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Case Acceptance

We regularly receive questions about case acceptance, indicating that there is a lot of confusion in dentistry about the subject in general.  It seems to mean different things to different people.  If you attend enough continuing education courses, you never seem to discover a common consensus about how you define or measure it.

In a recent email, a doctor posed 3 questions about case acceptance and how to measure it:

1. If the patient says yes at the chair, or in the consultation room, does that mean they have accepted your entire treatment plan?

2. Does the patient have to say yes and then pay for all of the treatment for there to be case acceptance?  (If they pay as they go would that still be case acceptance?)

3. What if the patient starts the treatment but for some reason stops prior to completion of the entire treatment plan?

Over the next few months, we are going to answer these questions and give you everything you ever wanted to know about case acceptance.  I call it my “can’t miss, shooting dead fish in a barrel with a bazooka strategy to 100% case acceptance”.

So, what is case acceptance?  Remember, in any case presentation the bottom line is to “tie the patient to the office”.  I consider case acceptance to have occurred when the patient says yes, shows up, pays for treatment, and refers everyone they know.

Let me take a moment and tell you what case acceptance is not.  The patient can say “yes” and still not have accepted the case.  The only reason they said yes was to get out of the consultation room (otherwise they would have to listen to the Doctor go on and on and on and on).  They had no intention of actually showing up for the appointment.  The process of case acceptance starts with the first phone call.  Miss any step, mess up once, and you’re done.  What if they say yes, show up and change the treatment plan?  Instead of a crown and buildup you are faced with doing an extraction.  What if they say yes in the treatment room but can’t afford it or you can’t fit it into their budget?  They say yes but you’re not open during the hours when they want to come in?  They need to come in after work or maybe on Friday or Saturday.   As you can see, case acceptance is not a moment in time but a series of systems that set the stage and carry the patient through to a successful result.  Only if the patient says yes, shows up, pays for treatment, and refers everyone they know do we have true case acceptance. Our patients vote with their feet.  If you keep seeing the backs of their heads, something is wrong.

Where do we start?  Let’s look at it from the patient’s point of view.  I’m going to show up at your door step in one of two scenarios: I call with a problem (toothache) or I call and want my teeth cleaned.  From the perspective of the caller (potential patient) these are the only things I know to ask for.  As a consultant, I feel we need to give the patient more of what he or she wants, and less of what he or she doesn’t want.  Remember, you can’t get better at giving patients what they don’t want.   If a potential patient calls and you can’t say yes to what they ask for, the first step in the system of successful case acceptance has failed.  As the patient, I want my teeth cleaned or I want the problem to go away.  We sell “solutions to problems” and “good feelings”.  You must happily give them what they want, and tell them what they need.  The trick is to help them “want” what they need, and fit it into an already tight budget.

How, as dental professionals, do we balance this ethical dilemma with running a consumer driven business.  Let’s look at it from the doctor’s point of view.  We have conflicting strategies of what the new patient “experience” should look like.  It seems that every guru or consultant has a different definition of what “comprehensive dentistry” is and how we should deliver it.  How can we determine what to do?  Axiom #1: You must tell the patient what is wrong, what caused it, what will happen if it is not addressed and what you recommend as treatment options.  Axiom #2: You must give the patient what they want, in order to have the opportunity to eventually deliver what they need.  Vary from these principles and your case acceptance will plummet.  These last few sentences form the foundation to excellent case acceptance.  Misunderstand their implications and you will ruin any opportunity at success in dentistry.  Before you challenge any of the above, remember:  If you are not growing you are not meeting your patient’s needs.

Back to the original question from our doctor: There are really four potential outcomes from our case presentation and the patient will say or respond with “Yes” or “No” four separate times:

With the doctor Financial Secretary Scheduling Coordinator Show up for appointment
Yes No No No
Yes Yes No No
Yes Yes Yes No
Yes Yes Yes Yes

In each case the patient says “yes” at least once.  In the first three situations the patient could not afford it, put off scheduling the appointment, or made the appointment and didn’t show.  Only the last scenario is true case acceptance.  Remember: You can’t get better at giving patients what they don’t want.

The following form will help you start monitoring your progress in case acceptance.   Before you can get better at case acceptance you need to know where you are.  Keep very careful records for the next 30 days.

Daily Presentations Monitor

Date Patient Name Procedures Presented Fee Presented Procedures Accepted Fee Accepted

You can create something similar on your computer, or call or email us and we will email it to you right away.  It would be great to begin this monitoring at the start of the next month.    Next month’s installment in our Case Acceptance series will cover the goals of case acceptance and why patients say “yes”.