Overcoming Resistance to Fees--Survey Results
"Overcoming Resistance to Fees", which appeared in the November 1987 issue of JCO, addressed the problem of growing resistance to orthodontic fees as fees continue to increase, and suggested possible solutions. A survey card asked readers to evaluate--on a scale of "Very much", "Some", and "Not at all"--their patients' resistance to amount of initial payment, payment of balance in 24 months, child fee relative to adult fee, and collecting past active treatment. Readers were also asked to state which of the possible solutions they favored, and to offer any additional comments.
The response rate--about 3%--does not assure validity of the results, but there are clear indications about the extent and nature of the problem at the present time among those who did respond.
Seventy percent of the respondents reported experiencing some resistance to the amount of the initial payment, while 79% reported resistance to payment of outstanding fees after completion of active treatment (23% "very much" and 56% "some").
There appears to be less of a problem with resistance to payment of the balance in 24 months and to payment of the child fee compared to the adult fee. Around 30% of the respondents are encountering some resistance in these categories, but almost two-thirds replied "not at all". Perhaps the reason for the response with reference to child fees is because there is so little difference--around 10%--between child and adult fees in the average practice.
There does not appear to be any relationship between resistance to fees and size of fees, years in practice, or geographic location.
Four of the possible solutions presented received about 20% of the "votes" each. These were:
The rest of the solutions discussed lagged far behind. Two of the four leading choices (add services and niche marketing) are internal--instituted within a practice--and two (direct reimbursement and bank plans) are external--developed from the outside. The two internal measures were considered in the article to be effective in the short term (one to two years), while the two external choices were considered to be longer term (more than two years to develop).
There were a number of comments to the effect that high-quality treatment is the number one solution to resistance to fees. This may be true for certain practices, but it is not a dependable solution for most practices. All specialists are expected to offer high quality treatment. In that context, top-quality treatment is a maintenance factor. It must be present for patient satisfaction, but it is more notable if it is not present. Assisting the patient to perceive excellence in treatment and care is a different factor, and the important one as far as quality is concerned.
In a marketplace where top-quality treatment is expected of specialists, there is not usually a distinction to be gained in that area. On the other hand, top-quality service is a feature that can distinguish a practice from its neighbors. Top-quality service means accommodating to patients' comfort and convenience in location and hours, being on time for appointments, completing treatment on time,being accessible to patients, avoiding painful procedures wherever possible, being solicitous when that is not possible (making comfort calls routinely), maintaining communication with patients and parents about progress, treating adult patients with adult amenities, seeking patients' opinions about the practice, giving a high priority to everything that contributes to patient satisfaction, and being attentive to patient complaints.
However, while a patient's perception of top-quality treatment and service may make for a distinctive difference between one practice and others, the article "Overcoming Resistance to Fees" was based on a harsh economic reality. As orthodontic fees are increasing, an increasing number of practices are meeting resistance to the sheer number of dollars required for an initial payment and for monthly payments. Most "solutions" aimed at either getting more referrals or making more lenient fee payment arrangements may ameliorate the problem temporarily, but not solve it. A new way or ways must be explored to provide an appropriate solution, and many of the possibilities were evaluated in the article.
It might be interesting to repeat the survey after two or three years to compare the results with the present ones. There appears to be some resistance to orthodontic fees currently, and this can be expected to increase as orthodontic fees increase. The current survey results might be considered an early signal. If they are accepted as such, orthodontists may have some time to take appropriate steps to minimize the problem in the future.