Invisalign: Is it right for my practice?

One question we deal with regularly from clients relates to Invisalign.  Questions arise because the cost for Invisalign cases does not flow in the same way as the cost for a standard treatment case.

As a quick background, Invisalign offers a series of clear retainers to help straighten teeth.  Put in the first retainer and after a period of tooth movement, you pop that retainer out and put the next one in your mouth.  For us, this has proven popular with adult patients who want straighter teeth, but appreciate the aesthetic component of having the clear retainers instead of metal brackets.

We don’t comment on treatment so none of this post relates to the efficacy of treatment under this method.  Rather, the issue at hand is the payment for the Invisalign product. 

Typically, for a full treatment case (18-24 months), Align Technologies (maker of the Invisalign product) will charge $1,200 upfront for a set of retainers once ordered.  Obviously, that is a substantial increase in lab expense over the standard retainer issued at the end of treatment (plus any other appliance that might be added during treatment).  But, the offset is a decrease in personnel time to treat the patient.  Once the case is diagnosed and the retainers ordered, there’s really no doctor or clinical assistant involvement.  Popping the retainers in and out takes no time, especially if movement progresses as planned.

The key question is this: does the decrease in personnel time offset the increased lab cost?   Taking things a step further, is there any decrease in personnel time?

To examine, let’s start with the case of a single-office practice doing nothing but Invisalign cases.  Here, the doctor can spend his or her time simply diagnosing and doing brief reviews of patient progress.  His or her capacity to see patients increases substantially.  Seeing 100-125 patients a day is no problem.  Further, that practice would need a minimal number of assistants to make sure that the retainers are organized and that any emergencies are addressed.

Now consider a less pure situation.  Consider a case where the practice has 10-15% of its cases in the Invisalign vein (commensurate with a typical orthodontic adult population).  With this arrangement, you need to consider the fact that clinical assistant cost is basically a fixed cost – you usually have to provide them a certain minimum number of work hours or that person cannot afford to work for you.  Having a small percentage of Invisalign cases does not permit you to materially reduce the number of assistants or the days those people work.  In other words, if you have 10 Invisalign patients scheduled on a 100 patient day, you really don’t have much room to change hours worked or the number of people.  So, in this case, having some Invisalign cases doesn’t produce the lower employee costs to offset the higher lab cost.

Let’s take this one step further into a multi-office practice situation.  Here, chances are good that the doctor working is an associate earning a fixed daily rate for his or her services.  Again, with a small load of Invisalign cases, you cannot really reduce the cost of this person by reducing days or the number of work hours in a given day.  Again, even though you may be spending less time on those specific Invisalign cases, the overall picture prevents you from actually reducing cost.

Given that, what do you do?  As mentioned earlier, Invisalign does appeal to a market segment who might otherwise simply elect to go elsewhere or not start treatment.  So, you may not want to ignore it completely.

If you do elect to see Invisalign patients, you need to make sure that the payment plan reflects the cost to treat the patient.  We constantly preach the wisdom of a no down payment offer to patients, but in the case of Invisalign, you almost have to collect something upfront to offset that lab cost and consider the impact on your overall cost noted above.   Note that we did not say to have the total fee reflect the total cost.  The payment plan and timing of payments is far more important her and in the case of standard treatment.

Of course, if you ever want to discuss your pricing and payment plans in more detail to make sure that you are offering your patients a good opportunity while earning a reasonable return, please do not hesitate to contact us.