Effective Case Presentation

Generally speaking, treatment plan presentation is not as difficult for specialists as it is for GPs. The reason is obvious; a patient who is in your office has most likely been seen by another dentist already, and has been told about the need for the treatment you are providing. Therefore, these patients come to your office with an understanding and desire to receive care. However this does not mean you should take the presentation lightly, because patients still have a number of questions and concerns that need to be addressed.

A successful presentation is not limited to a scripted conversation by the treatment coordinator after the doctor's exam; as a matter of fact, presentation is a process. It starts with the impression patients get from the moment they call your office and continues during the patient's experience (Also review Image).

The important part of the presentation begins with the doctor after the exam is completed. By following these guidelines you will significantly increase the chance of having a successful presentation:

1. After the exam, sit your patient up and sit in front of him at the same eye level.
    
2. Take off your gloves and mask, and relax in the chair like you have all the time in the world.
    
3. Give the patient your full attention; make sure your staff does not interrupt you during this time.
    
4. Be well organized and first explain the big picture of the situation to your patient; this should not take more than a few seconds. Do not get technical at this point. Instead, say something like this: "Mr. Smith, there are a few things that we are going to talk about: Your gums, your missing teeth and the timing of the treatments".
    
5. Specialists naturally have more of a tendency to get technical. You are doing the same thing all day and what you do is technical to you, so it is hard to look at the issue from the patient's point of view. Nevertheless, you have to avoid using confusing terminology.
    
6. After the overview, go to the next step. This step is a critical point in your conversation. What you must do is convert a "need" into a "want". Therefore, you must choose your words wisely. The first thing to avoid is using the word "need". Try "should" or "want" instead. Begin the conversation by asking questions such as:
   -  "I understand that you want to save your teeth as long as possible, right?"
   -  "Do you want to have a more beautiful smile, Kim?"
   -  "I am sure you want to be out of pain as soon as possible, wouldn't you?"
   Questions like these help demonstrate to the patient that what he wants is indeed what he needs. After establishing the "want" factor, half your work is done. Now you continue by saying something like, "Let me see how I can help you achieve what you want."
    
7. The next step is going over the ideal treatment plan. Throughout the presentation remain focused on what the treatment does for the patient, not just what it is. Stop yourself from getting into the technical details at this point. Speak loudly and clearly, and maintain eye contact at all times. Use visual aids as much as possible, such as digital X-rays, pictures, brochures and educational software.
    
8. When you are done, finish by saying, "Tim (the treatment coordinator) will go over your treatment plan and will arrange your appointments for you. Do you have any questions?"
    
9. Your entire presentation should take no longer than five to a maximum of ten minutes (for very complicated treatment plans). The more you talk, the less likely your patient is to accept the treatment plan. Talking too much makes it seem like you are trying too hard to convince patients of what they "need"; they will figure this out for themselves once you translate their "need" into a "want".
    
10. Do not rush! Even if your time is restricted, you should not look like you are in a hurry. Give the patient your full attention and stay focused.
     
11. As a specialist, one challenge we all face is ensuring that what we say does not interfere with the GP's treatment plan or what he/she has told the patient. I cannot tell you how many specialists lose their referral sources because of miscommunications and misunderstandings that are created among the three parties involved at presentations. Now, I am not saying that you should be less than truthful or compromising your ethical standards at any point just to "cover" for GPs. What I am suggesting is that carefully choosing your words can prevent a lot of misunderstandings.
    
    For instance, as an Endodontist, rather than telling a patient that their original root canal failed because the dentist "missed a canal." you can say something along the lines of, "I am sure your dentist did his/her best, but the fact is there are sometimes small hidden openings inside the roots that may cause a treated tooth to become re-infected. So your dentist has done the right thing in sending you to us to check that possibility. Now we will try one more time to hopefully save this tooth." There are hundreds of examples of alternatives you can use to prevent these complicated situations from resulting in unhappy patients and unsatisfied referral sources. (Also see the "What To Do" section in "XL-Clib" to submit your own situations that you have encountered.)
    
    One thing you must remember is that bringing your GP down (for whatever reason) does not make you the hero. As a matter of fact, as you have and will learn in many parts of this software, a crucial element in shaping a successful image is giving patients an overall positive feeling. Any negative experience, even if it is regarding their general dentist, will ultimately affect you. We talked about this issue when we mentioned the negative effects of criticizing one's insurance (see "Case Presentation").

Going back to the actual presentation, when you are done talking turn things over to your coordinator, who will then pick up where you left off. Remember, your treatment coordinator does not have to be an extra person in your office; he can be your office manager or even one of your assistants. He should be in the treatment room during your conversation about the treatment so at the time of his presentation he will already have a rapport with the patient at the time of his presentation, and will be somewhat familiar with the details of the treatment.

 Notes for treatment coordinator:

1. Continue concentrating on the "this is how we can take care of what you want" approach.
2. Keep things simple, and do not talk about the details of insurance coverage unless you are directly asked; even then stay on track, and keep the talking to a minimum. Be thorough, but not over explanatory.
3. Begin the your presentation with something like this: "OK, Mr. Jones, the doctor went over all your treatments and I have your treatment plan here. As far as the costs go, you can get all of your treatments done for as little as $40 a month (the actual number, of course, will depend on the total fee for the whole treatment plan).
4. The bottom portion of the treatment plan should have 4 numbers in this order:

Total cost: $ ____ Insurance benefit: $ ____ Patients portion: $ ___ /month or $___

Let me use an example:

Look at this table to get an idea of what I am going to talk about:
 

PPO patient:

Let's say you are presenting a plan for a crown lengthening on tooth #30. The patient has a PPO plan that you are contracted with. Your UCR fee is $850 for the procedure; the insurance fee schedule is $600 which is covered at 50%.

Is this how you would present it?

“OK, Mr. Jones, you need a crown lengthening on tooth # 30. Your insurance covers only 50% of the cost, so you have to pay the difference; that makes your portion $300."

Now, let me tell you what the effects are of presenting the plan this way and what the messages are that you are sending to your patient. When you say something like above, this is what is going on in your patient's mind:

1. Damn, I have to pay $300 for this!
2. My insurance is really worthless if I have to pay half of the cost! So much for having insurance!
3. These guys really charge a lot of money for a surgery!

The scenario is even worse when it comes to presenting the same treatment plan for a patient with HMO insurance. Isn't this how it goes?

  You: “Mr. Jones, your insurance does not cover this procedure so you have to pay the total cost, which is $500.
  Mr. Jones: “But aren't they paying for at least a portion my treatment?"
  You: “Well, they actually don't pay anything anyways, besides even for your exam and x-rays that we did today they don’t pay anything, this is how HMO plans work."

This is what is going on in your patients mind:

1. This is crazy- I just came for a second opinion, now I have to pay $500!
2. I really have a horrible insurance!
3. I don't believe this guy. How can it be that insurance doesn't pay anything? Something is not right here!
4. I am going to call my insurance company and let them have it!
5. I hate this; the dental office, the insurance company, and the fact I need a surgery!

6. I am too upset to do anything today. I am going to talk to my wife first!

Let me tell you the main things that were wrong with these two presentations:

If a cash patient comes to you and wants a crown lengthening, what is the cost to him? $850 (assuming this is your UCR) right? Now, when you are charging your PPO patient $300 and the HMO $500, what are the patients saving? Isn’t it $550 for the PPO patient and $350 for the HMO patient?

You told your PPO patient that he is paying half of the cost, and you told your HMO patient that he is paying  the total cost, but isn't the total cost $850? So what did we miss here?

The problem is that when insurance is involved we don't base our presentations on our UCR. What we should have told our PPO patient is something like this: your total cost is $850, your insurance benefit (not coverage) is $550 and your portion is $300!

How do you think your patient is feeling about this whole thing now? Does it feel better to save $300 or $550?

Now I know you may say that the insurance does not pay $550. Yes this is true, but who cares!! The fact of the matter is that your patient is saving $550 because of that insurance. The benefit comes in two forms, direct payment and discount. Nevertheless, it is his insurance benefit. So why is it that you don't tell your patients about this benefit?

You do this because you are worried that if you base your presentation on your UCR (while you are charging on an insurance fee schedule) your patient may think you are making too much money! Believe me, they don't care about how much you are making nearly as much as they care about how much they are paying! All that matters to them is what kind of a deal they are getting.

It gets even worse with HMO patients; this time you really made them feel bad. Yes, it is true that HMOs don't pay us much. But whose fault is that? Patients? I don't think so! So why should we make them feel bad? 

The truth is that your patient is saving $350 for having their "HMO" insurance. You have to inform them of this, because it makes them feel better when they see they are getting something out of their insurance.

The point is that you should find out every single benefit your patient is receiving through their insurance and emphasize it. This is a crucial part of making them feel good about the whole treatment. (See fact#2 in Case Presentation, also see Case Acceptance.)

Remember, people who are upset, disappointed, or confused, even if it is about their insurance company, will not make a decision to commit themselves to a big treatment plan. Have you ever been in the mood to shop for a luxury item you were unhappy, sad, or disappointed?