Patient Enrollment: Initial Call to Appliance Placement

The basic premise of this column is that there are orthodontists throughout the world who are not only adept clinicians, but also innovative and knowledgeable enough about management and marketing to operate highly successful practices. This know-how is not limited to a few individuals; many of our colleagues have a great deal to teach us.

My goal in this quarterly feature is to show how different orthodontists have developed time-tested ideas, or invented new ones, and melded them into a successful and workable program.

Dr. Terry Dischinger is a renowned clinician whose method of using the Herbst appliance is rapidly gaining acceptance. This first installment of Management & Marketing displays a lesser-known side of Dr. Dischinger's abilities.

Any successful orthodontist must be able to generate a sufficient flow of patients, and the key to that is what Dr. Dischinger calls "patient enrollment". In this article, you will learn not only about how he starts patients in his practice, but about the caring attitude that pervades his office. I would like to thank Dr. Dischinger for an insightful presentation, and I welcome your suggestions on topics or authors for future columns.

Patient Enrollment: Initial Call to Appliance Placement

Our office mission statement is as follows: "It is our desire to provide a unique professional experience for all who encounter our office. To that end, we commit to treating with love and care our patients, parents, each other, and anyone else who comes to our office, placing their concerns before our own. We commit to providing excellence in our orthodontic treatment, maintaining our nonextraction philosophy and our goal of treating to a balanced face and healthy jaw joints. Our primary concern is about relationships, not just about treatment of teeth."

Initial Telephone Call

The first step in enrolling a patient is the initial phone call (Fig. 1). Our receptionists follow a script that is designed to gather the information we need to begin our relationship.

Because the acceptance of orthodontic treatment and how to pay for it are major decisions for any family, I feel an important aspect of our script is the encouragement of both parents to be present at the initial visit. If the patient is a child from a two-parent family, then both parents need to make the commitment to treatment. The initial appointment helps begin the bonding between the orthodontist and the parents and patient.

Another significant part of the script is to inform the parents or patient that we can take the records at the first visit so that, if they choose, treatment can be started at the next appointment. I believe when people call for an appointment, they have already felt the need to have orthodontic treatment, and generally their attitude is "the sooner, the better". If a patient needing treatment does not start, it is because we have placed some sort of roadblock in the way--and it is not usually money.

Therefore, when our receptionists take an initial patient call, they proceed as if the patient is going to go into treatment. The language we use conveys the idea that we have arranged our schedule to make it possible for the patient and parents to start treatment at their convenience. It also lets them know that we are not too busy to meet their needs (or too busy, period). Our goal--although schedule conflicts sometimes prevent us from meeting it--is to make no one wait more than a week to start treatment.

Welcoming Letter

The next step in patient enrollment is to send out a welcome letter the day after the initial appointment is scheduled. We have different texts for these letters, depending on the patient's age. Along with the letter goes our brochure, which was designed to present our mission statement and other information the patient or parent needs to know before coming to the office.

Initial Exam

The first visit is the most important one, because even though patients and parents may have already decided to have orthodontic treatment, this is when they determine whether treatment will be in our office. This is when we can prove that they will have a unique professional experience by choosing our practice.

We always set aside enough time so they will not feel I am rushing, and that I have adequate time to meet their needs. Our treatment coordinator greets the patient and parents when they walk through the door (Fig. 2), and sits down with them to fill out our patient information form (Fig. 3). One of the questions on the form concerns personal interests and hobbies--letting them know that we are interested not only in excellence of orthodontic treatment, but also in patients as unique individuals.

The treatment coordinator also begins to develop a relationship. She is quite knowledgeable about the types of treatment I use, so she takes this time to lay some groundwork. She affirms my expertise as a professional and discusses my treatment philosophy. If I am delayed, she can show before-and-after pictures that further validate my results (Fig. 4).

The information form is made in two copies, one of which goes to our financial secretary and the other to me for reference during the exam. The financial secretary has a terminal that enables her to run an immediate credit check on the person designated as the responsible party (Fig. 5). She evaluates the credit history, along with the stability evidenced from the patient information form, to assign a rating from "A+" to "C".

The credit rating, which determines the kind of financial arrangements we will offer, is a result of our association with Paul Zuelke. When he first visited our office, he told me, "If you do what I tell you, Terry, you will be more profitable--but that's not what we're about. We're about the quality of your practice and relationships. If patients cannot pay you, they will not be in a positive relationship with you and treatment will not proceed as desired. They will miss more appointments and have more broken appliances, plus they will not refer patients to your office. Also, when they do talk about their orthodontic treatment, it will not be in positive terms."

Once the necessary information is gathered, the treatment coordinator brings the patient and parents into my exam room. There is a saying that "patients want to know how much you care before they care how much you know", so I spend the first few minutes asking patients about the interests listed on the information form.

I open the professional part of the visit by asking the patients what they would like to see happen to their teeth as a result of orthodontic treatment. I then move into the actual examination. I point out the problems and the treatment I believe is needed to correct them (Fig. 6).

Once the treatment plan is discussed, I show before-and-after photographs of patients who had similar problems. This visualization process is extremely important, because most people have no comprehension of the extraordinary capabilities of today's orthodontics.

Equally important is being able to see the appliances that accomplished the results they observed. We have models with all the appliances we use, and the patients and parents can handle them and find out that the patients will be able to function with these appliances in their mouths.

I ask the patients and parents if all their questions have been answered, and if there is anything that would prevent them from proceeding with treatment. In almost all cases, I quote a treatment fee at this time. Sometimes more difficult cases require further evaluation.

Orthodontic Records

If I feel comfortable in proceeding with treatment, the patient is told that the next step in our office is obtaining orthodontic records, which I will review to confirm that my treatment plan is the best way to correct the orthodontic problem.

At this point, the treatment coordinator escorts the parent or adult patient to a consultation area to discuss the fee and financial terms. The patient is taken to the clinical area, where a clinical staff member gathers information to be used in letters to the parents or adult patient and their dentist. I use the PCS Ortho program, in which the clinical assistant fills in a scan sheet based on her examination of the patient's mouth, my initial exam, and my treatment plan.

The follow-up letter is extremely important, because it would be impossible for the parents and patient to remember everything from the appointment. The letter goes into great detail in describing the orthodontic problem, our treatment goals, how those goals will be achieved, and the fee. Our objective is to get the letter into the family's and dentist's hands as quickly as possible.

If the responsible party has an "A" credit rating and it fits into the patient's schedule, we take complete records at this first appointment and then place separators so that treatment can begin at the next appointment. Recently we have even begun placing appliances at the initial visit, if our schedule allows and the patient is ready to start. We offer as much flexibility as possible, so that patients know our schedule is designed to accommodate their needs in starting treatment.

After the Initial Visit

The next visit after records are taken is called an "information appointment". The patient coordinator goes over the records with the parents and patient to reiterate the orthodontic problem, using the letter I sent them to review treatment goals. She shows them the appliances that will be used and gives them handouts explaining how the appliances work and how to deal with any problems that may arise. Brushing and hygiene instructions are given, along with any other information about our office that will enhance the treatment.

I call patients the evening after an appliance is placed to ask how they are doing and if they have any questions. I find that my patients adapt well to the initial inconvenience of an appliance if they receive this follow-up call, and they greatly appreciate the minimal amount of time it takes to make the call.

Conclusion

Our schedule is designed to enroll patients in the practice as quickly as we can, letting them know that their felt need of straight teeth and a perfect smile can be accomplished in the shortest amount of time possible without compromising excellence. Our desire throughout treatment is to provide patients and parents with a unique professional experience.

ACKNOWLEDGMENT: Special thanks to Pitts and Co. for being instrumental in the evolution of our enrollment process.