I didn’t think my patients wanted (or needed) finance... Boy, did I get that wrong!

I've been practising in a pretty, idyllic little coastal village for almost 20 years. There are about 4000 people in the town itself and 18,000 all up in the surrounding area. It's not so small that you know everyone, but you know most people.

There are advantages and disadvantages to knowing everyone's business. One of the advantages is you think you have a feel for people's financial circumstances (remember "think you have a feel" for later in the article). Yes, I know you're not supposed to diagnose and recommend treatment based on your perception of what people can afford, but we all do it, or at least we all occasionally do it. I've recently discovered, however, that many of my preconceptions about what people can, and can't, afford (and want) have been very wrong.

Dentistry is a tough job. What makes it even tougher is when you have to compromise. I prefer providing patients with the best standard of care I have at my disposal. I don't like patching up teeth that should have crowns. I don't like making dentures when I know an implant is a better option. I don't like doing large composites when a CEREC would last a lot longer. I find practising like that soul destroying.

We've tried in-house payment plans in the past to help people afford treatment, but they're difficult to administer and we were let down a few too many times. The team do not like having to make payment reminder calls. We have also tried other external payment providers, but we found them expensive, clunky and often took up too much staff time. So, what to do?

Fortunately for me, one of my more persuasive colleagues (Dr Brett Taylor from Sydney) convinced me to have a look at a new product called Smile Right.

Smile Right is an integrated communication and financing strategy. Actually, calling it that doesn't do it justice; I need to explain how it works.

When a patient requires any treatment, we prepare a plan for them with our practice management software. Nothing special there. Before that, of course, I diagnose whatever is wrong and offer treatment alternatives with approximate pricing. If they decide to go with ideal treatment, that's great. What happens more often than not, however, is they "want to think about it". That's not unusual; most dentists hear that every day. What I say then is "that's a good idea. Would you like me to send you some written information about the different options we discussed and a plan with exact fees and item numbers?" Everyone says yes to that and then I say "great, we'll send it to you via email and SMS. You'll also get payment options to spread the cost out over time if you want and you can let us know via the website what you want to do... Even if you want to put it off for a while or do something different. Are you OK with that?" At this point, the patients are very happy because they get to make a decision out of the dental chair (which we often forget for many people is the worst place on Earth).

So what happens then? We have uploaded our patient database to Smile Right. It takes one click to get onto our Smile Right dashboard. We click on "New Invitation", type a few letters of the patient's name and a list of possible people comes up. We select that patient and their contact details appear. We type in the value of the treatment plan and drag and drop a PDF copy into Smile Right. I also like to drag and drop a quadrant photo of their condition and a before and after photos of a similar case. Finally, I'll attach the Smile Right information documents appropriate for the procedures I'm suggesting. This document explains the treatment and gives all the benefits, options and risks, as well as pre- and post-op instructions and forms an integral part of my informed consent process.

Once you have your systems in place, the process of sending a patient an invitation with all of that information can be done in about a minute. What has that minute of staff time gotten me?

The patient will receive an SMS and an email that directs them to their own personalised treatment card. The card holds all of the information I mentioned above. The Smile Right platform is classy and attractive and generally not what patients are expecting. "Can I think about it" is often code for "I don't think I can afford it". One of the first things they see on the website, however, is not that their Invisalign will cost $8000, but that they can have it from as little as $5.01 a day (as a loan). Or they can have their $1800 crown for only $9.35 a day, with no interest or charges (as a payment plan). So now they're thinking maybe they can afford it and start looking at the photos and information documents which hopefully will cement the decision to go ahead with the proposed treatment.

What if they don't want to go ahead, or don't want to go ahead now? While offering payment options is a big part of Smile Right, handling decisions is just as significant. No one gets to fall through the cracks (which is very important medico-legally). Patients are asked to make a decision. In one click, they can choose from these options:

1. Accept the treatment plan and pay by cash or credit card on the day;
2. Accept the treatment plan and apply for finance;
3. Delay the decision;
4. Discuss other options; or
5. Decline treatment.

If they want to delay the decision, they are asked how long they want to delay it for and are automatically reminded at that time. If they don't want to go ahead, they get a questionnaire as to why. Patients are a lot more honest online than they are to your face, so it's a great way to find out if there's a breakdown in your systems, or something else is going wrong you don't know about.

If patients do apply for finance, they can get conditional approval in as little as 5 minutes. I get paid in full as we complete treatment rather than in dribs and drabs like some other payment plan options. Once treatment is complete, we put in a payment request and settlement occurs at the end of the week for that component of the plan. This keeps the cash flow moving and Smile Right assumes the risk and responsibility for tackling any payment issues.

So what's the bottom line? What have I discovered? Well, I've discovered that many patients will accept ideal treatment if you make it affordable for them. I've come to understand there are many people out there carefully managing their cash flow and they can't afford to slam another $2-6K on their credit card when they break a tooth. They can, however, afford treatment (and want it) if you make it easy for them to spread the payments out. There are a lot of young people out there who can't afford $200-$600 for fillings or whitening in one hit, but will have it done if they can spread the payments out. Unlike my generation, they view this as forced saving in reverse.

I've been very pleasantly surprised by the boost in production Smile Right has given me. I get to do more ideal treatment and I get to help people avoid problems (by not putting things off). I get to save staff time and automate a lot of my informed consent, patient communications and patient follow-up. I offer no fee payment plans for smaller amounts (which cost me a little money) and low-interest loans for treatment up to $30,000 (which cost me a negligible amount). Smile Right is an ethical lender, so patients don't get stung with outrageous penalties on interest fee options like some other companies do. Smile Right gives the patient time to pay, so they don't get into unaffordable debt traps.

I'd love to say I was so impressed I bought the company (I wish), but when the opportunity arose, I did buy a small bit of the company. Almost all of the investors are dentists and we get a big say in how the platform is improved. It's gotten to the point where we dream of a new feature and a few months later it's there. I'd certainly encourage every dentist to have a good hard look at Smile Right as a user. We intend to make it so good you'd be mad NOT to use it. If you want a say in future development, consider becoming one of our final few investors.

About the author

Dr Craig Newman is a general dentist with an interest in implants and complex restorative. He owns a practice in Merimbula on the south coast of NSW. After using Smile Right he became a shareholder and is on the Smile Right Advisory Board.