As I’ve mentioned in recent posts I’ve put a lot of thought into how Invisalign works in the marketplace and in my practice. After doing several hundred cases in and around 2006-2007 I stopped doing Invisalign cold turkey for 8 years due to many factors. Recently I talked about my decision to go all in with Invisalign because, frankly, Align has won the war for the heart and soul of Susie Q Patient. Anyway, as we implement and execute our plan to be THE Invisalign provider in our area I’m constantly asking for insight from Invisalign gurus and experts across the country. The most interesting topic discussed thus far is the subject of this blog: why don’t they do more aligner cases?
I know several people who do 1000-2000 starts or more a year and many of them are “all in” with Invisalign but, for some strange reason, the percentage of aligners they do hovers around 10-25%. It’s eerie how consistent the 10% mark is across the country and across the continent. It doesn’t seem to be planned, it just works out that way. So I’ve made a point to ask several people who do Invisalign why they don’t do more as a percentage of the cases they start. It’s a simple question but the answers are complex, varied and incomplete.
What answers do I get? I’m glad you asked. Here they are ranked by frequency (this is not a scientific poll)
1) I don’t know.
2) That’s just the way it works out.
3) Cost of aligners vs. brackets.
4) I don’t want to cannibalize my braces cases. (This is the one I’ve always identified with and it has a lot to do with #3)
5) Why would I want to do more aligners?
Now I’m sure there are other answers/reasons but these are the most common ones I’ve heard. (Feel free to comment with your reasons!) Anyway, I find it curious that we, as a profession, don’t do more aligners as a percentage of case starts and I want to understand so I make the right move in my offices. In that vein, I have a few more questions and would like you to help me answer them in order to find enlightenment.
1) Does every Invisalign case we sell take away a bracket and wire case?
I would have said yes before but these days I’ve started to realize that there is a huge and untapped patient pool sitting in my waiting room already – parents! That plus my GP patients make it easy to see that there are lots of patients who I will never get brackets on but who might do aligners. As I mentioned in Fear only 1.5 percent of patients who consider braces actually get them.
2) Does Invisalign work? Is it a good product? Do we feel good prescribing it to patients and would we do it for our kids and spouse?
Yes is the answer here but it’s a matter of degree. Invisalign can certainly work to improve most cases and it can “correct” many. So if it works, why are we shy to prescribe it? Especially to adult patients. Forget perfection, it’s unattainable. Think enhancement in the way Ackerman talked about it in his text (way ahead of his time btw). Which is better? A patient who gets enough improvement from aligners to be satisfied or a patient who gets elective endo, crowns and/or veneers to get a better smile? No contest!! Aligners every time. So what’s the holdup? Why do we surrender these cases to GPs instead of doing them ourselves?
3) Does being on the Invisalign doctor locator bring in new patients? Does Invisalign’s marketing do a good job in creating demand? What’s that worth?
Yes, yes and a lot! Again, I fought this for a long time but Align has won the war and it is what it is. Why not harness this for our practices?
4) Are you willing to give up money and discount to start a case?
No? Really? Don’t you take Care Credit and give up 14.9%? Aren’t you a provider for some insurance company that reduces your fee? Don’t you drop the price for shoppers?? C’mon… Be honest. Isn’t the lab fee for Invisalign comparable to those discounts? Would you spend $1,000 dollars if you thought it would bring you in more cases and create visibility for you?
5) Are you willing to drop your price to get people in the door?
Sure you are. It’s called advertising cost and it reduces your profit margin just like discounting your fee does! Same goes for taking insurance in the hopes to be listed as “in network”. But there’s no comparison between the number of people who seek out Invisalign and those who look on the insurance website to see who’s in network. Plus our practice marketing just isn’t that good when compared to Align’s.
Res ipsa loquitur.
I hate when my world and my beliefs are uprooted by the facts but once it happens I tend to run with it and get maximum bang for my buck when it comes to change. I’m very interested to see how this shakes out and what else I discover as we implement Invisalign in our practices. I’m working hard to dispel my belief possession and shed all the things I thought I KNEW about aligners in the context of an orthodontic practice. Learning and changing are a journey that can be painful but the rewards for those of us who are willing to take the necessary steps are far greater than mere financial gain. Help me hash this out. Tell me what I’m missing and why I’m wrong… But also be sure to consider what I’m saying here about the answers I’ve discovered.