TBU: #030 How I Set My Biomimetic Fees and Schedule to Find My Ideal Patient

New Issue of The Biomimetic Uprising

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 I get a lot of questions about the business side of biomimetics.  Its a common theme.

Let me start this issue expanding off last week's issue.  Last week I spoke about keeping treatment in house because with biomimetics, you just dont NEED to refer or a lot of biomimetics can AVOID referrals. I also gave some information about fees, reviews, scheduling, etc.

Let me start with my fees.  I'll be transparent here.  I  really don't mind because this is what fits my office, location, and how I want to run things.  Everyone is different and has a different method of doing things.  

**FEES**

Ok, so first, I have solely focused my career on biomimetics.  Its what I've done since 2012.  At this point, I consider myself a specialist in Biomimetic Dentistry.  I'm not into extraction, implants, endo, removable, surgeries, etc.  I mean, I like them, and do them occasionally, but its not truly what I enjoy.  I enjoy the challenges that come with biomimetics, restorative, adhesively bonding, cosmetics, etc. So I'm almost exclusively doing biomimetic restorative dentistry.  

I've tailored my practice to specializing in biomimetics and I feel my fees should reflect that.  I'm high for the Usual and Customary fees in my office's neighborhood. I'm typically in the 95 percentile and above.  I'm also practicing in Highland Park which is one of the higher affluential neighborhoods in Dallas.  That really was a criteria when selecting an office to buy.  I knew that I wanted to have high fees so I found one accordingly.  

I'm also technically OON, out of network, with all the insurances.  The office was prior to me as well.  Which was another criteria I had to have. I accept their insurance, but at the OON rate.  So that means we file for them, estimate what the insurance will cover, then charge the patient the difference and we accept their benefits.   Typically the patients don't mind this and are happy they have a coverage.  Our cash paying patients understand as they are used to this type of system.  We charge same day for all treatment.  There are no 'in house' plans, financing, etc.  If they are looking to spread out payments, I do care credit and am in the process of starting to use Sunbit (ask me about it if you want! Looks good!).  I also don't warranty my work (don't need to really). If something happens, I'll make small fixes, but hardly ever will I need to do a complete redo.  I feel that I  have given them the best scenario and treatment and can't control what they are doing with their teeth after they leave the office.  Who knows if they are eating ice, fingernails, or using their teeth to hold their sewing needle or what (I've had that).  So, if the work needs to be redone, I'll meet them in the middle with depending on the time its been or other factors.

When deciding how to set my fees, I dont want to charge may patients lots of little codes or fees.  To compensate that, I build in those smaller accessory fees into the larger one.  A common question I  get is about buildups.  Honestly I    hate this code because, as dentists, we know we need it.  Insurance companies on the other hand, say its "an integral" part of the treatment and should be included.  So most often then not, this code doesn't get sent to the insurances.  Some people will say to send it even if it gets denied.  I    dont know.  This is part of why I'm not in network.  Don't want to play their games.  I just want to fix teeth. The only time I really bill a buildup is maybe with an Endo treated tooth.  

So what I do, is set my fees according to my overhead, or practice goals, to what I need to produce an hour. Then from there, I'll figure out how long it takes me to do a certain procedure and then build out the fee that way.  

So last week, I mentioned my indirects are about $2200 to do.  This is typically the same fee regardless if its crown, veneer, onlay, inlay, 3 to 4 surfaces, etc.  They're all about the same.  The reason being for that is so I can use my dental clinical judgement to decide what I think is best for the patient.  Not the fee that I need to payoff whatever new toy.  That being said, those fees will include any type of time I might need for a build up, deep margin elevation, or whatever else. If some offices wanted to charge extra for a deep margin elevation, cusp replacement, or another biomimetic code, I'd have no problem with that.  I've been in some offices that will also include their in house biomimetic codes and marked at zero dollars to help illustrate what they are doing and how they're different from their competitors.  Make these codes your own.  Part of the beauty of being OON is the freedom to do things like this!

**SCHEDULING**

When I'm building my schedule, I  really only want to do one indirect restoration a day.  This allows me to balance out my schedule so it becomes more predictable.  This does a few things for me.  It helps build in some 'exclusivity' as I will be booked out and semi harder to get to see. It also allows my day to become a little easier and can fill my time with smaller filler appointments.  Crown seats, Invisalign checks, limited exams, consults, smaller direct composites etc are great to fill in the rest of the day.  This typically leads to about a $5000 day.  Multiply that out per month and year, thats coming in at $80k a month and $960,000 on the year.  I have low overhead (another topic) so things become fairly predictable, profitable, easy, and low stress days. 

I do have a long term goal of becoming totally fee for service. The ideal setup I'd like to have is: them to pay for the services upfront, we submit their claim to insurance for them, and then they receive the benefits.  This is a hard transition tho as it can have a high entrance barrier as people aren't always excited about paying $500+ just to get in the door. 

Ok what? $500+ to get in the door?

Yup.

So how do I find people to come see me with such high prices?

Reviews. 

**REVIEWS**

Reviews really are the magic of the office.  This is just the way things are now.  Social sharing of information.  Last week I shared my reviews for the office.  I'm at 189 of 5 stars.  Take that for what it is. It tells a good story.  Anyone curious about the office can read those and get a good feel for how they will be handled and the care they will receive. 

Gathering reviews was one of the first things that I emphasized when I took over this practice three years ago.  I think we had like 8 when I started. 😂

I just have a basic statement like "If you have enjoyed your experience here, please tell us your thoughts here..." with a link to leave a google review.  These typically go out a few hours after they were seen.  At first, everyone got one as I was new.  As I have continued to see the same patients, we won't spam them.  We send them using Weave, a dental texting service.  There are tons of great options for this.  But text is an easy and great way to ask.  No one likes to ask another for a review. However, we will occasionally if it fits the conversation, but its not our main focus on how to get them.  Its a numbers game at that point, so the more you ask the better.  They will start to compile up the more you ask.  

Once I get a review, I always try to respond to them and say a quick thank you.  They gave their time to thank me after all.  I used to not do that, but I quickly to corrected by some advertising/PR people. It's important to the patients, the future patients reading them, and the goggle algorithms. 

Google has been great to me.  I literally don't spend anything on marketing.  Maybe thats good, maybe thats bad.  I probably should, but we have the internal focus with our patients with reviews and referrals so our need isn't as high.  I also use Google's business page and try to update it periodically.  This to me, is more important than paying for sponsored ads on Facebook, Instagram, etc.  

I also make my own websites. I'm not computer SEO genius, but I have a few things in there to help with searches, I  think, if its working correctly. But nearly all of our new patients say they came from Google searches. As mentioned in other posts, I'm getting one new patient per work weekday, so about 12-18 per month.

So all this comes down to the ideal patient.  Who is it?

**THE IDEAL PATIENT**

Lets review. 

I have set my fees higher than my competitors, who are also in a well to do area.  I'm not spending on advertising but am relying on the personal connection with my patients, their referrals, and reviews.

So my ideal patient is anyone that wants to search me out, search out better care, search out someone that will listen to them and ATTEMPT to help them with their problems.  Patients have problems.  They want someone to listen to them so they can stop hurting. 

I try to treat people like people.  We typically only have two patients being seen at a time one with hygiene and one with me.  I hate jumping out of treatments for exams, injections, impressions, etc.   You know how it is.  When someone is there, I try to give them my focus and energy. People notice when they have it compared to when they are a number and being pushed though quickly just to get the next one in.  People have left, due to high prices, the long travel, etc, but they often come back after one trip to a different office. People see the care that we have for them and want to keep that.  These are the people that I want to see, people that care about quality.  I'll spend an hour sometimes on new patient exams listening, answering, showing, etc just to make sure they leave with no unanswered questions.  These people are happy to pay a higher fee because they know I will take care of them, for their initial treatment and if anything were to happen.  I have patients within a few mile radius of my office, but I also have some that are willing to travel.  I see patients from California, Utah, Colorado,  Oklahoma, Louisiana, Wisconsin, Mississippi, Mexico, etc.  People are willing to travel.  So I'm not narrowing my patient base to just Dallas.  I guess in some ways, they are searching me out as much as I'm searching them out.

Again, this is for my current office.  I've been in lots of different styles and always did biomimetics.  This is just one way of many to implement biomimetics. Literally no wrong way to do it, as long as you're doing it. 

Whenever you're ready, here are the ways I can help you:

1.  If you're looking for better application in your practice, take a look at our online courses and guides 
   1. The Foundations Of Biomimetic Dentistry
   2. How To Do Biomimetic Posterior Direct Composites.
   3. Get our 53 page biomimetic protocols guide for posterior direct restorations. 
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