In this day of digital everything, it is easy to forget that real people and members of our community are at the other end of a website and appointment request form. Jokes have long been made about dentists being expensive, and root canals (modern-day treatment is usually very comfortable) are commonly used in analogies, alongside taxes when talking about the worst things imaginable. Did you know that while most dentists are free to set their fees for treatment, most patients, at least on the West Coast, have insurance that locks dentists into their fee schedules? Dental insurance companies set dentists allowable charges based on an average of fees from a vast region. Great news for a small dental practice in the middle of the desert or a less developed area that pays minimal rent and staffing fees but for dentists and patients in highly populated and costly areas like San Francisco and Los Angeles, this often equates to reimbursement that hovers around 55-60%. Why should you, a dental patient, care about the economics of dentistry? Firstly, can you afford only to get half a paycheck? The people who work in a dental office are part of your community too and help fund the local economy. Something has to give. Many dentists have been forced to cut hours and working days, leading to patients having to wait longer for appointments, especially those coveted early morning, lunch and late afternoon times. Some dentists have created a "health spa" atmosphere which often includes as many elective cosmetic and self-care services as actual dental services. Other dentists have chosen to kick insurance plans to the curb and require patients to seek reimbursement for treatment on their own or pay out-of-pocket for all treatment. These changes impact dental patients not only because they now have to spend time sending in claims (not a fun process, believe us) but also because depending on the type of plan the patient has, reimbursement if any will take a long time. Insurance companies have 30 days to respond to claims and often aren’t required to pay after 6 months.
Dentists and their teams went into dentistry to number one, help people and secondarily make a stable income, a fact that seems too often glossed over. In this turbulent economic and political time, healthcare has been put on a big stage. Politicians, lobbyists, and insurance companies often discuss the expense of healthcare and lack of access. Adressing these problems are absolutely important but did you know that upward of 30% of scheduled appointments in the US are failed? “We take our patients time and care seriously” says San Francisco Cosmetic Dentist Dr. Edward L. Loev, DMD. “In our office, we take a comprehensive approach to dentistry and generally schedule 2 hours for a new patient visit. The first hour is spent with me and my dental assistant, the second hour, is spent with either our dental hygienist or hygiene dentist for a cleaning. Patients have told us that scheduling appointments online is generally most convenient for them, so we have set-up a couple of systems and participate with a couple of groups that make this ease of scheduling secure and possible. We have had this capability since about 2009 and have had an amazing response.” Numerous studies show that in some healthcare specialties upward of 70% of appointments are scheduled online. Yay, so why should I care? Like Dr. Loev, providers set aside time just for the patient. If they set-up an appointment, either online or by phone, especially a 2 hour one and then don’t show up or cancel this dramatically impacts the doctor, his/her team and in turn, your access to care. “We are fortunate if one can try and look at the bright side that failed appointment rates in dentistry are lower than the average medical faulure rate at only ~17%”, says Dr. Loev’s office Manager Theresa. “It is so frustrating to have to tell a patient that I can’t schedule them for three weeks because of a full schedule, put them on a call list only to have the person scheduled for their requested time fail. In our office, we accept texts, emails and even after-hour phone messages; I just don’t understand why it’s so hard to reach out”, she says. So why do patients fail appointments? Many articles and studies have been conducted to try and figure out. One of the best-known studies is titled “Why We Don't Come: Patient Perceptions on No-Shows.” According to this study and the many ones that followed the three main reasons for appointment failure without notice are emotions, perceived disrespect, and not understanding the scheduling system. What does this mean?
- Emotions: Very important factor in dentistry. People are frightened of the dentist for many reasons. Perceived pain, cost, and in some cases, fear of shame contribute to appointment failure for this reason. Dr. Loev has written many articles about this fear one is Who’s the Boss…When it comes to Health at Home? Tips to Convincing Your Husband to Visit a Dentist. Not just Dr. Loev and his team, but dentists across the world spend countless hours and continuing education dollars trying to positively impact dental emotions and create environments that are welcoming and calming to patients.
- Perceived Disrespect: This one is fascinating, especially in the age of online scheduling. Have we in the healthcare industry shown disrespect to patients unintentionally by not staying on schedule? “Your time is important to us, is not just the title of a blog post for us,” says Dr. Loev “based on patient feedback we have increasingly been scheduling longer appointment times and fewer patients on each day to ensure that our patients are seen on time and cared for expediently.” Have our front desk or other provider front desk representatives offended patients by calling to confirm appointments when they are not confirmed by text or email? We aren’t sure, but on behalf of all healthcare professionals, we apologize and kindly request appointment requests and cancelation so that we don’t have to call and “bug’ you.
- Not under-standing the scheduling system: We aren’t sure about this one. If one makes an appointment for a specific time, then usually that means that time has been aside for your care. If care is no longer wanted or needed, then the healthcare provider only knows this if somebody lets them know.
- Lack of Pain or Urgency (We added this one): Cause and effect sum this one up. Many emergency and new patient appointments requests are made outside of regular office hours because pain is felt, or something inspires a patient to recommit to their health. When the pain subsides or something more exciting than the dentist presents itself, the urgency disappears. Online appointments are especially susceptible to this type of failure because no actual communication between living people occurs. Research shows that the younger generation is at least twice as likely to fail an online appointment as a middle aged or older individual because they have been raised in a “virtual world”. We challenge all Millennials to change this perception and allow online scheduling to continue to flourish by coming to appointments that you schedule or cancel them in any way that you find convenient before your appointment so that other patients can benefit from the open time.
At some point, probably in the not so distant future virtual dental care will perhaps join the ranks of virtual medicine but until then, let’s try and do what we can to make healthcare reforms in our own communities. As providers, let's make sure that we are listening to patient concerns and as patients try and be cognizant of the fact that you matter to your doctor when you fail appointments it impacts not only the practitioner whose time has been wasted but also the community and healthcare innovation as a whole.
Dr. Edward L. Loev, DMD has been caring for his patients for decades from his dental office that overlooks San Francisco’s Union Square. He and his team take pride in providing the best quality and most gentle dental care available. Over the years, they have transformed 100’s of “non-dentist” people into people who actually enjoy their visits and take pride in their smiles. A dental relationship should be a positive one; make sure that you feel comfortable and cared for by your dentist if the experience is “meh…” then ask friends, family, and colleagues about their dentist. If you are in the San Francisco Bay Area and are in need or want of a new dentist, Dr. Loev and his team would love the opportunity to meet you and earn your trust and loyalty call them at 415-392-2072 or schedule an appointment online today.