Do you let your patients know upfront that you'll give them a 10% discount for referrals or do you surprise them with the discount after they send you a referral?
JADA covers this in their new issue:
What are the Ethical Issues I Need to Consider When Developing Marketing Strategies for My Practice?
Rod B. Wentworth, DDS
Q
I recently attended a practice management seminar on recruiting and retaining patients. One of the topics discussed was the use of incentives to motivate patients to make appointments. For new patients, the speaker suggested using a marketing technique in which the practice gives gifts (such as department store cash cards) to patients who receive an initial examination. To motivate patients who are overdue for their regular prophylaxis appointments, the speaker suggested that when telephoning these patients, office staff members should stress links between periodontal disease and systemic disease and use the phrase periodontal maintenance when informing patients of the importance of returning for recall appointments. Are there any ethical concerns I should have regarding
A
I think your question may best be explored by dividing it into two parts: one regarding the strategy to attract new patients and the other regarding strategies to encourage existing patients to return for their regular recall visits. In addition to this ethical assessment, it is important for you to check your states regulations to determine how they may apply to any marketing plan you decide to implement.
First, consider incentives for new patients. In a private practice setting, your business success may well depend on your ability to attract new patients, and there are many ways to market your professional services. You mention using a cash card to accomplish this. This may or may not be an ethical choice, depending on how you plan to use it.
On the basis of the American Dental Association Principles of Ethics and Code of Professional Conduct1 (ADA Code), we cannot ethically pay for patients. Just as it states in Section 5.F.4, Referral Services, that a dentist is generally not permitted to make payments to another person or entity for the referral of a patient for professional services,1 it also is unethical to pay your current patients to refer other patients to your practice. An example of this is a marketing campaign in which you offer a significant gift to existing patientsfor example, a $100 cash cardfor each patient they refer to you. Another possibility is to hold a contest in which you pay the patient who refers the most patients to your practice each month. In these examples, you have tendered an offer of a gift with value and given the patient making the referral a financial incentive to do so. This also could be considered a rebate, which is prohibited by Section 4.E, Rebates and Split Fees.1
However, this likely would not apply to an unsolicited cash card that you send along with a thank-you note to an existing patient who, on his or her own accord, recommends a neighbor to you. In this case, the patient did not solicit the gift and, particularly if it is nominal in value, the cash card likely would be considered a gesture of thanks, with no unethical overtones. Likewise, items that you may dispense gratuitously such as oral hygiene aids and toothbrushes typically would not be considered an ethical problem, because they are adjuncts to your care.
If you are considering offering some form of cash card to prospective patients for an initial visit, you should take into account the ethical implications as they relate to Advisory Opinion 5.B.1, Waiver of Copayment, which states that
[a] dentist who accepts a third party payment under a copayment plan as payment in full without disclosing to the third party that the patients payment portion will not be collected is engaged in overbilling. The essence of this ethical impropriety is deception and misrepresentation; an overbilling dentist makes it appear to the third party that the charge to the patient for services rendered is higher than it actually is.1
Simply put, if you discount a fee to a patient, then you must disclose the discount to any third-party payer involved. To illustrate, let us say you decide to offer a $100 merchant cash card for a new-patient examination, radiographs and a prophylaxis. In effect, you have discounted one or more of the procedures and may be obligated to inform the third-party payer of the discount.
The second issue concerns marketing strategies to motivate your current patients to return for their scheduled prophylaxis appointments. Because much of the practice of dentistry involves educating patients, you will want to inform and remind them regularly of the need to maintain their scheduled appointment sequence. Concerning research into links between oral health and systemic health, not only is this a hot topic within our profession, but also it is a popular news item of which many of our patients are well aware. However, this is a complex topic that involves various diseases and systemic conditions and the extent to which they are associated with oral conditions. Levels of evidence vary dramatically, and the science is changing as more is learned. As Lantz and Foy2 noted, dentists have an ethical obligation to include an evidence-based approach when making treatment recommendations. The overriding principle is veracity; as stated in Section 5, Principle of Veracity (truthfulness), [t]he dentist has a duty to communicate truthfully.
On the basis of current scientific evidence, it may be acceptable to inform patients that heart and periodontal diseases have a number of factors in common and that a significant amount of research is ongoing to better define the relationship between them. On the other hand, if you were to tell all of your patients that they would be at risk of experiencing a heart attack if they did not return for their recommended recall visits, you would be treading on unethical ground in view of the ADA Code, Section 5.A.2, Unsubstantiated Representations:
A dentist who represents that dental treatment or diagnostic techniques recommended or performed by the dentist has the capacity to diagnose, cure or alleviate diseases, infections or other conditions, when such representations are not based upon accepted scientific knowledge or research, is acting unethically.1
Conversely, ignoring or withholding accepted scientific knowledge or research findings in your discussions with a patient when making treatment decisions also may have ethical implications.
As for the speakers recommendation that, after informing patients of potential oral-systemic links, you stress the need for the patient to return for periodontal maintenance, it is important to keep in mind section 5.A, Representation of Care, which warns us not to represent treatment in a false or misleading manner.1 Remember that periodontal maintenance is a specific procedure defined by the Code on Dental Procedures and Nomenclature3 and is reserved for continuing periodontal care of patients who have undergone periodontal therapy; dentists can use this code ethically only for such patients. Periodontal maintenance is not appropriate for patients who are to receive a routine cleaning or prophylaxis. Directing staff members to tell patients to return for periodontal maintenance would not be ethical unless you limit this practice to patients who have been treated with scaling and root planing or surgery for periodontal disease.
Marketing is an important part of all business interactions with the public. In our profession, we provide care based on the trust our patients place in us. They expect us to be truthful and put their health ahead of our bottom line. As long as we market our services in an honest manner that maintains that trust, we will continue to meet our professional responsibility.
