WEBVTT 00:00:00.000 --> 00:00:02.220 Do you feel like insurance companies are running 00:00:02.220 --> 00:00:05.160 your practice more than you are? You're struggling 00:00:05.160 --> 00:00:07.500 to get your team on board with big changes you 00:00:07.500 --> 00:00:10.099 want to make in your practice? Or you're just 00:00:10.099 --> 00:00:12.660 wondering how to build a practice that runs more 00:00:12.660 --> 00:00:15.099 smoothly, supports your lifestyle and is not 00:00:15.099 --> 00:00:17.839 going to burn you out? Well then this episode 00:00:17.839 --> 00:00:22.190 is for you. Welcome to Bite Size Dental Marketing. 00:00:22.350 --> 00:00:26.149 My name is Ian and today we have a special guest 00:00:26.149 --> 00:00:29.750 joining us. The godfather of dental podcasting 00:00:29.750 --> 00:00:33.590 himself, Mr. Gary Tuckers. Gary Tuckers is a 00:00:33.590 --> 00:00:36.469 true pioneer in dental coaching and one of the 00:00:36.469 --> 00:00:38.950 most respected voices within this profession. 00:00:39.289 --> 00:00:41.649 Gary has helped hundreds of dental practices 00:00:41.649 --> 00:00:44.850 reduce insurance dependence, build stronger systems 00:00:44.850 --> 00:00:48.149 and create practices that they actually enjoy 00:00:48.149 --> 00:00:52.119 leading. We talk about how you can get your team 00:00:52.119 --> 00:00:54.939 on board before dropping plans, how to shift 00:00:54.939 --> 00:00:58.479 from people dependence to system dependence in 00:00:58.479 --> 00:01:01.200 your office, and why marketing becomes essential 00:01:01.200 --> 00:01:05.060 when you're no longer listed on the PPO directories. 00:01:05.359 --> 00:01:11.819 Enjoy. Welcome to Buy Size Dental Marketing. 00:01:12.000 --> 00:01:15.120 Today I have Gary Takis. Gary has had an amazing 00:01:15.120 --> 00:01:17.280 career as a veteran dental coach, a practice 00:01:17.280 --> 00:01:19.519 consultant. He's the co -owner of Last Miles 00:01:19.519 --> 00:01:22.219 Dental Care and Thriving Practice Academy. I 00:01:22.219 --> 00:01:25.780 mean, Gary, no one can Google dental and not 00:01:25.780 --> 00:01:28.659 find your picture somewhere out there in the 00:01:28.659 --> 00:01:33.280 world. And the godfather of dental podcasting. 00:01:33.280 --> 00:01:36.439 I mean, how can we not address that? Well, Eric, 00:01:36.540 --> 00:01:38.659 I would like to point out that that picture in 00:01:38.659 --> 00:01:40.519 the post office, that's a different guy. That's 00:01:40.519 --> 00:01:43.359 not me. I understand. It's a different guy. Just 00:01:43.359 --> 00:01:46.859 like you, though. Just there. How did you get 00:01:46.859 --> 00:01:49.799 started? You know, Eric, first of all, it's great 00:01:49.799 --> 00:01:52.599 to be here on Bite Science Dental Marketing Podcast. 00:01:52.879 --> 00:01:55.540 Thanks for the invitation. You know, I started 00:01:55.540 --> 00:01:58.579 right out of college. I'm a University of Oregon 00:01:58.579 --> 00:02:01.260 graduate, which makes me a fighting duck. You 00:02:01.260 --> 00:02:03.060 know, not just a regular duck, but a fighting 00:02:03.060 --> 00:02:08.340 duck. And we had a young family, and I had to 00:02:08.340 --> 00:02:12.849 make a living. I was hired as a law clerk in 00:02:12.849 --> 00:02:15.469 a law firm that worked with physicians and dentists. 00:02:16.189 --> 00:02:22.330 And it sounds like kind of a noble job, but actually 00:02:22.330 --> 00:02:25.150 I was the copy boy. I was the guy that pressed 00:02:25.150 --> 00:02:28.110 the button on the copy machine. And Eric, I don't 00:02:28.110 --> 00:02:30.830 want to sound overly proud about it, but I did 00:02:30.830 --> 00:02:33.469 a very good job of pressing the button on the 00:02:33.469 --> 00:02:36.009 copy machine in the workroom. Those were breaking 00:02:36.009 --> 00:02:38.930 down all the time. Those Xerox, I know what you're 00:02:38.930 --> 00:02:42.669 talking about. Shortly after I was hired as the 00:02:42.669 --> 00:02:48.090 clerk, the law firm expanded their client base. 00:02:48.169 --> 00:02:50.750 They were a regional firm in Oregon, Washington, 00:02:50.870 --> 00:02:54.229 and Northern California. And they expanded it 00:02:54.229 --> 00:02:57.150 to be nationwide. And their clients were physicians 00:02:57.150 --> 00:02:59.969 and dentists. And the founder of the firm, Rick 00:02:59.969 --> 00:03:01.569 Mercer, you might recognize that name. Some of 00:03:01.569 --> 00:03:04.129 our listeners will recognize that name. Rick 00:03:04.129 --> 00:03:07.409 was a visionary. And he wanted to deliver exemplary... 00:03:08.489 --> 00:03:10.629 customer service to our clients. So clients would 00:03:10.629 --> 00:03:12.569 fly from all over the country, visit us in Eugene. 00:03:13.009 --> 00:03:16.590 And so he bought a 1957 Silver Cloud Rolls -Royce. 00:03:17.009 --> 00:03:20.509 But I'd worked there for two weeks and it was 00:03:20.509 --> 00:03:24.189 being delivered and got delivered to the top 00:03:24.189 --> 00:03:26.289 floor of the parking garage for our building. 00:03:26.370 --> 00:03:28.849 And we could look down at it to see the car and 00:03:28.849 --> 00:03:31.969 everyone in the firm, you know, raced over to 00:03:31.969 --> 00:03:33.590 the window when the car got delivered. And I 00:03:33.590 --> 00:03:36.389 was at the copy machine making copies. And Rick 00:03:36.389 --> 00:03:40.629 said, he had a booming baritone voice. He said, 00:03:40.650 --> 00:03:44.349 Gary, come here. I didn't know I knew my name. 00:03:44.590 --> 00:03:46.330 I'd worked there two weeks, right? This is a 00:03:46.330 --> 00:03:49.569 firm that had about 80 employees. Didn't even 00:03:49.569 --> 00:03:51.349 think he knew me. And he said, Gary, come here. 00:03:52.009 --> 00:03:55.169 He said, can you drive a Rolls Royce? I said, 00:03:55.210 --> 00:03:57.389 sir, if it involves keeping this job, yes, I 00:03:57.389 --> 00:04:02.090 can. And he threw me the keys. And said, pick 00:04:02.090 --> 00:04:05.110 up Dr. Baker at 2 o 'clock at the airport. And 00:04:05.110 --> 00:04:07.250 now I became the copy boy Rolls -Royce driver. 00:04:07.490 --> 00:04:09.650 And we were still living in married student housing, 00:04:09.830 --> 00:04:15.389 Eric, in a little duplex with two young kids. 00:04:15.569 --> 00:04:17.709 And we were living in married student housing. 00:04:17.790 --> 00:04:20.290 And I had to drive that car home because I had 00:04:20.290 --> 00:04:24.089 to pick clients up at odd hours. And I know you'll 00:04:24.089 --> 00:04:27.029 find this amazing, but it was the only 1957 Silver 00:04:27.029 --> 00:04:29.750 Cloud Rolls Rice in the married student parking 00:04:29.750 --> 00:04:34.509 lot. So that's where it all started. I served 00:04:34.509 --> 00:04:37.389 in the 1980s. I worked for two large dental consulting 00:04:37.389 --> 00:04:40.350 firms, essentially learning my craft as a coach, 00:04:40.410 --> 00:04:42.930 learning the foundation of my craft as a coach 00:04:42.930 --> 00:04:46.670 and a consultant. In 1989, I decided to take 00:04:46.670 --> 00:04:49.069 a leap and leave the comfort of the corporate 00:04:49.069 --> 00:04:51.370 world and start my own consulting firm. I still 00:04:51.370 --> 00:04:53.269 had a lot to learn, but by then I had worked 00:04:53.269 --> 00:04:55.730 with over 500 practices in all 50 states, and 00:04:55.730 --> 00:04:57.750 I thought, well, I've got a lot to learn, but 00:04:57.750 --> 00:05:00.269 I know enough to get started. My wife was a kindergarten 00:05:00.269 --> 00:05:02.910 teacher. We had two kids later to become four, 00:05:03.029 --> 00:05:05.610 and we launched my consulting firm. I've had 00:05:05.610 --> 00:05:09.149 my own consulting firm ever since. And it's really 00:05:09.149 --> 00:05:12.009 been a wonderful, wonderful ride. Pardon my enthusiasm, 00:05:12.230 --> 00:05:15.910 but I love our dental profession. You know, we 00:05:15.910 --> 00:05:17.730 have the ability to change people's lives every 00:05:17.730 --> 00:05:20.069 day. It could be something that we do clinically, 00:05:20.189 --> 00:05:22.189 or it could be something we do behaviorally. 00:05:22.449 --> 00:05:25.769 Maybe we just, you know, are extra empathetic. 00:05:26.269 --> 00:05:28.310 become extra good listeners to help a patient. 00:05:28.430 --> 00:05:30.269 But there's so many things we can do that have 00:05:30.269 --> 00:05:33.389 a positive impact on our patients' lives that 00:05:33.389 --> 00:05:37.949 it truly is an amazing profession. Yeah, I find 00:05:37.949 --> 00:05:40.790 that dentists underestimate the impact they have 00:05:40.790 --> 00:05:46.629 on people's lives. And my story is well -documented, 00:05:46.750 --> 00:05:49.569 but I didn't meet a dentist until I was around 00:05:49.569 --> 00:05:52.910 23, 22 years old, coming from rural Oklahoma. 00:05:53.449 --> 00:05:56.490 But yeah, I mean, there was a dentist. did right 00:05:56.490 --> 00:05:58.370 by my mom and I was trying to do right by him. 00:05:58.430 --> 00:06:00.589 And next thing you know, here we are with the 00:06:00.589 --> 00:06:05.350 company. But if you think through your time in 00:06:05.350 --> 00:06:08.949 dentistry and think from an asset business owner 00:06:08.949 --> 00:06:12.949 standpoint, right, what do you see as the big 00:06:12.949 --> 00:06:16.449 milestones in dentistry ownership since the, 00:06:16.449 --> 00:06:20.250 you know, the 90s to the aughts to today? Well, 00:06:20.269 --> 00:06:22.550 if I fast forward for your listeners benefit 00:06:22.550 --> 00:06:26.519 in 07. 2007, I learned that in Arizona, where 00:06:26.519 --> 00:06:28.620 I am, you don't have to be a dentist to own a 00:06:28.620 --> 00:06:31.259 practice. I thought, what? Wait, I thought you 00:06:31.259 --> 00:06:33.160 had to be a dentist. Well, not in Arizona. So 00:06:33.160 --> 00:06:35.379 I decided I wanted to own a practice so I could 00:06:35.379 --> 00:06:37.980 have a test kitchen where I could test concepts 00:06:37.980 --> 00:06:41.199 out and I could report back to my clients. And 00:06:41.199 --> 00:06:43.139 by then I was speaking quite a bit and I could 00:06:43.139 --> 00:06:45.620 report to my audiences what was working and what 00:06:45.620 --> 00:06:48.100 wasn't working. So I partnered with a young dentist, 00:06:48.199 --> 00:06:51.139 Dr. Paul Nielsen, a 2005 grad at the University 00:06:51.139 --> 00:06:53.420 of Washington. And we bought what could only 00:06:53.420 --> 00:06:56.360 fairly be described as a fixer upper practice. 00:06:57.360 --> 00:06:59.439 It had ankle high orange shade, copper, avocado 00:06:59.439 --> 00:07:02.939 green countertops, you know, was really in need 00:07:02.939 --> 00:07:05.279 of a lot of things. But it did have about a thousand 00:07:05.279 --> 00:07:07.779 active patients, all of whom needed treatment. 00:07:07.920 --> 00:07:09.560 And we said, well, hey, we can change that other 00:07:09.560 --> 00:07:12.120 stuff. Let's start there. And Eric, I have to 00:07:12.120 --> 00:07:14.060 tell you that I thought it would be extremely 00:07:14.060 --> 00:07:17.579 useful to have that experience, you know, as 00:07:17.579 --> 00:07:20.439 my clients were experiencing as an owner. but 00:07:20.439 --> 00:07:23.620 it massively exceeded my expectations. I jokingly 00:07:23.620 --> 00:07:32.439 like to say that prior to 07, I had 27 years 00:07:32.439 --> 00:07:36.399 of experience working as a coach and as a consultant 00:07:36.399 --> 00:07:42.240 in all 50 states. But I say, after 07, I thought 00:07:42.240 --> 00:07:43.980 I knew a little bit about cancellation and no 00:07:43.980 --> 00:07:46.850 -shows, and then I got a PhD. in cancellation 00:07:46.850 --> 00:07:48.930 of no -shows because we're dealing with the day 00:07:48.930 --> 00:07:53.649 -to -day. But to answer your question, I think 00:07:53.649 --> 00:07:56.649 every career path in dentistry has its merits, 00:07:56.709 --> 00:08:00.189 and every career path can be a good career path 00:08:00.189 --> 00:08:03.689 for an individual. You know, practice ownership, 00:08:03.930 --> 00:08:06.910 being an associate doctor, teaching, maybe working 00:08:06.910 --> 00:08:10.870 in a community health clinic. You know, it's 00:08:10.870 --> 00:08:15.319 all good. But I happen to really believe That 00:08:15.319 --> 00:08:19.939 if it's your aspiration, a great career path 00:08:19.939 --> 00:08:22.639 is becoming a practice owner because you truly 00:08:22.639 --> 00:08:24.459 have control of your destiny at that point. It's 00:08:24.459 --> 00:08:27.800 up to you. You get to decide. Now it comes with 00:08:27.800 --> 00:08:30.939 consequences as well. You know, we bought the 00:08:30.939 --> 00:08:34.879 practice in 07. And in Arizona, you might remember 00:08:34.879 --> 00:08:39.620 what we now call the Great Recession. Folks in 00:08:39.620 --> 00:08:43.759 economics will remember that. And 08, 09, 07, 00:08:43.759 --> 00:08:46.000 08, and 09 are what's now considered the Great 00:08:46.000 --> 00:08:49.700 Recession. In Arizona, it hit us in 08. We were 00:08:49.700 --> 00:08:51.960 a little bit lagged behind the national economy. 00:08:52.460 --> 00:08:56.480 And it hit like a ton of bricks. And we had to 00:08:56.480 --> 00:08:58.080 figure out how to navigate that. And I had to 00:08:58.080 --> 00:09:00.639 figure out how to not only survive, but thrive 00:09:00.639 --> 00:09:02.820 in the midst of all of it. And we were able to 00:09:02.820 --> 00:09:06.480 figure that out. A lot of, you know, a lot of 00:09:06.480 --> 00:09:08.179 just seat -of -the -pants decision -making there. 00:09:08.639 --> 00:09:12.139 And we were able to not only survive it. but 00:09:12.139 --> 00:09:14.580 figure out how to thrive in what was a tough 00:09:14.580 --> 00:09:20.679 economic situation. But I do think pathways to 00:09:20.679 --> 00:09:25.940 practice ownership now, if a dentist has that, 00:09:25.960 --> 00:09:29.320 he or she has that as an aspiration, there's 00:09:29.320 --> 00:09:32.360 a lot of ways to do that. Paul had spent, he 00:09:32.360 --> 00:09:35.320 graduated in 05. So his first two years out of 00:09:35.320 --> 00:09:38.059 dental school, he and his wife, Erin, wanted 00:09:38.059 --> 00:09:40.580 to relocate to Phoenix coming out of Seattle. 00:09:41.100 --> 00:09:43.279 to be close to her family who was here in Phoenix. 00:09:43.639 --> 00:09:45.940 And so he worked in three different associateships. 00:09:45.940 --> 00:09:50.580 Each one was two days a week. And that was, he 00:09:50.580 --> 00:09:52.600 was working six days a week, but he was trying 00:09:52.600 --> 00:09:54.639 to get real world experience of what it was like 00:09:54.639 --> 00:09:58.360 in practice. And when I met him, I told him I 00:09:58.360 --> 00:10:03.019 was looking for a dentist to partner with. And 00:10:03.019 --> 00:10:06.120 that's how our partnership came together. And 00:10:06.120 --> 00:10:08.669 we bought this practice. over a period of time, 00:10:08.690 --> 00:10:11.769 proceeded to develop it into our version of our 00:10:11.769 --> 00:10:16.289 ideal practice. And we built an ideal office 00:10:16.289 --> 00:10:19.850 in 2011, added a second doctor, Dr. Tim Schmidt, 00:10:19.950 --> 00:10:26.809 in 2013. Tim became a partner in 2015. We continue 00:10:26.809 --> 00:10:29.809 to develop it. If I could describe the foundation 00:10:29.809 --> 00:10:34.149 of Lifesmiles, the foundation is a combination 00:10:34.149 --> 00:10:38.029 of two things. Everyday general dentistry. and 00:10:38.029 --> 00:10:40.509 a really strong hygiene department. So think 00:10:40.509 --> 00:10:42.669 about whatever you would think of Eric as everyday 00:10:42.669 --> 00:10:45.090 general dentistry. Paul and Tim both have a fellowship 00:10:45.090 --> 00:10:47.690 and a mastership in the AGD, so are well -trained 00:10:47.690 --> 00:10:50.730 in general dentistry. So everyday general dentistry 00:10:50.730 --> 00:10:54.690 combined with a really strong hygiene department. 00:10:55.049 --> 00:10:57.590 Dr. Reed, Omar Reed taught me when I met him 00:10:57.590 --> 00:11:01.190 in the early 80s. He said, Gary, always remember 00:11:01.190 --> 00:11:04.090 that the backbone of a thriving practice is the 00:11:04.090 --> 00:11:07.070 hygiene department. And he said it so convincingly. 00:11:07.470 --> 00:11:09.470 that I didn't really know what it meant. I mean, 00:11:09.490 --> 00:11:11.230 I certainly knew what it meant, you know, just 00:11:11.230 --> 00:11:13.970 conceptually, but I didn't fully understand the 00:11:13.970 --> 00:11:15.809 impact of that. But he said it so convincingly, 00:11:15.809 --> 00:11:17.990 it's like, it's imprinted on my brain today. 00:11:18.429 --> 00:11:20.490 And so the hygiene department has always been 00:11:20.490 --> 00:11:22.570 a really important part. And then we've added 00:11:22.570 --> 00:11:27.549 some specific high value services as, think about 00:11:27.549 --> 00:11:30.450 the foundation, and then think about the high 00:11:30.450 --> 00:11:32.990 value services as, you know, the... The structure 00:11:32.990 --> 00:11:34.590 we put on top of the foundation or the icing 00:11:34.590 --> 00:11:36.669 on the cake. So things like placing restoring 00:11:36.669 --> 00:11:39.149 implants, adult orthodontics, Invisalign specifically. 00:11:40.029 --> 00:11:41.730 Cosmetic dentistry, which can be a lot of things, 00:11:41.809 --> 00:11:43.730 but I tend to think of cosmetic dentistry as 00:11:43.730 --> 00:11:47.070 lab fabricated veneers. Oral conscious sedation 00:11:47.070 --> 00:11:50.250 for people that are nervous about going to the 00:11:50.250 --> 00:11:52.210 dentist. We can make a visit completely comfortable 00:11:52.210 --> 00:11:55.309 for them. Arizona, where a lot of the patients 00:11:55.309 --> 00:11:57.470 are older and have more complex needs. We can 00:11:57.470 --> 00:11:59.850 do full mouth restorative dentistry. And then 00:11:59.850 --> 00:12:03.820 more recently, helping diagnose and treat obstructive 00:12:03.820 --> 00:12:06.639 sleep apnea with some dental solutions. So those 00:12:06.639 --> 00:12:09.299 are the six high -value services that go, in 00:12:09.299 --> 00:12:12.000 our case, on top of the foundation of everyday 00:12:12.000 --> 00:12:14.879 general dentistry and a really strong hygiene 00:12:14.879 --> 00:12:17.679 department. You mentioned hygiene. What other 00:12:17.679 --> 00:12:22.200 factors or components do thriving practices have 00:12:22.200 --> 00:12:25.340 in common? Well, a couple things could immediately 00:12:25.340 --> 00:12:28.899 jump to mind. Thriving practices are systems 00:12:28.899 --> 00:12:34.289 -driven. as opposed to person dependent. You 00:12:34.289 --> 00:12:38.529 know, many practices become very dependent on 00:12:38.529 --> 00:12:43.250 an individual. And that individual may do their 00:12:43.250 --> 00:12:45.210 job extremely well. We had that happen at Lifesize. 00:12:45.289 --> 00:12:47.769 I had a really, really good team member, like 00:12:47.769 --> 00:12:50.309 someone that I wanted to be in our practice for 00:12:50.309 --> 00:12:55.009 the next 30 years. She was amazing. And one morning 00:12:55.009 --> 00:12:59.330 she came to me with a sad look on her face. And 00:12:59.330 --> 00:13:02.149 she said, Gary, I need to talk to you. No employee 00:13:02.149 --> 00:13:04.070 has ever needed to talk to me and good news came 00:13:04.070 --> 00:13:06.409 out of it. Not one time. And when you combine 00:13:06.409 --> 00:13:08.029 that with the look on her face, it was not going 00:13:08.029 --> 00:13:11.929 to be a good conversation. And we sat down and 00:13:11.929 --> 00:13:17.629 she said, Gary, this is my dream job. You and 00:13:17.629 --> 00:13:21.009 Dr. Paul are my dream employers. This is my dream 00:13:21.009 --> 00:13:24.490 job. I plan to be here forever. But it isn't 00:13:24.490 --> 00:13:26.309 going to work out that way. I need to relocate 00:13:26.309 --> 00:13:31.169 for family reasons. And, you know, we both shed 00:13:31.169 --> 00:13:33.950 some tears and hugs and support and let her know 00:13:33.950 --> 00:13:36.409 that you've got to do what you've got to do and 00:13:36.409 --> 00:13:38.549 we're going to support you and you're going to 00:13:38.549 --> 00:13:41.269 be missed. And it was at that point that I got 00:13:41.269 --> 00:13:44.230 serious about developing systems because the 00:13:44.230 --> 00:13:45.950 truth was I was person dependent because she 00:13:45.950 --> 00:13:49.289 was extremely good. She was our lead admin team 00:13:49.289 --> 00:13:51.769 member. You know, we didn't use the term at the 00:13:51.769 --> 00:13:53.509 time, but we would have considered her our office 00:13:53.509 --> 00:13:58.309 manager. And just extremely talented, deeply 00:13:58.309 --> 00:14:00.809 committed, committed to the style of practice 00:14:00.809 --> 00:14:02.830 that we had, committed to a great patient experience. 00:14:04.350 --> 00:14:08.169 And it allowed me to – we had other dragons to 00:14:08.169 --> 00:14:10.009 slay in the practice because it had so many things 00:14:10.009 --> 00:14:12.429 to do. We had so many things we had to upgrade. 00:14:12.610 --> 00:14:14.830 And we were on paper charts still at that point, 00:14:14.950 --> 00:14:16.490 film radiographs. Do you remember those days? 00:14:16.590 --> 00:14:19.850 Remember the stinky tank and the radiographs? 00:14:19.929 --> 00:14:23.049 So there were other dragons to slay. And so I 00:14:23.049 --> 00:14:27.159 was – sort of lulled into letting her do her 00:14:27.159 --> 00:14:30.100 thing. And that was going to work out perfectly 00:14:30.100 --> 00:14:32.820 until she had to leave. And that's when I said, 00:14:32.860 --> 00:14:35.879 well, we've got to become system driven. So one 00:14:35.879 --> 00:14:38.139 of the things we created was these 24 systems. 00:14:38.399 --> 00:14:40.460 I call them the 24 systems for a thriving practice. 00:14:40.700 --> 00:14:43.360 And they become part of our foundation. They 00:14:43.360 --> 00:14:46.240 provide the support for our team members, provide 00:14:46.240 --> 00:14:50.470 accountability, provide direction. And then we're 00:14:50.470 --> 00:14:54.450 systems driven rather than person dependent. 00:14:54.629 --> 00:14:57.230 Another element that I would say, and something 00:14:57.230 --> 00:14:59.710 I had some very good mentors early on, was the 00:14:59.710 --> 00:15:02.610 importance of having a relationship driven practice 00:15:02.610 --> 00:15:05.429 as well. You know, if you think about the spectrum, 00:15:05.610 --> 00:15:07.470 there's all kinds of different practice formats. 00:15:08.610 --> 00:15:13.009 And on a simplistic level, if we draw a horizontal 00:15:13.009 --> 00:15:16.129 line, you know, across our computer screen today, 00:15:16.190 --> 00:15:20.200 and on one end of the spectrum, We have transactional. 00:15:20.620 --> 00:15:23.340 And the other end of the spectrum, we have relationship 00:15:23.340 --> 00:15:26.019 -driven. And the truth is, I don't think any 00:15:26.019 --> 00:15:28.720 practice is purely one or the other entirely, 00:15:28.940 --> 00:15:31.659 but you'll be somewhere on the spectrum. Does 00:15:31.659 --> 00:15:34.659 that make sense? I want to be more over here 00:15:34.659 --> 00:15:38.360 on relationship -driven. What that means to me 00:15:38.360 --> 00:15:39.840 is we know our patients' names. We know their 00:15:39.840 --> 00:15:41.639 spouses' names. We know their kids' names. We 00:15:41.639 --> 00:15:42.960 know their hobbies. We know their interests. 00:15:43.179 --> 00:15:45.840 Maybe we know that a patient named Linda is taking 00:15:45.840 --> 00:15:48.899 care of an elderly parent right now. And by the 00:15:48.899 --> 00:15:50.480 way, you don't have to know that stuff at all 00:15:50.480 --> 00:15:55.179 times, you know, 24 -7, 365, because as your 00:15:55.179 --> 00:15:57.919 practice grows, you know, that becomes a bigger 00:15:57.919 --> 00:16:01.059 challenge. But we do need to know who we're seeing 00:16:01.059 --> 00:16:04.960 today, and we need to connect with them. And 00:16:04.960 --> 00:16:07.639 when we connect with them, I think we can create 00:16:07.639 --> 00:16:10.460 an environment where a new patient wants to be 00:16:10.460 --> 00:16:12.860 a patient for life, because they're being treated 00:16:12.860 --> 00:16:16.759 by people who they know, like, and trust. And 00:16:16.759 --> 00:16:19.240 we're not taking care of strangers. We're taking 00:16:19.240 --> 00:16:22.340 care of people we really care about. And I love 00:16:22.340 --> 00:16:25.019 to use the term, I know it sounds kind of corny, 00:16:25.019 --> 00:16:27.039 but I'm going to use it anyway, Eric, because 00:16:27.039 --> 00:16:30.480 I believe in it. I like to think about our patients 00:16:30.480 --> 00:16:33.740 as our patient family. You mentioned people versus 00:16:33.740 --> 00:16:36.559 systems, and I agree. One of the most, you know, 00:16:36.559 --> 00:16:39.559 I'm a business owner and there was a... It feels 00:16:39.559 --> 00:16:43.940 so good when you have this rock star person locking 00:16:43.940 --> 00:16:48.059 down a section of your business, right? How do 00:16:48.059 --> 00:16:52.799 you make the transition from, I have this rock 00:16:52.799 --> 00:16:54.960 star employee that just has something all locked 00:16:54.960 --> 00:16:56.879 out, and I'm so grateful, right? And winning 00:16:56.879 --> 00:17:00.299 fixes everything, and I can be seduced into just 00:17:00.299 --> 00:17:05.099 leaving it alone. How do you prepare to move 00:17:05.099 --> 00:17:08.160 toward more systems -driven? What does that mean 00:17:08.160 --> 00:17:09.720 to them? What does it mean to me? How do you 00:17:09.720 --> 00:17:11.980 make that transition? I think it's important 00:17:11.980 --> 00:17:15.279 to, within the practice, to create a practice 00:17:15.279 --> 00:17:18.500 culture. And a practice culture can be inward 00:17:18.500 --> 00:17:20.799 facing, but also outward facing. So practice 00:17:20.799 --> 00:17:25.180 culture inwardly means how do we, with our team 00:17:25.180 --> 00:17:27.819 members, interact to create a culture? What expectations 00:17:27.819 --> 00:17:30.579 do we have? How do we create an environment? 00:17:30.740 --> 00:17:34.299 One of the elements of Lifesmile's culture, practice 00:17:34.299 --> 00:17:37.220 culture with the team, is that we want to create 00:17:37.220 --> 00:17:39.799 an environment of continuous learning. We simply 00:17:39.799 --> 00:17:41.480 want to be better tomorrow than we are today. 00:17:42.339 --> 00:17:45.240 We want to create an environment of meeting people 00:17:45.240 --> 00:17:48.160 where they are. And that can apply to our patients 00:17:48.160 --> 00:17:51.339 as well as our team members. Leadership is extremely 00:17:51.339 --> 00:17:54.720 important. And you've got to lead your team. 00:17:54.759 --> 00:17:56.619 You've got to create an environment where they 00:17:56.619 --> 00:17:59.259 want to come to work, where it has meaning, it 00:17:59.259 --> 00:18:01.960 has purpose. You know, a majority of the workforce, 00:18:01.980 --> 00:18:06.329 the largest single demographic group, You probably 00:18:06.329 --> 00:18:07.750 know the answer to that. What do you think the 00:18:07.750 --> 00:18:12.710 largest demographic generation is in our society 00:18:12.710 --> 00:18:16.170 today? It's no longer baby boomers. Yeah, it's 00:18:16.170 --> 00:18:18.369 millennials, right? It's millennials. And one 00:18:18.369 --> 00:18:20.049 of the characteristics of millennials, now it's 00:18:20.049 --> 00:18:23.390 not fair to paint any generation with a broad 00:18:23.390 --> 00:18:26.630 brush. They're individuals. But one of the characteristics 00:18:26.630 --> 00:18:31.529 of millennials is as a generation, they like 00:18:31.529 --> 00:18:33.609 to be involved in something that's bigger than 00:18:33.609 --> 00:18:36.799 them. something that's bigger than them. They 00:18:36.799 --> 00:18:39.339 want to be involved in making a difference. And 00:18:39.339 --> 00:18:41.099 I believe a dental practice can be that platform. 00:18:41.279 --> 00:18:44.000 We can provide that environment where they get 00:18:44.000 --> 00:18:49.460 to make a difference and in turn fuel that appetite 00:18:49.460 --> 00:18:51.579 that they have to make a difference. We can do 00:18:51.579 --> 00:18:53.440 it through charitable work that we do. We can 00:18:53.440 --> 00:18:55.920 create our own charities within the practice. 00:18:56.000 --> 00:19:00.579 We can support causes of our team members. And 00:19:00.579 --> 00:19:02.740 a practice environment becomes a way to really 00:19:02.740 --> 00:19:05.779 just feed their soul so it isn't just coming 00:19:05.779 --> 00:19:08.359 to work and punching a time clock. And I think 00:19:08.359 --> 00:19:11.059 it's up to the owner, in our case owners, to 00:19:11.059 --> 00:19:14.359 create that environment where we want to be an 00:19:14.359 --> 00:19:16.480 environment that feeds their souls, that literally 00:19:16.480 --> 00:19:19.400 wants them to imagine being there for a lifetime 00:19:19.400 --> 00:19:22.259 of employment. How do you take someone, though, 00:19:22.359 --> 00:19:24.680 who's fallen out of love with dentistry, who's 00:19:24.680 --> 00:19:27.430 having burnout, who's... You know, they're in 00:19:27.430 --> 00:19:29.890 insurance programs. Of course, we all want to 00:19:29.890 --> 00:19:32.210 be fee -for -service. But, hey, look, being a 00:19:32.210 --> 00:19:34.670 fee -for -service practice in 2025 takes a level 00:19:34.670 --> 00:19:39.289 of execution that is above, you know, some. Well, 00:19:39.309 --> 00:19:41.309 I can speak to that very definitely. In my coaching 00:19:41.309 --> 00:19:44.529 work, I've been able to help over 400 practices. 00:19:44.529 --> 00:19:47.769 I call it reducing insurance dependence as opposed 00:19:47.769 --> 00:19:52.150 to going fee -for -service because you don't 00:19:52.150 --> 00:19:54.609 have to go all the way to significantly improve 00:19:54.609 --> 00:19:57.369 your practice. Every time you successfully drop 00:19:57.369 --> 00:19:59.930 a plan, then you've improved your practice. But 00:19:59.930 --> 00:20:01.569 I always tell my clients, if your goal is to 00:20:01.569 --> 00:20:03.029 go all the way to fee for service, I'm going 00:20:03.029 --> 00:20:04.769 to be your biggest cheerleader because that's 00:20:04.769 --> 00:20:06.650 the way to get the most out. But it's not always 00:20:06.650 --> 00:20:09.509 appropriate in every practice situation. But 00:20:09.509 --> 00:20:11.809 if you can reduce that footprint, and the main 00:20:11.809 --> 00:20:15.009 gripe that I have with PPO plans is I don't believe 00:20:15.009 --> 00:20:17.250 a third party should set our fees. We should 00:20:17.250 --> 00:20:20.269 be able to set our fees based on our style of 00:20:20.269 --> 00:20:23.460 practice, our cost of doing business. And have 00:20:23.460 --> 00:20:25.799 that be relevant to our practice and not have 00:20:25.799 --> 00:20:28.799 some third party that doesn't give a rip about 00:20:28.799 --> 00:20:31.299 the quality of care we provide setting the fees. 00:20:32.559 --> 00:20:36.160 And, you know, it's been able to do that in over 00:20:36.160 --> 00:20:39.119 400 practices in all 50 states in every practice 00:20:39.119 --> 00:20:42.720 locational environment, urban, suburban, large 00:20:42.720 --> 00:20:44.740 town, medium sized town, small town, company 00:20:44.740 --> 00:20:49.140 town. You know, two cities in our country are 00:20:49.140 --> 00:20:52.339 good definitions of company town, Seattle. Washington. 00:20:52.640 --> 00:20:55.940 In Seattle, there's four major employers in the 00:20:55.940 --> 00:20:58.460 greater Seattle area. In no particular order, 00:20:58.539 --> 00:21:03.200 it's Boeing, Aircraft, Microsoft, Starbucks, 00:21:03.779 --> 00:21:08.079 and Amazon. Amazon has a huge headquarters and 00:21:08.079 --> 00:21:11.079 distribution center there. And a lot of people 00:21:11.079 --> 00:21:12.940 in greater Seattle work for those four companies. 00:21:13.859 --> 00:21:16.339 And there's a lot of people who think, well, 00:21:16.380 --> 00:21:22.420 because those employers are so large here. I 00:21:22.420 --> 00:21:25.039 could never reduce insurance here. But my answer 00:21:25.039 --> 00:21:28.380 is, does everyone in your drawing area work for 00:21:28.380 --> 00:21:31.019 those four companies? How about finding people 00:21:31.019 --> 00:21:33.460 that don't have insurance? You only need 2 ,000 00:21:33.460 --> 00:21:36.900 people in Seattle that don't. Eric, you just 00:21:36.900 --> 00:21:39.940 hit the nail on the head. A 2 ,000 active patient 00:21:39.940 --> 00:21:43.220 base can be an incredibly successful practice. 00:21:43.460 --> 00:21:45.380 You only got to find 2 ,000. I'd find all of 00:21:45.380 --> 00:21:49.549 them. For me, the biggest challenge of moving 00:21:49.549 --> 00:21:53.109 to you know less insurance dependent is the culture 00:21:53.109 --> 00:21:56.349 of the front desk you know for us it goes from 00:21:56.349 --> 00:21:58.230 do you set my insurance being the biggest barrier 00:21:58.230 --> 00:22:01.150 to entry into the practice to i i don't want 00:22:01.150 --> 00:22:03.069 to be salesy but like you are moving to a sales 00:22:03.069 --> 00:22:06.589 position of how getting behind the question there's 00:22:06.589 --> 00:22:08.769 all there's all sorts of philosophies on on how 00:22:08.769 --> 00:22:10.450 to fill that call but you're definitely moving 00:22:10.450 --> 00:22:14.869 from a yes no binary question to a a nuanced 00:22:14.869 --> 00:22:17.420 question and that culture is the one that we 00:22:17.420 --> 00:22:19.640 struggle with in marketing? Well, the first step 00:22:19.640 --> 00:22:22.900 is to get the team behind it. When the team is 00:22:22.900 --> 00:22:26.819 behind this decision, everything goes swimmingly 00:22:26.819 --> 00:22:29.259 when the team is behind it. When they understand 00:22:29.259 --> 00:22:34.180 why we're doing it, what we're doing, and what 00:22:34.180 --> 00:22:38.700 their role is to support it. A recent example 00:22:38.700 --> 00:22:43.819 comes to mind. In a two -doctor practice, a nice, 00:22:43.839 --> 00:22:47.700 strong hygiene department, they've got 15 team 00:22:47.700 --> 00:22:49.460 members. I think you can envision what I just 00:22:49.460 --> 00:22:54.559 described, right? Nice practice. But 70 % of 00:22:54.559 --> 00:22:56.720 their income comes from PPO plans and they want 00:22:56.720 --> 00:22:59.440 to change that. So the first thing we did is 00:22:59.440 --> 00:23:02.380 help the team understand why we're doing this. 00:23:02.539 --> 00:23:06.859 And it can be at a very personal level. For example, 00:23:07.220 --> 00:23:11.880 I want to talk about what the decision means 00:23:11.880 --> 00:23:16.210 to them. And we can use an example. Let's say 00:23:16.210 --> 00:23:23.109 a team member is at $25 an hour. Just pick a 00:23:23.109 --> 00:23:28.309 round number that makes my math easy. And let's 00:23:28.309 --> 00:23:31.569 say that she'd like to make more money. Doesn't 00:23:31.569 --> 00:23:32.750 every team member in the industry want to make 00:23:32.750 --> 00:23:37.750 more money? All the ones that I know. But let's 00:23:37.750 --> 00:23:40.859 say that insurance company... requires us to 00:23:40.859 --> 00:23:45.160 take a 45 % haircut on our fees. And by the way, 00:23:45.180 --> 00:23:47.200 the average PPO adjustment today, the difference 00:23:47.200 --> 00:23:50.319 between your UCR and your contracted fee is 45%. 00:23:50.319 --> 00:23:55.539 So ask the team member, how would that feel if 00:23:55.539 --> 00:23:59.940 instead of making $25 an hour, you made $13 .75 00:23:59.940 --> 00:24:03.640 an hour? Are you going to sign up for that? Now, 00:24:03.680 --> 00:24:04.900 what do you think that team member is going to 00:24:04.900 --> 00:24:07.180 say? No, I don't want anything to do with that. 00:24:07.859 --> 00:24:10.640 Well, that's the effect that being in network. 00:24:10.700 --> 00:24:14.740 Can I use the D word? Absolutely. We can use 00:24:14.740 --> 00:24:17.779 any word you want. That's what Delta requires. 00:24:18.079 --> 00:24:20.000 When we're at Delta, I'm using Delta because 00:24:20.000 --> 00:24:22.740 they're the 5 ,000 pound gorilla, right? Well, 00:24:22.779 --> 00:24:25.740 that's what Delta requires. That instead of getting 00:24:25.740 --> 00:24:29.279 our usual fee, like if our usual fee was $1 ,000 00:24:29.279 --> 00:24:32.319 for a service, if they don't have insurance, 00:24:32.420 --> 00:24:36.990 they pay us $1 ,000. And if they are... display 00:24:36.990 --> 00:24:40.950 provider with Delta, the patient is, then we 00:24:40.950 --> 00:24:45.069 don't get $1 ,000, we get $550. And imagine how 00:24:45.069 --> 00:24:47.069 that would affect you as a team member instead 00:24:47.069 --> 00:24:50.710 of 25, it's 1375. I don't want anything to do 00:24:50.710 --> 00:24:52.809 with that. And that's why we're doing that. In 00:24:52.809 --> 00:24:55.849 one fell swoop, it can go from some abstract 00:24:55.849 --> 00:24:59.490 concept to, wait a minute, that's not right. 00:24:59.670 --> 00:25:01.930 And in this example that I'm going to give you, 00:25:02.309 --> 00:25:05.829 I was having a team meeting by Zoom. And I'm 00:25:05.829 --> 00:25:09.410 sharing this with the team and the lead dental 00:25:09.410 --> 00:25:12.410 assistant raised her hand in the Zoom meeting. 00:25:12.890 --> 00:25:16.490 Yes. She said, that's not right. That's not fair. 00:25:16.950 --> 00:25:19.049 She said, you know, I've been here many years 00:25:19.049 --> 00:25:22.309 and our doctors are amazing. I've never worked 00:25:22.309 --> 00:25:24.390 for, but before I worked here, I worked in many 00:25:24.390 --> 00:25:27.329 practices and I've never met doctors that are 00:25:27.329 --> 00:25:29.210 more committed to quality of care than the doctors 00:25:29.210 --> 00:25:31.809 right here. That's not right. What can I do to 00:25:31.809 --> 00:25:34.509 help? And as soon as she said that, I knew it 00:25:34.509 --> 00:25:36.710 was going to go great. The other team members 00:25:36.710 --> 00:25:38.670 were like, yeah, what she said. What can I do 00:25:38.670 --> 00:25:42.609 to help? And then we go through a six -step preparation 00:25:42.609 --> 00:25:45.430 sequence. And a lot of that is how to talk to 00:25:45.430 --> 00:25:48.029 patients about this. Because we found that if, 00:25:48.130 --> 00:25:50.970 I call it having a heads -up conversation with 00:25:50.970 --> 00:25:53.390 the patient. Eric, can I role -play that for 00:25:53.390 --> 00:25:55.650 you as if I was a team member and you were a 00:25:55.650 --> 00:25:57.829 patient? All right, let's do it. So just imagine 00:25:57.829 --> 00:26:00.349 this. Notice how many times I'm going to say, 00:26:00.490 --> 00:26:03.160 nothing's changing today. Okay, notice that. 00:26:03.400 --> 00:26:07.000 All right. Hey, Eric, I want to share a discussion 00:26:07.000 --> 00:26:09.640 with you today about a decision we've made that 00:26:09.640 --> 00:26:13.359 impacts you. Now, nothing's changing today, but 00:26:13.359 --> 00:26:15.359 effective, I'm going to pick a date in the future, 00:26:15.440 --> 00:26:20.299 effective this fall, September 1st, will no longer 00:26:20.299 --> 00:26:23.000 be contracted with your Delta Dental Insurance. 00:26:23.559 --> 00:26:25.279 Again, nothing's changing today, but that'll 00:26:25.279 --> 00:26:27.680 be in effect after September 1st. But here's 00:26:27.680 --> 00:26:30.559 the good news. After September 1st, you can continue 00:26:30.559 --> 00:26:33.240 to choose our office for your care. You can use 00:26:33.240 --> 00:26:34.920 those Delta benefits right here in our practice. 00:26:35.299 --> 00:26:37.400 We'll file your claims for you like we always 00:26:37.400 --> 00:26:39.660 have. And we're on your side to help you get 00:26:39.660 --> 00:26:42.299 every dollar of benefit that you have. And now 00:26:42.299 --> 00:26:44.900 I tell you what I want you to do. Nothing's changing 00:26:44.900 --> 00:26:48.440 today, but after September 1st, I hope you understand 00:26:48.440 --> 00:26:51.319 how committed we are to delivering the highest 00:26:51.319 --> 00:26:53.960 quality dentistry that you can possibly deliver 00:26:53.960 --> 00:26:57.079 and making every visit a positive experience 00:26:57.079 --> 00:26:59.839 for you that you continue to come to our office 00:26:59.839 --> 00:27:01.680 for your dental care. We're going to send you 00:27:01.680 --> 00:27:03.529 a letter. But I want to have the conversation 00:27:03.529 --> 00:27:07.990 with you so you would know. And it wouldn't be 00:27:07.990 --> 00:27:10.990 a surprise. And that's the heads -up conversation. 00:27:11.289 --> 00:27:13.410 And we do that. So let's say we're resigning 00:27:13.410 --> 00:27:15.970 from Blue Cross Blue Shield. What we'll do is 00:27:15.970 --> 00:27:18.230 we'll pick every patient on the schedule that 00:27:18.230 --> 00:27:20.289 day that's Blue Cross Blue Shield. And we'll 00:27:20.289 --> 00:27:23.069 assign a specific team member or doctor to have 00:27:23.069 --> 00:27:24.750 the conversation with the patient. We do that 00:27:24.750 --> 00:27:26.470 to make sure no one slips through the cracks. 00:27:26.809 --> 00:27:29.890 And we typically will base that on who's got 00:27:29.890 --> 00:27:32.420 the best relationship with Eric. It could be 00:27:32.420 --> 00:27:33.640 the doctor. It could be the hygienist. It could 00:27:33.640 --> 00:27:35.380 be an assistant. It could be an admin team member. 00:27:35.599 --> 00:27:37.319 And we have the heads -up conversation with them. 00:27:37.660 --> 00:27:40.140 How are you answering? So when I said something 00:27:40.140 --> 00:27:42.019 to the tune of, okay, that's great. So I'm going 00:27:42.019 --> 00:27:46.460 to pay more money for my cleanings? Or how much 00:27:46.460 --> 00:27:49.039 more? For some people, when you have that conversation, 00:27:49.299 --> 00:27:52.180 you know, September is way off. And I said at 00:27:52.180 --> 00:27:54.140 least three times, nothing's changing. Oh, so 00:27:54.140 --> 00:27:57.380 nothing's changing today? No. Oh, okay. It goes 00:27:57.380 --> 00:27:59.619 in one ear. But the most common question is, 00:27:59.700 --> 00:28:03.250 is it going to cost me more? to come here. And 00:28:03.250 --> 00:28:05.869 specifically what they're asking for is the hygiene 00:28:05.869 --> 00:28:07.690 appointment. Because the, you know, you think 00:28:07.690 --> 00:28:10.150 about when you're in network, what's the copayment 00:28:10.150 --> 00:28:13.470 for a hygiene appointment? You know, zero. And 00:28:13.470 --> 00:28:15.849 so how we answer that question? So Eric says, 00:28:16.009 --> 00:28:18.349 well, will it cost me more? You know, after September 00:28:18.349 --> 00:28:22.109 1st, what we'll say is, you know, Eric, right 00:28:22.109 --> 00:28:23.950 now we don't know. It is possible that you'll 00:28:23.950 --> 00:28:27.450 have to pay more. Right now we don't know. Delta's 00:28:27.450 --> 00:28:29.630 being a little, you know. Blue Cross Blue Shield 00:28:29.630 --> 00:28:30.890 has been a little bit difficult with us, but 00:28:30.890 --> 00:28:33.529 we will find out. Here's what I suggest you do. 00:28:34.029 --> 00:28:36.369 Let's go ahead and make your appointment in September. 00:28:36.609 --> 00:28:38.609 So we have it on the schedule and you have it 00:28:38.609 --> 00:28:42.009 marked. Between now and then we'll find out and 00:28:42.009 --> 00:28:43.670 then we'll reach out to you well before your 00:28:43.670 --> 00:28:45.670 appointment time and let you know. Once we know, 00:28:45.730 --> 00:28:47.529 we can give them the answer. You know, once we 00:28:47.529 --> 00:28:49.509 start collecting EOBs and seeing what the out 00:28:49.509 --> 00:28:51.049 -of -network fee schedule is, we can actually 00:28:51.049 --> 00:28:54.009 answer it. But I don't really think I don't know 00:28:54.009 --> 00:28:56.490 is a good answer. But sometimes it's the best 00:28:56.490 --> 00:28:58.529 answer we have. All the while, we're gauging 00:28:58.529 --> 00:29:00.650 what patients are doing. Like I had a call this 00:29:00.650 --> 00:29:02.849 morning with an office that's midstream on this. 00:29:02.950 --> 00:29:04.910 And I checked in with the office manager. I said, 00:29:05.029 --> 00:29:08.029 what are you hearing from your patients as you're 00:29:08.029 --> 00:29:11.210 having these heads up conversations? It's kind 00:29:11.210 --> 00:29:14.269 of all over the map. And we talk about it. And 00:29:14.269 --> 00:29:17.549 then said, are they making their next hygiene 00:29:17.549 --> 00:29:19.690 appointment? She said, yeah, I can only think 00:29:19.690 --> 00:29:21.769 of one patient. that we've had a conversation 00:29:21.769 --> 00:29:24.089 with out of hundreds that didn't make their next 00:29:24.089 --> 00:29:26.630 appointment. So they're voting with their feet. 00:29:26.710 --> 00:29:28.150 That doesn't mean they're committed to that next 00:29:28.150 --> 00:29:31.190 appointment, but they're moving in that direction. 00:29:31.430 --> 00:29:33.630 I love that you went back to a more data -centric 00:29:33.630 --> 00:29:36.029 view of it because I can tell you how I feel. 00:29:36.089 --> 00:29:38.329 These conversations are hard. I'm having to do 00:29:38.329 --> 00:29:41.190 extra work. But if the patients are reappointing, 00:29:41.190 --> 00:29:44.349 you're trending to success. Well, the other thing 00:29:44.349 --> 00:29:45.809 that's really important in our prep, I tell you, 00:29:45.829 --> 00:29:48.109 we go through a six -step process. And you'll 00:29:48.109 --> 00:29:51.740 appreciate this next one. The next one of our 00:29:51.740 --> 00:29:54.059 steps, it's actually step number two in our six 00:29:54.059 --> 00:29:57.220 -step process to successfully resign, it's to 00:29:57.220 --> 00:30:01.200 get ahead of it with marketing. I want every 00:30:01.200 --> 00:30:05.099 one of your listeners, I want you to think of 00:30:05.099 --> 00:30:07.359 your insurance adjustments from this moment forward 00:30:07.359 --> 00:30:11.259 as a marketing expense. Now, it won't show up 00:30:11.259 --> 00:30:13.420 on your profit and loss, and the adjustments 00:30:13.420 --> 00:30:15.359 are the difference between your UCR fee and your 00:30:15.359 --> 00:30:17.599 contracted fee. I want you to think of that as 00:30:17.599 --> 00:30:20.200 a marketing expense. It won't show up and your 00:30:20.200 --> 00:30:21.720 accountant won't agree with me on that because 00:30:21.720 --> 00:30:23.980 it doesn't show up on your P &L statement. It's 00:30:23.980 --> 00:30:25.740 even worse. Delta takes the money before you 00:30:25.740 --> 00:30:28.000 even get it. That's right. You don't even get 00:30:28.000 --> 00:30:29.359 to see it on the P &L. You don't send them a 00:30:29.359 --> 00:30:31.980 check. You don't even see it. I'll give you a 00:30:31.980 --> 00:30:36.859 great example. This is a new client of ours that 00:30:36.859 --> 00:30:42.180 he enters his contracted fee in his fee guide, 00:30:42.279 --> 00:30:43.700 you know, in the fee schedule as practice management 00:30:43.700 --> 00:30:45.380 software. There's two ways to enter your fees. 00:30:45.950 --> 00:30:47.990 You can enter your contracted fees or you could 00:30:47.990 --> 00:30:51.970 enter your UCR fee. I like to enter the UCR fees 00:30:51.970 --> 00:30:54.869 because then you can run a report from your computer 00:30:54.869 --> 00:30:57.150 and find out what you're writing off. Well, this 00:30:57.150 --> 00:31:00.329 doctor did it the more common way. 90 % of doctors 00:31:00.329 --> 00:31:03.670 enter their contracted fees. And so this is an 00:31:03.670 --> 00:31:08.589 office that last year in 2024 collected strong 00:31:08.589 --> 00:31:11.609 solo practice right at a million dollars. It 00:31:11.609 --> 00:31:15.210 was a little bit over a million. I said, would 00:31:15.210 --> 00:31:17.009 you like to know what you actually have to produce 00:31:17.009 --> 00:31:19.809 to collect a million? Because I wrote a custom 00:31:19.809 --> 00:31:21.910 Excel spreadsheet that will give you that answer 00:31:21.910 --> 00:31:25.589 to an accuracy of plus or minus 2%. He said, 00:31:25.630 --> 00:31:27.289 yeah, I'd love to know. So I run the numbers 00:31:27.289 --> 00:31:30.029 in there. And his practice was 80 % PPO. His 00:31:30.029 --> 00:31:32.710 average adjustment was 42%. Those are built into 00:31:32.710 --> 00:31:37.710 the equation in Excel. He had to produce a million. 00:31:37.849 --> 00:31:39.529 Let me guess. OK, go ahead. Let me guess. Let 00:31:39.529 --> 00:31:44.140 me guess. All right. 80 % PPO. 40 % average adjustment. 00:31:44.839 --> 00:31:53.460 What do you think? 1 .38. A million, 537. Wow. 00:31:53.740 --> 00:31:57.359 He had to produce a million, 537 in order to 00:31:57.359 --> 00:31:59.420 collect a million. Now, if you've just popped 00:31:59.420 --> 00:32:01.519 into this podcast and you just heard that statement, 00:32:01.539 --> 00:32:03.140 you think, wow, that office has a collections 00:32:03.140 --> 00:32:05.240 problem. No, no, no, no, no. They don't have 00:32:05.240 --> 00:32:07.960 a collections problem. They have an adjustment 00:32:07.960 --> 00:32:12.700 problem. a $537 ,000 a year adjustment problem. 00:32:13.000 --> 00:32:16.480 Now, if the doctor will accept that as a marketing 00:32:16.480 --> 00:32:20.740 expense, just, you know, air quotes, what could 00:32:20.740 --> 00:32:23.720 you do with a $537 ,000 annual marketing budget? 00:32:23.900 --> 00:32:27.099 I mean, it's obscene. I mean, you can spend a 00:32:27.099 --> 00:32:29.640 fraction of that and get a better result. Now, 00:32:29.660 --> 00:32:31.599 here's another example that I love to use. I 00:32:31.599 --> 00:32:33.539 can't use the doctor's name out of confidentiality, 00:32:33.559 --> 00:32:35.519 but I can use the situation. And the reason I 00:32:35.519 --> 00:32:37.819 love to use this is because it represents two 00:32:37.819 --> 00:32:42.190 years side by side. So in 2023, this office, 00:32:42.410 --> 00:32:44.890 a really strong solo dentist, big, strong hygiene 00:32:44.890 --> 00:32:49.549 department, was in network with 12 plants, including 00:32:49.549 --> 00:32:52.849 Delta, and stayed in network. But we timed it 00:32:52.849 --> 00:32:55.390 so that by the end of the year, by December 31st, 00:32:55.390 --> 00:32:58.529 he'd be out of network with all 12. And in 2023, 00:32:58.769 --> 00:33:02.529 this office produced $1 .9 million in real fees, 00:33:02.670 --> 00:33:06.789 in UCR fees, and collected $1 .4 million. Now, 00:33:06.809 --> 00:33:09.690 next year, we have the perfect canvas. to track 00:33:09.690 --> 00:33:11.789 it for the entire year being out of network. 00:33:12.789 --> 00:33:17.029 Okay, drum roll, please. In 2024, the office 00:33:17.029 --> 00:33:20.390 produced 1 .8. Production went down from 1 .9 00:33:20.390 --> 00:33:25.950 to 1 .8, but collected 1 .7. Eric, we're getting 00:33:25.950 --> 00:33:29.329 to know each other, but I think you're going 00:33:29.329 --> 00:33:31.410 to get this one right. Which one would you prefer? 00:33:31.670 --> 00:33:35.319 Which year would you prefer? The dream is always 00:33:35.319 --> 00:33:39.279 to work less and make more. I like the second 00:33:39.279 --> 00:33:41.279 shirt. Yeah, the second one. By the way, can 00:33:41.279 --> 00:33:44.160 you guess what the $100 ,000 difference, so the 00:33:44.160 --> 00:33:47.140 difference between producing $1 ,800 and collecting 00:33:47.140 --> 00:33:50.440 $1 ,700 was? Can you suggest? Because by then 00:33:50.440 --> 00:33:53.099 he's out of network. What was that $100 ,000 00:33:53.099 --> 00:33:57.319 adjustment? I mean, it had to be the patients, 00:33:57.359 --> 00:34:00.180 the Delta patients, right? No, it was the in 00:34:00.180 --> 00:34:01.880 -office membership plan. The in -office membership 00:34:01.880 --> 00:34:04.859 plan. I see, I see, I see. So I like the idea 00:34:04.859 --> 00:34:06.420 of an in -office membership plan because it's 00:34:06.420 --> 00:34:08.980 a great carrot to attract people that don't have 00:34:08.980 --> 00:34:11.719 insurance. And the way I typically teach that 00:34:11.719 --> 00:34:15.340 is you come up with an annual fee for two clinics, 00:34:15.440 --> 00:34:17.960 exams, and x -rays. You could add things that 00:34:17.960 --> 00:34:20.239 you want. It could be fluoride, sealants, whatever, 00:34:20.440 --> 00:34:24.340 whitening. And then we offer those patients that 00:34:24.340 --> 00:34:26.780 are part of the membership plan a 10 % savings 00:34:26.780 --> 00:34:30.000 on, and let's be honest, it's a 10 % discount. 00:34:30.579 --> 00:34:33.199 on any service in the practice. Now, Eric, I 00:34:33.199 --> 00:34:36.000 don't like the 10 % discount, but I like it a 00:34:36.000 --> 00:34:39.119 lot better than the 45 % under Delta. Yeah, and 00:34:39.119 --> 00:34:43.639 for us, as you're having those heads -up conversations, 00:34:43.940 --> 00:34:47.420 it allows you to ease the transition if they 00:34:47.420 --> 00:34:49.380 are having to pay more. I now have something 00:34:49.380 --> 00:34:51.119 else I can offer you, too. Right, and one other 00:34:51.119 --> 00:34:53.699 thing that I think will be important for your 00:34:53.699 --> 00:34:56.539 listeners, we always assume if the patient has 00:34:56.539 --> 00:34:59.139 insurance that their employer is paying for the 00:34:59.139 --> 00:35:02.590 insurance. right? As a benefit of being of employment. 00:35:02.650 --> 00:35:05.969 That's not always the case because in many cases, 00:35:06.010 --> 00:35:09.050 the employer will provide it as an option because 00:35:09.050 --> 00:35:11.710 of they have group buying power, but then the 00:35:11.710 --> 00:35:13.710 employee actually pays for it themselves in the 00:35:13.710 --> 00:35:15.909 form of a payroll deduction. And so we always 00:35:15.909 --> 00:35:18.429 ask, does your employer pay for that? Or do you 00:35:18.429 --> 00:35:20.190 pay for it in the form of a payroll? And then 00:35:20.190 --> 00:35:24.489 they'll say, well, I know it's, I see it in my 00:35:24.489 --> 00:35:28.150 pay stub. And then we say, Let me show you our 00:35:28.150 --> 00:35:30.449 in -office membership plan. You can opt out of 00:35:30.449 --> 00:35:32.210 that one. This one might be a whole lot better. 00:35:32.469 --> 00:35:35.369 Now, I have a final question for you. And my 00:35:35.369 --> 00:35:41.289 answer is one, by the way, all the time. In your 00:35:41.289 --> 00:35:46.630 experience, has anyone ever gone closer down 00:35:46.630 --> 00:35:50.630 the spectrum of fee -for -service and been like, 00:35:50.690 --> 00:35:53.070 this is not for me, and gone back? I have advised 00:35:53.070 --> 00:35:57.059 a very, very, very small, twice. I've advised 00:35:57.059 --> 00:35:59.880 clients not to do this. And it wasn't that they 00:35:59.880 --> 00:36:04.440 couldn't ever do it, but they weren't in a position 00:36:04.440 --> 00:36:08.579 now to do it. I have a quick exercise. I'll close 00:36:08.579 --> 00:36:12.840 on this. It's kind of a litmus test I use before 00:36:12.840 --> 00:36:17.119 we actually pull the trigger and resign. I call 00:36:17.119 --> 00:36:19.599 it the ultimate team meeting. You ready for this? 00:36:20.019 --> 00:36:22.880 Ready. I asked the doc, call a team meeting. 00:36:23.139 --> 00:36:27.750 It'll be by Zoom with me. don't have an agenda, 00:36:27.829 --> 00:36:30.429 just say, Gary asked us to have a meeting today. 00:36:30.909 --> 00:36:32.630 And then I open the meeting and say, guys, we're 00:36:32.630 --> 00:36:34.849 gonna do something fun today. We're gonna go 00:36:34.849 --> 00:36:38.190 around the room. We'll just go clockwise around 00:36:38.190 --> 00:36:41.010 the room with your doctor or doctors being last. 00:36:42.050 --> 00:36:46.389 And here is the game that we're gonna play. Give 00:36:46.389 --> 00:36:49.289 me one reason why a patient should come to your 00:36:49.289 --> 00:36:51.489 office for their dental care. Just one reason, 00:36:51.530 --> 00:36:53.989 anything at all. And let's start with you, Maria. 00:36:54.309 --> 00:36:57.440 And we go around the room. Okay? With doctor 00:36:57.440 --> 00:36:59.219 being last because it gets harder. Oh, and the 00:36:59.219 --> 00:37:00.960 rule is you can't repeat what someone else said. 00:37:01.000 --> 00:37:02.599 I like it. Okay, good. You cannot repeat what 00:37:02.599 --> 00:37:04.840 someone else said. One reason, it could be anything 00:37:04.840 --> 00:37:08.099 at all, small, big, in between, whatever. And 00:37:08.099 --> 00:37:10.059 we go around the room. And we're going to go 00:37:10.059 --> 00:37:12.260 around the room twice. So after we go around 00:37:12.260 --> 00:37:13.380 the room, I said, we're going to go around one 00:37:13.380 --> 00:37:15.880 more time. Now, I recently did this in a larger 00:37:15.880 --> 00:37:19.219 practice by Zoom. Between doctors and team members, 00:37:19.320 --> 00:37:24.320 26 people. 26. We go around the room and literally. 00:37:25.089 --> 00:37:27.949 Didn't miss a beat. Got to the three doctors, 00:37:28.210 --> 00:37:32.409 went around round two. So at that point, 26, 00:37:32.590 --> 00:37:36.409 we're at 52 unique answers on why a patient should 00:37:36.409 --> 00:37:38.449 come to their office for their care. And the 00:37:38.449 --> 00:37:39.750 office manager, who I'd gotten to know pretty 00:37:39.750 --> 00:37:42.030 well, says, Gary, I know you said we only had 00:37:42.030 --> 00:37:44.929 to do this twice, but I'm so confident in my 00:37:44.929 --> 00:37:48.590 team. Can we go around one more time? Knock yourself 00:37:48.590 --> 00:37:52.000 out. We went around it one more time. That's 00:37:52.000 --> 00:37:55.739 so cool. 76 unique answers. And remember, that 00:37:55.739 --> 00:37:58.239 just arms every team member when they're talking 00:37:58.239 --> 00:38:00.760 to their patients about why they should stay 00:38:00.760 --> 00:38:05.260 here. And so I've never had this happen, but 00:38:05.260 --> 00:38:07.900 imagine that I was doing this and say it was 00:38:07.900 --> 00:38:11.739 a team of 12. And we get to team number four 00:38:11.739 --> 00:38:15.659 and we get crickets. We got crickets. We got 00:38:15.659 --> 00:38:19.340 nothing. Guess what? We're not ready to go out 00:38:19.340 --> 00:38:21.599 of network. That's right. You can't articulate 00:38:21.599 --> 00:38:27.260 the R value proposition or RY, whatever gets 00:38:27.260 --> 00:38:29.480 you up in the morning. You're probably just there 00:38:29.480 --> 00:38:31.199 for a paycheck. You're there for a paycheck. 00:38:31.519 --> 00:38:33.840 But when you have a relationship -driven practice, 00:38:33.900 --> 00:38:35.960 when you have a team that's all on the same page, 00:38:36.019 --> 00:38:38.840 committed to the vision of the practice and knowing 00:38:38.840 --> 00:38:42.380 their roles, knowing how they fit as a spoke 00:38:42.380 --> 00:38:45.900 in the wheel. and truly having a connection with 00:38:45.900 --> 00:38:49.679 patients. It's the 80 -20 rule. You're definitely 00:38:49.679 --> 00:38:53.280 generating 80 % of your profit from 20 % of your 00:38:53.280 --> 00:38:56.260 patients, and conversely, you're generating 80 00:38:56.260 --> 00:38:58.980 % of your discord by 20 % of your patients. It's 00:38:58.980 --> 00:39:02.019 really joyful work, and it's fun to see team 00:39:02.019 --> 00:39:05.420 members get engaged and understand. That last, 00:39:05.539 --> 00:39:08.480 that ultimate team meeting is a lot of fun, and 00:39:08.480 --> 00:39:10.119 it's cool to see some of the things they come 00:39:10.119 --> 00:39:14.480 up with. And when, you know, I said we went around 00:39:14.480 --> 00:39:17.519 the room and had 76 unique answers in this office. 00:39:17.539 --> 00:39:20.599 And the doctor said, oh, my gosh, we should have 00:39:20.599 --> 00:39:22.699 done this a long time ago. We should have bailed 00:39:22.699 --> 00:39:24.800 on these plans a long time ago. When we're working 00:39:24.800 --> 00:39:26.619 on an account together, Gary, and we're doing 00:39:26.619 --> 00:39:28.380 the marketing, I want you to send me that meeting 00:39:28.380 --> 00:39:30.900 because that's marketing gold. Yeah, that would 00:39:30.900 --> 00:39:33.519 be a blast. But it is very important to get your 00:39:33.519 --> 00:39:37.840 marketing ahead of it. You want to replace people 00:39:37.840 --> 00:39:40.369 that you're going to lose patients. I wish I 00:39:40.369 --> 00:39:41.449 could tell you there's a way to do it and not 00:39:41.449 --> 00:39:43.030 lose patients, but I've never seen that happen. 00:39:43.130 --> 00:39:45.429 But the goal is to minimize the loss of patients. 00:39:45.670 --> 00:39:48.969 But if you can replace those proactively through 00:39:48.969 --> 00:39:52.369 marketing, which you know, then you're set up 00:39:52.369 --> 00:39:57.150 well to navigate this. The mistake is to deal 00:39:57.150 --> 00:39:58.969 with maybe you think, well, I've never needed 00:39:58.969 --> 00:40:00.849 marketing. It's because you're listed on Delta's 00:40:00.849 --> 00:40:03.670 website. But as soon as you get delisted, then 00:40:03.670 --> 00:40:05.510 you need another source, which I'd much rather 00:40:05.510 --> 00:40:08.530 go to Google than Delta anyway. And the truth 00:40:08.530 --> 00:40:09.690 of the matter is you're not going to have to 00:40:09.690 --> 00:40:11.909 put that much money behind it. Most of our practices 00:40:11.909 --> 00:40:14.449 are somewhere in the 3 % to 5 % collections. 00:40:14.469 --> 00:40:16.349 Well, and compare that to that office that was 00:40:16.349 --> 00:40:20.510 $537 ,000 a year in adjustments. Yeah, yeah. 00:40:21.110 --> 00:40:23.090 It's going to feel like a big bill because you've 00:40:23.090 --> 00:40:25.369 never paid it for a minute. But in reality, it's 00:40:25.369 --> 00:40:29.050 an investment into yourself. You and I are on 00:40:29.050 --> 00:40:31.949 sync on marketing budget. I'd like to spend as 00:40:31.949 --> 00:40:34.230 little as I need to to produce the quality of... 00:40:35.000 --> 00:40:38.539 That's right. But 3 % would match up with a practice 00:40:38.539 --> 00:40:41.579 looking for, say, a single -digit percentage 00:40:41.579 --> 00:40:44.199 growth every year. That's right. And if you're 00:40:44.199 --> 00:40:45.960 looking for more aggressive growth, like 10 % 00:40:45.960 --> 00:40:48.119 or more, closer to 5%, somewhere between 3 % 00:40:48.119 --> 00:40:52.880 and 5%. And when you compare that to 45%, you 00:40:52.880 --> 00:40:57.039 know, it's an easy math equation. That's right. 00:40:59.420 --> 00:41:01.960 We need to change the paradigm of how we think 00:41:01.960 --> 00:41:04.679 about those numbers because one of them is a 00:41:04.679 --> 00:41:08.559 bill and the other is an investment. And there's 00:41:08.559 --> 00:41:10.679 so many ancillary benefits, too. If you're growing 00:41:10.679 --> 00:41:13.679 and you're maybe looking for an associate doc, 00:41:13.900 --> 00:41:16.800 imagine the difference recruiting a dentist into 00:41:16.800 --> 00:41:19.260 a fee -for -service practice or a reduced insurance 00:41:19.260 --> 00:41:22.539 footprint practice. Those associations are thin 00:41:22.539 --> 00:41:26.400 on the street. They're unicorn practices. Imagine 00:41:26.400 --> 00:41:28.929 you're recruiting. Imagine your ability to… to 00:41:28.929 --> 00:41:30.849 hire quality team members when you have a budget 00:41:30.849 --> 00:41:34.570 to pay them well. All of this, it just has, you 00:41:34.570 --> 00:41:37.170 know, it's the domino that falls that allows 00:41:37.170 --> 00:41:39.929 you to do all these other things that make your 00:41:39.929 --> 00:41:43.150 environment so much more positive for attracting 00:41:43.150 --> 00:41:46.389 and keeping quality team and doctors. Gary, thank 00:41:46.389 --> 00:41:48.489 you so much for your time. I appreciate you. 00:41:49.929 --> 00:41:52.190 Well, it's mutual. This has been a lot. It's 00:41:52.190 --> 00:41:55.589 fun to be on the other side of the mic. Usually 00:41:55.589 --> 00:41:57.409 I'm the one asking the questions, but it's really 00:41:57.409 --> 00:41:59.150 fun to be on the other side of the mic. I'd love 00:41:59.150 --> 00:42:03.210 to join you for a future one as well. But I'll 00:42:03.210 --> 00:42:05.849 provide some contact information for the show 00:42:05.849 --> 00:42:08.269 notes for you and just let your listeners know, 00:42:08.329 --> 00:42:10.510 please feel welcome to stay in touch. I would 00:42:10.510 --> 00:42:12.070 love the opportunity to hear from any of you. 00:42:12.329 --> 00:42:13.909 We'll provide that in the show notes. But in 00:42:13.909 --> 00:42:15.070 the meantime, thanks so much for the invitation. 00:42:16.010 --> 00:42:17.989 Gary, thank you for your time. It's been a pleasure.