
"The doctor told me 'Betty' would be able to discuss
their new payment option with me, but Betty didn't know what
the
doctor was talking about. I was embarassed for her and
didn't think they were very professional."
-
"Everybody in the waiting room could hear us discuss
my late payments. I finally told her I'd call her on the phone to
talk about it. I didn't want the world to know!"
