In the past two months, I have spoken with four clients whose Production Per Patient (PPP), a very useful statistic calculated by dividing gross production for a period by the number of first time case starts for that same period, was up substantially compared to the previous year.  Assuming an equal or greater number of new case starts, having greater PPP is a very good thing, unless overhead has risen by an equal or greater amount.  Unfortunately, in each of these four cases, the doctor’s overhead was way up and gross production, revenue (collections), and the number of new starts were down from the previous year.  Two of the doctors were actually borrowing from their credit line to pay their overhead.  Each of these four doctors eventually agreed that in their desire to reach “Elite” or “Super Elite” status, and thereby gain acclaim, glory, and a lower lab fee, they were recommending aligner treatment to patients who had expressed no felt desire for such treatment.  The resulting higher fees in three of these practices and the significantly greater monthly payments (due to the shorter treatment times) in all four practices resulted in reduced case acceptance and lost sales, reduced production, income and a serious erosion in net profitability.  The PPP went up (again, normally a good thing!) even though total production and revenue went down, simply because of the greater treatment fees.

This situation would not have been quite so bad had these practices been successful in “down-selling” the patients to traditional appliances once the T/C learned the patient could not afford the treatment, but none of these practices had been successful in accomplishing that task.  I later called these offices and asked to be put on hold so I could listen to their message-on-hold.  Guess what I heard?  Each of these offices were heavily promoting aligner treatment as their “standard of care” on their message on hold.  One of the four spoke about nothing but aligners during their entire message loop!

The “Elite” and “Super Elite” provider marketing plan is the greatest and most successful marketing plan I have seen in my 34 years of consulting in this profession.  Shortly before deciding to write on this topic I had just hung up from a long call with the fourth of the doctors I described above, a client whose case acceptance had declined from a lousy 69% to a truly terrible 60% directly because he started promoting aligner treatment to patients who did not ask for it or need it.  To demonstrate how incredibly successful this marketing has been, this doctor charges $800 less for an aligner case than he charges for the same clinical case done with traditional braces, yet his typical aligner lab fee is $1600!  He said he wants to become an “Elite” provider so his lab bill will decline by $500 a case.  He is pushing aligners, losing case acceptance, and incurring a huge lab bill in the process!

Unfortunately there are a lot of doctors who have bought into this type of marketing, who are recommending high dollar, short treatment time appliances, and whose practices are being damaged in exactly the fashion I have described!  I have written in the past about the complete fallacy regarding the idea that shorter treatment time and a reduced number of patient visits reduces practice overhead and creates space in the schedule for a greater number of new patient exams and case starts.  While there surely are individual, isolated, examples of doctors who can grow their practices by reducing treatment times and opening up their schedule, the vast majority of practices today simply do not have enough new exams or sufficient case acceptance rates to build the practice by cutting treatment time.

A week does not go by when a doctor, usually a client but often not, does not call me wanting to know how he can increase case acceptance and do more aligner type treatment.  The simple answer is he cannot.  Even if he does not upcharge to cover the lab fee, just the short treatment time alone – and the resulting increase in monthly payments – assures a decline in case acceptance if doctors try to sell this treatment modality to patients who had no request for aligners, nor felt need for aligners, to straighten their teeth.

Almost all of our clients offer clear aligners, and we recommend that!  It’s a great product that works, clinically, as advertised.  If you have a new patient who had been exposed to aligners via advertising or perhaps from another orthodontist, and comes in wanting aligner type treatment and you do not offer it, you are most likely going to lose that patient.  However, if you promote this technology and try to sell it to people who did not ask for it, and when patients who did ask for it decide it is not affordable and you do not educate them of the financial benefit and perfect clinical result available with traditional braces, then all you have accomplished is a serious decline in profitability and the erosion of the practice performance.

Aligner technology should be handled exactly the same way most practices have handled the gold brackets, ceramic brackets, and other cosmetic appliances that have been around for years.  It is a cosmetic (value added) short treatment time (value added) product that is available to the patients who would like to have it and the practice charges appropriately for it.  Remember doctors, you are in business to give your patients perfect function and beautiful smiles.  You are not in business to sell a certain product to your patient.  If you can get a lower lab fee by selling a certain quantity of aligner cases, that is a wonderful and profitable thing to do, but not if the result is reduced case acceptance!