Wednesday, May 22, 2013

Meet & Greet

In my first blog of this series, I demonstrated how converting your routine radiographic series in the hygiene department from four bitewings to seven bitewings generates a minimum of an additional $24,000 a year while better serving the patient through more comprehensive diagnostics. Every such suggestion I will present should have such a mutually beneficial aspect; good for the patient and good for the practice.

To continue this series, let us go back to the beginning—the new patient experience. The first thing to consider is the form that this experience takes. Depending on your practice philosophy, the patient’s first visit may be on the doctor’s or the hygienist’s schedule or, in some cases, both. Is it a 15-minute nuisance on your schedule, or is it a 3-hour marathon? We would like to believe that any new patient is a good patient. However, it is very common for the no-show percentage for new patients to range from 10 to 30%. That has a dramatic impact on the doctor’s production and can greatly affect the practice’s bottom line if time was set aside on both the doctor and hygienist’s schedules.

Time is money and you can never have enough of either. How can we try to minimize the lost time associated with a new patient no-show? The first step is to categorize the new patients into one of two groups: those who come via direct referrals and those who come from some form of advertising. These are two very different types of new patients, and they should be treated very differently. We have found that a productive new patient visit occupies 1 to 1-1/2 hours of doctor time on the schedule. This allows adequate time for rapport-building, data collection, and preliminary patient education.

I suggest that you go ahead and commit that 1 to 1-1/2 hour slot on your schedule to patients that come to you via direct referral from one of your wonderful patients. These potential patients have some level of investment in your practice, as they were told by their friend, family member, or colleague, that they should trust you with their care. It is very rare for these patients not to show up.

On the other side are those patients who come through some form of advertising, whether it is online, newspaper, signage, direct mail, or even a dental insurer’s list of providers. These patients invariably have little to no personal investment in the practice and have the highest no-show rate of any other category of patient. When that patient does not show up for their appointment, that is 1 to 1-1/2 hours of time lost forever; even more if they were scheduled on the hygienists’ schedule also.

A number of years ago, I came up with an alternative method by which to bring these “un-invested” new patients into the practice: the “complimentary consultation.” When a patient calls the office for the first time and identifies themself as a new patient, the first question from any staff member should be “Oh, that’s wonderful. How did you hear about our office?” The answer to that question now dictates the rest of the conversation and how that patient will be scheduled for their first visit. The patient who just found you is scheduled for a complimentary consultation.

“Jane, we are so happy you have chosen us. Let me explain to you how we will schedule your first visit. We like for you to come in for a complimentary consultation. We want you to decide if we are the practice for you by coming and taking a tour, speaking with our staff, and meeting the doctor for a few minutes. See if our location is convenient for you and if you enjoy what we have to offer. We don’t want you to come see us, invest your time and money in x-rays and an exam and then feel obligated to come back. We want to earn your return trip and loyalty. This visit is completely complimentary and has no obligation associated with it. How does Tuesday at 9 work for you?”

You have now put this appointment in a positive light for the patient. They know you are going to put forth your best effort to earn their return trip and that they can come without the pressure of having to return just because you have their records. They usually appreciate this. What does that do for the practice, though? This introductory appointment is put in the doctor’s secondary time and does not take away from his/her prime production time. While it would be disappointing if this patient does not show, it does not impact production or overhead. The financial implication to the practice takes two forms: the decrease in overhead loss due to new patient no-shows and the time savings of their return trip.

Let’s look at this in detail. Plug your own numbers into the formulae below to see the direct impact in your own practice.

1. Overhead saved by decreasing new patient no-shows.
Let us assume you currently average four potential patients a month that don’t show up, or an average of one per week. Let us also assume that, to meet your financial obligations, you have to produce $250 per hour.

4 (current number of new patient no-shows per month)
x $250 (hourly overhead)
x 1.5 (time, in hours, of new patient visit)
x 12 (months in a year)
= $18,000 saved from open chair time

A side benefit of this complimentary consultation is that there is a good chance that you will win this patient over and they may well be interested in allowing you to take your records during this visit. This means is you may save a significant amount of time when they return for their comprehensive examination, having taken your records and built your rapport during that first visit; all on your secondary time.

2. Overhead saved by shortening comprehensive examination visit.
Assume overhead per hour is $250 and you have 10 new patients per month that enter the practice without direct referral and thus receive the complimentary consultation. Finally, let us assume for this calculation that you save 30 minutes on the comprehensive exam visit.

10 (patients per month who had records taken already)
x $250 (hourly overhead)
x 0.5 hr (time saved)
x 12 (months in a year)
= $15,000 overhead saved by taking records during complimentary visit

So, in this conservative example, you have saved $33,000 in chair time overhead by minimizing non-invested new patient no-shows and streamlining your comprehensive examination. Extrapolated over the typical 35-year dental career, you will save $1,155,000 in overhead. This is a very conservative estimate and does not take into account the change in your hourly overhead over the years.

These are the first of a series of suggestions I will make over the coming months. Now that we have established the protocol for patients’ entry into the practice, we will walk through the new patient examination and review the hidden dentistry you might find. Until then, remember to open your eyes to the possibilities.

Christopher J. Perry MS, DMD, FAGD


Anonymous said...

Interesting suggestion, but most patients request that they have their exam and cleaning upon their first appointment, they do not want to waste their time on a tour and have to come back for another hygiene visit, for which an appointment may not be available right away. How do you deal with that?

Anonymous said...

I agree with the above. New patients generally request a CLEANING at their first visit.

Dr. Chris Perry said...

Dear Anonymous (s). You are getting to the crux of the situation and the difficulty of my suggestion. This is, of course, not for every office. But at the risk of sounding cliche, let me suggest that a: who is the doctor? Who determines how you run your practice? Who determines what type of "cleaning" the patient needs? and b: patients that don't appreciate the opportunity to get to know their health care provider, at no cost, and no obligation, likely are not going to appreciate the level of care that you provide.
As I mentioned, this is a weeding out process for us, as much as it is an opportunity for the patient to get to know us in a relaxed fashion. If someone calls the practice from an advertisement or signage, they have no investment in the office and their no show rate can be quite high. If that patient was scheduled with the hygienist and the doctor, that is significant lost production and expensive overhead.
Growing a fee-for-service practice is hard. It requires a lot of dialogue and value-building in the patient's mind. The long-term benefit is tremendous. Fewer staff and fewer patients can generate the same production with much less stress and overhead. I like to pick my charities, and insurance companies are not one of them. :-)
Anonymous #1, you ask a great question, "How do you deal with someone who doesn't want to waste their time, etc."
#1, we never turn away an emergency. If someone's in pain, we take care of them. #2: Long-term, if a patient doesn't appreciate the complimentary consultation and the way in which you want to run your office, they inevitably are going to have some issues with compliance: whether their homecare, adhering to office financial policies, etc.
Again, this idea won't work for everyone, but at the risk of rehashing my whole post, I invite you to go back through and read through the reasoning. It all starts with the premise of the new patient comprehensive exam. I simply can't give my full attention to a comprehensive exam in less than one to 1-1/2 hours from start to finish. I need that time for rapport building, diagnosis, and education. It's the one thing I can't compromise in my practice. I can speed through a filling or crown and work on multiple ones at a time, but I think we often give short shrift to the examination process....and that is our greatest value to our patients and the thing that only we, the doctors, can do.
How that appointment is scheduled will determine if these suggestions are valuable are not. If the exam doesn't compromise much doctor time, then these kinds of suggestions won't make much difference.
My staff is so much better at explaining the dialogue they use to explain this to patients upon that first call. Feel free to call my wonderful team, Jorion or Kathryn, at 210-DrPerry and ask them how they speak with patients about this. Thanks so much for your comments!!!


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