The Records ‘Nudge’

When it comes to the issue of fees, and specifically, what services to charge for, I see more variation in the handling of records fees than any other service that practices provide.

In the United States, many practices do not charge a fee for records at all; in Australia, the practices that I have worked with charge separate fees for both records and the consultation itself – and patients don’t have a problem with it, because it is the norm there and is expected.

This indicates to me that practice visitors do recognize a value to your and your staff’s time. So I assume that what happened here was that at some point in the past, a domestic practice made the decision to do records for free, his or her competitors felt obligated to follow suit, and this spread to eventually become, domestically, standard operating procedure.

There are pros and cons to both positions on the issue of charging for records. On one hand, I could make the argument that your and your staff’s time is valuable, that you incur an expense in both labor and materials to provide this service, and that you are entitled to recover your costs.

I could also take the opposite position, as many do, that the cost to you for doing records is minimal, the step of doing records is, by itself, a lead-in to committing to treatment, and that you put yourself at a fee disadvantage if you do not tow the line with your local no-charge-for-records competitors.

I choose neither. Instead, I suggest a third option – one that blends benefits from each approach, and gives your patient-visitor a ‘nudge’ to move forward.

Let’s assume that you charge a nominal fee for records – say, $100. The first thing you need to understand is that the purpose for this fee is not to recover your costs, but rather, to give patients a financial incentive to start treatment with you. The way this works is as follows:

• There is a one-time, non-refundable fee of $100 to do records.
• This nominal fee is paid at the first visit, or, if necessary, at the records appointment.
• The $100 is applied to (deducted from) the down payment/deposit when the patient starts treatment; in other words, it becomes a part of the down payment/deposit.

As a former sales professional, there are several things that I like about this from a closing/commitment perspective. These include:

• First and foremost, this is a litmus test. A visitor not willing to put a token down-payment towards treatment is not serious, is shopping, or has decided that they don’t want to move forward. Better to learn this now rather than later. (From my training program, you should already know about the shopper issue at this point in the meeting).
• Because the records fee is part of the fee deposit, this allows you to compete with no-records-fee competitors; it is free at your practice too – as long as the patient starts.
• If the patient doesn’t start, you are compensated for your and your staff’s time. (In most cases; more on this later).
• The transfer of $100, while a small amount, represents ‘skin in the  game’. It virtually ensures that the family is moving forward with the decision to start at your practice, greatly reducing the potential for shopping.
• Psychologically the patient is “in treatment” at the point that this payment is made; now your staff can invest additional time knowing that you will be compensated for it.

Lastly, I will answer a question that I know some of you are thinking: suppose the patient pays the fee, decides to go elsewhere, and wants their records transferred. Do you comply with this request?

Of course you do.

However, remember that the more skilled you and your staff are at communicating your value proposition, the rarer of an occurrence this will be.

Plus, when it does happen, at least you got paid $100 for the trouble.