Table 16-1 can be used as a worksheet to evaluate the potential profit a laser can bring to the practice. To begin, the number of procedures that could be performed with the laser for 1 week is recorded. The appropriate fees are then inserted for the necessary calculations. Of note, this rough estimate does not include the amount of hours per week gained by using the laser for procedures that save time compared with conventional techniques (e.g., gingival retraction, implant recovery, gingivectomy), which will allow the practitioner to see more patients per week, thereby generating even more income. This estimate also does not take into account the reduced time per week spent tending to postoperative visits for discomfort after surgical procedures, which are greatly reduced when lasers are used. Strauss4 has emphasized that “one of the main advantages of using the laser is the lack of postoperative problems and the minimal need for wound care.”
To evaluate the financial return of introducing a laser into the dental practice, the income derived from the laser must be known over time. Current computerized practice management systems simplify tracking the factors used to determine the performance of the office profit centers, using key performance indicators (KPIs). The tracking of desired KPIs starts by listing the factors used in evaluating the success of the profit center, as follows:
• Procedures performed with a laser
• Patients referred to the practice by other patients for laser procedures
• Patients referred to the practice for laser procedures by other professionals (dentists, physicians)
• Patients who come to the practice because they know a laser is available
Unique Selling Proposition
The introduction of a laser into the dental practice brings an entirely new area of marketing to highlight in counseling patients regarding treatment: the unique selling point, or unique selling proposition (USP). Lasers are still not available in a majority of practices, whereas other USPs are common to many practices, such as tooth bleaching or veneers. The relative newness of laser technology provides the opportunity to capitalize on its availability.
The USP is a marketing concept first proposed as a theory to explain a pattern among successful advertising campaigns of the early 1940s, making unique propositions to the customer that convinced them to switch brands. The USP is the “factor or consideration presented by a seller as the reason that one product or service is different from and better than that of the competition.”5 The USP of laser availability can be highlighted by emphasizing the following advantages of laser dentistry:
• Nonsurgical periodontal treatment
• Less need for antibiotics and analgesics
• Easier healing
• Less bleeding
• Less postoperative discomfort
• Less chair time
• No scalpels, no blades, no cutting
Dental practices with lasers that perform both hard and soft tissue procedures can highlight the following:
• Reduced anxiety and elimination of fear of the drill
• Reduced noise—no more “whine” of the high-speed handpiece
• Anesthesia-free operative dentistry
• Restorative dentistry without the side effect of numb lips
• Multiquadrant operative dentistry, with faster completion of the treatment plan
Advantages and Influence
Laser techniques are considered the standard of care in ophthalmology, dermatology, plastic surgery, and many other disciplines. Most patients have a friend or relative who has had laser treatment for diabetic retinopathy, a dermatologic disorder, vascular surgery, or plastic surgery procedure. The term laser evokes a positive attitude and response in consumers of medical services, who associate it with the latest medical advances. The perception is that laser treatments are better, faster, and less painful, with higher success rates.6 Dental practices that offer laser treatment generally are viewed with more confidence and as more patient-oriented offices that provide better treatment and services. Wigdor7 surveyed 100 patients on their perception of lasers and found that 69% thought that lasers would make their visit to the dentist easier.
An initial question on incorporating a laser into the practice is how to charge for laser procedures. Several philosophies may be used to set fees for laser dental procedures. At one extreme, the fees are set based on an hourly rate plus a charge for materials. The other extreme allows for the dental insurance company to set the fees, regardless of the real costs. Most practices, however, use what they have developed as a standard fee schedule, or what the insurance industry might refer to as the office’s usual, customary, and reasonable (UCR) fee schedule.
The approach for many offices that incorporate lasers into their practice is to leave the fees as they are and simply benefit from the increased productivity, as follows:
1. Efficiency and time savings with laser use
2. Addition of new procedures that can now be performed in the office
3. Enhancement of procedures being performed
4. Attraction of new patients
Another approach is to add a surcharge for any procedure using the laser. A third option is either to increase all fees across the board by a certain percentage to help cover the added expenses or to increase all fees simply because adding a laser provides a good reason, possibly long overdue, to update the office fee schedule.
Dental UCR Fee Reports
One way of gauging the fee level compared with that for the rest of the dental community is to use a “fee subscription service.” Determining the correct fee schedule is an important annual decision. Two types of fee reports are available to dentistry: those based on “surveys,” whereby offices from each area voluntarily submit fee information, and those based on insurance company data from actual claims. These reports allow clinicians to determine where they want to set fees with respect to percentiles of the fees charged in the community. Fees charged by a dentist who offers laser services should be in at least the top 50th percentile for the community, and probably much higher. These services allow fees to be compared with the 40th, 50th, 60th, 70th, 80th, 90th, and 95th percentile fees and provide “geographic multipliers” for all U.S. three-digit zip code prefixes.8,9 Fees differ significantly relative to the cost of living in different locations.
It is difficult and time-consuming to determine a fair fee for dental services and still remain competitive. Knowing what value the marketplace and third-party payers place on dental procedures performed in the community allows dentists to set fees at a level that will best achieve their practice goals. These reports are excellent sources of information for reviewing or updating the office’s fee schedule. Knowing what third-party payers may allow will help prevent pricing oneself out of the marketplace.
Preparing the Staff
After it has been decided to add laser-assisted dental services to the practice and an appropriate laser has been chosen, the next step is delivery of those services in accordance with the community’s “standard of care.” This standard of care begins with proper training for all staff members involved with delivery of dental services (dentists, assistants, hygienists, administrative staff) and successful completion of a comprehensive overview of laser dentistry. The Academy of Laser Dentistry (ALD) Standard Proficiency Certification Course meets the Curriculum Guidelines and Standards for Dental Laser Education developed at the University of California–San Francisco College of Dentistry,10 which are recognized by many organizations, states, government agencies, and universities. In December 2005, the Board of Dental Examiners of Nevada passed language in Chapter 631 of the Nevada Administrative Code (NAC) that requires educational criteria for these guidelines, as interpreted by the ALD. Dentists and dental hygienists in that state must comply with the new regulations presented in sections NAC 631.033 and NAC 631.035, as follows:
Each licensee who uses or wishes to use laser [ir]radiation in his practice of dentistry or dental hygiene must include with his application for renewal of his license:
1. A statement certifying that each laser used by the licensee in his practice of dentistry or dental hygiene has been cleared by the Food and Drug Administration for use in dentistry; and
2. Proof that he has successfully completed a course in laser proficiency that:
(a) Is at least 6 hours in length; and
(b) Is based on the Curriculum Guidelines and Standards for Dental Laser Education, adopted by reference pursuant to NAC 631.035.
A standard proficiency certification course includes the curriculum for basic education in laser use and specific device instruction with demonstrated proficiency in didactic and hands-on knowledge. Hands-on exercises include demonstration and clinical simulation with appropriate oral tissues (e.g., cow or pig jaws) and must meet participation course guidelines. Practitioners must demonstrate competency in the safety aspects of laser use. This is the level of education that defines the standard of care. Dental auxiliaries also are encouraged to demonstrate competency in the safety aspects of laser use.
These courses are available through the ALD’s “recognized course providers,” as well as several major dental meetings, dental school continuing education (CE) programs, and state and local dental societies. At least one laser manufacturer mandates that each laser customer participates in this type of course as a condition of purchase. Many “professional liability” insurance carriers now require proof of proper training for policyholders engaged in laser procedures (e.g., AIG’s Dentist’s Advantage Professional Liability Insurance). Additionally, from a medical-legal perspective, proper laser training is indispensable.
Preparing the Patient
Dentists can introduce lasers to their patients in several ways. The most subtle approach is to wait until an appropriate use of the laser arises and then inform the patient that a laser will be used to accomplish a specific procedure, pointing out the benefits of laser treatment for this indication over other, conventional methods. This approach is the basis of informed consent and is the minimal introduction used to inform patients about laser use in the practice. From that level, it is then appropriate to implement marketing (internal and external) and promotional options now available to the dental profession.
Internal Marketing and Patient Education
Internal marketing is one of the simplest and most productive business promotional activities that can be used to enhance patient relations. Internal marketing educates the employees about the practice’s new services and alerts existing patients to new options through in-office promotional devices.
Prerecorded Educational Videos and Computer Simulations
An effective outreach approach is to show an educational video that describes the new laser and the enhanced procedures in the reception room for all visitors to see. Commercially available video programs such as Guru and Casey feature sections on laser dentistry that can be adapted to a specific dental practice, with news or promotional clips made for the office or featured on local or national news. An informed patient is much more likely to be a satisfied patient, with fewer surprises encountered during treatment and postoperatively. The resulting positive opinion formed by such a patient will now be communicated to family members, co-workers, and acquaintances, creating another source of patient referrals.
The strategic placement of posters (such as in the waiting room) can spark questions or discussion about the laser treatments depicted. Before-and-after pictures showing laser use in “patient-friendly” procedures such as cosmetic recontouring of a gummy smile before veneer placement, bleaching, and tooth-colored fillings prepared with a laser without use of an anesthetic can be displayed. Such posters tell the patient that not only does the practice offer laser procedures, but that other patients are satisfied with the results. Office staff can check with the laser manufacturer or distributor about poster availability.
Patient Information Brochures
Brochures about lasers are available from several sources, including laser manufacturers, dental supply companies, and the ALD. Brochures often can be personalized, or customized brochures can be produced in-house or professionally (Figure 16-1).
Photographs are one of the best means of communication available. The practitioner should take photos of the various laser procedures performed in the office, or secure photos from the laser distributor and then make a book of laser procedures that can be used to show patients their recommended treatment. Also, a clinical atlas with preoperative and postoperative photos of most laser procedures is useful in explaining procedures to patients.11
Before taking photographs of patients, the practitioner must be sure to obtain proper releases to use the photos. Such photos should be restricted to preoperative and fully healed postoperative views. Intraoperative photos or those that show a bloody or healing surgical site are off-putting or unappealing to most people.
All administrative staff members have a role in internal marketing to the current and prospective patients. This component of the dental team includes all “front desk” personnel: the receptionist, financial coordinator, insurance coordinator, and patient care coordinator. If they themselves have experienced laser dental procedures, they can speak with firsthand knowledge, experience, and enthusiasm. This kind of communication affords special opportunities to influence the patient as a consumer. The attitude and involvement of the office team are critical to successful integration of a dental laser into the practice. The clinician should make educational opportunities available to all personnel, who also may be treated with laser procedures so that they are well qualified to deliver personal testimonies. The practitioner should consider allowing employees to offer selected new laser services at a discount to appropriate patients. Employees who become advocates for the practice’s services become the practitioner’s best referral source for new patients. Nothing is better than word-of-mouth advertising.
The receptionist has unique opportunities to promote the practice when greeting patients and answering the telephone. This person should have a clear understanding and working knowledge of the use of the practice’s laser, to provide effective answers to basic questions. All front desk personnel should be able to communicate to patients the advantages, and thus the value, of laser use. Gaining the patient’s confidence for future treatments is a major goal. If the practice uses a “message on hold” telephone answering system, laser use should figure prominently in the message.
Patient Care Coordinator
The patient care coordinator has several opportunities to promote the practice when interacting with patients and reviewing treatment proposals. This person too should have a clear understanding and working knowledge of the use of the office’s lasers so that he or she can answer basic questions. The care coordinator should be able to relate to the patients the advantages of laser use, such as greater comfort, quicker healing, less postoperative discomfort, little to no bleeding, greater precision, and less need for anesthetic or antibiotics, reinforcing its value to the patient. The care coordinator also may be the person to discuss informed consent with the patient, both oral and written, requiring confirmatory signatures of the patient, the person reviewing the information, and the dentist. The patient must be given the opportunity to discuss any questions with the dentist before the procedure is performed (see later discussion on informed consent).