Do you feel like insurance companies are running
your practice more than you are? You're struggling
to get your team on board with big changes you
want to make in your practice? Or you're just
wondering how to build a practice that runs more
smoothly, supports your lifestyle and is not
going to burn you out? Well then this episode
is for you. Welcome to Bite Size Dental Marketing.
My name is Ian and today we have a special guest
joining us. The godfather of dental podcasting
himself, Mr. Gary Tuckers. Gary Tuckers is a
true pioneer in dental coaching and one of the
most respected voices within this profession.
Gary has helped hundreds of dental practices
reduce insurance dependence, build stronger systems
and create practices that they actually enjoy
leading. We talk about how you can get your team
on board before dropping plans, how to shift
from people dependence to system dependence in
your office, and why marketing becomes essential
when you're no longer listed on the PPO directories.
Enjoy. Welcome to Buy Size Dental Marketing.
Today I have Gary Takis. Gary has had an amazing
career as a veteran dental coach, a practice
consultant. He's the co -owner of Last Miles
Dental Care and Thriving Practice Academy. I
mean, Gary, no one can Google dental and not
find your picture somewhere out there in the
world. And the godfather of dental podcasting.
I mean, how can we not address that? Well, Eric,
I would like to point out that that picture in
the post office, that's a different guy. That's
not me. I understand. It's a different guy. Just
like you, though. Just there. How did you get
started? You know, Eric, first of all, it's great
to be here on Bite Science Dental Marketing Podcast.
Thanks for the invitation. You know, I started
right out of college. I'm a University of Oregon
graduate, which makes me a fighting duck. You
know, not just a regular duck, but a fighting
duck. And we had a young family, and I had to
make a living. I was hired as a law clerk in
a law firm that worked with physicians and dentists.
And it sounds like kind of a noble job, but actually
I was the copy boy. I was the guy that pressed
the button on the copy machine. And Eric, I don't
want to sound overly proud about it, but I did
a very good job of pressing the button on the
copy machine in the workroom. Those were breaking
down all the time. Those Xerox, I know what you're
talking about. Shortly after I was hired as the
clerk, the law firm expanded their client base.
They were a regional firm in Oregon, Washington,
and Northern California. And they expanded it
to be nationwide. And their clients were physicians
and dentists. And the founder of the firm, Rick
Mercer, you might recognize that name. Some of
our listeners will recognize that name. Rick
was a visionary. And he wanted to deliver exemplary...
customer service to our clients. So clients would
fly from all over the country, visit us in Eugene.
And so he bought a 1957 Silver Cloud Rolls -Royce.
But I'd worked there for two weeks and it was
being delivered and got delivered to the top
floor of the parking garage for our building.
And we could look down at it to see the car and
everyone in the firm, you know, raced over to
the window when the car got delivered. And I
was at the copy machine making copies. And Rick
said, he had a booming baritone voice. He said,
Gary, come here. I didn't know I knew my name.
I'd worked there two weeks, right? This is a
firm that had about 80 employees. Didn't even
think he knew me. And he said, Gary, come here.
He said, can you drive a Rolls Royce? I said,
sir, if it involves keeping this job, yes, I
can. And he threw me the keys. And said, pick
up Dr. Baker at 2 o 'clock at the airport. And
now I became the copy boy Rolls -Royce driver.
And we were still living in married student housing,
Eric, in a little duplex with two young kids.
And we were living in married student housing.
And I had to drive that car home because I had
to pick clients up at odd hours. And I know you'll
find this amazing, but it was the only 1957 Silver
Cloud Rolls Rice in the married student parking
lot. So that's where it all started. I served
in the 1980s. I worked for two large dental consulting
firms, essentially learning my craft as a coach,
learning the foundation of my craft as a coach
and a consultant. In 1989, I decided to take
a leap and leave the comfort of the corporate
world and start my own consulting firm. I still
had a lot to learn, but by then I had worked
with over 500 practices in all 50 states, and
I thought, well, I've got a lot to learn, but
I know enough to get started. My wife was a kindergarten
teacher. We had two kids later to become four,
and we launched my consulting firm. I've had
my own consulting firm ever since. And it's really
been a wonderful, wonderful ride. Pardon my enthusiasm,
but I love our dental profession. You know, we
have the ability to change people's lives every
day. It could be something that we do clinically,
or it could be something we do behaviorally.
Maybe we just, you know, are extra empathetic.
become extra good listeners to help a patient.
But there's so many things we can do that have
a positive impact on our patients' lives that
it truly is an amazing profession. Yeah, I find
that dentists underestimate the impact they have
on people's lives. And my story is well -documented,
but I didn't meet a dentist until I was around
23, 22 years old, coming from rural Oklahoma.
But yeah, I mean, there was a dentist. did right
by my mom and I was trying to do right by him.
And next thing you know, here we are with the
company. But if you think through your time in
dentistry and think from an asset business owner
standpoint, right, what do you see as the big
milestones in dentistry ownership since the,
you know, the 90s to the aughts to today? Well,
if I fast forward for your listeners benefit
in 07. 2007, I learned that in Arizona, where
I am, you don't have to be a dentist to own a
practice. I thought, what? Wait, I thought you
had to be a dentist. Well, not in Arizona. So
I decided I wanted to own a practice so I could
have a test kitchen where I could test concepts
out and I could report back to my clients. And
by then I was speaking quite a bit and I could
report to my audiences what was working and what
wasn't working. So I partnered with a young dentist,
Dr. Paul Nielsen, a 2005 grad at the University
of Washington. And we bought what could only
fairly be described as a fixer upper practice.
It had ankle high orange shade, copper, avocado
green countertops, you know, was really in need
of a lot of things. But it did have about a thousand
active patients, all of whom needed treatment.
And we said, well, hey, we can change that other
stuff. Let's start there. And Eric, I have to
tell you that I thought it would be extremely
useful to have that experience, you know, as
my clients were experiencing as an owner. but
it massively exceeded my expectations. I jokingly
like to say that prior to 07, I had 27 years
of experience working as a coach and as a consultant
in all 50 states. But I say, after 07, I thought
I knew a little bit about cancellation and no
-shows, and then I got a PhD. in cancellation
of no -shows because we're dealing with the day
-to -day. But to answer your question, I think
every career path in dentistry has its merits,
and every career path can be a good career path
for an individual. You know, practice ownership,
being an associate doctor, teaching, maybe working
in a community health clinic. You know, it's
all good. But I happen to really believe That
if it's your aspiration, a great career path
is becoming a practice owner because you truly
have control of your destiny at that point. It's
up to you. You get to decide. Now it comes with
consequences as well. You know, we bought the
practice in 07. And in Arizona, you might remember
what we now call the Great Recession. Folks in
economics will remember that. And 08, 09, 07,
08, and 09 are what's now considered the Great
Recession. In Arizona, it hit us in 08. We were
a little bit lagged behind the national economy.
And it hit like a ton of bricks. And we had to
figure out how to navigate that. And I had to
figure out how to not only survive, but thrive
in the midst of all of it. And we were able to
figure that out. A lot of, you know, a lot of
just seat -of -the -pants decision -making there.
And we were able to not only survive it. but
figure out how to thrive in what was a tough
economic situation. But I do think pathways to
practice ownership now, if a dentist has that,
he or she has that as an aspiration, there's
a lot of ways to do that. Paul had spent, he
graduated in 05. So his first two years out of
dental school, he and his wife, Erin, wanted
to relocate to Phoenix coming out of Seattle.
to be close to her family who was here in Phoenix.
And so he worked in three different associateships.
Each one was two days a week. And that was, he
was working six days a week, but he was trying
to get real world experience of what it was like
in practice. And when I met him, I told him I
was looking for a dentist to partner with. And
that's how our partnership came together. And
we bought this practice. over a period of time,
proceeded to develop it into our version of our
ideal practice. And we built an ideal office
in 2011, added a second doctor, Dr. Tim Schmidt,
in 2013. Tim became a partner in 2015. We continue
to develop it. If I could describe the foundation
of Lifesmiles, the foundation is a combination
of two things. Everyday general dentistry. and
a really strong hygiene department. So think
about whatever you would think of Eric as everyday
general dentistry. Paul and Tim both have a fellowship
and a mastership in the AGD, so are well -trained
in general dentistry. So everyday general dentistry
combined with a really strong hygiene department.
Dr. Reed, Omar Reed taught me when I met him
in the early 80s. He said, Gary, always remember
that the backbone of a thriving practice is the
hygiene department. And he said it so convincingly.
that I didn't really know what it meant. I mean,
I certainly knew what it meant, you know, just
conceptually, but I didn't fully understand the
impact of that. But he said it so convincingly,
it's like, it's imprinted on my brain today.
And so the hygiene department has always been
a really important part. And then we've added
some specific high value services as, think about
the foundation, and then think about the high
value services as, you know, the... The structure
we put on top of the foundation or the icing
on the cake. So things like placing restoring
implants, adult orthodontics, Invisalign specifically.
Cosmetic dentistry, which can be a lot of things,
but I tend to think of cosmetic dentistry as
lab fabricated veneers. Oral conscious sedation
for people that are nervous about going to the
dentist. We can make a visit completely comfortable
for them. Arizona, where a lot of the patients
are older and have more complex needs. We can
do full mouth restorative dentistry. And then
more recently, helping diagnose and treat obstructive
sleep apnea with some dental solutions. So those
are the six high -value services that go, in
our case, on top of the foundation of everyday
general dentistry and a really strong hygiene
department. You mentioned hygiene. What other
factors or components do thriving practices have
in common? Well, a couple things could immediately
jump to mind. Thriving practices are systems
-driven. as opposed to person dependent. You
know, many practices become very dependent on
an individual. And that individual may do their
job extremely well. We had that happen at Lifesize.
I had a really, really good team member, like
someone that I wanted to be in our practice for
the next 30 years. She was amazing. And one morning
she came to me with a sad look on her face. And
she said, Gary, I need to talk to you. No employee
has ever needed to talk to me and good news came
out of it. Not one time. And when you combine
that with the look on her face, it was not going
to be a good conversation. And we sat down and
she said, Gary, this is my dream job. You and
Dr. Paul are my dream employers. This is my dream
job. I plan to be here forever. But it isn't
going to work out that way. I need to relocate
for family reasons. And, you know, we both shed
some tears and hugs and support and let her know
that you've got to do what you've got to do and
we're going to support you and you're going to
be missed. And it was at that point that I got
serious about developing systems because the
truth was I was person dependent because she
was extremely good. She was our lead admin team
member. You know, we didn't use the term at the
time, but we would have considered her our office
manager. And just extremely talented, deeply
committed, committed to the style of practice
that we had, committed to a great patient experience.
And it allowed me to – we had other dragons to
slay in the practice because it had so many things
to do. We had so many things we had to upgrade.
And we were on paper charts still at that point,
film radiographs. Do you remember those days?
Remember the stinky tank and the radiographs?
So there were other dragons to slay. And so I
was – sort of lulled into letting her do her
thing. And that was going to work out perfectly
until she had to leave. And that's when I said,
well, we've got to become system driven. So one
of the things we created was these 24 systems.
I call them the 24 systems for a thriving practice.
And they become part of our foundation. They
provide the support for our team members, provide
accountability, provide direction. And then we're
systems driven rather than person dependent.
Another element that I would say, and something
I had some very good mentors early on, was the
importance of having a relationship driven practice
as well. You know, if you think about the spectrum,
there's all kinds of different practice formats.
And on a simplistic level, if we draw a horizontal
line, you know, across our computer screen today,
and on one end of the spectrum, We have transactional.
And the other end of the spectrum, we have relationship
-driven. And the truth is, I don't think any
practice is purely one or the other entirely,
but you'll be somewhere on the spectrum. Does
that make sense? I want to be more over here
on relationship -driven. What that means to me
is we know our patients' names. We know their
spouses' names. We know their kids' names. We
know their hobbies. We know their interests.
Maybe we know that a patient named Linda is taking
care of an elderly parent right now. And by the
way, you don't have to know that stuff at all
times, you know, 24 -7, 365, because as your
practice grows, you know, that becomes a bigger
challenge. But we do need to know who we're seeing
today, and we need to connect with them. And
when we connect with them, I think we can create
an environment where a new patient wants to be
a patient for life, because they're being treated
by people who they know, like, and trust. And
we're not taking care of strangers. We're taking
care of people we really care about. And I love
to use the term, I know it sounds kind of corny,
but I'm going to use it anyway, Eric, because
I believe in it. I like to think about our patients
as our patient family. You mentioned people versus
systems, and I agree. One of the most, you know,
I'm a business owner and there was a... It feels
so good when you have this rock star person locking
down a section of your business, right? How do
you make the transition from, I have this rock
star employee that just has something all locked
out, and I'm so grateful, right? And winning
fixes everything, and I can be seduced into just
leaving it alone. How do you prepare to move
toward more systems -driven? What does that mean
to them? What does it mean to me? How do you
make that transition? I think it's important
to, within the practice, to create a practice
culture. And a practice culture can be inward
facing, but also outward facing. So practice
culture inwardly means how do we, with our team
members, interact to create a culture? What expectations
do we have? How do we create an environment?
One of the elements of Lifesmile's culture, practice
culture with the team, is that we want to create
an environment of continuous learning. We simply
want to be better tomorrow than we are today.
We want to create an environment of meeting people
where they are. And that can apply to our patients
as well as our team members. Leadership is extremely
important. And you've got to lead your team.
You've got to create an environment where they
want to come to work, where it has meaning, it
has purpose. You know, a majority of the workforce,
the largest single demographic group, You probably
know the answer to that. What do you think the
largest demographic generation is in our society
today? It's no longer baby boomers. Yeah, it's
millennials, right? It's millennials. And one
of the characteristics of millennials, now it's
not fair to paint any generation with a broad
brush. They're individuals. But one of the characteristics
of millennials is as a generation, they like
to be involved in something that's bigger than
them. something that's bigger than them. They
want to be involved in making a difference. And
I believe a dental practice can be that platform.
We can provide that environment where they get
to make a difference and in turn fuel that appetite
that they have to make a difference. We can do
it through charitable work that we do. We can
create our own charities within the practice.
We can support causes of our team members. And
a practice environment becomes a way to really
just feed their soul so it isn't just coming
to work and punching a time clock. And I think
it's up to the owner, in our case owners, to
create that environment where we want to be an
environment that feeds their souls, that literally
wants them to imagine being there for a lifetime
of employment. How do you take someone, though,
who's fallen out of love with dentistry, who's
having burnout, who's... You know, they're in
insurance programs. Of course, we all want to
be fee -for -service. But, hey, look, being a
fee -for -service practice in 2025 takes a level
of execution that is above, you know, some. Well,
I can speak to that very definitely. In my coaching
work, I've been able to help over 400 practices.
I call it reducing insurance dependence as opposed
to going fee -for -service because you don't
have to go all the way to significantly improve
your practice. Every time you successfully drop
a plan, then you've improved your practice. But
I always tell my clients, if your goal is to
go all the way to fee for service, I'm going
to be your biggest cheerleader because that's
the way to get the most out. But it's not always
appropriate in every practice situation. But
if you can reduce that footprint, and the main
gripe that I have with PPO plans is I don't believe
a third party should set our fees. We should
be able to set our fees based on our style of
practice, our cost of doing business. And have
that be relevant to our practice and not have
some third party that doesn't give a rip about
the quality of care we provide setting the fees.
And, you know, it's been able to do that in over
400 practices in all 50 states in every practice
locational environment, urban, suburban, large
town, medium sized town, small town, company
town. You know, two cities in our country are
good definitions of company town, Seattle. Washington.
In Seattle, there's four major employers in the
greater Seattle area. In no particular order,
it's Boeing, Aircraft, Microsoft, Starbucks,
and Amazon. Amazon has a huge headquarters and
distribution center there. And a lot of people
in greater Seattle work for those four companies.
And there's a lot of people who think, well,
because those employers are so large here. I
could never reduce insurance here. But my answer
is, does everyone in your drawing area work for
those four companies? How about finding people
that don't have insurance? You only need 2 ,000
people in Seattle that don't. Eric, you just
hit the nail on the head. A 2 ,000 active patient
base can be an incredibly successful practice.
You only got to find 2 ,000. I'd find all of
them. For me, the biggest challenge of moving
to you know less insurance dependent is the culture
of the front desk you know for us it goes from
do you set my insurance being the biggest barrier
to entry into the practice to i i don't want
to be salesy but like you are moving to a sales
position of how getting behind the question there's
all there's all sorts of philosophies on on how
to fill that call but you're definitely moving
from a yes no binary question to a a nuanced
question and that culture is the one that we
struggle with in marketing? Well, the first step
is to get the team behind it. When the team is
behind this decision, everything goes swimmingly
when the team is behind it. When they understand
why we're doing it, what we're doing, and what
their role is to support it. A recent example
comes to mind. In a two -doctor practice, a nice,
strong hygiene department, they've got 15 team
members. I think you can envision what I just
described, right? Nice practice. But 70 % of
their income comes from PPO plans and they want
to change that. So the first thing we did is
help the team understand why we're doing this.
And it can be at a very personal level. For example,
I want to talk about what the decision means
to them. And we can use an example. Let's say
a team member is at $25 an hour. Just pick a
round number that makes my math easy. And let's
say that she'd like to make more money. Doesn't
every team member in the industry want to make
more money? All the ones that I know. But let's
say that insurance company... requires us to
take a 45 % haircut on our fees. And by the way,
the average PPO adjustment today, the difference
between your UCR and your contracted fee is 45%.
So ask the team member, how would that feel if
instead of making $25 an hour, you made $13 .75
an hour? Are you going to sign up for that? Now,
what do you think that team member is going to
say? No, I don't want anything to do with that.
Well, that's the effect that being in network.
Can I use the D word? Absolutely. We can use
any word you want. That's what Delta requires.
When we're at Delta, I'm using Delta because
they're the 5 ,000 pound gorilla, right? Well,
that's what Delta requires. That instead of getting
our usual fee, like if our usual fee was $1 ,000
for a service, if they don't have insurance,
they pay us $1 ,000. And if they are... display
provider with Delta, the patient is, then we
don't get $1 ,000, we get $550. And imagine how
that would affect you as a team member instead
of 25, it's 1375. I don't want anything to do
with that. And that's why we're doing that. In
one fell swoop, it can go from some abstract
concept to, wait a minute, that's not right.
And in this example that I'm going to give you,
I was having a team meeting by Zoom. And I'm
sharing this with the team and the lead dental
assistant raised her hand in the Zoom meeting.
Yes. She said, that's not right. That's not fair.
She said, you know, I've been here many years
and our doctors are amazing. I've never worked
for, but before I worked here, I worked in many
practices and I've never met doctors that are
more committed to quality of care than the doctors
right here. That's not right. What can I do to
help? And as soon as she said that, I knew it
was going to go great. The other team members
were like, yeah, what she said. What can I do
to help? And then we go through a six -step preparation
sequence. And a lot of that is how to talk to
patients about this. Because we found that if,
I call it having a heads -up conversation with
the patient. Eric, can I role -play that for
you as if I was a team member and you were a
patient? All right, let's do it. So just imagine
this. Notice how many times I'm going to say,
nothing's changing today. Okay, notice that.
All right. Hey, Eric, I want to share a discussion
with you today about a decision we've made that
impacts you. Now, nothing's changing today, but
effective, I'm going to pick a date in the future,
effective this fall, September 1st, will no longer
be contracted with your Delta Dental Insurance.
Again, nothing's changing today, but that'll
be in effect after September 1st. But here's
the good news. After September 1st, you can continue
to choose our office for your care. You can use
those Delta benefits right here in our practice.
We'll file your claims for you like we always
have. And we're on your side to help you get
every dollar of benefit that you have. And now
I tell you what I want you to do. Nothing's changing
today, but after September 1st, I hope you understand
how committed we are to delivering the highest
quality dentistry that you can possibly deliver
and making every visit a positive experience
for you that you continue to come to our office
for your dental care. We're going to send you
a letter. But I want to have the conversation
with you so you would know. And it wouldn't be
a surprise. And that's the heads -up conversation.
And we do that. So let's say we're resigning
from Blue Cross Blue Shield. What we'll do is
we'll pick every patient on the schedule that
day that's Blue Cross Blue Shield. And we'll
assign a specific team member or doctor to have
the conversation with the patient. We do that
to make sure no one slips through the cracks.
And we typically will base that on who's got
the best relationship with Eric. It could be
the doctor. It could be the hygienist. It could
be an assistant. It could be an admin team member.
And we have the heads -up conversation with them.
How are you answering? So when I said something
to the tune of, okay, that's great. So I'm going
to pay more money for my cleanings? Or how much
more? For some people, when you have that conversation,
you know, September is way off. And I said at
least three times, nothing's changing. Oh, so
nothing's changing today? No. Oh, okay. It goes
in one ear. But the most common question is,
is it going to cost me more? to come here. And
specifically what they're asking for is the hygiene
appointment. Because the, you know, you think
about when you're in network, what's the copayment
for a hygiene appointment? You know, zero. And
so how we answer that question? So Eric says,
well, will it cost me more? You know, after September
1st, what we'll say is, you know, Eric, right
now we don't know. It is possible that you'll
have to pay more. Right now we don't know. Delta's
being a little, you know. Blue Cross Blue Shield
has been a little bit difficult with us, but
we will find out. Here's what I suggest you do.
Let's go ahead and make your appointment in September.
So we have it on the schedule and you have it
marked. Between now and then we'll find out and
then we'll reach out to you well before your
appointment time and let you know. Once we know,
we can give them the answer. You know, once we
start collecting EOBs and seeing what the out
-of -network fee schedule is, we can actually
answer it. But I don't really think I don't know
is a good answer. But sometimes it's the best
answer we have. All the while, we're gauging
what patients are doing. Like I had a call this
morning with an office that's midstream on this.
And I checked in with the office manager. I said,
what are you hearing from your patients as you're
having these heads up conversations? It's kind
of all over the map. And we talk about it. And
then said, are they making their next hygiene
appointment? She said, yeah, I can only think
of one patient. that we've had a conversation
with out of hundreds that didn't make their next
appointment. So they're voting with their feet.
That doesn't mean they're committed to that next
appointment, but they're moving in that direction.
I love that you went back to a more data -centric
view of it because I can tell you how I feel.
These conversations are hard. I'm having to do
extra work. But if the patients are reappointing,
you're trending to success. Well, the other thing
that's really important in our prep, I tell you,
we go through a six -step process. And you'll
appreciate this next one. The next one of our
steps, it's actually step number two in our six
-step process to successfully resign, it's to
get ahead of it with marketing. I want every
one of your listeners, I want you to think of
your insurance adjustments from this moment forward
as a marketing expense. Now, it won't show up
on your profit and loss, and the adjustments
are the difference between your UCR fee and your
contracted fee. I want you to think of that as
a marketing expense. It won't show up and your
accountant won't agree with me on that because
it doesn't show up on your P &L statement. It's
even worse. Delta takes the money before you
even get it. That's right. You don't even get
to see it on the P &L. You don't send them a
check. You don't even see it. I'll give you a
great example. This is a new client of ours that
he enters his contracted fee in his fee guide,
you know, in the fee schedule as practice management
software. There's two ways to enter your fees.
You can enter your contracted fees or you could
enter your UCR fee. I like to enter the UCR fees
because then you can run a report from your computer
and find out what you're writing off. Well, this
doctor did it the more common way. 90 % of doctors
enter their contracted fees. And so this is an
office that last year in 2024 collected strong
solo practice right at a million dollars. It
was a little bit over a million. I said, would
you like to know what you actually have to produce
to collect a million? Because I wrote a custom
Excel spreadsheet that will give you that answer
to an accuracy of plus or minus 2%. He said,
yeah, I'd love to know. So I run the numbers
in there. And his practice was 80 % PPO. His
average adjustment was 42%. Those are built into
the equation in Excel. He had to produce a million.
Let me guess. OK, go ahead. Let me guess. Let
me guess. All right. 80 % PPO. 40 % average adjustment.
What do you think? 1 .38. A million, 537. Wow.
He had to produce a million, 537 in order to
collect a million. Now, if you've just popped
into this podcast and you just heard that statement,
you think, wow, that office has a collections
problem. No, no, no, no, no. They don't have
a collections problem. They have an adjustment
problem. a $537 ,000 a year adjustment problem.
Now, if the doctor will accept that as a marketing
expense, just, you know, air quotes, what could
you do with a $537 ,000 annual marketing budget?
I mean, it's obscene. I mean, you can spend a
fraction of that and get a better result. Now,
here's another example that I love to use. I
can't use the doctor's name out of confidentiality,
but I can use the situation. And the reason I
love to use this is because it represents two
years side by side. So in 2023, this office,
a really strong solo dentist, big, strong hygiene
department, was in network with 12 plants, including
Delta, and stayed in network. But we timed it
so that by the end of the year, by December 31st,
he'd be out of network with all 12. And in 2023,
this office produced $1 .9 million in real fees,
in UCR fees, and collected $1 .4 million. Now,
next year, we have the perfect canvas. to track
it for the entire year being out of network.
Okay, drum roll, please. In 2024, the office
produced 1 .8. Production went down from 1 .9
to 1 .8, but collected 1 .7. Eric, we're getting
to know each other, but I think you're going
to get this one right. Which one would you prefer?
Which year would you prefer? The dream is always
to work less and make more. I like the second
shirt. Yeah, the second one. By the way, can
you guess what the $100 ,000 difference, so the
difference between producing $1 ,800 and collecting
$1 ,700 was? Can you suggest? Because by then
he's out of network. What was that $100 ,000
adjustment? I mean, it had to be the patients,
the Delta patients, right? No, it was the in
-office membership plan. The in -office membership
plan. I see, I see, I see. So I like the idea
of an in -office membership plan because it's
a great carrot to attract people that don't have
insurance. And the way I typically teach that
is you come up with an annual fee for two clinics,
exams, and x -rays. You could add things that
you want. It could be fluoride, sealants, whatever,
whitening. And then we offer those patients that
are part of the membership plan a 10 % savings
on, and let's be honest, it's a 10 % discount.
on any service in the practice. Now, Eric, I
don't like the 10 % discount, but I like it a
lot better than the 45 % under Delta. Yeah, and
for us, as you're having those heads -up conversations,
it allows you to ease the transition if they
are having to pay more. I now have something
else I can offer you, too. Right, and one other
thing that I think will be important for your
listeners, we always assume if the patient has
insurance that their employer is paying for the
insurance. right? As a benefit of being of employment.
That's not always the case because in many cases,
the employer will provide it as an option because
of they have group buying power, but then the
employee actually pays for it themselves in the
form of a payroll deduction. And so we always
ask, does your employer pay for that? Or do you
pay for it in the form of a payroll? And then
they'll say, well, I know it's, I see it in my
pay stub. And then we say, Let me show you our
in -office membership plan. You can opt out of
that one. This one might be a whole lot better.
Now, I have a final question for you. And my
answer is one, by the way, all the time. In your
experience, has anyone ever gone closer down
the spectrum of fee -for -service and been like,
this is not for me, and gone back? I have advised
a very, very, very small, twice. I've advised
clients not to do this. And it wasn't that they
couldn't ever do it, but they weren't in a position
now to do it. I have a quick exercise. I'll close
on this. It's kind of a litmus test I use before
we actually pull the trigger and resign. I call
it the ultimate team meeting. You ready for this?
Ready. I asked the doc, call a team meeting.
It'll be by Zoom with me. don't have an agenda,
just say, Gary asked us to have a meeting today.
And then I open the meeting and say, guys, we're
gonna do something fun today. We're gonna go
around the room. We'll just go clockwise around
the room with your doctor or doctors being last.
And here is the game that we're gonna play. Give
me one reason why a patient should come to your
office for their dental care. Just one reason,
anything at all. And let's start with you, Maria.
And we go around the room. Okay? With doctor
being last because it gets harder. Oh, and the
rule is you can't repeat what someone else said.
I like it. Okay, good. You cannot repeat what
someone else said. One reason, it could be anything
at all, small, big, in between, whatever. And
we go around the room. And we're going to go
around the room twice. So after we go around
the room, I said, we're going to go around one
more time. Now, I recently did this in a larger
practice by Zoom. Between doctors and team members,
26 people. 26. We go around the room and literally.
Didn't miss a beat. Got to the three doctors,
went around round two. So at that point, 26,
we're at 52 unique answers on why a patient should
come to their office for their care. And the
office manager, who I'd gotten to know pretty
well, says, Gary, I know you said we only had
to do this twice, but I'm so confident in my
team. Can we go around one more time? Knock yourself
out. We went around it one more time. That's
so cool. 76 unique answers. And remember, that
just arms every team member when they're talking
to their patients about why they should stay
here. And so I've never had this happen, but
imagine that I was doing this and say it was
a team of 12. And we get to team number four
and we get crickets. We got crickets. We got
nothing. Guess what? We're not ready to go out
of network. That's right. You can't articulate
the R value proposition or RY, whatever gets
you up in the morning. You're probably just there
for a paycheck. You're there for a paycheck.
But when you have a relationship -driven practice,
when you have a team that's all on the same page,
committed to the vision of the practice and knowing
their roles, knowing how they fit as a spoke
in the wheel. and truly having a connection with
patients. It's the 80 -20 rule. You're definitely
generating 80 % of your profit from 20 % of your
patients, and conversely, you're generating 80
% of your discord by 20 % of your patients. It's
really joyful work, and it's fun to see team
members get engaged and understand. That last,
that ultimate team meeting is a lot of fun, and
it's cool to see some of the things they come
up with. And when, you know, I said we went around
the room and had 76 unique answers in this office.
And the doctor said, oh, my gosh, we should have
done this a long time ago. We should have bailed
on these plans a long time ago. When we're working
on an account together, Gary, and we're doing
the marketing, I want you to send me that meeting
because that's marketing gold. Yeah, that would
be a blast. But it is very important to get your
marketing ahead of it. You want to replace people
that you're going to lose patients. I wish I
could tell you there's a way to do it and not
lose patients, but I've never seen that happen.
But the goal is to minimize the loss of patients.
But if you can replace those proactively through
marketing, which you know, then you're set up
well to navigate this. The mistake is to deal
with maybe you think, well, I've never needed
marketing. It's because you're listed on Delta's
website. But as soon as you get delisted, then
you need another source, which I'd much rather
go to Google than Delta anyway. And the truth
of the matter is you're not going to have to
put that much money behind it. Most of our practices
are somewhere in the 3 % to 5 % collections.
Well, and compare that to that office that was
$537 ,000 a year in adjustments. Yeah, yeah.
It's going to feel like a big bill because you've
never paid it for a minute. But in reality, it's
an investment into yourself. You and I are on
sync on marketing budget. I'd like to spend as
little as I need to to produce the quality of...
That's right. But 3 % would match up with a practice
looking for, say, a single -digit percentage
growth every year. That's right. And if you're
looking for more aggressive growth, like 10 %
or more, closer to 5%, somewhere between 3 %
and 5%. And when you compare that to 45%, you
know, it's an easy math equation. That's right.
We need to change the paradigm of how we think
about those numbers because one of them is a
bill and the other is an investment. And there's
so many ancillary benefits, too. If you're growing
and you're maybe looking for an associate doc,
imagine the difference recruiting a dentist into
a fee -for -service practice or a reduced insurance
footprint practice. Those associations are thin
on the street. They're unicorn practices. Imagine
you're recruiting. Imagine your ability to… to
hire quality team members when you have a budget
to pay them well. All of this, it just has, you
know, it's the domino that falls that allows
you to do all these other things that make your
environment so much more positive for attracting
and keeping quality team and doctors. Gary, thank
you so much for your time. I appreciate you.
Well, it's mutual. This has been a lot. It's
fun to be on the other side of the mic. Usually
I'm the one asking the questions, but it's really
fun to be on the other side of the mic. I'd love
to join you for a future one as well. But I'll
provide some contact information for the show
notes for you and just let your listeners know,
please feel welcome to stay in touch. I would
love the opportunity to hear from any of you.
We'll provide that in the show notes. But in
the meantime, thanks so much for the invitation.
Gary, thank you for your time. It's been a pleasure.