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February's Tip: How to Run a Successful Orthodontic Practice

By: Dr. Mark Paschen

Click picture to view Dr. Paschen's website

Click picture to view Dr. Paschen's website

This is the first in a series of articles outlining how to successfully implement orthodontics within your general dentistry practice. I am not a consultant but a "wet-fingered" dentist like the rest of you. About ten years ago, I made the decision to convert my general practice into an orthodontic-focused practice, and I stopped doing general dentistry. I had four partners and two associates in a fee-for-service office, and I thought the conversion would be simple due to a built-in referral base. I was totally wrong in that assumption and within six months of the conversion, my gross production dropped by 50%. I was on a downward spiral. New orthodontic patients were not scheduling, especially since I didn't have my own hygiene pool from which to get new patients.

 I knew that I had to make some changes in order to survive in my "orthodontic only" practice and continue to earn a good living. I set a personal goal of increasing my production to where it had been before I dropped general dentistry. I figured it would take me approximately five years to achieve that goal. It actually only took me a little over two years to reach and surpass that goal, once I realized how different orthodontics is compared to general dentistry.

This series of articles will show what changes I made within my practice, and what is needed to get your practice to the next level. I learned this through orthodontic consultants, attending courses intended just for orthodontists (I felt like James Bond going incognito), by reading countless orthodontic practice management articles, and by trial and error.

My first article deals with systems that you already have in place in your office. These simple changes will not cost you much more than time and effort, but the dividends they will pay, in terms of increased efficiency and production, are enormous.

The Orthodontic Receptionist
The receptionist is vital to the success of an orthodontic practice. Start out with having your receptionist answer the phone by saying, "Good morning Dr. Smith's office for general dentistry and orthodontics, Mary speaking, how may I help you?" How many of your patients know that you do orthodontics, also? This is especially important for new patients. The receptionist should take control of conversations, asking the usual questions concerning name, age, address, in a conversational tone. She should not make it appear that she is reading off of a list. She also needs to be very well informed on all procedures that you perform at your office. For example; if a patient asks if you do Invisalign and you do Essix-MTM, she should be able to relay that to your patients. That is why scripting is so important. Play act and rehearse with other team members. The three main goals that the receptionist needs to accomplish are:
    1. Get the patient to schedule the consultation appointment
    2. Procure any insurance information
    3. Try to get both parents, for minors (whenever possible) to attend the orthodontic consult

The first goal is obvious but not always followed. You should give the patient two choices of appointments for the consultations and ask which one works better for them. If neither, then ask what times usually work well. It is imperative that you template ideal times for your consultations to assure that you will get patients in the door. Your schedule should be templated for orthodontics, and orthodontics should be kept separate from general dentistry appointments. By templating your schedule, you will be able to schedule your consultations "interruption free".

The second goal has probably doubled my case acceptance. When the insurance is known before the consult, that information can be covered at the consult in order for the payer to know what the out-of-pocket expenses will be. Otherwise; the decision to start treatment will probably be delayed. One of my assistants is dedicated to verifying coverages on line. Most of the time, the information can be printed and presented to the patient during the consult. Have your receptionist simply ask, “Could I please have any insurance information that may be pertinent to the orthodontic treatment? That way, we can check on coverage prior to your consultation. We may be able to find ways to save you some out-of-pocket expenses on your treatment." Always think of the patient when asking questions and getting information, because they are always thinking of "What's in it for me (them)?"

The third goal is important because some spouses will not have the authority to make a decision to start treatment until they talk to the person responsible for paying for the treatment. All of your time and effort that went into giving the best possible consultation (which we will discuss in a future article) will be lost because the payer only cares about the bottom line (price) and does not realize what a value you are giving for your treatment, since they were not present at the consultation. This transforms a valuable consultation appointment into a "how much does it cost" orthodontic treatment appointment. Also, if the decision to proceed with treatment is not made at the consultation (due to all decision makers not being present) the amount of follow-up necessary can be a tremendous burden on your office. Not only is it difficult to follow-up by e-mail or phone calls, it is time-consuming and adds frustration to the office environment. Have your receptionist ask, "Are there any other decision makers that should be present for X's orthodontic consultation?" If this is the case your receptionist should respond, "if possible, doctor would like all decision makers to be present so you can make an educated and informed decision on X's orthodontic treatment. This is a huge life-changing decision, and we want everyone involved to be as comfortable with treatment as possible and ask any questions that you may have." Think about it--most parents are used to having one spouse attend any medical appointments and go along with any decision that is made. Orthodontics is different, as there is a large out-of-pocket commitment, and the treatment can be considered elective (in the opinion of many parents). Having both decision-makers present at my consultations has saved dozens of follow-up calls and letters because the decision to start can be made right at the consult. Also, all decision makers can see the quality of my office, my credentials, and the great way that I treat my patients. The decision will then be based more on value rather than just on the fee. Having both parents present at the evaluation has definitely increased my treatment acceptance.

The last, very important step that your receptionist should do is ask permission to send out a welcome packet. Even if the caller is a patient of record, you need to separate orthodontics from general dentistry which will give you a lot more credibility. Orthodontics involves special skills, different decision making and scheduling, and a totally unique practice management approach. The welcome packet should consist of a cover letter welcoming the patient to your orthodontic practice, medical/dental history forms, insurance forms, biography card from the doctor listing credentials, accomplishments, professional affiliations, civic affiliations, hobbies, and family. Listing hobbies and family are very important as patients want to know you as a person. The fact that I've been married over 30 years is a big plus, as is the fact that I have children, and I like pets.

I do all of my own confirmations for orthodontic evaluation appointments. This may be awkward for some of you, but it has proven to be very effective. I simply let them know the time and date of the appointment, how long it will take, and what will be accomplished. I have never had a parent or patient keep me on the phone or ask me a series of questions. They are so shocked and surprised that the doctor is making the call, that all they can do is thank me for the call and say they will see me at the appointment. This is a great way to connect with parents and patients before the consultation, and the comments that I receive are overwhelmingly positive. This also sets you apart from the dentist down the street. Individuality, mixed with customer service, is what will make you successful.

The next article in this series will focus on your hygienist and what she should be saying to prospective orthodontic patients. Also discussed will be the four key steps that every hygienist needs to follow to convert your general dentistry patients into orthodontic patients.

Note: The full set of articles in this series will be published in following three consecutive International Journal of Orthodontics. All IJOs are posted on the IAO website after publication.

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