Sheri's Solutions: The $59 initial event

"I only paid $59 for my cleaning last year at Dr. Jones' office." If I have a small practice, how do I compete with the discounts?

It has been an interesting year with patients. People aren't price shopping anymore. They are looking at Google and seeing who has the best deal for dental care.

Sheri B. Doniger, DDS.

Sheri B. Doniger, DDS.

Is this a wise way to seek out a practice? Probably not. What do patients think our professional time, experience, and procedures are worth? For all the discussions about investment in the rehabilitation of their teeth to normal form and function, what are they really thinking?

It usually dumfounds me when patients are on the "hunt" for the cheapest dentistry. Do they realize the true cost of such "inexpensive" dentistry? I recall, as a young practitioner, I worked in an office that saw 15-minute "hygiene" appointments and charged out the full going rate. I left that practice immediately. We all are aware of the paradigm: "Fast, cheap, good." You can't have good dentistry if it is cheap or done fast. I decided many years ago to go with the other protocol.

Like many of us, I am not on any specific dental plan or in any participating provider option program. We opted out of health maintenance organizations (HMOs) and dental maintenance organizations (DMOs) because of the size and capacity of our practice. It just didn't work for our practice philosophy and the time we wanted to spend with our patients.

Also, we did not want to be in any plans that "dictated" treatment. Although we are the true professionals, plans do tend to "tell" the patient what they feel is necessary. In essence, they are merely giving the options the employer purchased for the group. Some plans are "Cadillac" and some are "Yugo." Additionally, some dental plans tend to "swap" out benefits to a lesser costly service, such as amalgams for composites. As many offices do not perform historic amalgams, this is not something we are able to offer our patients as an alternative restorative option. But, the dental benefit company will give reimbursement on the amalgam level. And, the patient thinks this is the right thing to do since the benefit company said so. Needless to say, we are also not part of a daily deal of discounted or coupon dentistry.

So, how do you battle these very real demons out there? It is all about communication. First, we ask patients why they are coming to see us. We need to know why they scheduled that appointment. I accomplish this by sitting out in the reception area and personally welcoming patients. This will establish a personal relationship that they may not have at one of the discount dental offices. We show patients that their time is just as important to us as our time is to them. We take the time to listen.

From the beginning, we give our patients an informational guide on dental benefits. Regardless if patients do not have any dental benefits or the level of benefit they do have, we discuss with them the depth and scope of their treatment needed, slowly, and with as many visuals as possible. We always go back to their initial concern.

People have different learning styles. Some are visual and some are auditory. We start with our intraoral camera. I believe it is one of the most important pieces of equipment we have in our arsenal to show patients what they need in their mouths. To show a patient a cracked historic restoration or a lingual ridge of calculus almost reaching the incisal edges is very powerful. The intraoral camera is used at every initial oral evaluation and many periodic oral evaluations.

A picture does tell a vivid story but so do our words. We explain each step for each procedure, as we do during the actual restoration itself. We all know good dentistry can't be rushed. So, neither should the explanation of a patient's dental needs.

After a complete discussion, we inform patients we will be submitting a schedule of procedures to their dental benefit company to assess what their particular plan will or will not cover. Once we receive their preauthorization, we then call the patients to see if they have any questions. Unless there is an emergent situation, we try not to do anything further than preventive services prior to receipt of an estimation of benefits. This seems perfunctory, but, in an upcoming Sheri's Solution, I will be discussing a patient who came into the office and her previous dentist did not do this very important step.

Communication is the key throughout dental care. Patients need to be aware of the scope of restorative procedures and the professional fees that are attached. Once they realize what is involved, one would hope they will not seek out that $59 cleaning.

I never apologize for my fees. I prefer to explain them. I know what I am doing and the time it takes me to do it. I have always felt that if you advertise for a lower fee, patients will consistently expect the lower fee or seek services elsewhere. I choose to have more long-term patients that appreciate the value of a personal relationship with their dentist who truly cares about their oral health. Not a discount. I can't think of any time I would want my own doctors to be offering a cheap service. You do get what you pay for!

Sheri B. Doniger, DDS, practices clinical dentistry in Lincolnwood, IL. She is currently vice president and president-elect of the American Association of Women Dentists and editor of the American Association of Women Dentists "Chronicle" newsletter. She has served as an educator in several dental and dental hygiene programs, has been a consultant for a major dental benefits company, and has written for several dental publications. You can reach her at [email protected].

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