The 95/5 Dental Case Acceptance Rule

How to Improve Dental Case Acceptance in Your Practice

In this episode of Dental All-Stars, host Alex Nottingham sits down with Eric Vickery, President of Coaching at All-Star Dental Academy. Eric is a respected expert in practice management and dental case acceptance and has been delivering keynotes and training events all over North America since 2001. Tune in to gain insight from this veteran of the dental industry!

HIGHLIGHTS – Dental Case Acceptance

  • [01:01] The biggest mistake offices make when it comes to dental case acceptance
  • [04:55] Removing friction in dentistry for dental case acceptance
  • [07:03] What offices need to realize to improve case acceptance
  • [13:07] Focussing on the “90-5-5” rule
  • [15:05] Main reasons patients may object to treatments
  • [17:53] What you can do in your practice tomorrow to improve dental case acceptance
  • [20:04] How to get the patient to move forward with dental case acceptance
  • [24:50] Eric talks about the growth summit and his coaching team

QUOTES – Dental Case Acceptance

  • What we have to realize is that every profession has some sort of sales in it.
  • The goal that we have is to help patients get healthier faster.
  • We have to help the patient understand that the things that we’re doing are preventing painful, bigger problems like an abscess, a root canal, missing tooth, broken tooth, all those things.
  • The patient is wondering, “why would I need to do this? I’m not feeling anything.” And if you don’t know how to address that, it becomes “because I said so” dentistry.
  • People buy for their reasons, not your reasons. And people don’t buy a solution to a problem they don’t perceive to be.
  • 95% of our attention, focus, or guidance has to be on the diagnosis, the condition, and the consequences.
  • When people buy into the diagnosis and what’s happening, they’ll be more likely even to ask you for the solution and say, “well, doctor, what do I need to do to fix it?”
  • Instead of telling, focus on asking. When you tell people what to do, it creates a bad taste in their mouths, but when you’re asking, it feels like they are along for the ride, making the decisions, and they’re in control of that process.
  • Your communication skills are your dental case acceptance skills.

About Alex Nottingham JD MBA

Alex is the CEO and Founder of All-Star Dental Academy®. He has authored the dental practice game-changer book “Dental Practice Excellence” and co-wrote a bestselling book with Brian Tracy. Alex has shared the stage with Michael Gerber (the author of “The E–Myth Revisited”), and lectures nationally and internationally to prestigious dental organizations. He is a former Tony Robbins top coach and consultant, having worked with companies upwards of $100 million. His passion is to help others create personal wealth and make a positive impact on the people around them. Alex received his Juris Doctor (JD) and Masters of Business Administration (MBA) from Florida International University.

About Eric Vickery:

Eric Vickery is All-Star’s President of Coaching. He holds a degree in business administration and brings a strong business and systems approach to his consulting. His initiation into the field of dentistry was in the area of office management. He managed dental practices for over ten years and has been consulting over 250 offices nationwide since 2001.

Episode Transcript for Dental Case Acceptance

Transcript performed by A.I. Please excuse the typos.

[0:01:01]  ALEX NOTTINGHAM: What is the biggest mistake that you see offices make when it comes to dental case acceptance?

[0:01:07]  ERIC VICKERY: Biggest mistake? Well, most people, when I talk to them in dentistry, usually have them raise their hands, and I get no hands raised is, how much do you love being a salesperson in dentistry? How many of you love being a salesperson in dentistry? How many of you got into dentistry because you were a phenomenal salesperson before this? And typically, nobody raises their hand. Every now and then, you’ll get one or two people raise their hand, they really get it.

And the understanding from a dentist or dental team member’s perspective is, I’m not in sales. I’m in health I’m in health care, and there’s no sales in that. Well, the problem is, you also will come back and tell me, how do we stop cancellations? Well, that you can’t have your cake and eat it too, in that situation. The thing that we have to realize is that every profession has some sort of sales in it. And that just means patients buying into what’s going on clinically, buying into the condition, buying the diagnosis.

If you understand how to communicate from that perspective, it will really relax the feeling of, oh, my gosh, I’m in sales. And the next part of that is, most people don’t like the thought of being in sales because they think that means they have to be in pressure sales. And for two days, we teach you how to not be in pressure sales. The other funny thing about this is when I hear these same people say, oh, no, I’m not in sales, when we’re on site and we’re evaluating them, one of the most common phrases we hear from the dentist, from the team member is, you need a crown.

Well, to me, that line is pressure sales. When you’re telling somebody what they need to do, and it’s solution based, and people hear crown, they think of money. It’s what it’s all about. So teaching them how to get away from that and getting into a want category instead of a need category from the patient’s perspective, it’s a very smooth transition, and it’s eye opening for team members and dentists to realize, I don’t have to be a pressure salesman.

I can actually just focus on the health care and the diagnosis and get patients to want to move forward. That’s the biggest thing.

[0:03:23]  ALEX NOTTINGHAM: What’s interesting to me is I think sales is the end game or the end result in terms of certain skill sets to get to that. And sales, especially in service based like dentistry, have a negative connotation. It’s fine in retail, what have you, we’re commoditizing things and so on. I think that here we’re looking to persuade, to empower, I would say even more our patients to be congruent. I will say that the skill sets that predate or are prerequisites to good sales and persuasion are the same.

The problem is, once you get to the end and you use those skills to pressure people, to manipulate people on things they shouldn’t do, and it’s from your best interest. That’s the problem we would like to get away from. But what we’re looking to do is take the good of persuasion skills, of communication skills, and that leads to a result that you increase revenue. You don’t have to work as hard. You’re in alignment with your vision, your mission, you’re feeling great and empowered.

I think that it would some dentists shut down and say, I don’t want to deal with that. And then they’re not training on those skill sets that are needed to run a great business. And that’s what you’re going to be teaching. And that’s what you’re talking about is you have to have that baseline of foundation to be successful.

[0:04:54]  ERIC VICKERY: Yeah, absolutely. The biggest thing that we’re trying to do is make this easy, make it simple. And we talk about friction removing friction in dentistry, that friction concept in business of man, we make it so hard to do business with us. Yeah, we’re taking new patients. Our next spot is in May. It’s two or three months from now. Why is that? And how can we just take a step back and look at it and say, how do we really focus on getting patients completely healthy as fast as possible?

And what you’re talking about is, simply put, more dentistry per visit, meaning patients get healthier faster. That’s when we talk about dental case acceptance, not only preventing cancellations, it’s making sure that obviously they keep the appointment, but they’re not just doing one thing at a time for the next six years, they’re getting all of it done within the next six months. That’s the goal that we have is to help patients get healthier faster.

[0:05:57]  ALEX NOTTINGHAM: The end result or the big point to take away here is that the degree to which you master these skills are the degree to which you can grow your business. Because if we say outside of dentistry, anybody that’s good at, quote, sales, can create any business, those are the hardest people to cultivate. Now. They take shortcuts, and there’s cheat codes, which we’re not advocating, but if we can get good at the power of influence, the power of serving people at the highest level, because often dentists have in their heart the right thing they would like to do.

And for many of you that are listening, my father’s a dentist. Eric comes from a line of dentists and his family, and they have the heart. But it’s then being able to communicate it in a way that the patient can understand, and it’s not the way you always see it is to be able to convert what you feel into how they can receive it, if that makes sense.

[0:07:03]  ERIC VICKERY: Yeah.

[0:07:03]  ALEX NOTTINGHAM: So what do offices need to realize in order to improve dental dental case acceptance?

[0:07:10]  ERIC VICKERY: Well, you’re summing it up really well. Seeing it from the patient’s perspective. There’s two things you have to understand. First of all, people don’t buy a solution to a problem they don’t perceive to have in sales. You hear this all the time pain points. Discover a pain point and provide them a solution. Well, if we’re going to be, quote, in sales, then it’s funny. Dentistry will disguise that in a lot of ways. I’m not in sales.

Let me go do this case presentation right now. Let me do this consultation. I’m going to do a review of findings. It’s sales. It’s synonymous. And so the first thing you do is give yourself permission to realize, okay, if I’m going to be in sales, how do I do this the right way? And the first thing you have to understand is that that patient’s not buying a crown when you say you need a crown when they don’t perceive to be a problem.

And the reason they don’t perceive there to be a problem, because they don’t have any pain, I like to say, no pain, no problem, no pay. And this is why the admin team members will tell you they’re calling two days out to remind the patient that they have an appointment coming up with a doctor for this crown that they scheduled. And as the phone rings, the patient picks up the phone, and she introduces herself to the patient and calling from Dr. Nottingham’s office, and the patient will say back to them, oh, I’m so glad you called me.

And immediately, our dental team member has a sinking feeling in their stomach as soon as they hear that response. And all of those listening who’ve heard us before will relate, because they know what’s coming. The patient will say, I’m so glad you called me. I was just getting ready to call you. You know what? That tooth, it’s not even bothering me, so I’m going to go ahead and wait. And their perception is, I don’t have pain in my tooth, therefore, I don’t have a problem.

We have to help the patient understand that the things that we’re doing are preventing painful, bigger problems, like an abscess, a root canal, missing tooth, broken tooth, all those things. So they not only have to understand the condition, the diagnosis today, but they also have to be let in on the fact that there’s bigger problems coming if they don’t do anything. And if you look at the human body, it works the same way with high blood pressure. No pain till there’s a heart attack, even early stages of cancer, no pain until it’s too late.

It goes on and on. It’s the same thing. And we have to help them correlate this. They don’t know what a crown is in comparison to a root canal. In fact, patients will call up, new patients will call up and they’ll ask the person answering the phone, how much is a crown? And our perception is, right away, oh, they’re shopping. Somebody told them that they, quote, needed a crown and they’re calling, looking for the cheapest price.

When, in fact, if you follow the great call process and you get into rapport and engage and you start asking some questions, what you’ll find out more often than not is they haven’t been in the dentist in four years. They have a toothache. And because they have a toothache, their belief is, I must need a crown. How much is a crown? And that’s what they’re calling, asking about. And so if you don’t know the verbiage to engage in that, you’re going to be at a disadvantage to scheduling that new patient, because you’re going to get into a transactional conversation and talk money and they’re going to just keep moving along, looking for somebody who has, quote, the cheapest crown. Now, the second thing I think that officers have to realize is that when that patient’s in the chair with you, they’re going to be making the decision on their own accord, their own reasons, not because you said so. It doesn’t matter how many initials are after your name.

Yes, you are the expert, but they’re going to make up their own mind for their own reasoning. And Alex, you know this people buy with emotion, justify with logic, right? What is that emotional reason why they would be making that decision? And when you don’t know that, again, you’re at a disadvantage. So, for example, if somebody were to talk to a patient about why they want to save their teeth and they use this and get in a conversation, you would hear things like, my grandparents lost their teeth, I lack in confidence when I smile.

I’m being overlooked for job promotions. I’ve got a wedding coming up that I want to have a nice smile for. There’s many reasons why in life they would want you to care for their teeth. But if you don’t tap into that, I like to call it because I said so. Dentistry. When you, quote, sell your need for a crown, I don’t know if your parents ever did this, Alex, but my parents, if I was asking, why do I need to do that. Why don’t you do that? Because I said so, was their response.

[0:11:45]  ALEX NOTTINGHAM: I got that before.

[0:11:46]  ERIC VICKERY: Yeah. Okay.

[0:11:49]  ALEX NOTTINGHAM: And that’s the last resort I will use with my son. I try to be a little bit more engaging until the.

[0:11:58]  ERIC VICKERY: I’ve reached my limit, the number of whys. But the patient is wondering, why would I need to do this? I’m not feeling anything. And if you don’t know how to address that, it becomes because I said so, dentistry. So instead, we want to teach you how to present it in the format of which they can digest, they can understand it. Which means if I was going presenting to Ricky Bobby, I’d say ricky Bobby.

You told me you wanted to have that peace of mind, knowing you weren’t going to lose your teeth like your grandfather did. I’m concerned about you. Start laying out all the diagnosis to them. All of these things stand in the way of you achieving what you said you wanted. How concerned are you with that? Would it make sense to talk about a plant? And then we get into that conversation. So if you can understand these two premise, people buy for their reasons, not your reasons. And people don’t buy a solution to a problem they don’t perceive to have. If you can understand that, you have a different angle to approach your patients from, which is healthier.

There’s a lot more integrity with it. You don’t feel like you’re pressure selling. And they feel great about the process. That’s what’s huge about it.

[0:13:04]  ALEX NOTTINGHAM: And that’s the new focus you’re talking about, correct?

[0:13:07]  ERIC VICKERY: That’s right, yeah. The focus really has to be what I call the 95 five rule.

[0:13:12]  ALEX NOTTINGHAM: Okay?

[0:13:13]  ERIC VICKERY: 95% of our attention, our focus, our guidance has to be on the condition, the diagnosis, the condition and the consequences. Most dentists and even team members, if you give them this phrase, they will finish a sentence for you. They know what you’re talking about when you say this. And it’s before you can prescribe, you must first diagnose. We get that we diagnose, but we don’t tell the patient what that diagnosis is. We just go right in a prescription, right into treatment planning, treatment plan, presentation, case presentation, consultation, review of findings, whatever it is, and you focus on what I call the 5%, the treatment side of it.

But if you flip that script and you’re the patient, and the patient hears that same phrase, they would actually say that back to you as well. Before you could prescribe something to me, doctor, I need to co diagnose with you. And if you could take that and understand it’s, a ratio 95 versus 595 percent of your attention and focus has to be on condition and the consequences of that. So the systems we teach within that, it’s. What is the patient hearing during the exam?

How are you speaking to your assistant so that they can decipher what’s being said? If you’re using a lot of dental mumbo jumbo and then saying, yeah, crown on number two, all they’re going to think about is the crown and what the cost of that is. You’ve lost them. That’s bad sales. So the 95 five rule is really a system that we created to make sure that the team member has a healthy approach where they let the patient soak in, marinate in, absorb in all of that condition and consequence before we ever talk to them about treatment.

[0:14:56]  ERIC VICKERY: Does that make sense?

[0:14:57]  ALEX NOTTINGHAM: Totally makes sense. So clear. I love how you make it so simple to understand. Now, in terms of patient objections, what do you think the main reason is that they object to treatment?

[0:15:13]  ERIC VICKERY: It’s actually a reflection of that because if you reverse that formula, the five and the 95 and your focus is on the 5%, it’s on treatment and all that. When they’re thinking about treatment, they’re thinking about money. And so when you ask dental offices, hey, what’s the number one objection? You hear 100% of the time. And we’ll cover this in May at our event, they will say money. And we’ll do survey says, and the first one will be money on the slide. Right? Money is the number one objection that dental offices believe is the objection. Well, the reason money is an objection is why would I want to spend money on a crown when I don’t perceive there to be a need, a problem?

That’s the biggest challenge that we have to realize, hey, it’s not about the money. Because if they believed in the condition and the problem, they bought into the diagnosis, they will figure out how to afford it. If you believe there’s something wrong, if you have a problem with your shoulder, you’re going to go spend the money to take care of that issue because you believe it. The problem is they don’t have the diagnosis. So the actual biggest objection that we are dealing with is lack of urgency.

When I don’t understand the diagnosis, I don’t have urgency to it. I’ll throw money out almost as a smokescreen. Yeah, I don’t really have the money to take care of this right now or I need to go home and talk to my spouse about it, whatever it is. I don’t really want to open another credit account. If they had urgency and value in what was being discussed, these things you would not hear. So those are smokescreens to the lack of urgency objection.

And it’s really, really hard to overcome a lack of urgency objection, especially if you’re an administrative team member, you don’t carry a lot of clinical clout. And how are you going to go back and say, well, let me show you the X rays again when you’re the administrative team member. And so the best way to deal with, deal with objections is to prevent them. If you can prevent the objection lack of urgency, then you’re not going to hear those things and how do you prevent it? You work on making sure that you, quote, sell the condition, you sell the consequence.

[0:17:29]  ERIC VICKERY: When people buy into the diagnosis and what’s happening, they’ll be more likely to even ask you for the solution and say, well, doctor, what do I need to do to fix it? That’s when they have buy in. So I’m more of the, yeah, we could talk about how to handle objections, but if we can really figure out how to prevent them, it’s so much easier.

[0:17:53]  ALEX NOTTINGHAM: My favorite question, what is the one thing that a practice can do tomorrow and put into place, easy to implement, that can improve dental case acceptance?

[0:18:07]  ERIC VICKERY: Instead of telling, focus on asking. When you tell people what to do, it creates a bad taste in their mouth. But when you’re asking, it feels like they’re along for the ride, making the decisions, and they’re in control of that process. When we listen to dental offices and we’re on site and listen to what people say, we hear a lot of, well, you need a crown, so go up front and see Betty and she’ll get you scheduled.

Do you have any questions for me? No? All right, go up front. They’ll get you scheduled for that crown or they’ll won’t even talk to the patient. They’ll look to the assistant and say, take Ricky Bobby up front. He needs two crowns. Have him scheduled back with me. There’s just this tell that goes on, and especially without the 95 five rule being followed, the patient feels pressured. People don’t like to be told what they need to do.

And so if you can convert the tell into an ask, you have a huge advantage. Nearly two thirds of patients, this goes we talk about this with great phone call process with new patients. If we’re just answering questions and answering questions, and yeah, how much is this? And what does your doctor do with that? And then there’s silence. And we never get to a place where we ask for the appointment. We’re at a huge disadvantage because the patient isn’t going to say, well, why don’t I go ahead and get an appointment scheduled?

So if you can get to a simple thing that you can do, if you can just get to a place where you’re asking for them to move forward, you’re at a whole nother level of dental case acceptance. Now, how you ask would be an important distinction. I’m not a huge fan, as you can tell, of pressure sales. I’m a huge fan of mutual agreement. The phrase used to be close, right? Remember that phrase, Alex? Close. We don’t like that term. Right?

We’re trying to get commitment, and that commitment comes from mutual agreement. And so if you can ask the patient about moving forward, that’s a healthier place to be for you, because the patient feels like they have a say in this and they can agree with you. And you can know where they are. So what I would not do with, quote, closing is say something like, how soon would you like to get this done?

There’s more pressure there. Do you see any good reason why you wouldn’t want to go ahead and get this scheduled? I’m just confused when I hear that what it’s like a double negative. What am I supposed to say? You can get to those questions, but start with something that feels more mutual. And so we use the word how. So if you can use the word how in your questioning, you know that you’re going to create an open ended concept, an open ended answer.

In other words, would you like to go ahead and get this scheduled? Yeah. Well, there’s a lot to decipher in that one word they gave you. Yeah. Does that really sound like they’re committed to it, or are they just getting away with lying to you in one word? One syllable? They can do that. But when you create an open ended dialogue by using the word how, the conversation can unfold. You can actually hear objections if you need to, and you can hear wavering. And I’d rather not schedule someone who has no intention of coming in because I didn’t do a good enough job five minutes ago.

So we’ll say, you can do it two different ways. How do you feel about moving forward with this plan? Nobody can say yeah to that question. They’re going to have to give you some sort of response. Or you could say, how much sense would it make to move forward with this plan? That word how creates the dialogue. It forces the dialogue in the conversation. And now the patient has to really give you some conversation, and you might hear things like, well, it’s not bothering me.

And now you can get into that and engage and play it forward and talk about, well, what happens when it does bother you? We won’t be talking about this plan. We’ll be talking about something bigger before this plan. Now, once you say, how do you feel about moving forward this plan? And they say, you know, this really sounds like what I’d like to do, then you can get into more questions like, well, how soon would you like to get this done?

If you could walk away with something, really figure out and learn, how am I going to ask these patients if they’re ready to move forward? So we use three different questions in the process. When you’re in that 95 five rule, how concerned are you with this problem? How concerned are you with the infection of your gums? How concerned are you with the decay, the fractures? If the patient says, yeah, I’m really concerned about it, or they say, no, it doesn’t make sense to talk about treatment. But if they say yes, you can now talk about a plan. Well, why don’t we talk about a plan and how we take care of it.

Yes. Now you’re in the 5%. You can talk about treatment, and then at the end, you can then say, how do you feel about moving forward with this plan? Ricky, Bobby, shake and Bake, that’s what we like to hear. So you can ask questions. Through this process, you will have more patients saying yes, more patients keeping their appointments instead of feeling like they were told to do something. And you can always ask your Admin team member how salesy you’re coming across.

Ask them how often patients will say to them, oh, doctor must need a new car, or, I got to pay that car payment out there, or, oh, kid must be in college. That is your patient relaying to you those that are external processors. Not everybody’s going to say it out loud, but if they’re hearing that up front, it’s a reflection that out back. They feel like you’re telling them they need to do something in a sales format because you need money from them, and that’s not where you want to be.

So that’s a good barometer, good testing question to ask your Admin. Do you ever hear that question that’s going to open your ears and your eyes and your mind to say, okay, we really ought to be working on our case presentation process.

[0:24:25]  ALEX NOTTINGHAM: Yeah. You’re really starting to go into the matrix of understand the personality types, understanding looking for cues in your environment. Often with dentists and anybody who’s leading an organization, sometimes it’s easy to be blinded or to go head on with what you’re looking to do, and you’re not paying attention to what’s happening in the environment, what information you’re getting. So, Eric, tell me a little bit about the growth Summit and also your coaching team.

[0:24:57]  ERIC VICKERY: Yeah, so my phrase for those things would be like this you’re only as good as you can communicate. And what I mean by that is, from my father in law’s standpoint, he said, if I get my magd, I’m going to be at the top of my game, and they will flock to me. The patients will come in, well, they have no idea what any of that means. They’re looking at Google reviews, sure, but they don’t know that because you’ve done 300 hours of clinical ce what that means to them. So you might be a ten clinician like my father in law. You might be way up their clinician, but if your verbal skills are down here, they’re a five. Your patient will perceive you as a five clinically.

Right. So you’re only as good as you can communicate. So with the growth summit in May, we are all about how you communicate, really hearing yourself and learning how you communicate to others, because your ability to communicate will tell them how great you’re going to take care of them. Your communication skills are your dental case acceptance skills. Same thing. Now, the coaching team, I have to say, Alex, I think we’ve put together an amazing group of people.

We have a whole team of coaches. There’s seven of us who range from hygiene, coaching, doctor on the team to helping with insurance resignation, to dental case acceptance, to systems like scheduling and huddle. They have it all. They’ve been trained well, and they’ve been in dentistry for a long, long time and know how to help teams implement this stuff, whether it’s systems, dental case acceptance, insurance free, any of that.

So I don’t know how in depth you want to get, but I’m pretty proud of them.

[0:26:49]  ALEX NOTTINGHAM: Well, one question I like to ask about both of these topics the Growth Summit in May 19 and 20th in Fort Lauderdale, and then also the coaches who’s a good fit to go to the Growth Summit and who’s good for coaching?

Well, as far as the Growth Summit goes, if you want your whole team to be on the same page and how you communicate to getting patients healthier, that would be a good fit. So if you want to do ideal treatment planning and ideal dental case acceptance, bring your team to the Growth Summit May 19 and 20th. And as far as coaching goes, if you really want to see accountability to those things that you learn, you really want to have implementation, you really want to dive deep into it and do some practicing of this and create some leadership within your team, having people lead different systems that we teach, then that’s where coaching comes into play.

Along with we measure it. We have KPIs that we put in place that measure how well you’re implementing this. Are you at the standard of honestly production per patient or production per hour, either in hygiene or doctor? Is your period percentage at the rate it ought to be? That will be a reflection of how good you are at communicating with your patients.

[0:28:12]  ALEX NOTTINGHAM: So everybody very succinct to the point. Absolutely. Well, thank you, Eric, so much for being on the program. And as I was listening to you, I’m like, I’m going to make a commitment every month, at least every month, to have you at least once a month. And for those that are listening or watching, please remember to subscribe on YouTube and Apple podcasts and follow us on Spotify. And until next time, go out there and be an all-star.

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