Tech tip: Pricing and profitability

In a recent tip, we shared our checklist for clear aligner success, which touches briefly on the topic of setting prices in your practice.

The checklist was created for our practice building e-course, which provides further details regarding pricing and profitability. Here's a taste:

Doctors often ask us: “How much should I charge for clear aligner treatment?” It’s not our place to tell doctors how to run their business, but we can share some suggestions.

Aligner treatment can involve anywhere from a couple of aligners to fifty or more. Instead of calculating a unique fee for each patient based on the number of initial aligners plus an additional cost to cover estimated future revisions, replacements, and retainers, Dr. Ken Fischer recommends a simple two-tier pricing strategy:

  • One fee for simple cases with short treatment times
    • (often handled with Flex)
  • A higher fee for complex cases with longer treatment times
    • (often handled with Unlimited)

Unless a dental service organization or group practice sets prices for you, each doctor (with their accountant or financial advisor, if applicable) must determine how much to charge for services. Whether you’re providing an occlusal composite, a prophy, or orthodontic treatment, you need to set your treatment fees so that the practice's expenses (lab fee, rent, utilities, payroll, etc.) can be covered while allowing yourself a healthy profit.

Because these variables can change from practice to practice, one doctor’s fee for a “simple” case may be set at $,1500 and another’s at $2,500. One doctor’s fee for an “complex” case might be set at $3,000 while another’s is at $8,000. The important thing to remember is to set the fee based upon the value of the service provided, not just the cost of the lab fees or or materials used.

Once the fee is determined, we recommend offering the patient a variety of payment options:

  • Paid-in-full (which may include a "bookkeeping" discount)
  • Down payment with following monthly payments
  • Monthly payment plan (number of months limited to the anticipated treatment time excluding the retention phase)
  • Securing financing through a 3rd party provider
  • Or any other plan (custom or otherwise) that is favorable to the practice and the patient.

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Check out our practice building e-course, available on our online store.

Orthotown Corporate Profile: Shaping the Future of Digital Orthodontics

The November 2017 issue of Orthotown features a story about how we've teamed up with the Straumann Group to disrupt the digital orthodontics market.

Read about it below. 

Tech tip: Patient photos and the occlusal plane

There are a number of reasons ClearCorrect requires patient photos. One of these is to accurately orient the patient's occlusal plane. 

The occlusal plane is an imaginary curved plane formed by the incisal edges of the anterior teeth and the occlusal surfaces of the posterior teeth. 

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The angle of the occlusal plane varies from patient to patient. After scanning impressions the technicians must attempt to accurately orient the patient's occlusal plane before staging treatment from your prescription.

Without a photo of the patient smiling, the models may be oriented with the occlusal plane too flat or excessively tipped, causing the maxillary incisors to look like they need to be intruded or extruded. Note in the images below the difference when the occlusal plane is calibrated.

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For further information on occlusal planes and digital treatment planning, check out the online article "Importance of the Occlusal Plane in Virtual Treatment Planning" by Dr. David Paquette. 

Tech Tip: Best practices for treatment setups

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We've put together a summary of best practices for reviewing and approving a treatment setup. This guide covers recommendations on what you can verify, review and communicate as well as treatment adjustment options.

1. Compare to patient photos to confirm that the software has accurately captured the:

  • Articulation of the models and bite registration
  • Midline relationship
  • Overjet 
  • Overbite
  • Canine and molar relationships
  • Shape of teeth 

2. Carefully review the subsequent steps to verify the planned tooth movements are safe and effective.

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3. Verify that any recommended IPR and engagers are sufficient to achieve your goals.

Here are some adjustments you can make, depending on the patient age, dentition and  ease or complexity of treatment:

  • You can slow down difficult movements to help roots stay upright and translate
  • You can adjust the wear schedule to 1, 2 or 3 weeks (1 week wear schedules are often done in combination with accelerated tooth movement technologies)
  • You can adjust your engager preferences
    • Remove or reduce engagers
    • Request vertical or horizontal engagers
    • Specify when to place or remove engagers
    • Add engagers to increase aligner retention (short clinical crowns)
  • You can adjust your IPR preferences
    • Schedule IPR for specific stages
    • Adjust the scheduled amount between 0.1 and 0.3 mm.

You can let the technician know if you are:

  1. Extracting a tooth
  2. Using class II correction techniques
  3. Using any other auxiliaries, such as:
    • Buttons and elastics for extrusions and/or rotations
    • Class II correctors (such as TAD's, Forsus, coils/springs, etc).

Note: If you find yourself frequently requesting standard changes to treatment setups (for example, "add overcorrection" or "end with a digital powerchain"), the best place to do that is on your case submission form. 

When you are done evaluating a treatment setup, you have four options:

  1. Approve the setup, select a price option and start the case
  2. Decline the setup and ask for changes
  3. Decline the setup and submit new impressions or intraoral scans
  4. Decline the setup and cancel the case

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If you want to make an adjustment, click "disapprove" and let us know what you want to do. Our technicians will do their best to make any changes you request and upload a new version for your approval within a few days. 

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If you are inclined to show the patient the treatment setup, you can show them in your office or use the "share link" option to copy the URL and send it to them. 

Tech Tip: Backtracking

Backtracking is when you have a patient wear the previous aligners longer than originally planned. Often, when the teeth have gone off track, they need additional time in a previous aligner to move fully into position.

Indicators for when backtracking may be needed:

How to...

Here is an example of how to backtrack:

Lets say there is a poor fit on aligner #15.

1. Ask the patient to return with their bag of aligners they have 'worn and saved'.

2. Starting with the aligner they are currently wearing (#15), have them try the previous set (#14). If it does not fit satisfactorily, ask them to put on the next previous aligner (#13). Repeat this process until you find a set of aligners that fit well, (lets say, for the sake of example, #12 fits well).

3. Then with the aligner that fits well (#12), have the patient begin wearing the next aligners in sequence, (#13) for 2 weeks each.

4. Progress forward through the series until reaching the last aligner that did not fit well (#15), then continue moving through the series of aligners as long as each aligner fits as it should.

A couple notes on backtracking:

  • Patients should be educated to keep (do not throw away) their previously worn aligners through treatment.
  • If your patient does not have their previous aligners, they can be remade by the lab. Keep your patient in their current aligners until these arrive. 
  • Backtracking may not work if some teeth have progressed and others have not. If you do not find an aligner that fits well, you may need to do a revision. 

Tech Tip: Checklist for clear aligner success

In recent surveys, you've said that you want help getting patients in the door.

In response, we've collected the best advice from top providers, account reps and support staff and created this checklistto guide you step-by-step all the way from registering as a brand new provider to promoting your practice. 

Here's an outline of the steps covered in this checklist:

  1. Register as a provider
  2. Prepare your practice
  3. Treat your first patient
  4. Prioritize aligners in your practice
  5. Assign team responsibilities
  6. Market your services to the public

If you're brand-new to ClearCorrect, just start at the beginning and work your way down. If you've already treated a few cases, you may be able to skip ahead. Don't be overwhelmed! You can do this. Just take it one step at a time. Wherever you're at in the process, we hope that this guide helps you take your practice to the next level. 

A PDF version of this checklist is available here.

1. Register as a provider

  • Register at clearcorrect.com/doctors.
  • Log in to the doctor’s portal at dr.clearcorrect.com and familiarize yourself.
  • Watch the Basics of ClearCorrect playlist on YouTube.
  • Visit our Help Center at support.clearcorrect.com and take a look around. This should be your first stop whenever you have questions.
  • Get acquainted with your account rep. Tell your receptionist to expect a call from a ClearCorrect representative within a day or two of registration. You can also call us at the phone number listed in the sidebar of the doctor's portal. 

2. Prepare your practice

  • Gather supplies. You’ll need a way to take and upload high-quality photos.
    • Digital camera or smartphone
    To capture your patients’ dentition, you’ll also need an intraoral scanner or:
    • PVS impression material
    • Plastic impression trays
    We don’t accept alginate impressions, stone models, or metal impression trays.
  • Prepare to place engagers. You might not need this immediately, but as you move into more complex cases, you’ll probably need to place engagers. You can get supplies from store.clearcorrect.com or another vendor. See How to Place Engagers.
  • Prepare to perform IPR. You’ll also probably eventually need supplies for IPR, available from store.clearcorrect.com and other vendors. See How to Perform IPR.
  • Set pricing. Typical patient costs for aligner treatment range from $1,500 to $8,000, depending on the complexity of treatment and what the market will bear. Be sure to allow yourself a sustainable proft margin. Choosing Unlimited treatment keeps costs predictable. Choosing Flex can save money upfront, but allow headroom to accommodate revisions, replacements, and retainers—or prepare your patient for possible future costs.
  • Register for an e-course or live workshop at store.clearcorrect.com. This isn’t required, but we highly recommend it. ClearCorrect offers CE credit for a range of courses on topics related to clear aligners. These courses answer many of the most common questions that our support staff receives. Your staff can take any e-course you take at no additional cost, and they can accompany you to live workshops at a reduced rate.

3. Treat your first patient

  • Start with a simple case. Look for a minor issue that can be corrected in less than a dozen steps, without major crowding that might require interproximal reduction (IPR) or difficult movements that might require engagers. Anterior teeth are easier to correct than posterior teeth, and tipping is easier than extrusion or rotation. You may find it convenient to start with a staff member, a family member, or even yourself.
  • Get informed consent. Every patient should read and sign an informed consent form. Make sure they understand these key points:
    • You, the doctor, are responsible for their care.
    • ClearCorrect manufactures aligners based on your prescription.
    • Patients should contact you if they have any questions or concerns.
    • Any orthodontic treatment carries some risks.
    • No one can guarantee a successful outcome.
    • Aligners need to be worn consistently—22 hours a day, every day.
    • Most people will need retainers after completing treatment.
    • There may be additional costs for revisions, replacements, or retainers.
  • Take photos and impressions or scans. See How to Take Photos & X-Rays and How to Take One-Step Impressions.
  • Submit your prescription. See How to Submit a Case.
  • Review & approve the treatment setup. See Treatment Setups.
  • Teach your patient how to wear & care for their aligners. Instructions are printed on the back of each aligner bag. It is absolutely essential for your patient to understand the importance of wearing aligners consistently. This is the single most important factor in treatment success.
  • Give your patient two sets of aligners and check their progress at each appointment. See Checkups & Revisions.
  • Follow up with retainers after treatment. See Retention.
  • Don’t be afraid to ask for help. From the doctor’s portal (dr.clearcorrect.com) or the Help Center (support.clearcorrect.com.), click the green Help button in the lower-right corner to chat with a support rep. You can also call us or email support@clearcorrect.com. Be prepared with your office email or phone number, and (if applicable) the case number. 

4. Prioritize aligners in your practice

Unfortunately, you probably can’t just sit back and wait for patients to walk in to your practice asking for clear aligners. That might happen occasionally, but most people don’t consider correcting malocclusion until the benefits are presented to them. Here are some of the actions that set successful practices apart:

  • Ask every patient whether they’re happy with their smile. Give every new patient a smile survey with questions like:
    • How would you rate your smile from 1 to 10?
    • What would you change about your teeth?
    • Does it feel like your teeth fit together properly when you bite down?
  • Talk to every patient about clear aligners, regardless of what they come in for. Even if a patient isn’t a good candidate, they may know someone else who is. If they are a good candidate, include aligners in their treatment plan and make sure they have a copy when they leave.
  • Play videos for patients in the waiting and exam rooms to introduce them to the benefits of orthodontics and how clear aligners work. There’s even a waiting room video playlist that can be played on a loop.
  • Tell patients about the benefits of correcting malocclusion. We offer a chart of conditions & benefits that you may want to laminate and keep on hand.
  • Put out promotional materials. Make sure ClearCorrect is visible in every part of your practice. You can order promotional materials from your rep or store.clearcorrect.com.
    • Display brochures in your waiting room and exam rooms
    • Hang posters throughout the office
    • Attach a window cling by your front door
    • Stock your front desk with ClearCorrect pens
    • Teach patients about aligners with a fiipbook and before & after photos
    • Let patients get hands-on with a typodont and sample aligners
  • Update your website. Add information about ClearCorrect to your practice’s website. You can find logos, images, and sample copy at support.clearcorrect.com.
  • Set achievable treatment goals. Start simple and work your way up to treating more difficult malocclusion as you gain experience and confidence with aligners. Even minor anterior corrections can make a big difference in a patient’s self-confidence.

5. Assign team responsibilities

  • Get the whole team on board. Make sure every member of your staff understands their role in the successful implementation of clear aligner treatment. Everyone should be prepared to promote clear aligners to any patient that could benefit from them.
  • Educate your staff. Every staff member should understand the basics of clear aligners and where to get help. They can:
  • Conduct regular staff meetings to review the effectiveness of each individual, and the successful growth of the practice thanks to clear aligners.
  • Distribute laminated cards to your staff outlining roles and responsibilities.

Here are some examples of specific duties you might assign to staff members:

  • Receptionists are usually the first people to welcome new patients, so they must be prepared to discuss clear aligners. They can:
    • Promote your practice as a provider of clear aligners
    • Identify potential clear aligner patients
    • Get patients to fill out a new patient survey/questionnaire
    • Note any interested patients watching videos in waiting room
  • Dental hygienists are in a unique position to identify potential clear aligner patients and initiate a conversation about clear aligners before turning things over to the doctor. A hygienist that's educated thoroughly on the numerous benefits of orthodontics can do a lot of the sales work. They can:
    • Identify conditions that may benefit from orthodontic correction
    • Identify symptoms of occlusal disease
    • Educate patients about how correcting malocclusion can improve oral health
  • Dental assistants play a key role in patient education and promotion of aligners because of their direct, frequent contact with patients. They can:
    • Identify potential patients by asking if there’s anything that they want to change about their smile
    • Perform an initial workup:
      • Confirm that the Informed Consent Agreement has been signed
      • Take impressions/scans
      • Take photos
      • Conduct a chairside examination
      • Fill out an online prescription or pre-submission worksheet
    • Educate the patient about clear aligners:
      • How to wear aligners
      • The importance of following the wear schedule
      • How to clean and care for aligners
      • What to expect regarding engagers and IPR
    • Assist with checkup appointments:
      • Retrieve the next set of aligners for distribution
      • Review the treatment plan
      • Determine whether engager or IPR procedures are scheduled, and if so, ready the required materials and inform the doctor
      • Ask the patient whether they are wearing their aligners 22 hours a day, and whether they are they experiencing any discomfort
      • Document the treatment notes and progress
    • Encourage existing patients to tell their friends about ClearCorrect
    • Enroll in continuing education for clear aligner treatment
  • Treatment coordinators (or office managers) can have an important role in getting new clear aligner patients. In many practices, the treatment coordinator discusses pricing and financing with patients. A treatment coordinator that is comfortable discussing these topics can really help to seal the deal. They can:
    • Discuss clear aligners with patients to identify prospects for the doctor
    • Show patients their treatment plans when needed
    • Discuss insurance, pricing, payment, and financing options
    • Inform patient of their responsibilities with regards to payments, appointments, etc.
    • Follow up with potential patients that were interested in clear aligner treatment
  • Clear aligner manager is not a necessary role for every practice, but some practices find it helpful to dedicate a team member specifically to managing the clear aligner workflow. This could mean additional responsibilities for an existing employee, or a dedicated staff member in a high-volume practice. They can:
    • Work with the doctor to submit clear aligner prescriptions online
    • Alert the doctor when treatment setups are available for review
    • Store and organize boxes of aligners
    • Schedule patients for the delivery of their aligners
    • Order and track revisions
    • Order retainers and replacements
    • Organize marketing and promotion of clear aligners
    • Coordinate with a ClearCorrect representative to get promotional materials and resolve support issues
    • Act as a team leader in motivating other staff members (and the doctor) to make the practice a community leader in clear aligners
    • Work with the practice’s financial manager to administer the costs and fees related to clear aligner treatment
    • Coordinate with the finance company to verify qualified patients and promote to them

6. Market your services to the public

  • Create an on-hold message promoting clear aligners.
  • Send postcards and emails to current and potential patients announcing that you offer ClearCorrect, and promoting specials.
  • Run promotions such as:
    • Free whitening with clear aligner treatment
    • Free initial consultation and treatment setup
    • Free starter kit items (OAP cleaner, Outie tool, Chewies, aligner case)
    • Discounts on aligners or retainers
  • Generate good word of mouth. Hold a staff meeting to get everyone on board identifying actions to create positive referrals.
  • Print referral cards. These can offer services such as free x-rays, exam, and a consultation, and should be distributed to every patient that comes into your office. Be sure to mention the typical cost of these services, to increase the perceived value of the offer.
  • Send bouquets of flowers, cookies, or balloons to patients starting treatment. These can include referral cards along with gifts such as a branded mug, toothbrush, or gift card. Send to the patient’s place of work to create buzz with their co-workers.
  • Always have a staff member in treatment. It’s a great conversation starter, and they’ll be able to speak from personal experience.
  • Make sure your website is up to date and optimized for search engines. You can also invest in paid search results and email marketing. S3SB offers discounted website design and internet marketing services to ClearCorrect providers.
  • Manage your presence on social media. Stay in touch with patients and prospects on Facebook, Twitter, and Instagram, and keep up your reputation on review sites like Yelp, HealthGrades, RealSelf, and Google My Business.
  • Send monthly newsletters promoting current specials and services.
  • Establish a practice mission statement and regular goals.
  • Consider traditional advertising like TV, newspaper, radio, and billboards if they fit your budget and location.
  • Conduct “Lunch and Learn” sessions with other interested professionals.
  • Speak about clear aligners at community meetings, school programs, and other events.
  • Ask your patient financing service to conduct a “soft hit” to identify pre-qualified prospects in your patient database, and target them in your marketing. (If your service doesn’t offer this, consider beWell patient financing, who also offers free registration to ClearCorrect providers with the promo code CCFREE.)
  • Schedule a “ClearCorrect Day” promoting clear aligners and offering discounts for anyone who signs up that day.
  • Hold contests and giveaways to gather leads for potential patients.
  • Give back to the community. Select a cause that will position you better with your targeted audience.

Tech Tip: Excessive Crowding

severe crowding.jpgThere are many possible causes for crowding, including the size and shape of the teeth, the form of the dental arches, the relationship of the skeletal components and patient's own harmful habits.

Determining the cause of each patient's malocclusion is essential for successful diagnosis, treatment planning and prognosis.

Some common causes for crowding are extra teeth, lost teeth, impacted teeth or abnormally shaped teeth.

Please see our series of videos on the topic of malocclusion in our Basics of Orthodontics series.

Solution

The simplest option is to check “only if needed” and allow our dental technicians to offer their recommendations.

If you have specific preferences for a patient's treatment, though, please let us know when you submit your case. At ClearCorrect, doctors are in charge. We will customize the clear aligners to carry out whatever treatment you prescribe to the best of our ability. If you don't see an option on the form, feel free to provide special instructions in the “additional instructions” section.

For patients with severe crowding, it's usually best to use a combination of techniques. For instance, proclination and expansion are more predictable together than either technique alone.

If the crowding is not too severe, however, you may be able to achieve your goals with just one of the four options (procline, expand, distalize, or IPR).

For more informationonthe above techniques, check out this article in our help center. 

Tech Tip: Predictability of tooth movements

Due to variations between teeth, some are more amenable to certain types of orthodontic tooth movements with clear aligners than others. Here are some rough guidelines to help you choose cases and calibrate expectations.

Basic movements

Clear aligners are particularly-well suited for facial/lingual movements. They excel when there's a broad surface to apply force to, and adjacent retentive surfaces to anchor against.

Moderate movements

  • Distal/mesial movements - if there is inadequate tooth contact with the aligner with the portion of the clinical crown to "push" the tooth in the desired direction, consider adding an engager for additional surface area
  • Most rotations/rotations of lower premolars - ensure there is adequate space to rotate the tooth and consider the position of the tooth root as it is easier to rotate a tooth that is normally inclined. For example, a tooth that is mesially tipped should be uprighted first before attempts to correct its rotation. Conically-shaped teeth, such as mandibular premolars, offer little natural morphology for an aligner to "grip" onto. These teeth commonly require engagers to provide for added morphology.
  • Torquing - evaluate the crown morphology, particularly length of the clinical crowns as these are more easily torqued. Short clinical crowns and lack of defined crown morphology (e.g. bulbous shaped crowns) may be assisted with engagers

More challenging movements

These tooth movements require added attention to details such as the crown morphology, position of the tooth root, available space/arch length to perform the movement and can be assisted with engagers and/or auxiliaries such as buttons and elastics.

  • Extrusions - most effective with single rooted teeth that have a straight root. Also consider the crown morphology and interproximal areas. Triangular shaped tooth crowns and or interproximal areas that allow for the aligner to engage more of the crown may be extruded without engagers. Short clinical crowns, lack of defined crown morphology and multi-root teeth more commonly require engagers
  • Intrusions - consider the morphology and retentiveness of the adjacent anchor teeth. If they do not provide sufficient natural undercut, engagers are often used. ClearCorrect's extended trimline design often provides sufficient retention for intrusion of single rooted teeth without the need for engagers. Intrusion of multi-rooted teeth is extremely rare as this is a very difficult movement and will require engagers on adjacent teeth to assist. 

 For further education on difficult movements and auxiliaries, check out our advanced e-course.

Final Workshop Of 2017: Chicago - Nov. 4

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If you're in the Chicago area, and need CE credits before the end of the year, register for our Treatment Basics, Practice Success and Advanced Treatment workshops coming up on November 4th, 2017 in Chicago, IL. Doctors (and staff!) have been loving these courses, and we think you will, too. 

Register today to secure your seat for up to 9 hours of CE training led by Dr. Ken Fischer and Dr. Duane Grummons, two highly experienced Orthodontists at the top of their field.

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Topics include:

  • How to select and submit cases for treatment with clear aligners
  • Case examples – simple to moderate cases
  • Hands on exercises
  • Technician Talk
  • Advanced troubleshooting techniques
  • Tips for practice success
  • Marketing & branding tips
  • And much more.

Whether you're a clear aligner novice, an old hand, or somewhere in between, by the end of the day you'll be excited to put some new ideas to work in your practice. Plus, you'll have racked up a bunch of CE credits, and that ain't bad, either.

Don't wait. Sign up today, because these Early Bird rates end this Friday, October 6th.

Hope to see you there!

Tech tip: Tips on closing patients

This week, while we are on the subject of talking to patients, we thought we would share an oldie but a goodie. 

In this video, our very own Dr. Mah chimes in to give us all a few tips on talking to patients about ClearCorrect. 

What's the best way to approach the subject of clear aligners with a patient who needs corrective treatment? What should you do if your patient balks at the cost of their aligners? How can your staff pitch in to help, and why is staff participation so important? What good will aligners do for them besides a nice looking smile? Click the video to hear what Dr. Mah has to say and find out!

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