EP 102: Four Ways Dental Teams Can Increase Case Acceptance

If patients don’t move forward with treatment, everybody suffers. The patient’s condition worsens over time, team members get frustrated, and the practice performance declines.

Part of providing the very best care for patients is helping them feel comfortable saying yes treatment. When it comes to case acceptance, small things make a big difference and when everybody on the team does their part, case acceptance rises quickly.

In this episode of the Double Your Production Podcast, Dr. John Meis and Wendy Briggs talk through their 4-part case acceptance formula for dental teams. They address why patients decline or delay treatment, what gets them to move forward, and how to systematize case acceptance throughout the practice.

 You’ll learn:

  • The 4 parts of the case acceptance formula 
  • How to navigate and work through disagreements about patient care between the doctor and other team members
  • How to establish a consistent standard of care
  • How to present and communicate treatment options to patients clearly so they feel confident moving forward (even if they need a lot of treatment)
  • How to present simple and flexible financial options to patients to reduce money stress
  • Important benchmarks to measure your success in case acceptance

In this episode, Dr. John & Wendy mention our upcoming Practice Growth Retreat. These events are reserved for clients, but we have a select number of guest seats available. If you’re interested in joining us as a guest, click here to fill out a quick form and we’ll be in touch: http://www.theteamtraininginstitute.com/guest 

Or, listen to the episode below:

Speaker 1:
Welcome to The Double Your Production Podcast with the Team Training Institute, the one place designed for dentists and their staff who want to grow their practices by following in the footsteps of those that have done it, who are in the trenches, who know exactly what you are going through. And now you leaders, the stars of the podcast, Dr. John Meis and Wendy Briggs.
Wendy Briggs:
Great. Hey, everybody.
Dr. John Meis:
Hey, everybody. Welcome to this episode of The Double Your Production Podcast.
Wendy Briggs:
Yeah, we have a great topic plan for today, Dr. John, we've had so many questions from our members and from the public at large about case acceptance. I know we have a very amazing event coming up soon that we'll talk about at the end. But I've gotten so many questions about this that we decided to do a Facebook Live today walking through four steps that we know that can help practices have a team driven approach to case acceptance. And I thought before we dug into some of the solutions, it might be kind of fun to share some struggles that practices have. So I'll share one.
This is on literally almost every single hygiene forum. The famous, "This is the x-ray, and this is what my doctor said. What do y'all think about that?" And then depending on the scenario, almost always, it's something that needed to be diagnosed that actually wasn't. So doctor said, "Let's watch that or let's write the patient a prescription for an antibiotic." And no root canal or service was treatment planned. And it causes a high level of frustration for the hygiene team. So let's talk about that for just a second.
Dr. John Meis:
Yeah, it's just so common and it really speaks to the challenge that teams have in communicating. So the team has a concern about what the doctor's recommending, they don't know how to talk to it about the doctor. The doctor doesn't know how to explain what it is. Doctors can sometimes feel like their judgment's being questioned and, "Ms. Hygienist, how dare you question me. I'm the doctor. I'm the one with the license." And so some of those attitudes can really be destructive. It is so unnecessary because really people can have a conversation that is respectful and mutually positive, but it doesn't happen naturally.
Wendy Briggs:
Right. I would say when we see scenarios like that, sometimes they occur in a practice where a hygienist is temping or subbing for the day, and so they haven't had a chance to get alignment on diagnostic assertiveness or diagnostic philosophy. But frankly, it does happen consistently as well in practices with long time hygienists of record. It can cause angst, certainly because hygienists, I like to assume that most of us have a good heart and we want what's best for the patients, and sometimes when we find ourselves in situations where we disagree on what's best for the patient, or maybe we recognize that our doctor isn't up to their usual standard of care for whatever reason, it can cause us anxiety and stress. So one of the things that we love about the team driven approach to case acceptance is that it does help us establish a standard of care that becomes consistent in our practices, and it can eliminate a lot of these team dynamics or situations where we're not necessarily seeing eye to eye.
Dr. John Meis:
Yeah. Really it is a matter of mutual respect and discussion. And I'd like to think that doctors diagnose things the exact same way all the time. But the reality is they don't. So there is variation from day to day, there's variation from time in the day, there's variation if you're running behind, there's variation if you're not feeling well, variations for you're stressed, variations by who the patient is and what you think they might afford and whether they're a friend of yours or not. There's all these different things that are just reality. Part of the process of getting better at case acceptance is becoming very, very consistent on your diagnosis. So the more consistent you become, the better off your team can support you in that team case acceptance process.
Wendy Briggs:
Yeah, Dr. John, it's funny because we see the same thing on doctor forums. Doctors will post an x-ray or an image and say, "Hey, doctors, what would you do here?" And if there's 47 comments, there's 47 different opinions of what the ideal treatment is.
Dr. John Meis:
It's so true.
Wendy Briggs:
So recognizing that there's not a one size fits all approach to dentistry is also part of the process. And I think we have to understand that everyone brings their own unique education, their background, their experiences. A more seasoned doctor might go a different direction than a newer doctor. I think that's part of the problem, it's part of beauty of dentistry and what we do in helping serve our patients at the highest possible levels and helping patients get the care they need. But it also adds to the complexity, and it adds to the frustration and the unknown that patients have and the team has. As a hygienist myself, it's stressful to be working with the new doctor and not know how they see the world. "What would they do on this tooth?" And so what I love about what we teach in this category is I love seeing the magic that happens when the team understands the doctor's diagnostic philosophy and knows what to do to support that. Magic happens. And it all begins with building that process and communicating those standards.
Dr. John Meis:
Yeah, for sure. And that is sometimes easier said than done, but really a thoughtful pause to really get down exactly what you diagnose, "When you see this, you do this." Just getting it down to something as simple as that, and making sure you communicate that with your team and then invite your team to hold you accountable to it. You're the one who came up with the diagnosis. So if you vary from that, if the team has the freedom and the mutual agreement ahead of time that the team's going to tell you when they think that you're falling short of what you said or you're differing from what you said, and then it begins another conversation, which will lead to better clinical understanding on the team's part, and the doctor, it'll lead to really just being able to do a better job at staying consistent.
Wendy Briggs:
Yeah, so let's break it down for our listeners today. Let's talk through our case acceptance formula. We really have four key pieces to this puzzle. And what we found is when practices work on building these four pieces, all of a sudden the team has clarity on what's expected and clarity where we're going, and everything seems to fall into place a lot more consistently. So we can go through those four steps.
Then Dr. John, before we're done today, we also might want to talk about some benchmarks. I think one of the most amazing things about practicing dentistry today is we actually have advanced tools that can provide some analytics so we can measure this. In the past, it's been really, really difficult to measure how well we're performing in the case acceptance categories. It's been almost impossible to measure that, but now we have some tools that can help us measure. So the first piece to the puzzle is treatment planning standards and tribal language. We've talked a little bit about this, but really if we were to define what treatment planning standards and tribal language is, it's really having diagnostic and treatment planning laid out and consistent and understood by the entire team. So that's really critical.
Dr. John Meis:
Yeah. Oh, it sure is. Otherwise, they can't support you well. Doctors really defining interproximal caries, what does it look like? When do we treat it?And having a very specific standard for that, so the team knows where you're headed before you even walk in the room. What do you do with occlusal staining, for instance, or pits? And how do you decide whether that is a sealant treatment? How do you decide whether that's decay treatment? How do we handle teeth that are fractured? How do we handle large restorations that are failing? How do we handle edentulous spaces? All those things, just having a very standard way of doing it. How do we replace missing teeth? There's more than one way, what's our preferred way? Or what's our preferred way in this situation and not in this situation? So really defining all of that is so important for the team.
Wendy Briggs:
Yeah, I would say ultimately the end goal is to have the team be able to identify They can look at a tooth, look at an image, look at an x-ray and say, "When I see this, doctor does this." We're able to clarify exactly what that is. And certainly we recognize we're not going to be correct 100% of the time, but we want to be correct the majority of the time, even 95% is better than a 50:50 guess based on what the doctor's mental energy threshold looks like. So having clarity and understanding.
Over the years, there were countless times where I'd go in and fill in for a colleague, and at the beginning of the day, I'd get, "Here's your instruments, here's your room, here's your schedule. Go." I barely heard about anything about what kind of dentistry the doctor wants to do. How do they want their patients to be served? And I think clarifying that from the very, very beginning provides everyone with the opportunity to have a huge sigh of relief. Because if I know what your expectations are, I'm much more likely to be able to deliver and care for patients up to those expectations. So it provides a happier existence for everyone.
Dr. John Meis:
Absolutely. And another one is you have one restoration needed in a quadrant that has other restorations that are still serviceable but getting to the end of their lifespan. Do you offer to the patient, "If you'd like, we could replace all of these."? Giving that as an option is another thing that varies quite a bit from dentist to dentist.
Wendy Briggs:
Yeah, having the team know powerful phrase, "While you're here and numb in this area..." It's a very powerful phrase. So having those things clarified and discussed ahead of time, and if they haven't been, what's the ideal process for this moment right now? All of those things matter. The second piece of that strategy, Dr. John, was tribal language. So let's talk about that for a minute.
Dr. John Meis:
Yeah. I've been in many, many offices, as have you, and listening to teams discuss treatment with patients, we often see that they will use different terms for the same thing. So the hygienist may describe it one way, the dentist may describe the same thing using different language, and then the finance person, admin person describes it yet another way, which just creates a lot of confusion for patients. And when there's confusion, people don't have confidence and they tend to not move forward. So if we want to increase case acceptance, we certainly want to have patients in a place where they're hearing the same thing in the same way by everybody on the team. And deciding what to do then is really getting your tribal language in unified. It doesn't have to be hard scripted word for word, but if we have caries, we're all going to call it a cavity. Of course, we're never using words that we learned in dental school in front of patients if we can help it. And that's just a good example and one that we've seen teams really struggle with at times.
Wendy Briggs:
Yeah. Very good. Let's move on to the second segment, and that is data gathering and team persuasion. And this is such a powerful one because we hear all the time the age old battle with hygiene is once the doctor gets in the room for the exam, we can't get the doctor out. It's super difficult to get the doctor in the room and then it's also super difficult to get the doctor out. One of the main reasons for this, in our experience, is that as a team, we haven't really established systems for what type of data gathering we need ahead of time. We don't have the confidence because we haven't set up tribal language or treatment planning standards. We don't have the confidence to tell the patient, "I'm not the doctor, but my best guess is this is what you need." So all those pre-suasion, those important conversations that happen before the doctor gets in the room aren't happening.
Therefore, when the doctor does finally get in the room for the exam, they're having to do all the heavy lifting and it's taking way too long. So I think in my mind, this is one of the tremendous advantages of having systems in place for diagnostic criteria and gathering that data as well as working as a team on how we're going to pre-suade patients about treatment that they need before the doctor enters the room.
Dr. John Meis:
It helps the doctor in so many ways, helps the hygienist in so many ways, and most importantly, it helps the patient. So the patient gets to hear information from maybe a less threatening team member, a hygienist or an assistant, and they get to be able to ask questions to that person. Then the doctor comes in and they get to hear some of it again, or a confirmation of what they've already discussed. It's just more powerful. And every team member will say, "Well, here's what happens after the doctor leaves the room." After describing some treatment. The patient will turn to me and say, "What do you think?" Right? So it gets that out of the way ahead of time, and it greatly shortens the exam time for doctors, which allow doctors more time to be able to treat patients and provide value to another patient that really isn't providing extra value when they're doing all the heavy lifting during the exam process.
Wendy Briggs:
Yeah, we love that. When we see that dialed in, a lot of things happen that are amazing. I also can't tell you how many times we hear from doctors, "I bought the new TRIOS scanner, but I can't get my hygienist to use it." Or, "We have state of the art intraoral cameras and I can't get my teams to take images." So this solves all of those headaches. We establish a process for how we use the technology, what's our standard of care? How do we do that in a timely manner? Once we have those images, once we've taken the scan, what are we doing with it? What are we sharing with the patient? How are we utilizing that as a part of the exam? All of these things need to be choreographed. I heard one time that an examination should be a well choreographed dance. And I think that's very true. We need to have, "Places, everyone." Everyone should know what their responsibility is and how they're going to do that, and then make a commitment to one another that we're actually going to get those things done.
Dr. John Meis:
Far too frequently we doctors will go, we'll learn some new technology or buy some new technology, we bring it back to the office and we say, "Go to it, team." And it's not quite that simple. They need to understand the technology. They didn't get all the training, they didn't get all the hype, so they're not excited about it. And we just bring something that many times they'll look at as just being more work, taking more time when they already feel stressed for time. So really stepping back and, as you said, choreographing this, "Here's how we're going to use it. Here's what we're going to say. Here's what we're looking for. Let's start here. It can do this, but let's start here. Let's start simple. Let's make it easy." That is a step that's so frequently missed. So when we can choreograph that out, it puts our team at ease, and our likelihood of successfully integrating something like that is much higher.
Wendy Briggs:
Much, much higher. In fact, we get texts all the time. I just got one not too long ago from a doctor that said, "Finally got our hygienist to use the iTero scanner. In the last six weeks, we've had 21 patients start with clear aligner treatment." So it has a huge impact when all of these systems are aligned and in the right places. And that's really rewarding for us to see, as well as I'm sure the doctors are over the moon too, right?
Dr. John Meis:
Right. And just as many times we've seen texts from team members saying, "How on earth do they think we're going to get a scan on every single patient every single time? That's insane." And might be. So really understanding when, how, and make it easy to start. You can always get more advanced, make it easy to start to build everybody's confidence and get things moving.
Wendy Briggs:
Yeah, I love that. All right. Our next piece then, Dr. John, is actually about the case presentation. How do we present the treatment that's needed? We call this case presentation and focus treatment planning. And there's so many different ways to do this and so many different schools of thought on it. And one of the things that we pride ourselves on is we like to teach what's working in dentistry today. Not theory, not things that sound good in principle, but things that actually work in dentistry. And we've seen a shift, if you will, from creating a state of overwhelm, the 200 point exams on every single patient, a two to three hour experience where we're gathering literally every scrap of data on every patient. We've seen a shift to a more focused approach with treatment planning. And certainly that's something that's so complicated, we can't really run through it in just a few minutes. But I know there's a few things that we can probably share with our listeners today.
Dr. John Meis:
Sure. One of the things that I did during my career was the whole complete exam, and then laying out every bit of treatment they needed to have and then trying to make financial arrangements on the entire thing. And for some patients, that's perfectly appropriate, and it works just fine. Other patients, it becomes overwhelming. They don't have a context in which to think of the cost. And instead of moving forward with something, they move forward with nothing. And some of those may go to another dentist and seek care somewhere else, but some of them, unfortunately, probably didn't do that. And so all the dental conditions that they had got worse over time.
One of the things that we've seen in practices that has increased our case acceptance, increased our patient retention, is using a more focused treatment plan where we're telling them everything that we find. We tell them everything that's wrong, but then we make financial arrangements on just a narrow portion of that, a focused area. So often, that focused area is a quadrant or a neighborhood. "We're going to start down here, Mrs. Jones, how's that sound to you? Is that where you'd like to start? Here's what we're going to do." Very simple language and creating financial arrangements just on that segment. So this has been extraordinarily powerful, and we see practices in lower income neighborhoods having tremendous case acceptance. You wouldn't think that'd be the case, but they have tremendous case acceptance when they use this approach.
Wendy Briggs:
Yeah and I think what's amazing is we're always worried about how to create... We don't want to create a situation where they're overwhelmed. We can have someone that has 15 patients and neglect, I know you worked on a lot of sedation high trigger patients, as did the practice that I worked at for 12 years. We saw a lot of patients like that, and it took a tremendous amount of courage for them to even come in today. So the last thing we want to do is overwhelm them and make them feel hopeless about their circumstance. We're dealing with 15 years of neglect, and as you mentioned, all a lot of those problems can compound on one another. So I feel like this strategy, it helps drive case acceptance, but it really is the most patient friendly strategy I think we could employ because we're focusing on primarily their chief complaint and a small portion of what's necessary to restore them to health. But they know that. We're just empowering them to be able to make one choice, not the whole choice, but one choice while they're here today. Then after that area gets finished, we move on to the next area. So we've seen that working tremendously well in today's world.
Dr. John Meis:
Yeah. Now, we know there's cases where you can't do that. So before you send in little messages to us, we know there's certain cases where you can't do that. But where you can, I think it's very helpful. We also know that there are some patients who want the whole picture, who want to know everything and maybe want to do it all at once. I get that too. And so being able to be flexible and having good communication with the patient, checking in where they are, checking in with what they want, is how you get to this place where we've got a negotiated focused area, which might in some patients be the whole mouth, some clinical conditions must be the whole mouth. But if we can break it down, that's more successful with most people.
Wendy Briggs:
Right. And I would say one of the things that we recognize is that we want to have systems in place for all of those scenarios. But let's begin with the most common, which is the patient focused on one neighborhood absolutely does work.
Dr. John Meis:
Yeah.
Wendy Briggs:
So the fourth piece to the puzzle, Dr. John, is firm financial arrangements and having flexibility in financials. This is really key in today's world as well.
Dr. John Meis:
Yeah, I like to think of them as friendly. It's friendly both ways. Number one, the practice is clear on when they're going to get paid, and the patient is also clear on what's expected of them and when. And finding a way to bridge between those two, whether that be making a partial payment before the treatment, a partial payment during the treatment, whether that be third party financing, whatever it is, just finding a way to help the patient accept the care that they really need. So this is something that is... You use the word flexibility. And that's really what it takes. And it takes someone kind of creative that's willing to sit down and work through it with the patient. It takes time. But work through what works for them. "What kind of payment can you make? Would you like a discount if you prepay?" All those kind of things. Walking through the entire financial arrangements, starting with what that practice would prefer, and going down a list of options to find something that'll work with the patient.
Wendy Briggs:
Yeah, I would say probably the most common mistake we see in this area is practices are way too complicated. We teach a process by which we have a simple one page financial form. We're not just turning over the financial, I guess, the estimate that the software spits out. We simplify. We're focusing on one neighborhood at a time. And I've heard some of our people will say, "Listen, you have the difficult part to the patient. You've got to decide what you want us to do, and then my job's easy. I just help you fit that into your budget." So we have a variety of options that can help patients with that. I see another common mistake is that we tie payments directly to appointments, and that is a no-no as well, because patients will cancel. So whatever financial arrangements you make shouldn't be half on the prep date, half on the seat date, or it shouldn't really be tied to their appointments at all.
If you have a patient coming back for scaling and root planing, for example, you don't want them having to bring $400 with them to that appointment for their portion because there's a higher chance then that they're not going to show up for that appointment. So we want to make sure that whatever financial arrangements we're making, we're not tying those to appointments. You can say, "We'd like you to pay for this on the 15th." You can take a deposit today and pay the rest on the 15th, but don't tie it to a visit. Otherwise, that's one of the main reasons people's schedules fall apart. So again, having firm and flexible financial arrangements is really a part of that puzzle that drive case acceptance that people often overlook when thinking about it.
Dr. John Meis:
So Wendy, we've taught these four principles in pieces and bits and pieces for a decade at least. And what we found was that people will get little pieces here and there that'll be helpful, but we found that it was very difficult for people to put in the entire process. So I remember distinctly when we were running through this at one of our conferences, and we were talking to our members and our clients, and I asked, "Who here has this all package put together?" And I was expecting, not everybody's hand, but I was expecting quite a few hands to go up saying, "Yeah, we got this done." Not a single hand went up. So then I realized just how hard it is to do this, and it really is difficult to get in place, which is why we decided to create an experience where people could come, we would support them, they would get it done and packaged and finished and ready to go out, spread to the rest of the team and make it happen.
Wendy Briggs:
Yeah, so this will be our third annual case acceptance breakthrough workshop. It's coming up here in November. So for those who are listening and want the information, we'll post the PDF in the comments that you can look about a little bit more what it is. And like Dr. John said, what it is is it allows our members to come and in two days you are building these four systems that we're talking about. You actually create your diagnostic philosophy. We walk you through a process called treatment planning for predictability, and there's 12 categories that you will have scripted out and done. It's incredibly effective for you if you have associate doctors, if you have multiple locations, this is incredibly helpful.
As well as all of the other things that support that. I'm presenting on diagnostic gathering, data gathering and pre-suasion. Dr. John is presenting on diagnostic assertiveness, and we're going through all of the data so that you know what to track, what to measure, and how these systems can have a direct impact on that. So again, I think you're exactly right, Dr. John, we had spent so many years telling practices, "You got to get it done, you got to get it done. This what's holding you back. This is what's missing." And finally they said, "Can you just help us do it?" And that's what we're doing.
Dr. John Meis:
Yeah, yeah. Very good. It's an amazing event. We've got other people that are part of the group teaching it. Dr. Jason Howell teaches communication and that negotiation with patients coming down to the treatment plan. The amazing Heather Driscoll is helping talk about friendly financial arrangements and how we set up guardrails for our teams so that they have enough room to be creative, but they don't get the practice in trouble as far as having a predictable cash flow.
Wendy Briggs:
Yeah. Well, Dr. John, at our summit, we had about 450 people in the room, and I can tell you at this meeting, we don't allow that many people in the room.
Dr. John Meis:
No.
Wendy Briggs:
Right? We have it limited. I think we only have seven places left. So if this is something that you feel is missing in your practices and you want more information, I would say reach out sooner rather than later. Because historically, this event has sold out. So we do have a few places left. And this is an awesome opportunity for you to spend some time working on your practice, not in your practice, and building some of these vital systems that can help propel you forward. So again, we'll post that link in the comments for those who want that information.
Dr. John Meis:
Yeah, great. So we have room for seven more practices. And typically a practice will bring a doctor, maybe the associates, they'll bring someone from the hygiene team, somebody from the assistant team and somebody from the front desk team. So they're able to use everybody's perspective as they build the tribal language, and everybody can get the perspective on the doctor's treatment planning philosophy. And they're documenting while they do it, so they have something to go back and train the team when they get back to their offices for the team that doesn't come to the meeting.
Wendy Briggs:
Right. Well, we love it. We'll do our next Facebook Live next week on the most important criteria, the KPIs, if you will, to measure so that you can look at some benchmarks on whether you feel like this is something that you really need. In the meantime, if you're a member of ours and you have one of our business coaches, you're certainly welcome to reach out to them and ask them, "Can you walk me through the KPIs? Would this be a good thing for me to do?" If you're not a member, this is one of our few events that we do open up to outside practices. So certainly, if this is of interest to you, be sure to reach out. We'd love to have you join us for this event.
Dr. John Meis:
It's one of the most powerful events that we do, and so much of the dental world is focused on trying to get more new patients, trying to get more new patients, instead of helping the patients that you already have accept the care that they want and need. So that's what this is all about, is making more with what you have already and bringing your patients to a higher level of dental health.
Wendy Briggs:
We love that. Well, thanks so much, Dr. John for joining us on this episode of The Double Your Production Podcast We have done this one by Facebook Live because we wanted to get the information out there as soon as possible about our case acceptance workshop in November. So thanks everybody for joining us.
Dr. John Meis:
Thanks, everybody.
Wendy Briggs:
Bye.

Resources:

1. All listeners of the Double Your Production Podcast are invited to schedule a customized Practice Analysis Amplifier where we will review your current production and create your personalized roadmap for doubling your production. Click here to schedule.

2. All listeners of the Double Your Production Podcast can test-drive our Double Your Production Membership where you have access to training, videos, and live Q&A sessions with both Dr. John and Wendy- all for just $1. Click here to see what’s included.

3. Follow us on Facebook for live updates: https://www.facebook.com/TeamTrainingInstitute/