what practices need now 082708 - aafprs zupko.pdfwhat practices need now 082708.doc here’s how to...

What Practices Need Now!

Sponsored by: Organization of Facial Plastic Surgery Assistants Chicago, IL September 18, 2008

Presented by: Karen A. Zupko KarenZupko & Associates, Inc.

2 Text and Format © 2008 KZA, Inc. What Practices Need Now 082708.doc

Here’s How to Reach Us…

Be sure to visit our website for useful practice management ideas and course information!

www.karenzupko.com [email protected]

KarenZupko & Associates, Inc. 625 N. Michigan Avenue Ste 2225

Chicago, Illinois 60611

312/642-5616 312/642-5571

Check out your course alumni page for updates, sample forms and more tips & links Password:

FACE


Karen Zupko President and Speaker Advising and educating plastic surgeons on practice management and marketing has been a central focus for Karen Zupko since 1978. Known as an informative and entertaining speaker, Karen first participated in the AAFPRS annual meetings in 1985. Her firm conducts the reimbursement and coding workshops for ASPSENTs and plastic surgery specialists. Karen brings 30 years of experience to her lectures, writing, and consulting assignments. KarenZupko & Associates has analyzed and advised more than 240 plastic surgery specialty practices. With a deep understanding of both aesthetic and reconstructive surgery, Karen and the KZA consulting team perform a 360 degree analysis of the business side of facial plastic surgery practices—from personnel, billing, computer usage, coding, and practice expansion. Karen’s proven approach to relationship marketing offers surgeons a sensible, non-cookie cutter approach to practice building. Karen’s training tools include:

■ Handling Patient Objections About Fees ■ Job Descriptions on CD-rom ■ Employee Manual on CD-rom

Karen writes for a number of publications and is frequently quoted in Plastic Surgery Products, Plastic Surgery Practice Advisory, Medical Economics and Cosmetic Surgery Times. The firm’s Plastic Surgery Alert is a popular free email newsletter. Karen has been featured on international plastic surgery and dermatology programs in Australia, Mexico, Argentina, and England, as well as in Toronto, Canada. Prior to opening her Chicago-based consulting firm 20 years ago, Karen directed the American Medical Association's Department of Practice Management where she established a national reputation as an authority on practice management and marketing. Ms. Zupko is a member of the Board of Editorial Consultants of Medical Economics magazine and The Journal of Medical Practice Management. She is a member of the Forum for Healthcare Strategy.


The Patient’s Journey A Moment of Truth is defined as: “Any episode in which a patient has contact with some aspect of a physicians’ practice and forms an impression of quality of service.” Consumers are now willing to pay a significant premium for goods and services that are emotionally important to them and that deliver the perceived values of quality, performance and engagement. Silverstein, “Trading Up: The New American Luxury, 2nd edition.”

11Conversation

with friend visit to website

221st phone call

33Pre-visit follow up

44Arrive at

office

55Consultation

66Fee

discussion with PC

77Post consult

activity

882nd Consult

99Schedule procedure

1010Post op activity

1111Keeping in

touch

11Conversation

with friend visit to website

221st phone call

33Pre-visit follow up

44Arrive at

office

55Consultation

66Fee

discussion with PC

77Post consult

activity

882nd Consult

99Schedule procedure

1010Post op activity

1111Keeping in

touch


What Makes a Good Patient Coordinator, Great?

1. She acts as a concierge for the entire patient journey. From the first phone call to the final post op visit or follow up, she is a guide helping the patient anticipate what is coming next.

2. He recognizes the difference between casual conversation

and choreographed conversation and becomes Fred Astaire. 3. She knows that asking a patient, “Do you have any

questions?” is not effective. 4. She dresses well and presents professionally. 5. He has an arsenal of questions and uses the patients name

often. 6. She ignores the Golden Rule. 7. She understands the level of detail necessary for tracking. 8. She knows how to follow up a patient who has not yet

scheduled. 9. She handles objections well. 10. Great patient coordinators are falcons.


Making the Phone Ring…. and knowing what to do when it does

Trend: __% of offices don’t ask for the appointment. __% fail to schedule follow up. ■ Phone skills

■ Marketing communications

■ Web analytics and increasing web referrals

■ Renew relationships with existing patients

■ Follow up

Get patients in the door

now

Know what your stats are from consultation to surgery for each major procedure.


Mystery Shopper Report

Doctor Procedure Consultation Fee Appointment Dr. G Face Lift $75 Consult Fee/all procedures (not deducted

for facelift) Facelift approx. $11,000 all inclusive.

1-Aug

Facial Rejuvenation Fraxel Laser: $1,000/per treatment; 4/$3500 All injectables: $550/syringe done by RN/Esthetician

We will call back

Dr. D Face Lift $75/paid day of consult; applied towards procedure Facelift approx. $7 to $10,000

Middle of August, 07

Facial Rejuvenation Fraxel Laser: $900/treatment; 3/$2500. Fillers: Need to talk to Dr. D. Costs per injection.

Call for appointment

Dr. O Face Lift $100 Consult fee (not deducted from facelift) Facelift approx. $12 to $13,000 all inclusive.

Dr. O: October, 07

Facial Rejuvenation NO Laser -refers all patients to Dr. M. Have esthetician who does injectables; chargesbased on per syringe.

Have openings for 7/25/07

Dr. F Face Lift $100 Consult fee (not deducted from facelift). Facelift approx. $10 to $12,000 all inclusive.

2nd. Week of August, 07

Facial Rejuvenation No laser or injectables - refers to Dr. H.

Dr. B Face Lift $100 Consult fee (deducted from facelift). Facelift: $14,275 all inclusive

2nd. Week of August, 07

Facial Rejuvenation Have Fraxel laser & education seminar tomorrow, July 11, 2007 at 6:30 pm. Also have injectables which are done by RN. Prices based on syringe use.


The Patient Relationship Starts with the First Phone Call…and, So Does Your Database

If you are spending money marketing to generate “patients” it goes to figure that more than 80% of the first contacts are made by phone. That means the “The Voice of Your Practice” is the receptionist. And, in many plastic surgery practices the receptionist is the newest person on the team. Often they receive little or no training.

Look at what’s riding on that first call. The appointment is made—or not depending on a number of things:

Is the receptionist able to explain why you charge a consultation fee and why you are “worth it?”

Can the receptionist persuade the patient to wait for that “next available” appointment slot?

Does the receptionist offer to do “a little extra” to make the appointment and make a positive first impression with your patient?

We hope you can answer “yes” to each question.

The goal of that first phone call is turn “prospects” into “patients” and schedule consultations. Here’s a step-by-step procedure for accomplishing that.

1. Introduce herself and use the patient's name in conversation. Names go a long way in personalizing the call. An old adage states, "There is no music sweeter to our ears than the sound of our own name."

2. Put a smile in her voice. Research has shown that smiling projects a more positive and enthusiastic tone into the speaking voice. A mirror often helps receptionists see themselves literally.

3. Introduce the unique elements of your practice. Don’t wait until the patient's first visit to begin differentiating your practice from your competitors. Have your receptionist introduce the uniqueness of your practice during the initial phone call.



4. Provide callers with a choice of consultation times. Experienced schedulers offer prospective patients a choice when arranging the visit with the plastic surgeon. (“You could come in at 10:30 a.m. or 2:30 p.m. Which is best for you?")

5. Determine the purpose of the consultation. Too many receptionists miss the opportunity to optimize the patient’s visit, help them accomplish their goals and at the same time get control of the schedule. The receptionist should ask probing questions regarding injections. Does the patient expect to consult and be treated the same day for Restylane? If so, they need to stop with all aspirin products, plan to spend 45 minutes at the office to allow for numbing, etc. And equipped with a list of criteria and questions, the receptionist can determine if the Mom of three needs information on mastopexy as well as breast augmentation prior to the consultation.

6. Be prepared to discuss fees. Whether or not your practice policy is to quote fees over the phone, the receptionist can rehearse appropriate responses to fee inquiries so that she explains your policy in an understandable way. Make sure the receptionist can explain what is and is not included in the fee range. Decide if she should quote only the professional fee or if the amount is a “global or all inclusive fee.” If your policy precludes fee quotations, then make sure you rehearse how you want these questions answered.

7. Obtain and enter prospective patient demographic data. Your expensive software is worthless if it isn’t used properly. Educate the entire staff about why it is important to get the caller’s data. This will include: name, address, home, work and cell phone numbers, email and either how the patient learned about the practice or who referred them to you. Make sure you also ask about preferred methods of contact—can you call her work or home?



8. Track how each caller found you. If you are spending money on marketing, make darn sure you know if it is working. You need the “points of origin” for each caller entered into your tracking system. In today’s electronic world, the referral source could be a web site, Care Credit or your ad. Hopefully, most of your callers are referred the best way—from a satisfied patient.

9. Offer to send information to all callers. If the caller becomes a patient, they should receive a confirming letter from you. With the cost of postage on the rise and some patients’ need for confidentiality, email is often the best way to communicate. Therefore, you need to have a system for sending professional correspondence out via a PDF.

10. Choose words carefully. The difference between the denotation (dictionary meaning) and connotation (our perceived meaning) may make a difference in the caller's impression of the practice. When choosing medical terminology, the receptionist should speak at the caller’s level of sophistication and comprehension. (If the patient uses the term “rhinoplasty” then continue to use that term. If the caller refers to the procedure as a “nose job,” the receptionist may want to refer to it as “nasal surgery.”)

11. Never make inflated claims. Providing broad assurances of excellent results to callers is not a good idea. “Dr. Smart is the best surgeon in the city for facelifts!” is the type of remark that can cause problems later. Better to say, “Dr. Smart is not only a board certified surgeon, he has more than 12 years of experience in facial rejuvenation surgery.” Assure the patient that the consultation is an experience that will educate, inform and provide answers to their key questions.


Designing a No-Show Prevention Plan

No-shows are stealing your opportunity to have a full surgery schedule. The incidents of patients who make appointments and fail to keep them have grown steadily over the last five years. The no-show problem is not unique to doctors. Noted restaurants now often require a credit card number to guarantee a reservation. Hotels and top hair stylists also have this policy. Airlines now charge for changing reservations.

Here’s a formula for improvement in your practice.

1. Make sure no-shows are tracked in your computerized scheduling system. Run that list now and see how many no-shows you had for 2007. Get ready to run 1st quarter of 2008.

2. Try to avoid scheduling too far in advance. Make the schedule work for the patient.

3. Preregister patients by phone, or have your forms downloadable from your website.

4. Take a credit card to guarantee the appointment.

5. Charge half the fee on the card the day the appointment is made.

6. Remind patients to call ahead if they can’t keep their appointment to avoid a charge.

7. Send an appointment confirmation letter whether or not you charge for appointments or take a credit card guarantee. Send a receipt if you charge.

8. Make reminder calls. Good cell phone numbers will increase your success rates, as will email addresses—especially if the patient has a Blackberry or other instant messaging device.

9. Use a negative option. “We’ll release the time if we don’t hear from you.”

10. Always keep a list of ready-to-be-worked-in patients.

11. Never give patients with a history of no-shows prime time appointments.


From Free to Fee

Charge ½ on credit card

NYC/Chgo $ $ $ $ $ but 2 consults 200 500

Group consult with past patient there or revision patient ■ Appointment later Only thing

for free

Consult fee deducted from surgery

Take credit card only as guarantee

Charge Zero (Lisa the Lemon Sucker)


What to Say? Guaranteeing Appointments and Reducing No Shows Here’s how to institute this policy in your office. For all aesthetic new patients, established patients returning for a new procedure and in some practices for filler-injection patients you have two options. Option One calls for you to simply take the credit card as a guarantee for the consultation. You will charge the card if the patient doesn’t come in. Option Two results in 50% of the consultation fee charged in advance of the appointment or a full syringe of whatever the patient is having. The later might be beneficial if you look at your Saturday no show rates. We assume that all no shows are being entered into NexTech. If not, you need to begin doing this immediately. Run the no show report at the end of each month. After making the appointment for the patient, you will say: “What credit card would you like to use to guarantee your consultation time?” Patient: “Why do I have to do that?” You: “Because (very important you use that word) we have scheduled you for 45 minutes with Dr. C, we ask for a credit card guarantee. We’ve found that by doing this, patients remember to call us if their plans change.” So, if you can’t come in and you call us 24 hours before your consultation, there’s no charge to your credit card. I’ll send you a confirming letter restating this..” Patient: I don’t think a doctor has ever asked me to guarantee an appointment. “Well, Mrs. B, no show rates are a real problem—for all physicians and dentists And, while I can’t speak for every other office— I do know that asking for a credit card is a practice is growing among physician offices. As you know it has been customary at high end hair salons, spas for massages, fine restaurants, luxury hotels, and airlines—so most patients don’t find it unusual.”. Note the adjectives used—“high end, luxury, fine…” don’t leave this out.


You Can’t Manage What You Don’t Measure

Why Measure Activity at All?

What Keeps Practices from Measuring Activity and Tracking?

What are Good Aspects of Marketing to Measure?

How many people responded to your marketing?

How many people made appointments?

How many kept their appointments?

How many scheduled surgery, got an injection, had a skin treatment or bought a product?

What was the value of the transaction?

What do those patients have in common-geographically, by age, sex, lifestyle?

Do patients cross the lines between reconstructive and aesthetic?

What financial controls must be in place?

Prepayments

Codes

Credit card fees


You Can’t Manage What You Don’t Measure

CONSULTATIONS Dec. 06 Jan. 07 Feb. 07 Quarterly

Total Facelift (Rhytidectomy) 4 2 6 12 Browlift 0 1 1 2 Upper Eyelids (Blepharoplasty) 1 0 0 1 Lower Eyelids (Blepharoplasty) 7 6 5 18 Rhinoplasty 4 1 5 10 Fat Grafting 4 0 6 10 Liposuction 5 2 6 13 Abdominoplasty 1 3 1 5 Breast Lift (Mastopexy) 3 3 2 8 Breast Augmentation 3 5 7 15 TOTAL 32 23 40 95 Botox 10 8 6 24 Cosmoderm/plast 2 4 4 6 Radiesse 0 4 4 4 Restylane 6 8 9 15 TOTAL 18 24 23 49

PROCEDURES Dec. 06 Jan. 07 Feb. 07 Quarterly

Total

Patient Acceptance

Rate Facelift (Rhytidectomy) 0 0 1 1 8% Browlift 0 0 0 0 0% Upper Eyelids (Blepharoplasty) 0 0 0 0 0% Lower Eyelids (Blepharoplasty) 0 3 2 5 28% Rhinoplasty 0 1 2 3 30% Fat Grafting 1 1 2 4 40% Liposuction 4 2 3 9 69% Abdominoplasty 1 1 1 3 60% Breast Lift (Mastopexy) 0 0 0 0 0% Breast Augmentation 0 2 6 8 53% TOTAL 6 10 17 33 Botox 10 8 6 24 100% Cosmoderm/plast 2 4 4 6 0% Radiesse 0 4 4 4 100% Restylane 6 8 9 15 0% TOTAL 18 24 23 49


Truisms on Tracking Tracking Your Patient Acceptance Rates by Procedure Everyone agrees that it’s important know how many patients seen in consultation actually schedule surgery. However, many surgeons and staff quote an overall “conversion rate.” This is not a good idea. You are very likely to find that your Patient Acceptance Rates (PARs) are quite different from procedure to procedure. In fact, that would be “normal.” What could explain the variation in the number of patients who say,

“Yes, please schedule me.”?

1. Does the doctor enjoy doing noses as much as eyes?

2. Reputationally are you known as the “facelift expert” or the “sinus doctor?” The challenge of a mixed practice.

3. Is your fee higher than the market for the procedures with the lower

PARs?

4. Is the consultation flow or technique different between the higher and lower scheduling procedures? Should it be different?

5. Does everyone on the staff understand the procedures with low

PARs as well as they do the highest scoring ones? Is your staff enthusiastic about the procedure?


Why We Hate Overall Averages

“What’s a good overall ‘conversion rate’?”

Patient Acceptance Rate

2007 2006

Blephs 87% 68%

Fat transfer 70% 0%

Face Lift 68% 57%

Rhinoplasty 30% 30%

Total: 64% 56%

How to calculate PAR Number of surgeries by procedure Number of consultations by procedure

= PAR


Monthly Analysis of MD Productivity for Dr. Hours

SEPTEMBER PATIENTS OCTOBER PATIENTS Patient hours: 39 Patient hours: 43 Patients seen: 177 Patients seen: 233

Pre-ops 16 Pre-ops 27 Post-ops 39 Post-ops 53 FU 74 FU 83 Cosmetic 27 Cosmetic 41 Recon 10 Recon 18 Botox 11 Botox 11 Fillers 2 Fillers 4 Combo 0 Combo 0 Total 177 Total 233

OR Time Available 90 hours OR Time Available 118 hours OR Time Used 50 hours OR Time Used 83 hours OR Time Unused 40 hours OR Time Unused 37 hours AWAY 4 DAYS AWAY 5 DAYS

NOVEMBER PATIENTS DECEMBER PATIENTS Patient hours: 30 Patient hours: 38 Patients seen: 185 Patients seen: 220

Pre-ops 25 Pre-ops 23 Post-ops 50 Post-ops 56 FU 63 FU 89 Cosmetic 28 Cosmetic 26 Recon 7 Recon 7 Botox 10 Botox 12 Fillers Fillers Combo 2 Combo 1 Total 185 Total 220

OR Time Available 82 hours OR Time Available 112 hours OR Time Used 70 hours OR Time Used 76 hours OR Time Unused 12 hours OR Time Unused 36 hours AWAY 7 DAYS AWAY 3 DAYS

TOTAL OF TIME AVAILABLE 868 HOURS TOTAL OF UNUSED HOURS 220 HOURS 25%


Ground Rules for the Consultation

1. There is more than one “right” way to conduct an aesthetic consultation.

2. It is always healthy to challenge “this is the way we’ve always done it” thinking.

3. If you don’t know what patients liked and didn’t like about the “feel” of the consultation – you’re not playing with a full deck!

Patients judge their consult experience using three criteria:

E _________

T _______ F _______


10 Questions About the Patients’ Consultation Experience 1. Do you conduct consultations the same way for every procedure? 2. How have you modified your consultations as your practice has matured? 3. Pick a procedure you’d like to do more of: ________________________ 4. What two or three things about the consultation order, timing, content would

you alter that might affect the patient’s response? 5. Do you believe that everyone on your team shares the same service mentality? 6. Do you believe that you spend adequate time with the patient in consultation? 7. On what do you base this belief? 8. What would the economic impact be of adding two additional elective, cosmetic

cases, every month to your schedule? 9. How do you connect the patient’s personal life with the treatment plan? 10. What’s the road block to improving the consultation?


Why Prospective Patients Don’t Schedule Price is usually blamed. Or, the consultation patient is derisively labeled, a shopper. This is amusing because everyone before they buy is—a shopper. Few people have extra hours to simply hang around plastic surgeons recep tion rooms loitering for lack of any better pursuit. Interestingly, while some surgeons and staff are eager to blame the customer, few will say, “You know we didn’t do a good job of listening.” Rarely do you hear anyone say, “If we’d done a better job of meeting her needs she might have scheduled with us.” Look at your patient acceptance rate (PAR) and dare to do some soul searching. And, while you’re at it, don’t forget these powerful reasons. 1. Preoccupation. Believe it or not, they have more than you think on their

mind. My hips and wrinkles may take the back seat when another health problem arises, or a family member is in need. Learning how to tell the difference between a shopper and a postponed opportunity, is a sign of maturity.

2. Impossibly Off Target. The patient came in for her eyes and the doctor

moved on to cheek implants, her ethnic nose (she likes it) and laser resurfacing. His ideas won’t work for her—she is furious, insulted and furthermore, doesn’t have the money.

3. Unpredictable. The buyer you are dealing with changes. Funds are made

available or taken away; the husband cancels the two week business trip she needed to recover. The potential patient is transferred, gets a new boyfriend, winds up with a promotion despite her second chin and decides no surgery.

4. Strange. The horoscope for the day of the consultation said, “Make no major

decisions…” Patient idiosyncrasies are endless and can derail the most effective plan.


Increasing Patient Acceptance Before and during the consultation process, good patient coordinators develop skills that enable them to “qualify” patients, or predict the probability of patient acceptance. A patient’s answers to these questions can help you quickly gain valuable insight:

Receptionist:

““HHooww ddiidd yyoouu hheeaarr aabboouutt uuss??””

HINT: Using software to track your referral sources gives useful predictive information for qualifying prospective patients.

““WWhhaatt ttiimmee--ffrraammee ddoo yyoouu hhaavvee iinn mmiinndd ffoorr yyoouurr pprroocceedduurree??”” HINT: Patients with time frames are typically more ready to schedule surgery. Time frame tracking also allows you to fill in gaps that inadvertently appear in the surgery schedule.

Patient Coordinator or Nurse: ““TTeellll mmee aabboouutt tthhee ttiimmee yyoouu’’rree eennvviissiioonniinngg ffoorr rreeccoovveerryy””

““WWhhaatt ssppeecciiaall eevveennttss oorr ttiimmee ccoonnssttrraaiinnttss aarree yyoouu wwoorrkkiinngg aarroouunndd??””

““AArree yyoouu wwoorrkkiinngg wwiitthh aa bbuuddggeett tthhaatt II sshhoouulldd bbee aawwaarree ooff??”” oorr ““WWhhaatt rraannggee hhaavvee yyoouu bbuuddggeetteedd ffoorr yyoouurr ffaacciiaall rreejjuuvveennaattiioonn??””

““HHooww lloonngg hhaavvee yyoouu bbeeeenn tthhiinnkkiinngg aabboouutt ddooiinngg tthhiiss??””

““WWhheerree aarree yyoouu iinn tthhee ddeecciissiioonn mmaakkiinngg pprroocceessss??””


Why Don’t Patients Schedule Surgery? One of the most common questions asked by aesthetic surgeons is: “Why don’t more of my consult patients schedule surgery?” 1. Aesthetic patients wait too long in the reception

areas and reception area education materials do not meet their needs or advance the consultative process.

2. No cross education or selling is done during waits. 3. Overbooking is common. Doctor starts late. No one values the patients’

time. 4. Consult patients spend too little time with the patient coordinator. 5. Doctor discusses too many risk management details at the time of the

initial consultation. 6. Fee quote procedures lack finesse. 7. Patients leave without fee quotes. No one can state the USPs. 8. No one follows up—at all.

SSuurrggeerryy bbooookkiinngg rraatteess tthhaatt hhoovveerr aatt tthhee 2255 –– 3300%% mmaarrkk iinnddiiccaattee ssoommeetthhiinngg iiss wwrroonngg.. AArree tthheessee ppeerrcceennttaaggee bbuusstteerrss lluurrkkiinngg iinn yyoouurr pprraaccttiiccee??


The Power of Differentiation If a client is not familiar with what they are buying then price is a low risk way to make a decision. Mature buyers are able to modify the price with experience. As a seller, you must be able to handle both situations. From: “Let the Seller Beware” Webinar

Your USPs

What makes our practice

unique?

And how do we show/tell prospective

patients?


Pricing Is NOT What Drives Patient Decision Making. Stingy Patients Are Easy To Blame…

Surgeon

+ Fee

+ Plan

=

So, how do you pre-qualify leads?


A Good Practice Financial Policy Should Include:

The cost of the consultation: deductible or not?

When the surgical booking or reservation fee is due

How long the fee quote will be honored

The timing and breakdown for payment of the remainder of fees

The policy for releasing surgical dates when fees are not paid in a timely manner

Refunding policies in the event of cancellation or re-scheduling for non-medical reasons: Careful here!

A clear definition of what is and what is not included in the fee quote: prescriptions, garments, overnight stays, etc.

Credit card and other payment options

Policies for payment within the check clearing period (“Only certified check or credit card payments for payment within two weeks of the scheduled surgery date”)


KZA Financial Policy Survey Results

Do you charge a consultation fee?

Yes ......................................................................................................................86.6% No.......................................................................................................................12.6% I don’t know.........................................................................................................75%

How much is the consultation fee?

$50 or less ..........................................................................................................25.5% $51-$75...............................................................................................................50.7% $76-$100 ............................................................................................................38.4% $101-$150 ..........................................................................................................28.2% $151-$200 ............................................................................................................7.6% $201 or more.......................................................................................................3.7% The practice does not charge a consultation fee..........................................19.3% I do not know ........................................................................................................0% Other ....................................................................................................................5.3%

Is the consultation fee deducted from the surgical fee?

Yes ......................................................................................................................79.1% No.......................................................................................................................15.4% The practice does not charge a consultation fee............................................5.5% I do not know ........................................................................................................0%

Do patients make a deposit “to get on surgery schedule?”

Yes ......................................................................................................................76.0% No ......................................................................................................................23.8%

Is the deposit a flat fee (i.e. $500 or $1,000)?

Yes ......................................................................................................................41.5% No.......................................................................................................................56.3% I do not know .....................................................................................................2.1%

If the patient’s balance is not paid two weeks prior to surgery, do you cancel or postpone the surgery?

Yes ......................................................................................................................45.4% No.......................................................................................................................50.9% I do not know .....................................................................................................3.7%

Do patients guarantee their appointments with a credit card?

Yes ......................................................................................................................20.0% No.......................................................................................................................80.0%


Pricing

Transaction Buyers Relationship Buyers

Price driven

No loyalty

Pride in getting the best deal

Less profitable

Seeking “trust” in you

Friendly, reliable practices

People who recognize them, do favors

You get all the business, shopping wastes their time

Paul Wang, Professor, Northwestern University

Discounting Dangers If you are reducing your fee, you need a very good reason! Discounting Can Lead to Commoditization

You do not know who is friends with whom

Bought business does not build loyalty

Have a response to undercutting ready

Is your fee “too high”?

Do you articulate the value proposition that supports your fee?

This is a young surgeon’s mistake

Build in a place to cut

“Well, let’s look at what procedures best address your highest priorities. Think about only doing your ____ now.”


Setting Aesthetic Fees IS Art & Science

1. What is your revenue target for an hour of time in the OR? What is your revenue target for an hour in the office?

2. Look at the total fee to the patient.

Who controls anesthesia and facility?

Do you pay for “overages”?

Do you start on time?

Do you underestimate case length consistently?

3. Look at Society data.

4. Consider and re-evaluate your multi-procedure discount policy or lack thereof.

5. Does your quote show “savings” to patients? Does it demonstrate value? Is the language punitive?


AAFRPS

AAFPRS


ASPS 2007 Average Surgeon/Physician fees


Dr. Van Fee Schedule vs. 2006 Average ASAPS Fees

A B C D = B / C F G = B + F J K=B/J L M=J/L

DescriptionStandard

Fee

Hours of

Proce-dure

Dr. Van's Fee per

Hour

Facility and

Anesthesia Fee

Total Procedure

Cost

2006 ASAPS Average

Fee*Multi-plier

2006 ASAPS Hours of

Procedure*

National Fee Per

HourSurgical Services

Blepharoplasty - Upper & Lower $5,000.00 2.00 $2,500.00 $2,140.00 $7,140.00 $2,882.00 1.73 1.00-3.00$960.67-

$2,882.00

Facelift (Minimum Charge) $7,000.00 3.00 $2,333.33 $2,955.00 $9,955.00 $6,532.00 1.07 2.00-3.00$2,177.33-$3,266.00

Facelift (Maximum Charge) $8,500.00 3.00 $2,833.33 $2,955.00 $11,455.00 $6,532.00 1.30 2.00-3.00$2,177.33-$3,266.00

$ $ $*2006 is the most recent data available Dr. Van's Standard Fee Multiplier below 1.0 times ASAPS Average Fee

pDr. Van Fee Schedule vs. 2006 Average ASPS Fees

A B C D = B / C F G = B + F H I = B / H

DescriptionStandard

Fee

Hours of

Proce- dure

Dr. Van's Fee per

Hour

Facility and

Anesthesia Fee

Total Procedure

Cost

2006 ASPS

Average Fee*

Multi- plier

Surgical ServicesBlepharoplasty - Upper & Lower $5,000.00 2.00 $2,500.00 $2,140.00 $7,140.00 $2,877.00 1.74Facelift (Minimum Charge) $7,000.00 3.00 $2,333.33 $2,955.00 $9,955.00 $4,856.00 1.44Facelift (Maximum Charge) $8,500.00 3.00 $2,833.33 $2,955.00 $11,455.00 $4,856.00 1.75

*2006 is the most recent data availableNote: ASPS does not quote hours of procedure. Dr. Van's Standard Fee Multiplier below 1.0 times ASPS Average Fee


Analyze This Fee Sheet


Discounting Discussion Points

1. Who should receive “special offers”?

2. What if you add something of value? Luxury hotels add an extra night.

3. How can you effectively target the right patient groups with your message?

4. Never discount OR fees.

5. Track value of discounts offered.

6. Track value of discounts taken.

No random discounting!


Establishing Value Multiple Discounts

Full Multiple Procedure Options

Face $7,000 $7,000 $7,000

Eyes $3,000 $2,000 30% $1,500 50%

Peel $400 $300 25% $200 50%

$10,400 $9,300 $8,8700

Per hour $1,890 $1,690 $1,581

How Are OR Fees Set?

850 1st hour

1,350 4.5 x 300

$2,200

1. Same field?

2. Something extra?

3. Opportunity value for you?

Have you considered doing X now since that is what your highest priority is?

We offer returning patients

a 10% courtesy for 2nd procedures.


Financing for Patients?

Yes _______ No ______ Why this is important?

1.

2.

3. Tips for promoting financing:

1.

2.

3.

4.


The Mystery Shopper Speaks

The costs were presented without discussion for two surgical options. She then suggested I call her when I was ready to schedule. She needs sales training. Beverly was a pro – the best of all practices I visited. After discussing the consult, she verified my interest in the options Dr. Smith and I discussed. I said option one, she presented a quote – pointed out the value represented by having three procedures – surgeon fee, OR and anesthesia reduction. She asked me about dates and talked about the scheduling deposit. I felt pushed and she said, “It’s a good deal” and “he’s board certified” about five times! I said “it’s a lot.” She said, “Well think about it and call me.” I had to initiate the conversation about financing.”

The most expensive quote I received represented, for me, the most compelling value. This quote was delivered, in my opinion, by the best run practice. Very few of the “moments of truth” were unmanaged. Therefore, and without qualifying the competency of this particular physician, I would likely have been willing to pay a $5,000+ premium for this particular surgeon.

The cost seemed excessive—but even so, if I had the money and the nerve at this point, he is my first choice. Everything was perfect. The added features of a nurse and hotel room ($350 and $169 respectively) further sold me

The Presentation of the Quote

Procedure(s) Surgical Fee Total Anesthesia Estimated Time Surgical Room Overnight Estimated Total


Patient Recall Letter 3: Discounts for Slow Times Send to patients seen who have not scheduled in 90-120 days. Date! Dear Ms. Patient: We certainly enjoyed having you as one of our medi-spa patients and feel confident you are happy with the results. Because maintenance is the key to perpetuating the look you desire, we want to welcome you back for further treatments. We expanded our treatment options to solve a variety of skin aging issues including sun damage, brown spots, poor texture, dark circles and fine lines and wrinkles. We are currently booking appointments for Radiesse—recently approved as cosmetic filler by the FDA. It is a longer lasting and more cost effective solution for some areas of facial rejuvenation. Dr. John is available for consultations on Radiesse, or any other skin treatment you are considering. Take advantage of our featured special for the month—a 10% discount for all injection treatments booked in the next 30 days. Note our new Saturday hours (list hours or use evenings). We hope to see you again and are ready to help you in anyway we can. Please don’t hesitate to call me at 222-123-4567. By the way, we’ve launched our website and if you haven’t visited check out the patient stories and photos at www.beauty.com. Click on Skin Rejuvenation. I look forward to seeing you soon Cordially, Ms. Courtney Czarina Scheduling

Don’t say this if not

true!

New


Post Consult Letter with Survey Sent Via Email

Dear Ms. Patient:

Creating a quality experience for every patient is something we care deeply about. From your first phone call through your consultation our goal is to provide exemplary service. And when you schedule a procedure we are committed to your experiencing the best possible outcome.

In fact, we have engaged a Chicago-based consulting firm to assist us in identifying what aspects of the consultation experience we can improve. Here is a link to a short survey that asks about your recent consultation.

http://www.survey.com/

Everyone at Fine Beauty Plastic Surgery will appreciate your honest feedback. Your comments will enable us to make changes and/or congratulate the staff that met or exceeded your expectations. Coach for improvements or build on our strengths. The point is we won’t know unless you tell us.

If you’d like for us to follow up on your comment please sign your name and request a phone, letter, or email response. If you prefer to remain anonymous, that is fine.

We genuinely appreciate your time. In recognition of your cooperation we will make a donation of $5.00 for every response received to the Susan B. Komen Breast Cancer Foundation. We’ll post the results of our survey and the total donations on our website www.finebeauty.com

Sincerely,

John Doe, MD

Note incentive


Plastic Surgery Consultation Survey $99 from KZA

(Available customized with your name) Please answer the survey questions for your plastic surgeon. Additional comments may be written at the end. Consider “what was good” about your consultation and “what could be better.” How satisfied were you with:

Highly Dissatisfied Dissatisfied

Somewhat Dissatisfied

Somewhat Satisfied Satisfied

Highly Satisfied NA

The registration process

The timeliness of your appointment.

The way information was shared with you.

The overall care given by the staff.

The overall care given by the doctor.

How much do you agree with the following?

Strongly Disagree Disagree

Somewhat Disagree

SomewhatAgree Agree

Strongly Agree NA

The doctor treated me with respect.

The doctor listened to me.

The doctor seemed to care about my feelings.

The doctor and staff worked well as a team.

The doctor told me all I needed to know.


Notes


What Practices Need Now Please submit to the course instructor at the conclusion of the program. We appreciate your feedback!

What section or topic did you like best?

___________________________________________________________________________________

___________________________________________________________________________________

General comments about the course:

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

I am an:

MD DO Practice Administrator Office Manager

Reception RN Patient Coordinator Other ________________________

Please send me more information about the following KZA services:

Aesthetic Consultation Onsite Staff Training

Website Review Strategic Planning

Coding and Documentation Review

Name ______________________________________________________________________

Practice Name ______________________________________________________________________

Address ______________________________________________________________________

______________________________________________________________________

Phone ______________________________________________________________________

Website ______________________________________________________________________

Please sign me up for KZAlert e-mails for useful, practical, updated information and tips on practice building.

___________________________________________________________________________________

(Print your e-mail address clearly.)

Strongly

Agree Agree Neutral Disagree Strongly Disagree

Overall, the course met my expectations.

Karen was knowledgeable and presented in a clear, concise manner.

My questions were answered.

I would recommend this course to a colleague, who isn’t a competitor.☺

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