What is a Lack of Confluence?

What We Have Here Is a Lack of Confluence: As you know, the outcome you can get for your patient is so often a matter of their choices, not “just” your clinical skills. Put another way, if you could give your patients a magic pill that would have them understand, value and act on Dentistry to the same degree you would, it would do more for them than if you took a magical pill to further enhance your clinical skills.

In every practice there is a gap between what you can do for patients and what they choose to have done. This can lead to frustration, compromised care and tens of thousands of dollars in lost income per year.

It may give you some comfort that you’re not alone. This is common to all health care. Just looking at pharmaceuticals:

• According to Reuter’s, 22% of prescriptions are not filled, 28% are first time prescriptions (this was a study based in Massachusetts of 75,000 patients).
• From Consumer Reports (2007) in a large study of over 79,000 people, fully 3/4 who got a prescription in the previous 12 months said they had not filled a prescription, skipped a dose, forgot to take a drug or had taken less than the recommended treatment.
• Furthermore, 25%–50% of the people with diabetes, high blood pressure and high cholesterol stopped taking the medications as directed within a year.

All of this costs millions and millions of dollars and immeasurable loss to people’s health. In medicine the term they used to use was “patient compliance.” Nowadays, the phrase used is “confluence.”

Once you and your staff really own the fact that patients’ choices are critical to the quality of the care you can deliver, you will automatically start investing more and more of your energy and time into patient communication and other items that will help to positively influence their behavior. This affects your decisions regarding Continuing Ed, the technology you use (buying that intra-oral camera or CAESY for example), and even the staff you choose (obviously you want staff people who convey a positive attitude, communicate well and enthusiastically believe in your/their Dentistry).

There is just as much or more range of services delivered per patients between dental offices as number of patients seen. If you want to produce more, you have to see more people or do more for the people you see. For most of you, doing more for the people you see is the quickest and most satisfying way to growth. That growth gives you the resources (income) you need to further invest in the practice (e.g., practice advertising, website, technology, staff, etc.).

The care should drive the numbers, not the other way around.That is, if you and your staff have “Clinically Calibrated” so you’re in agreement about what criteria calls for the various sorts of treatments (everything from crowns to x-rays), the numbers will move! This approach is the opposite to using “quotas” where the numbers drive the recommendations.

Patient confluence is important but as important is making sure that you and your staff are presenting your best options in the first place. Ironically, more patient care is not delivered because of providers’ fear of rejection than actual patient rejection.

The truth about getting new patients on the internet

Getting New Patients from the Internet (continued): In the “old days” of dental advertising, we had the hassles of dealing with decisions regarding which Yellow Pages to be in and Yellow Page ad design, and negotiating rates. Or planning direct mail campaigns (demographics, offers, mail lists). Those mediums could be plenty expensive but they weren’t all that complicated to figure out.

Internet marketing is a whole different ball game. It can be less expensive (or not!), but it certainly is more complex. Every day you and I are getting bombarded by pitches for SEO, SEM, and this or that great new Internet marketing scheme. I know that getting new patients is important to you so you better believe that we at APM are keeping our eyes open as to what is working, what is not and what the industry trends are.

You have limited amounts of time, energy and money to spend on advertising (not to mention doing dentistry and keeping your patients and staff happy), so we understand that dealing with the nuances and sorting through the hype of Internet marketing can be overwhelming. I’m hoping these articles will help.

Souping Up Your Internet Presence: Stage I – Establishing Your Google Places Page & Cleaning Up Directories: When a potential patient searches for a dentist in your area, they are most likely doing a Google search for “dentist in Your City” or “cosmetic dentist in Your City.” Their results will list three to eight dentists’ in the local proximity who best match their search keywords. Clicking on the links for those dentists will take them to their Google Places page, a miniwebsite of sorts listing contact information, office hours, photos, driving directions, areas of specialty and, most of all, credible reviews from actual patients.

An absolutely essential first step is to claim and enhance your Google Places page, complete it with information, photos, videos, if available, and then to collect reviews. Some Doctors have multiple Place Pages, for example, and that does not help you get found and, in fact, can hurt you. There is often inaccurate information on these directories. We’ve seen completely wrong phone numbers, old addresses and many long-established practices that are virtually invisible when you try to find them on the Internet. So the first step is getting your presence in the multiple directories straight. This also includes adding pictures and other content on your “Place Page.” A very important part often is getting patient reviews posted.

Then, we want to submit your practice information to the search engines and directories that are getting traction in your area so that your information is consistent across the board and you have the best chance to be featured in this suggested list of dentists. We correct inaccurate information, eliminate duplicate listings which dilute your presence and help you to establish a consistent and broader footprint across the web. We call this first stage “Cleaning Up The Directories,” a very detailed but absolutely necessary task.

Stage II - Website Enhancements: The footwork of “Stage I” will increase your visibility in the local directories and get you impressions and, hopefully, clicks through to your website. Then, once they get to your website, it’s a matter of engaging the potential patient and moving them to make an initial contact by e-mail or phone.

A lot is involved, whole books have been written about this. Best practices for effective websites include having a call-to-action on the home page, pictures and bios of the doctor(s) and staff, video brochures, patient testimonials, and before and after pictures. This also may include introductory offers such as free or low cost whitening, a low cost complete kid’s check-up, or other type of offer similar to what you would see with direct mail advertising.

Different than the SEO methods that were popular a few years ago to load each page with all of your keywords, effective websites today strategize a purpose for each page and align the keywords, content, tags and descriptive code with that message. As they say, “Content is King.” This is also an important part of Stage II.

Stage III – Widen Your Internet Footprint: Once the housekeeping is in order, you can start expanding your presence on the web by adding content and through blogging and social media (Facebook, Twitter) or through paid advertising (such as Google Adwords Express or Pay -Per-Click) and special advertising promotions (Groupon, Living Social). With a little organization and persistence, your efforts will pay great dividends in expanding your presence on the Internet and attracting potential patients who are looking for a great dentist!

Putting It All Together:

New directories are constantly coming on to the scene and existing directories update and cross check information sometimes sending bad data around like a virus. Most practices need at least some directory work. You should be checking your listings periodically to make sure they are still accurate. You may have paid your website company to help you with directories at one point, but it’s been our experience that they are often like bad painters. They’ll throw some stuff together but not really pay attention to the details and therefore, some potential patient traffic is lost. Or, you may be already getting a decent amount of traffic to your website but the website itself needs work. Perhaps it doesn’t really reflect the nature of the office (i.e., it looks too “cookie cutter” or too “Plain Jane”) and doesn’t really give the patient a reason to e-mail or call you.

The devil is in the details. Just the technical nuances in getting the directories straight, the organization of the website and its pages optimized, pictures uploaded, patient reviews, etc. can be a daunting task. But again, it helps to have your priorities. For example, it doesn’t make sense to have a graphically beautiful website if the directories are haphazard and you get very few impressions. And, it doesn’t make a lot of sense to spend time on Facebook and doing blogs if you don’t have your website in order so that as you get interest, people can learn more about you in such a way that they’ll want to become new patients.

Our clients work with the whole gamut of website providers…everyone from their sister-in-law to the big generic companies like Officite and Prosites. It’s been our experience that website providers are happy to take your money each month and not really do much. That’s why we brought Kelly Larson on board. Her job is to “ride herd” over website companies and to keep us and you absolutely up-to-date on what is really working in Internet marketing.

I’ve met people with more technical knowledge of HTML programming. I’ve met others who are great graphic designers. I’ve certainly heard from others who are great sales people. I’m approached about new Internet marketing schemes almost every week. I have not yet met anyone who really knows as much as Kelly Larson does in terms of the nitty-gritty of all this, focused on getting new patients through your door. Whether you are just getting started or already have a sophisticated Internet presence, she can give you a push and help keep you ahead of the competition.

Trends to watch

Trends: Matt, Shelly, Robyn and myself make over 600 onsite visits per year. Here is an informal list of trends that we are observing:

1) Multiple location group practices (e.g., Midwest,Heartland). See our previous newsletters on this. (They are online at www.AdvancedPracticeManagement.com under “Dental News.”)

2) More GP’s doing ortho. For example, about 22% of offices now offer Invisalign.

I remember my travels to Outstate MN over 20 years ago when lots of GPs did ortho but that faded. It’s coming back now with the new technology and approaches.

3) Technology in the Operatories: Over 60% of Dentists have digital x-rays and in-operatory computer monitors. Add to that Laser Caries Detection (45%), Intra-Oral Cameras (65%), Patient Education Technology and Lasers.

This technology can easily run $14,000+ per operatory and that’s in addition to your clinical delivery equipment (chairs, dental units, etc.). So, you have to get “Result Control.” See the article on this at www.AdvancedPracticeManagement.com.

4) More Delta Participation: In 2004, provider Delta Premier participation was down to about 81%. Nowadays, 87% of area practices are with Delta Premier. With Delta continuing it’s domination of the dental market, it can be quite challenging for Doctors to be outside the network.

Another 31% of Dentists are with a “Delta within a Delta” (Delta PPO). In our opinion, many practices with Delta PPO do not need to be with Delta PPO… and it costs them thousands. Essentially, their Delta write-offs are almost doubled and there isn’t enough gain (in our opinion) to make up for the write-offs. Likewise for Met Life.

Other PPOs such as the Premier Group, Health Partners, etc., pay fees more akin to regular Delta Premier and, if an office is running efficiently, the bottom line can be fine.

5) The Internet as a Source of New Patients: I’ve seen several instances this year where the Internet had overtaken the Yellow Pages and other sources (e.g., Direct Mail) in the number of new patients brought into offices. This is not universal. In some places Yellow Pages are still pulling. Visibility (signage) remains a very major factor. Of course, so are patient referrals which still account for 50+% of most office’s new patients.

6) Treatment Coordinators: A treatment coordinator is usually a hygienist or an assistant who presents treatment all the way from the x-rays through to the financial arrangements. The most ready model for this is orthodontic offices who have had treatment coordinators for years. The Doctor looks at the treatment plan, the treatment coordinator goes through it with the patients, holds their hands and works out the financial arrangements.

It’s easy to hire a hygienist and plug them into your operations. Developing a treatment coordinator is a little more tricky. It is a less defined job description. It takes a unique set of skills (a good dental background with good communication skills) and can be hard to work into your routine if you are not used to it. However, when we see offices with treatment coordinators, they do well.

This is by no means a comprehensive list but the trends mentioned are worth your attention.