Technology Trumps Tradition

The new meaning of value for buyers and sellers of dental services

By Arlene Furlong

When it comes to consumers making everyday purchasing decisions, the opinions of family and friends carry about the same weight as the influence of the Internet. However, when it comes to making decisions about critical issues—such as their healthcare and that of their children—Americans have come to rely more heavily on the world wide web when finding information and seeking out a provider who best matches their perceived needs.

It revealed that 75% of its respondents went online to research healthcare products and services. Seeking advice from others, comparing healthcare options, researching healthcare professionals and services, and saving time and money while doing it were among Internet users’ reported activities, according to Fleishman and Hillard’s Digital Influence Index Annual Global Study.

The fact that consumers place a higher percentage of value on online information when making healthcare choices than when purchasing nonessentials illustrates the level of consumerism driving the healthcare marketplace and influencing the behavior of dental patients and even dentists in their quest to find like-minded solution providers.

In fact, dental care seeking behavior was described among critical trends affecting the future of dentistry in reports published by the American Dental Association in May 2013. A comprehensive scan of the profession (“A Profession in Transition: Key Forces Reshaping the Dental Landscape”), and an external ADA-commissioned report said consumer habits are shifting.

Americans are increasingly relying on technology and seeking greater value from their spending, while dentists will more frequently provide care for patients who proactively shop for value.

Polling up to 4,000 US adults each year since 2008, the Deloitte Center for Health Solutions’ 2012 research found that demand for more options, better information, and greater support of individual involvement in decisions and healthcare management is steadily increasing.

As Internet access proliferates via mobile devices and health information technology continues to expand, researchers studying the issue say consumer demands are bound to intensify. And as consumers increasingly bear the costs of their care, searching for value for the dollars they spend will be a rising factor in their purchasing decisions.

Dental stakeholders, dentists, and laboratories alike will have to embrace new ways for patients and clients to interact with their businesses and access information about their products and services. Remaining competitive and finding value in an environment where technology usage is integral to developing and maintaining relationships is the most prominent force driving decision-making processes.

The Search for Value

When new patients arrive in Paul Caselle’s Massachusetts practice, there’s one thing this DDS can count on—“They know a lot more about me than I know about them,” says the 35-year veteran practitioner.

He’s not alone. More dentists are finding that patients are taking an active role in managing their dental care. Although already a common step in pursuing medical care, consumers are increasingly using available technology to become better informed about dentistry and their choices of dental providers. They use the Internet to find dentists who have philosophies that align with their own and can provide the type of value they seek for the dollars they are spending.

Craig Armstrong, DDS, welcomes the change. The Houston general dentist attributes the recent growth of his 25-year practice to patients’ more discriminating practices.

“The patients who found me through the yellow pages were looking for a name in the book. They weren’t value-driven and I didn’t typically enjoy them as much as I do those who find me through my website. These patients are shoppers who know what they want. They’re looking for a custom fit,” says Armstrong. “I try to make my website reflective of who I am as a dentist so potential patients can evaluate whether I can provide the relationship and services they’re seeking.”

More than 96% of dentists include the services they provide to patients on their practice websites, according to the ADA’s 2010 Technology and Social Media survey, published in 2012. Dentists under 35 years of age were most likely to have a primary practice website (82.4%), and 78.7% of dentists between the ages of 35 and 44 did.

It’s marketing that works. Some consumers are going to great lengths to find a custom fit in the relationship with their dentist. As an example, a patient of Ann Marie Gorczyca, DMD, underwent five evaluations before selecting her orthodontic practice. That same patient later cherry-picked a provider through her own Internet search to fulfill a treatment plan including eight veneers, an implant, and a crown. Why? Because she liked the message conveyed on the practitioner’s website.

“The recession has affected every single aspect of the way we do business, yet people are very demanding when it comes to seeking out the best possible health care relationship they can find for themselves and their children,” says Gorczyca. “They understand they’ll get the quality they pay for and that it’s their choice. However, once patients make a decision, they demand the value they sought.”

Just as individuals are evaluating dentists on the Internet at their own discretion on their own time before selecting a provider, so too are dentists evaluating potential laboratory partners.

“I search for dental laboratory partners in much the same way that patients find me,” says Armstrong. “I want all my questions answered about the services provided while I’m searching, without having to pick up the phone. To communicate that information dental laboratories have to have an active website. A listing of prices and turnaround times just isn’t enough.”

Smaller dental laboratories have trouble maintaining useful websites because they don’t have enough staff to make frequent changes. But with dentists increasingly joining forums, blogs, and study groups, social media is revealing itself to be a practical, effective, and free marketing tool that dentists value.

Anthony Stefanou, DMD, a former practicing dentist and founder of the Dental Sales Academy, a company that assists vendors in selling their services to dentists, says many of his laboratory clients are trying to figure out how to move their businesses forward amid “brutal” competition.

He estimates that dentists get double the amount of mail solicitation they received 10 years ago. Dentist office managers are great at screening so sending letters in envelopes doesn’t work. Postcards advertising the lowest prices are another tactic many laboratories are taking, but Stefanou says many dentists equate that kind of marketing with mediocrity. “A low-priced crown that a dentist has to spend all day adjusting is no value to the dentist at all,” he states.

Instead, Stefanou values laboratories that become a resource center for dentists. “If you become an information resource for dental professionals, they will seek you out. Start following companies and have dentists follow you, then link to informative articles, new procedures, blogs or continuing education programs,” he advises. “Your name will become embedded in dentists’ minds as someone who provides great customer service. When dentists are looking for a laboratory, they’ll think of you.”

It is advice validated by the ADA’s survey on technology and social media use. Respondents to that survey indicate that the largest increases in their computer use between 2006 and 2010 was to visit dental forums or blogs, access professional products and patient education materials, participate in online continuing education, or visit social networking sites.

Seattle-based Kymata Dental Arts’ Mike Dominguez, CDT started his company as a one-person laboratory in 2009 and now employs two technicians. Dominguez says he knows firsthand how valuable dentists find useful social media, calling it “word-of-mouth on steroids.” He says using social media not only developed his client base, but brought him the type of clients he was hoping for—doctors that are passionate about providing beautiful restorations. Dominguez produces some 150 to 200 units per month and estimates a 50/50 split between single unit and implant production.

Kymata Dental Arts uses social media—including Facebook, Instagram, Tumblr, and YouTube—to share articles and new research about creating esthetic and stable restorations to the industry as a whole. For existing clients, Dominguez even schedules special services, such as webinars. Using a camera with a micro-lens and live feed through the desktop, he and his clients view the slide shows of current cases and talk about changes that otherwise would have to be made later by the doctor in the office. “We can save two days of production scheduling with a webinar meeting like this,” says Dominguez.

Dentists say time savings plays a big role in how patients choose their providers and, in turn, how dentists choose their laboratories. “With the speed of life being what it is today, patients are highly appreciative of time-saving conveniences,” says Paul Caselle. Likewise, dental professionals are appreciative of laboratory partners who recognize the patient demands being placed upon them and use computerized tools to help them meet those demands.

The Search for Time Savings and Efficiencies

Although cyber communication may initially seem impersonal and preparing restorations digitally may at first appear dehumanizing, dentists and dental laboratory technicians say the efficiencies are enhancing rather than hindering professional relationships. That’s because just as patients use the Internet to find dentists who can provide time saving conveniences, dentists are searching for time saving efficiencies that speed up treatment time and reduce their costs. The economy and increased demand for value in dental care spending is forcing practices to become more efficient. Consumer dental expenditures are down and unlikely to rebound to earlier levels as private insurers reduce payments and public programs reimburse at even lower rates. Commercial plans are using more selective networks, and pressuring providers to reduce costs.

Although the current heaviest users of health information technology are patients who have the highest income and can better afford to pay out-of-pocket for dental care, young adults, who have the lowest rates of dental coverage, are just as likely to search out providers and compare prices on the Internet.

“Indemnity insurance has changed. PPOs are taking over and patients don’t want to spend a lot more than what their benefits allow,” says C. William D’Aiuto, DDS. “Price points in dentistry have hit a ceiling.”

The October 2013 brief entitled, “Despite Economic Recovery, Dentists Earnings Remain Flat,” published by the ADA Health Policy Resources Center (HPRC) reveals the current climate. It includes, “The coming years are a period of major transition in the dental care sector and the prospects for dentist earnings remain unclear.” The findings shadow those found in earlier reports. HPRC says this “new normal” is expected to lead to a challenging practice environment where dentists have little choice but to become more efficient.

After 30 years as a general practitioner and five years of decreasing profits, D’Aiuto recently joined Dynamic Dental Partners, a dental practice management company founded and managed by dentists, where he also serves as a clinical mentor to new practices. “Unless you’re in a group that’s large enough to negotiate fees, you can’t accept all these PPOs or even limit them.”

The most common type of managed care dental insurance, PPO [preferred provider organizations] plans usually require patients to pay a deductible and choose from a network of dental providers who agree to provide care to the plan’s members at reduced rates. Patients can go outside the plan, but will only be reimbursed the amount that a network dentist would have accepted.

“Because we can’t escape this fee ceiling, we have to look for efficiencies within every structure of our work process,” says D’Aiuto. “Our laboratory fees have to run between 4% and 8% or we’re giving away the dentistry. As a result, the dental laboratories we’re working with know they have to optimize their operations to lower their price of production.”

Because fast turnarounds are so highly valued by patients, and therefore dentists, he suggests that smaller laboratories may be able to operate more profitably by working with bigger laboratories to establish effective delivery systems to dental practices, or even better, by growing enough to purchase technology enabling more efficient use of their own workforces.

Kymata Dental Arts’ three-person laboratory employs that philosophy. Utilizing two scanners enables the work of the laboratory technicians to be “much less labor intensive,” says Mike Dominguez. After one of the technicians scans and performs preliminary computer design work on a crown to about 80% completion, Dominguez provides the finishing touches and sends it to the milling center. When the job comes back to the laboratory, he then prepares the framework for porcelain and completes the work.

“As a small laboratory, we rely on being able to work with outside technology for accurate fit, minimum thickness and consistency, all the variables that can add up to create problems when a human performs the work,” says Dominguez. “We’re now freed up to have the opportunity to take the restoration to the next level, either by hand or with waxing instruments. Our focus is on the final product—to make it impeccable.”

Caselle says implementing technology has made relationships with laboratory partners better because fewer things can go wrong. “When files are sent electronically, adjustments can be made. And there’s an eventual cost savings for laboratories because most of the nitty-gritty work is done by machine.”

Paul L. Giovannone, CDT, says the ability to email digital files, highlighting multiple designs before a restoration is made, has greatly reduced remakes, a vital concern in today’s economy. The owner of Utica, New York-based Biogenic Dental Laboratories says despite adopting the latest technologies, dollar volume is down when compared with actual case volume. “We can charge less for crown and bridge work today than we could 10 years ago,” says Giovannone. “There’s no way to get around digital technology if laboratories want to make even a nominal profit.”

Dentists also say technology is helping them produce more. Some 87% under the age of 35 and nearly 80% in the 35-44 year-old age group strongly or somewhat agree that using technology has made them more productive in their practices, according to the ADA’s most recent survey on dentists’ use of technology and social media.

Janet Century, DDS practiced more than 20 years before building a new office five years ago, “beautifully timed to take advantage of the recession,” notes the Barrington, Illinois-based general practitioner. Although she says she incurred a financial hit, she also firmly believes the advanced technology she integrated into her strictly fee-for-service practice prevented greater losses. With her patients paying out-of-pocket for her services, Century is not hampered in her choice of dental laboratories. “I don’t have to use a discount laboratory out of necessity. My patients like the convenience of same-day service and the comprehensive care new technologies provide,” says Century. “Helping patients understand that those benefits are available is key to maintaining relationships.”

While dentistry continues to evolve and change to meet patient needs, there is no question that consumer—as well as dental stakeholder—shopping and spending behaviors have changed. The greater emphasis on value-based competition will continue to motivate dental professionals to use the untapped potential in newer technologies to develop and maintain relationships with patients and each other.