Monday, January 14, 2013

Discounted Dentistry

A few months ago, I read an article in a Canadian dental journal (which I am unable to trace back) about offering discounted dentistry and how to do it tastefully if one decides to do so. This article convinced me to write my own opinion about the subject, as it has always been in my mind to do so. During the past few years of practicing dentistry outside of academia, I’ve been encountering a lot of “discounted dentistry,” which I find questionable and a bit insulting, to be completely honest.

Dentists all over the U.S. give out all sorts of discounted services to their patients in good faith to try and make it more affordable for them. It is a very nice gesture and I completely understand the motive behind it, which seems to be beneficial to both parties. However, I am challenging myself to prove otherwise by discussing a multitude of issues that arise out of discounted dentistry.

We’ve all seen signs along the side of freeways and behind office windows advertising $600 implants and $400 crowns. I admire the dentists who can make this promise, keep it, and pull through without compromising their office’s financial stability or the quality of service delivered. I’m sure that if it is advertised, it is being done somewhere by a super dentist. But I would argue that it is very difficult, if not impossible, to make this work in a private practice. With an average of 60-65% overhead and the time required to complete these services, if you run a quick calculation in your mind, you will see where the difficulty arises. To get around this, one might cut down the time dramatically and consider using less than ideal materials. This, to me, borders on ethical issues related to standard of care and such. As a patient advocate, this does not sit well with me. I would be very careful in evaluating these offers before implementing.

Another scenario we all deal with on a daily basis is patients bargaining. They ask for discounts and most dentists are too kind to refuse. I live in a family of medical practitioners and have never heard a dinner table conversation about a patient bargaining for treatment from a medical doctor. Why is it that this is so prevalent in dentistry? Why does the public think that we are salesmen with overpriced good, but their primary care physician is trusted 100 percent?

A conversation about money with a medical doctor is almost considered rude. As a healthcare provider, I assume the ethical responsibility to provide my services to every patient at a fair compensation rate. If I truly believe that is being implemented in my practice, I would have no reason to discuss discounted rates with anyone. I would be happy to accommodate patient financial issues through proper treatment planning and payment options, but never by discounting and devaluing my services. If this is done universally among dentists, maybe this culture could change for us. Maybe the public could learn to respect and value dental services just as much as any other medical service provided by the medical society.

The article I read discussed a very common situation which I had never analyzed myself. I thought it was very interesting and worthy of spreading. Many dentists offer a senior discount, often without hesitation. We all take pride in extending a helping hand to our elders and it really is our responsibility to take care of those who took care of us. Understanding their needs, however, is the essential step in being able to provide the proper assistance that actually benefits them. One third of the total wealth of this country is owned by its senior citizens. This is disproportionately high. So if you really think about it, what our senior citizens have in their hands is a lot of money and a lot of free time. This makes them the ideal patients to practice ideal dentistry on! This is what every dentist dreams of and yet we discount our opportunities and their abilities by assuming their financial difficulties and pinning an uneducated prejudgment on them. It iss not ethical and it is not fair to you or your patient.

Now, by no means am I suggesting that the senior discount should be eliminated. There are many seniors who are in need of dental services and truly cannot afford them. What I am suggesting is get to know your patient and their true needs before you make a decision on how you can assist them. Not all seniors are in need of financial assistance. The 10 percent you take off in one place could mean nothing to someone and mean a whole lot to another; disperse it the proper way.

I also have a problem with the advertising of free dental services. Too many offices bring in patients by advertising for free exams and radiographs or other services. I cannot say it doesn’t work, but it is very interesting that, despite the large number of patients they collect, many still suffer financially. I attribute that to two causes. First, a practice offers a free service in hopes that the patient will move forward and pay for other parts of treatment. Once they receive the free service, chances are that they will not continue with other parts of the treatment.

Second, advertising a free service is a note to the consumer that you can afford to do the service for free. We all know we can’t afford that. It creates an expectation for free services going forward. Or, it implies that you plan to make up for the cost with an overcharge on another part of the treatment; this is an introduction for mistrust and triggers the patient to enter the negotiating phase once the rest of the treatment plan is presented. The key is not just to bring in as many patients as you can with free offers, but to retain and engage each and every patient within your practice.

And lastly, we need to pay attention to the fact that a discount extended to patients has to be extended uniformly and not selectively. If you promise to provide a free service for your patients, you have to honor it regardless of if they pay you with cash or insurance. It is illegal to charge the insurance for a service you have advertised for free. You have to extend the discount to the insurance company just as you would to your cash patients. So next time you decide to offer free services, keep this very important issue in mind.

There are a multitude of other issues and counter-arguments to this subject and I respect all of them fully. However the points brought up here are things I have been thinking about as I start a new practice. I believe in it but that doesn’t mean I’m right. As most business decisions go, there is most likely no right or wrong answer. What matters is how well you implement what you believe is the best for you and your patients.

I am looking forward to a day when healthcare is fully accessible to all and we can provide the ideal treatment for every patient, every time. Until then, let’s choose our battles carefully and ethically.

Mona Goodarzi, DDS


MikeDiggity said...

I think one big reason why people aren't concerned with discounts on interactions they have with physicians is because of insurance differences. Patients don't usually pay in proportion to what the treatment cost is, so they have no incentive to even know what charges are being made for services. With dentistry on the other hand, we inform patients of what treatments cost and ask them to make an informed decision.

Jon said...

Thanks for writing your post! Welcome aboard!
Dr Jon Hardinger
Communications council

Mona Goodarzi, DDS said...

well said. not only i agree with you but i also agree with the way insurances are set up. i much rather have my heart surgery or my ear infection treatment fully covered by insurance than the 2 fillings i need on my molars due to decay!
However what bothers me is that, for example, a routine oral cancer screening is just as important to me as a pap smear is and women get pap smears religiously with or without insurance and not nearly enough people ask for oral cancer screenings. Sadly, this was especially true prior to the whole Michael Douglas and Dr. Oz speaking about it.
To me this is a failure on our part, as Oral Health providers, for not creating enough value for the service. And this is the point i was trying to get across. We need to make patients understand the value of our services and with that patients will become more trusting of our treatment suggestions.
How many times have you heard a dentist say something along the lines of "my patient is wearing a rolex but can't pay for an srp!" there is a problem there. your accessories shouldn't be better than your health! Allowing patient to make informed decisions is absolutely critical but creating the trust for them to actually follow through with the treatment they NEED is a different story.
Thank you for reading and commenting and i hope this makes it a bit more clear than my original posting. -mona

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