Greg Winteregg, Dental Consultant - Case Management: 7 Steps to Comprehensive Case Acceptance - The MGE BlogIn this series of posts, I’m going to talk to you about case management and case acceptance. We dentists are an interesting breed.  Mechanically inclined, we are actually “engineers of the mouth.”  We have a tendency towards marked regimentation in our procedures, and once we figure something out we don’t like change.

If I had to pick a subject that the majority of us have difficulty with, I’d say it’s getting patients to accept dentistry they need.  When we hit resistance, we often acquiesce and compromise our treatment plans to fit within the “insurance allowance,” in an attempt to avoid patient upsets and at least do some dentistry.  Unfortunately, this attempt at conciliation potentially creates a perception with our patients that the initial diagnosis wasn’t really needed or even necessary!  Lack of a set system which smoothly progresses from diagnosis, to presentation (and acceptance) can not only be frustrating, but also costly and in some cases…embarrassing.

Lost in the exasperation of doing “only what insurance covers” and the resultant drop in professional satisfaction and practice revenues is what really matters: ineffective case presentations leads to patients receiving “phased” or less than ideal treatment.  What suffers most in this scenario is your patient’s dental health.

The remedy? I recommend a seven-step approach to case acceptance.  Will it work every time?  Absolutely not. But if you develop this approach and adapt it to your style and personality, you’ll most likely succeed more often than not.

Keep in mind as you read this: you are the one who is going to have to apply it in your office, not me. So, do it in a way that works for you.  Experiment a bit and adapt it as needed, but I’d recommend that you don’t skip any steps. And with that, let’s start with step one:

STEP 1: Perform a comprehensive exam.

Case Management: 7 Steps to Comprehensive Case Acceptance - The MGE BlogDo an exam that you are happy with.  It must be complete in order to provide the information you’ll need to create their treatment plan.  During the exam, I used to avoid most dental terms (e.g. “crown,” “root canal,” “extraction,” etc.).  I used a series of abbreviations with my dental assistant.  I found that throwing various dental terms around could either a) scare a patient away or b) confuse the patient (e.g. buccal, distal, etc.).

The other factor to consider is that you have no idea if a patient has a negative experience or concept of “crowns,” “root canals,” or “extractions.”  In some cases just hearing the term can be enough to prevent them from coming back for treatment or even a consultation.  So I developed a simple code of abbreviations for my office for each dental term e.g. ‘cr’ for crown, “ext” for extraction etc.  I also prepared my patients for this prior to the exam, e.g. “Jenny and I are going to use abbreviations for what I find today to help make the exam go more quickly.  I will explain everything to you and give you your options and how much it will cost before I do any treatment.”  Now you ABC, XYZ, 123 your way around their mouth.  When you’re done, you haven’t “triggered” anything with a specific term.  They don’t know what they need, but they do know you’ll be explaining it afterwards.

At some point (preferably early on) in the exam ask every patient:

“Do you want to keep your teeth?”

Why? Well, this serves up an immediate indication of this particular patient’s attitude towards restoring their teeth.  Their answer of “absolutely”, “just the front ones” or “I just want them all pulled” provides a window of insight as to what you are facing when it comes time to present treatment.

Initially, when I began asking my patients this question I assumed that one third or less would unequivocally state “Yes! I want to keep my teeth!”  I resigned myself to having to roll up my sleeves and work hard to convince the other two-thirds to make their dental health a priority. To my surprise, roughly three-fourths of my patients came back with some version of a “yes” answer.  And it was an excellent foundation on which to build comprehensive case acceptance and case management.

STEP 2: Be sure you have enough time to do the case presentation before you start.

Case Management: 7 Steps to Comprehensive Case Acceptance - The MGE BlogIdeally, we could do an exam, diagnose, treatment plan, present, arrange payment and start treatment all in the same day.  And this will happen on occasion but for most this is the exception rather than the rule.  Often patients have to come back for a consult/case presentation. This might be in conjunction with a prophy, or other minor or routine procedure, or it might be a consult on its own.

Note: currently, you might be doing all of this in one visit for every case, but not having a lot of success as a result…keep reading.

During the exam you should also be evaluating the patient’s attitude towards dentistry. For example, if a patient doesn’t view dentistry as a priority or is inordinately nervous/anxious, you’ll know immediately that their consult appointment will take longer than usual.  It’s similar to treating a nervous/anxious patient.  You’ll normally schedule more time, allowing for more time to explain, breaks, etc.  It will definitely take longer to “close” the scared or anxious patient on their treatment plan than a patient who is comfortable with the dentist and dental treatment.

The other factor to consider is how large the case will be.  The larger the case the longer it will take to enlighten the patient on their individual treatment plan.

So with this logic, a large case on a scared patient who is not particularly excited  about keeping their teeth will take longer to present than a routine procedure on a more relaxed patient who absolutely wants to keep their teeth.  Schedule the consult accordingly.  You will be making your best guess, but it’s akin to leaving more time in the schedule for a molar endo than a bicuspid.  It’s an estimation of the difficulty factor as it translates into time.

For small procedures (i.e. a couple of fillings, etc.) the exam, treatment plan, presentation, finance and scheduling would normally be handled the same day. You could also apply this concept with a patient who views dentistry as a priority and also has a not-too-large treatment plan. In either of these cases, you won’t really need a consult appointment.

And let’s hit on this for a minute. Consults are normally reserved for “large treatment plans,” i.e. ten-thousand dollar plus cases. So what happens with all of the routine “bread and butter” dentistry?  Normally, the doctor tries to present it in five minutes at the end of the new patient exam (or recall appointment as applicable) or leaves it to the front desk to do it. Result: poor acceptance.

I don’t really agree with this approach. I also don’t agree with scheduling a consult for two occlusal composites. We’re looking for a happy medium here.

First off, I’d build time into the schedule to present treatment. If you’re looking for a place to start, begin by allocating the first half hour to forty minutes in the morning and the first half hour after lunch to present treatment.  Why first thing in the morning? Well, you’re undistracted – not in the middle of any patients yet. And as an added bonus, if you’re productive morning procedure cancels or fails, you could present, get acceptance and START their treatment that day (if the patient has time)!

I’d suggest first thing after lunch in a similar vein.  Even if you run through lunch, you can grab a quick sandwich and then do your consult distraction-free.

WHAT you put into these consult time slots is up to you. In forty minutes (or an hour if you’d like) you could easily present routine cases – i.e. two implants, a four unit bridge, three inlays or crowns, etc. They’re not HUGE treatment plans, but present a couple these a day and you’ll have plenty of production on your schedule and healthier patients.

Which brings us to the most important rule in all of this:

DON’T START A CASE PRESENTATION YOU DON’T HAVE TIME TO FINISH OR “CLOSE.”

Case Management: 7 Steps to Comprehensive Case Acceptance - The MGE BlogThis right away explains the failure behind most of these “five minute” comprehensive case presentations at the end of an exam.  You know, you tell a patient what they need and run to the next patient.  You ask the Front Desk about this later and find out the patient is “going to think about it.”  The patient is then added to the “incomplete treatment list,” which as we all know is about as useless as a glass hammer when it comes to filling the schedule.

Here’s the problem: if you don’t have time to finish the presentation, answer questions, etc. you leave the patient in a perfect position to blow the office off. I’ve found it actually lowers overall office case acceptance.

So, keep if simple.  If you have time to present today (and the patient does as well), go right ahead! Keep the rules in mind of how much time you need (i.e. patient attitude and size of case) in mind as you do this.

If you don’t (or patient doesn’t) have time, then bring them back during one of your preblocked consult spots.

And the last thing about this: do it FAST. The longer you make a patient wait, the greater chance you have of them not showing up. Ideally, they can come back tomorrow or the day after at the latest.

And that’s all the time we have for this issue. In our next issue, we’ll touch on the last five steps – beginning with Step 3 – Present the optimum treatment plan. 

And if you really want to become a PRO on the subject of case presentations, I’d suggest MGE’s Communication and Sales Seminars! Give us a call at (800) 640-1140 for more information.

Click Here to Continue with Part Two!

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