How to Develop a Successful Fixed Hybrid Treatment Model

(Dr. William Ralstin co-authored this article.)

In a traditional restorative dental practice, it can be difficult to overcome inherent practice systems and policies to present a fixed hybrid. We may expect a smooth and uncomplicated pathway to treatment, yet obstacles exist that can cause confusion for the practitioners (restorative and surgical), the lab and, most importantly, the patient. Additionally, insufficient communication will compound the confusion, all of which may turn the patient away from treatment.

The goal is to make a definitive presentation with a united and consistent message concerning the patient's diagnosis and the recommended treatment of a fixed hybrid prosthesis (FHP). The greatest distraction for the patient are fees. It's important to quickly address the fee structures so the patient can then concentrate on the benefits or, if needed, other options.

The huge success of corporate FHP dentistry in the United States is due to two basic principles. The first is a single fee at a single location model. The second is getting patients into their office by creative and effective marketing. With appropriate training, most any of us can do this type of dentistry. Success for you is dependent on your current patients already in your practice to say “yes” to treatment. But there are likely many barriers in a traditional restorative practice that create confusion for the patient and make it difficult for them to accept treatment. It is important to create an effective FHP business model that will seamlessly eliminate confusion for the patient, doctors, staff and lab. Fees and expenses are usually the hang-up and barrier for the patient and the practitioner.

Setting a Fee Structure

So, how does a sole practitioner, either restorative or surgical, create a model for a higher conversion rate from consult to treatment? It's all about a coordinated effort of the restorative practice, the lab and the surgical practice. And each element of this tripartite group understands each other's roles, responsibilities and, most importantly, fees.

The biggest hurdle is the fee structures. There should be no question who is charging what amount and who is responsible for lab expenses and all the implant components, restorative or surgical. And the only way to achieve this level of clarity is through a predetermined set fee structure.

• The dental lab: The lab sets a single fee for the whole case that is disclosed to both the restorative and surgical partners. This includes the all the items necessary for the day of surgery, his time completing the conversion, assistance with impressions for the master cast verification, and fabrication of the final prosthesis.
• The surgical practice: The practice should set a single fee that is known to her restorative referrals. This figure does not fluctuate depending on the number of teeth being extracted, or how extensive the grafting procedures that may be required, or even the number of implants placed. It's a solid figure that the restorative practice can depend on and quote to the patient.
• The restorative practice: This practice also needs to set a single fee structure that is known to the surgical practice. If an unattached patient presents to a surgeon and he feels a patient is a candidate for removal of all their teeth and a FHP is one of the options, then both surgical and restorative fees can be offered to the patient.

The great benefit to this model is the patient is presented a global fee for surgical and restorative treatment before leaving the initial presentation at the restorative office or the surgical practice. If the patient cannot afford the treatment, they will not be wasting anyone’s time on a lengthy consult appointment.

Another important part of this fixed hybrid model defines allocation of expenses. The surgical practice pays the lab fees and provides all implant restorative inventory to the dentist and the lab. So the surgical practice has to budget for these items. The restorative practice gets the easy task when setting their fees! It's for time and materials, and it's generally four to six appointments, depending on the case complexity. The important point is the restorative practice has no out-of-pocket expenses for lab or implant components. But they are generally responsible for finding patients and making good referrals to their surgical partners. 

What Does the Patient Want to Know?

From a patient's perspective, once interested in a fixed hybrid, what they want to know up front is how much this is going to cost, how long it’s going to take, and how much it will hurt and take them out of work. The restorative practice can address all three of these lingering questions and concerns right out of the gate. Most important, the exact fee can be addressed, the surgical fee will be X and the restorative fee will be Y, so the total fee is Z. That's a solid number you can depend on and there will be no surprises down the line. Any complications will be addressed and cared for.

The postoperative expectations can be reviewed by both practices and they should be singing the same tune on all fronts: expected pain, time off work, diet, post-op visit frequency and the process for stage 2. Patients should be hearing the exact same information from the restorative and surgical doctors, and, more importantly, their staff. There is so much information coming to the patient on this process, and it's difficult for them to capture and retain it all on the first or second pass. If they hear the same message repeatedly, they will be better informed and certainly feel more comfortable without conflicting data confusing their thoughts during this trying time.

The Benefits of Pre-planning

What's paramount to success is pre-planning with setting goals and responsibilities between the practices. Once the ground work is laid and a few cases are under your belt, the system or model works really well and there is little confusion. If patients are well informed, they are more comfortable accepting treatment, which is an acknowledgment to the coordinated program of consistent information and a simple and straightforward fee structure. 

The only caveat to add would be the two options available with the final prosthesis. The “titanium bar wrapped with acrylic and denture teeth” prosthesis is the most frequently quoted fee. However, some patients demand a higher level of esthetics, and we offer a “zirconium bar and porcelain” prosthesis for an increased fee. This fee is passed straight on to the lab to cover their higher expenses. We certainly want our patients to see the advantages of this prosthetic option and to strongly consider it, so making it as financially reasonable as possible is our goal.

To recap, the opportunity for success is a FHP model that supports as close to a single-fee structure as possible, and this requires great communications between the lab and the dental and surgical practices with clearly defined roles and responsibilities.

William Ralstin, D.D.S., Spear Contributing Author
William Runyon, D.D.S., Spear Contributing Author