How should a dental practice build unusual case fee adjustments into the planning system?
Through a documented worksheet that names the unusual factor and applies a specific percentage adjustment, used the same way for every case. Unusual factors can be clinical: anatomy that complicates standard procedures, conditions that require extra time or specialty involvement, materials or lab work that exceeds typical case overhead. They can also be behavioral, surfaced during the CDP through observed patient patterns: chronic lateness, excessive talking that consumes appointment time, high anxiety requiring extra accommodation, unrealistic expectations requiring extra communication, or any other pattern that will reliably extend treatment hours beyond normal. The worksheet captures the factor in writing and applies a percentage surcharge or, in rare cases, discount. The numbers are derived from real cost data over time, not from gut feeling. The system protects against the temptation to remember the case factors after the fact and adjust the fee retroactively, which is unethical and reputationally dangerous. With the adjustments built in at the planning stage, the final fee at the case presentation is accurate and defensible.
If the answers you are finding here resonate with you, my team and I work with a small group of clients each year. The next step is a complimentary Discovery Consultation and Practice Review with Dr. McAnally.