How to Start Your Own In-House Dental Membership Plan

Do you tend to take insurance providers for granted? After all, it’s a system we are so accustomed to, even if most of us often complain about it.

In this week’s episode, I challenge you to shift your perspective to realizing that cutting out middlemen will not result in a drop in your revenue, on the contrary. Boomcloud founder, Jordon Comstock, shares his expertise on how to get started and what to keep in mind.

Key takeaways:

  • The dental insurance industry is deeply flawed, but there’s something else arising at the horizon
  • Generating recurring revenue stream will increase the valuation of your practice
  • Membership plans vs in-house financing

It all started with realizing that the dental insurance industry is deeply flawed

Jordon realized that many dentists in Utah, US, were complaining about dental insurance. He said to himself that there must be a better way to help dentists manage dental insurance.

One day he went into a dental practice and saw that they had an in-house membership plan. This happened right after he had read the book “The Automatic Customer”, which teaches business owners how to generate recurring revenue.

Jordon’s idea was just a side gig in the beginning and quickly expanded into a profitable business.

Would the concept of dental savings plans work for specialists?

Specialists cannot really have an in-house membership plan because they don’t have a regular flow of customers.

If you are a specialist, you basically have two options:

  • Go for a discount plan. If you are interested in doing that, you should first check the regulations in your state. Discount plans work by having patients pay a monthly fee in order to get a percentage discount off your service.
  • Go for in-house financing. The way this works is if a patient cannot afford a service, you can break out the payments, and then collect interest on these payments. This enables the patient to get treatment, and you get to increase your profit.

The idea is to generate recurring revenue stream

Boomcloud doesn’t currently have a credit check, but Jordon is looking at implementing that in the future. There are currently many third-party software that you can use.

Most dental practices choose to create a payment plan or a membership program. Jordon’s software allows bank transfers from the patient’s bank account to the practice through auto debit. Auto debit is not risky and it’s also quite cheap when it comes to merchant fees.

Jordon wants to help practices generate a recurring revenue stream through in-house financing or an in-house membership program.

If you are a dental practice owner, you should really look into this, because the larger recurrent revenue you can get, the more valuable your practice will become from a valuation standpoint.

Membership plans help increase the valuation of your practice

Generating recurrent revenue increases the valuation of your practice. This recurrent revenue can be valued at four to six times annual recurring revenue, instead of discounted.

When the time comes to sell your practice, you can easily tell the next buyer “This is the recurrent revenue stream that we’re generating. It’s predictable, we have a track record.” If you’re using the Boomcloud software, you also have a projection of cash flows on your dashboard.

If you prefer to keep your insurance system, you can try and renegotiate the terms in order to get a better deal.

Jordon’s colleague Ben Tuinei is the President of Veritas Dental Resources. Through Veritas, Ben helps practices negotiate insurance fees and get better rates.

If you’re a practice owner interested in either negotiating fees or separating yourself from your insurer, you should check out Jordon and Ben’s podcast, Say No To PPOs.

So we’ve convinced you to give membership plans a try. What should you do first?

If you are thinking of giving membership plans a try, you can first speak to your clients and see if they are happy with their dental insurance. Odds are most of them are not. Some may not even know which insurance they have because their employers purchased it for them.

You can then start creating an in-house membership program targeting uninsured patients. Nowadays uninsured clients are more numerous than insured ones. Together with Jordon you can develop a savings plan and start signing up uninsured patients.

The next thing you could do is to focus on an external marketing strategy to attract more patients to the membership program.

Don’t forget to check the regulations

So essentially what Boomcloud is doing is providing an in-house insurance program for the patient, rather than allowing the insurance company dictate its terms. They are cutting out the middleman.

It’s important to remember to check the regulations in your state. You can find many resources on Boomcloud’s website. Lately, Jordon has been working with attorneys in order to understand the laws that are out there. Together with his attorneys, he found a few laws that actually allow practitioners to bypass any type of insurance regulation with a legal agreement.

This agreement is typically called a medical retainer agreement, or a direct patient agreement. It’s a new movement happening in the US. The majority of the US states have so-called DPC (direct primary care) laws that allow dental or medical practitioners to bypass insurance regulations.

In the medical field, this practice is called concierge medicine. Dental practitioners call it a dental savings plan or a membership program. It’s basically the same thing.

The movement towards cutting out insurance companies in the medical industry, from dentistry to vets and optometrists, is growing larger and larger. It’s time to rethink your business plan and head for the future.

Want to receive our podcast on a weekly basis? Subscribe to our newsletter!

How to Take Your Dental Practice From Solo to DSO

Episode 091

This week I am joined by Brian Colao, Director of the leading US law firm Dykema. The firm handles the legal intricacies of expanding your business to a DSO. They offer advice on what practices are best for your business. On episode 91 of Business of Dentistry we specifically talk about how to take your dental practice from solo to DSO.

More About Business of Dentistry

Today Brian and his staff represent 350 group practices and DSOs in all 50 states. They handle any and all legal matters regarding compliance that could impact a group practice or a DSO. They help solo practitioners roll their organizations up to affiliate with DSOs, or he helps them get set up to do private equity deals because that’s the way the industry is heading. But if a solo wants to stay solo Dykema can help with any legal issues that affect their practice.

The first step to going from a solo to a DSO is to create a plan for expansion, and have your financing in order. You can do this either through bank financing or groups that offer DSO-specific financing like Citibank. As soon as a solo practitioner has lined up adequate financing to start acquiring or opening up additional offices then it’s appropriate to restructure as a DSO.

When I asked Brian to give a ballpark on how much capital is needed to begin a project like this, Brian says there are many variables that will determine the amount. It depends on where you are expanded, and what geographic part of the country you are in. An example is Dallas, Texas, where he is from, the general rule of thumb there is half a million dollars per de novo office.

As far as acquiring practices, the financing needed could be anywhere from a couple hundred thousand dollars up to 7 figures (depending on how big they are).

If your plan is to acquire as you can afford it, it becomes difficult to hit critical mass. You have to decide if it’s appropriate to take on non-dental investors and establish 15 or 20, rather than one or two at a time. It depends on your preference for your expansion plan.

I also asked him what most of his clients have as their end game, and he says the end game for everybody is to roll it up and sell it.

But how you get there depends on how much fun you are having in your current position. He knows a lot of young, aggressive people who are in their 30s now, and want to roll up and sell so they are financially secure by the time they are 40. They go for as much financing and/or investor funding as they can get so they can grow their organization go from 5 or 10 to 25 or 30.

You can’t typically fund a plan like that yourself, unless you are independently wealthy. A solo doctor would have a very difficult time doing so on their own without some type of outside investment. But if you are adding one or two a year and having fun there’s no rush to do anything differently.

The range for the final sum when selling also varies, according to Brian. If you are doing a deal with an established DSO, a national DSO, it’s probably around 5.5 to 6.5x EBITDA (Earnings before Interest, Tax, Depreciation and Amortization).

Now that’s a conservative deal. The multiple is lower in this type of deal but your future participation is limited. You can stay and exit after a few years

If you’re looking for a higher return (which also carries a higher risk) you’ll want to consider doing a private equity deal. Some of those have paid as much as 18x EBITDA!

But they require substantial future investment. If you do a deal like that you’re going to have roll over up to 40-45% of the amount you get paid as a reinvestment into the new entity. You’ll also have to hang around for up to another 5 years. And the future of how you do it and what your return is depends on the operators, the dental entrepreneurs’ continued involvement in growing the organization.

No one is going to give you a 14 or 15 multiple to exit your practice on the spot! You have to stay involved and be in a leadership role. In his experience this type of deal isn’t generally for dentists who are older because they don’t typically want to stick around that long.

Our next topic is what happens and what it means when you reorganize from a dentist-owned practice to a DSO. To put it simply you split the clinic from the administrative. The dentist still practices dentistry and the dental practice or the clinical entity is still going to employ all the clinical personnel. But all of the non-clinical administrative support functions and non-clinical employees will be performed and operated by a management entity rather than a practice.

Usually these organizations are legally structured as LLCs, you can set up as another entity but these tend to be the most advantageous tax structures for these type of organizations. Brian also explains why you shouldn’t do a C corp and why you should convert if you are a C corp right now.

We wrap up by talking about the first steps to take if you want to do this: set up a plan for your expansion. Think about and decide if you want to stay in your state, or go regional. You’ll want to know many offices you expect to have for the next 5 years. And you’ll need to answer other questions like who is your target market, do you own all of your equipment and do you own the trademark for your business name?

Once you have these questions answered and your plan is in place Brian shares what happens next, and why a dentist-owned DSO is easier to work with than a non-dentist-owned. Join us for that and more on episode 91 of Business of Dentistry!

 

Tweetable: “The end game for everybody is to roll it up and sell it.” 

Episode Resources

Dykema’s DSO web site
Email Brian
Email me

Business of Dentistry on Facebook

Connect with me on Twitter

Track CE With Sarah Thiel, RDH of CE Zoom

Episode 090

This week on episode 90 of Business of Dentistry I talk with Sarah Thiel, RDH of CE Zoom. We have a great conversation about finding and tracking continuing education through her company CE Zoom. We also touch on how you can set up your course to provide credit through AGD PACE. Worth a listen. Thanks, Sarah – very nice to finally meet you.

More About Business of Dentistry

CE Zoom has been in business for 3 years and I’ve been a subscriber since 2016, so I was curious to know how the company came about. When I asked Sarah about it she explained she started dental hygienist school so she could have time for her family, while still making a good income. After completing her education she got a job working 2 days a week, but she had a hard time remembering to get her credits. Her focus was on taking care of her patients and her family.

One day about eight years ago she realized her license expired in four months and she hadn’t done any CE! At the time she lived in rural New Mexico and had no idea where was going to get the necessary credits. She was also 8 months pregnant.

Fortunately she found a conference in Albuquerque, three hours from her home. It was expensive, but she knew she had to do it. So she paid for it, attended and completed the entire conference. As she was walking out the door with her hands full of conference materials, including her certificate for her CE credits, winds kicked up and snatched paper certificate!

She knew she had get it so she dropped everything, took her heels off and ran after it – despite being 8 months pregnant at the time! She did chase it down, but the entire experience was so challenging she wondered if it wasn’t a sign to stop being a dental hygienist.

And she also wondered why were they still relying on paper for something so valuable? Why wasn’t it being done electronically? Everything else could be done online so why couldn’t this? On and off over the next few months she searched for a solution, but she never found one.

When her renewal notice came in the mail, she received yet another push to do something about the CE paperwork situation.

By this time she had given birth to her daughter so she had a four-year old daughter and an infant at home. She took her paperwork and set it down while she attended to something her baby daughter needed. In the mean time, her eldest daughter spilled chocolate milk and saturated Sarah’s certificate. The milk saturated her paperwork so badly she couldn’t decipher some of it. And that was the last straw!

A few months later she was visiting with her brother in Utah when he told her his business partners build apps. A light bulb went off and she knew it was time to take action on her idea.

Despite her brother’s protests, she contacted his business partners. She didn’t work with them but it gave her the idea to do it herself and the push to move ahead. It all came together when Cat, her old boss and now business partner, called her and said she wanted to create it with Sarah. Together they began building it and two years the state-specific CE Zoom was complete.

When telling the story of how CE Zoom came to be Sarah also mentioned she is the vision behind the company and her business partner Cat is the details person, so I asked her about the future vision for CE Zoom.

Sarah says there are big contracts in the works, soon they will be on the map for the entire country! Once that is tied up, they’ll move on to DSOs to help them track their employees’ certifications and CE credits.

Once dentistry is fully built and operational they plan to move into all professions. They have about 120 different professions that have reached out to them wanting their services, everyone from CPAs to firefighters to real estate professionals.

On today’s episode we also talk about we talk about how she met Cat, why I signed up in 2016 and how we finally met in person without knowing it! Sarah is an inspirational powerhouse, tune in to hear more from her about CE Zoom and how their company is helping the dental industry on episode 90 of Business of Dentistry.

Tweetable: “It isn’t something most people know because it’s not taught
in dental school or hygienist school.”
 

Episode Resources

CE Zoom web site
Email me

Business of Dentistry on Facebook

Connect with me on Twitter

Illusion Of Control Is A Dangerous Thing With Dr. Justin Bhullar

Episode 089

This week we have a conversation with Dr. Justin Bhullar. He has some great insight on running multiple practices plus he is just an all-around cool guy. Take a listen on episode 89 of Business of Dentistry.

More About Business of Dentistry

Dr. Justin and I met while looking for the hotel gym one morning before the Voices of Dentistry conference began for the day. We started chatting and it felt like we were on the same wavelength right from the start, which is why I’m really glad he sat down with me for today’s conversation!

Dr. Justin is from British Columbia, Canada and went to the University of Saskatchewan where he studied Biochemistry and Dentistry. Today he owns multiple practices – scaled down from nine offices to four core offices. He did so with the principal goal of getting his life back. He explains that when you scale a business all your small problems are magnified.

He loved what he was doing but he still had to look at where he had to set firmer boundaries. He found a better way by scaling down, and creating more time for himself. Now he does clinical work two days a week and the other three days are left for focusing on the business aspects of his practice.

He’s been able to do so because he has a partner, associates, and great relationships with other doctors; Dr. Justin says these people are the reason he’s able to do what he does today.

Along the way he’s had to learn how not to micromanage, something dental school seems to set dentists up to be! Because dental school trains you to follow a cookie cutter recipe for everything it gives you the impression of control.

However none of us actually have control over everything so you have to delegate and automate wherever you can. You also have to take a step back in situations and ask if you are the right person to be doing what you are doing, or is there someone better suited to the task?

In general there are three questions to ask yourself when doing a task: do you enjoy it? Is there someone else who is stronger in this area who could be doing this? And is this going to bring you new patients, increase the revenue of this business and/or contribute to the growth of the business? If the answer is no to any question, especially to the last one, then you need to step back and have someone else do it for you.

We also touched on annual reviews and why we’re both changing to different ways of managing our teams performance. At the heart of it all Dr. Justin explains it is about effective communication and leadership.
As the leader of your practice you have to be able to support your team, and hold them accountable – but this is only possible through effective communication.

If someone isn’t doing an aspect of their job as well as is needed, we have to ask ourselves if we have talked to them about it and if we have taught them how to do what they are being expected to do. For example, you can’t discipline your child for not making their bed if you didn’t show them how to make their bed in the first place!

A better solution is to talk with that person and explain you have a certain goal and that goal will be measured in specific ways. Then make sure they are clear about the goal, the measurements to achieve that goal and the expectations involved. When you do all of that you’re being transparent with your staff and setting them up in the best possible position to achieve goals and for everyone to win.

You can also ask yourself: is it a training issue or a discipline issue? They are handled differently. If you’ve asked someone to do something but haven’t given them the tools or resources or guidance to do it properly and to do it in the way expected of them then it’s a training issue. And training issues fall on the shoulders of each of us as the practice owner.

The discipline issue happens when someone has the knowledge and the tools, but is still choosing not to do the task properly. How that situation is handled is quite different than a training issue. Personally I’ve found most of the time it’s a training issue and it’s my fault!

We also dig into the topics of why and how failure can be a great learning tool, why you have to be self-aware and take accountability for what isn’t working. We wrap up with how Dr. Justin turned his own health around, and why health is the cornerstone for all of us to be the best person we can be professionally and personally. Join us for all of that in our conversation today on episode 89 of Business of Dentistry!

Tweetable: “Look within before you look outwards for why things aren’t working.” 

Episode Resources

Dr. Justin Bhullar’s web site
Extreme Ownership, by Jocko Willink and Leif Babin
Email me

Business of Dentistry on Facebook

Connect with me on Twitter
Leave a review and subscribe on iTunes

15 Minute End Of Year Review

Episode 088

This week on episode 88 of Business of Dentistry I recommend 5 items for a quick end of year review of our practices. This snapshot will give us a look at where we have been. It will also give us an idea of where we want to go moving forward. Happy New Year!

More About Business of Dentistry

Typically I don’t dwell on new year’s resolutions, I set goals but I don’t focus on that at the first of the year. Today we’re going to look back – not to regret what we didn’t do but to give us a start to the new year. We can look at what we didn’t accomplish as information that helps us determine which way to go this year. It’s looking back to look forward!

On today’s episode I’ll cover 5 quick points to look at the big picture at the end of the year. The first is where did you start last year with your team? How many did you have at the beginning of the year and how many were with you at the end of the year? How many are the same team members, and how many transitioned out of your practice and into other work environments?

Personally I started with ten and ended with ten, but two transitioned out and two new people came in.
I look at this information because I believe stability in a team leads to success. It also gives you an indication of what kind of leadership you are giving and how you are taking care of your team. How you treat your staff impacts how your clients are treated, all of which impacts your long-term success.

In my case I had a 20% transition rate – I don’t think it’s too bad although I’d prefer to have zero! The two team members who left did so for different reasons.

One left to work in her children’s school as an administrative assistant. She wanted to be off when her kids were off and working when her kids were in school. Because I couldn’t offer her that type of schedule, I understood and we left on mutually good terms.

The second person was also working in an administrative role in my office. She gave her two week notice and was a bit upset when she did. She left because I brought a newer surgical assistant from a part-time position to a full-time role, because one of my other surgical assistants was out on maternity leave.

When I did that this administrative person was upset and found another job working on the clinical side. She was trained in both the clinical and administrative side of dentistry, but I didn’t talk to her enough to know she wanted to work on the clinical side. So  her leaving was on me, that was my responsibility as a leader.

Which leads to point #2: reduction, controlling overhead and spending in my practice. I had some goals in this area and we were close to reaching them. I’m still waiting on some final numbers to come back but I believe we will have a 3.5% reduction in my practice’s overhead. I know that may not sound like a lot to some people but I think about it like a 3.5% raise!

This second point also leads to our final three: production, collections and time off. This year I had a 1.6% increase in production (or charges) over last year.

It isn’t very much nor is it impressive. In fact I was disappointed in it. Then I compared it to collections, where we had a 1.4% increase – nearly the same.

The real factor that made me feel better though was I reduced my hours; I shaved off nearly an hour every day and took 16% more time off compared to last year. Those numbers tell me I worked 16% less but still increased production and collections and reduced my overhead – all of which are positives!

Those are all things to think about: team transition, overhead reduction, production, collections, and time off. I believe they give you an indication of what worked, what didn’t and where you want to go this next year. Take a look at these five areas in your practice and let me know what you find, after you listen to episode 88 of Business of Dentistry!

 

Tweetable: “Look back to look forward!” 

Episode Resources

Voices of Dentistry Summit 2018
Email me

Business of Dentistry on Facebook

Connect with me on Twitter
Leave a review and subscribe on iTunes

Schedule Like A CEO

Episode 087

We’re back after some time away from the podcast. This week we discuss a way to schedule our upcoming year like a CEO. We also talk about some ways to improve management of our email and team projects on this episode of Business of Dentistry.

More About Business of Dentistry

It’s the end of the year and I wanted to mention to you three things I’ve implemented as policies. The first is scheduling like a CEO. CEOs schedule months in advance, some as far as 18 months ahead of time. While we typically can’t do this with patients we can schedule our personal commitments in advance. We can put the big rocks in first, so to speak.

In our office I have a policy to go into the practice management schedule at the end of every December and look at the holidays for the upcoming year. Then I’m supposed to decide how many days off we are going to take around those holidays. For some it’s just one day, and for others it is multiple days.

I do that by the end of December so my entire staff can look at the schedule and make plans in advance for vacations and other time-off requests. This is the fourth year we’ve been scheduling like this and it has been working well.

Another thing we do is to plug-in fall breaks and spring breaks for the local school systems. They are important for those of us on the team with children, we want to plan for time off with our families.

The breaks are also important because it’s typically a highly productive time for the office. Fall and spring breaks are when many people want to schedule wisdom teeth removals and other surgeries; we need to know when these breaks will happen every year so we can schedule accordingly.

Finally, in my particular case, I have my Navy reserve obligations so I plug in the dates I know I will be away fulfilling those duties. You may have other commitments like conferences you know you are attending. You want to input those dates as far in advance as possible. For me I already know I have some conflicts with patient appointments, but I have caught those conflicts far enough in advance that we can reschedule easily ahead of time.

To actually add these dates I go through my calendar month by month. I look at which holidays fall in that month, and then I ask if I will be off on that particular holiday. Then I go back and look at any CE, conferences or Navy commitments, I add them to the calendar. Next I look at the spring break and fall break dates and add those.

If you look at this particular way of scheduling, this allows you to put in the most important things like time with kids, holidays, vacations and get them scheduled ahead of time. Doing so lets your team know those dates and plan around them. It will lessen your stress and your team’s stress, everyone can work out their requests for vacations and holidays well in advance and you all can avoid a lot of unnecessary conflict.

The second thing I have started doing is a personal policy regarding checking email. I’m constantly checking my phone and my desktop to see what emails have come in. I’ve decided to reduce this as much as possible since it is such a distraction. Someone I have been following about this topic said checking your email constantly is like running to the mailbox every two or three minutes to see if the mail has come!

So turn off notifications and schedule a specific time every day when you check emails. It could be first thing in the morning, over lunch or before you leave the office. Just pick a time and block it off to take care of email, and then focus only on email at that time.

Finally a third policy I’ve been following is to communicate drop dead dates and deadlines with my team. This is something I’ve been good at with my military team but haven’t done so well with in the office. You may already do this but this is something I am working on getting better at now.

Those are the three things I am focusing on going forward: scheduling like a CEO, managing email better, and setting deadlines for my office team.We will see how these all work out and will adjust as necessary.

Listen to today’s show to hear those details plus a listener shares what they are doing regarding free consults and no shows. Check it out on episode 87 of Business of Dentistry!

Tweetable: “Checking email constantly is like running to the mailbox
every few minutes to see if the mail has come!” 

Episode Resources

Voices of Dentistry Summit 2018
Email me

Business of Dentistry on Facebook

Connect with me on Twitter
Leave a review and subscribe on iTunes

FREE Consults – What Say You?

Episode 086

What are your thoughts on FREE consults for patients? This is a question I tackle (sorry, I don’t have the definitive answer) in this week’s episode of Business of Dentistry.

More About Business of Dentistry

We are dealing with a concern about free consults in my practice. In general, I’m not a big fan of giving free things from my practice. Some people think free consults are loss leaders. The idea is to give free exams to get people in the door and when they meet your staff and you and go through your customer experience  they will come to you for their future dental needs.

While I understand the concept, I think if you give something away for free people will value it and perceive it as not being worth anything. Plus consumers today are savvy, they know there is a catch to giving away an exam for free. And I think we are diminishing the value of the service we provide.

I say all of that to get into why I brought this up in the first place: we are giving away free consults for anyone looking to do dental implants.

We do a free CT scan and a free consult which is typically close to an hour to 1.5 hours of our time. Most of that is done by Meredith, my implant treatment coordinator. I come in and go over specifics as it is necessary. But regardless of who is with the potential patient we don’t charge for any of our time or our efforts.

Now our office is unique in that we do oral surgery and we get referrals from other practices for oral surgeries. We do free consults for those referrals.

But somewhere along the line people started to think we did free consults for everything. We don’t. But we have policies that conflict with each other: if you come in to talk about removing your wisdom teeth then you’ll get an office visit and will be charged for it.

But if you come in for a dental implant visit then you will get a free consult. There’s a conflict there.

In addition to the conflict in policies, another problem with free consults is we diminish the value of the implant itself.

Compounding these two issues is yet a third problem: today we get a lot more traffic online and we are getting more direct referrals as a result. We are getting people, people I call “free agents”, who are interested in dental implants and sign up for the free consult right away.

But a lot of these people don’t show up for their free consultations, as opposed to the people who are referred to us. Referrals typically show up, but the people who find us online often are no shows.

We don’t have a good process in place to pre-screen dental implants. If we had a better pre-screening process I think we could find out from people if they can afford to pay for the implants or not, and talk to them about how they expect to pay for it. Many people think Medicare will cover it because it’s a surgical procedure, but that’s not always the case.

So if we pre-screened potential dental implant patients better we’d clear up these issues and we’d avoid the no-shows and giving away our time for the consults.

What we are thinking about implementing is a consultation fee, a flat fee that includes our time plus the CT scan. People in my area are charging anywhere from $250 to $350. We are considering charging a fee in that range, but then crediting that fee back to the cost of the implants after people have the procedure done.

In essence it’s a free consult but it’s on the back end of the procedure, after the patient has followed through. But if the person opts not to do the consult then it’s a fee they have paid, and at least we have been compensated for our time and efforts.

We are considering doing this so I’d appreciate your feedback and would love to hear what you are doing and what your experiences are with free consults. Shoot me an email or leave a comment below and let me know if you have been through this and what you have done after you join me on episode 86 of Business of Dentistry.

Tweetable: “We have to bring value to our patients.”

Episode Resources

Voices of Dentistry Summit 2018
Email me

Business of Dentistry on Facebook

Connect with me on Twitter
Leave a review and subscribe on iTunes

Dealing With “No Show” Repeat Offenders

Episode 085

Some frustration behind the mic this week as I discuss having a repeat “no show” offender that found her way back on my schedule on episode 85 of Business of Dentistry.

More About Business of Dentistry

This is about a patient interaction I had, I want to know how you would respond. I have a policy we created a year or two ago so my team would know what to do in the event of a no-show or last-minute cancellations. It’s simple: 3 strikes and you are out. If you can’t be here, you cancel, or you don’t show up 3 times then you can’t get back on the schedule. I don’t think it’s harsh, even though some may think so.

We do have exceptions, if someone understands the impact of not showing up and want another chance we’ll allow them to prepay for their visit and reserve time on my schedule. Many people have done this and we haven’t had too many issues.

But this past week we hit a little bump. We had a patient on my schedule again after this person had cancelled or not shown up for 7 appointments over the last year or so.

You can imagine I almost went bonkers when I saw this person was on my schedule. I couldn’t understand why because I had specifically put an alert into our practice management software for this person’s name. The alert said this person was to receive no more appointments! And it had my name attached to the alert so my team would know the directive came from me.

My team overrode that alert and put her on the schedule anyway. When I asked around why this happened no one could give me a good reason. As I put this episode to air I still don’t know why this patient was on my schedule, even though I explicitly said not to allow her in again.

So this patient came in and I talked with her. I asked her several times if she is ready for this treatment and ready to follow through this time. She said yes.

I asked her to be sure because she has cancelled at the last minute or not shown up for 7 previous appointments. She again said yes she was ready to go ahead. I said okay, and told her my team would be in shortly to talk with her about insurance coverage and the like.

I then told my team we needed a 50% nonrefundable deposit for this patient’s procedure before setting an appointment date. I thought that would ensure this patient had some skin in the game. But at the end of the meeting when all was said and done, this patient didn’t set up an appointment.

I’m bringing this up because these are the types of things that kill me on the business side. I understand taking care of patients is important, but sometimes people don’t respect our time or the value we bring.

So don’t be like me and see someone who has cancelled 7 times previously.

My other issue with this experience is that my team basically ignored me and couldn’t give me a reason why they allowed this person to be on the schedule again.

By our office rules this person should not have been on the schedule. And I understand it can be difficult, sometimes people on the phone are pushy, or they give sob stories or all kinds of other reasons about why they need to be on the schedule.

But we can’t allow this, unless we have a very good reason. As the owner of your business you should be allowed to make an exception to a rule or policy or guideline in your practice. Be sure to write it down with input from your team. Don’t make changes based on emotions but on objective data, otherwise it will confuse your team, your patients and potential referrals.

So visit or revisit your policy on no-shows, cancellations, missed appointments. Do cancellations need to be done more than 24 hours before the appointment? Three days before? A week before? How do you define an acceptable cancellation timeframe? Whatever your window for cancellations, you also need to look at how effective you are at refilling that slot in your schedule and adjust accordingly.

These are important areas to look at in your practice and they are also important for your mental health!

To wrap up today’s show I share the three responses to have in a situation like this and the most important thing to learn from these types of experiences. Join me to hear those takeaways on episode 85 of Business of Dentistry.

Tweetable: “Perfection is a journey, not a destination.”

Episode Resources

Voices of Dentistry Summit 2018
Email me

Business of Dentistry on Facebook

Connect with me on Twitter
Leave a review and subscribe on iTunes

What Would You Do If You Couldn’t Practice Dentistry?

Episode 084

A happenstance meeting in a Mexican restaurant prompted this question. How would you answer? Listen to this week’s episode of the Business of Dentistry as we discuss my take on this topic.

More About Business of Dentistry

There’s a little Mexican restaurant near my office and a few times a month my office manager Paul and I go there to talk politics, business, shop, etc. We did the other day and a conversation we had with our waitress opened my eyes to a few things.

This woman was someone who had waited on us before. She spoke broken English but spoke Spanish perfectly. Something about her made me think she was from somewhere other than Mexico, somewhere like Central America or South America, and I said as much to Paul.

Because Paul is pretty direct and to the point he asked her where she was from when she returned with our drink order. She said she was from Venezuela. Paul continued talking with her and asked about her country. She described to us how it was poorly run, the food supply wasn’t great nor was the water, and the electricity was spotty.

As she left us to take care of another customer I thought she said (in Spanish) that she had been a dentist in Venezuela. When she came back to check on us, she used her phone to show us photos and videos of her working as a dentist in her home country. From what I could understand from her story, the military had come in and forced out all the civilian dental care providers and took over the hospitals. They sent her packing, basically.

Listening to this woman’s story put things in perspective for me. It wasn’t a great week at my office, we had some patient issues and other things. But hearing what she went through got me thinking about what would happen if I couldn’t be a dentist next week or three months from now.

Imagine if you were to go from a good profession like ours to not being able to do your work. Where would you go? What would you do? Some of us would be devastated if we couldn’t continue in our profession. Personally, I began wondering what would I do if I couldn’t do this. Would anything pay as well as this career? What kind of work would I do – would it have to be manual labor or could it be something more intellectual?

It also made me think, as a single practitioner in a private practice at the age of 50, what is my long play on this? I realized I don’t have a secondary source of income or another source of income. I’ve got all my eggs in one basket and I started wondering about different ways to add to my income streams.

This conversation made me think about this topic a lot: how would I add another stream of income? Would it be a product I could sell, a different business, a hobby? Is there something else I could monetize?

I have a few things I’ve thought about but never taken action on, and this experience is helping me shift my focus a bit to those things. And of course I know there is truth to doing the one thing and doing it well, but the conversation with this waitress has got me thinking about other options.

And I’m interested in hearing from you on this: what would you do if you couldn’t do dentistry tomorrow? How else would you generate revenue? Do you already have other streams in place? Do you have any other eggs in your basket? Let me know, I’d love to hear from you after you listen to episode 84 of Business of Dentistry.

Tweetable: “At what point do we start thinking about a different revenue stream?”

Episode Resources

Voices of Dentistry Summit 2018
Email me

Business of Dentistry on Facebook

Connect with me on Twitter
Leave a review and subscribe on iTunes

Patient Interaction And Reputation Management With Podium’s Nico Dato

Episode 083

This week I sit down and talk with Podium’s Nico Dato to discuss customer interaction and reputation management. He offered some great advice that apply to us as private practice dentists. Go give it a listen on episode 83 of Business of Dentistry…

More About Business of Dentistry

Podium is a software as a service company (SaaS) out of Utah. They work with a variety of industries, including dental practices, to help with customer interaction, communication, and online reputation management. In our conversation on today’s episode of Business of Dentistry we talk about improving our communication, his tips on how we can use Google chat and three steps to dealing with negative reviews.

We begin by talking about what Podium is and what it provides for businesses. Podium software offers everything from setting appointments to feedback on the appointment to online reviews. Podium’s software exists as more of a platform with the focus being on interaction between the business and the consumer and is meant to help the practice and patient develop a stronger relationship.

To elaborate on that point I asked Nico to spell out what he sees dental practices not doing, and how they can improve regarding communication with patients.

There are a few common mistakes or missed opportunities he sees regularly. The first is how a practice communicates with its patients. What will determine the preferred method of communication is who your demographic is, so you must find out what is convenient for the patient AND for your practice. In general, the easier it is to keep in contact with your patients the more money you will make. You will have fewer no shows, more appointments will be kept and more patients will become repeated patients for the long-term.

As far as feedback and online reviews: getting positive reviews is good but the piece so many practices miss out on is the actual feedback within the reviews. So dig in and understand what the patients says in their review, and then make changes within the practice. This is what the really smart practices are doing – it is gold for them!

Being focused on those two things is what the best practices are doing: communicate with patients how they want to be communicated with and adjust your practice based on the feedback you get within your online reviews.

We also talk about Podium’s Google click to chat feature. This is Google’s attempt to add another way for consumers to interact with businesses. From Google’s search results you can call, get directions, go to the web site or now with the click to chat feature you can message the business. It’s basically a text message sent to your practice.

Podium plugs right into this feature so you can manage it through their software, versus going to an individual’s cell phone. Nico says they’ve seen a lot of dental practices receiving messages after hours from this feature. Patients communicate and ask questions at their convenience, and the convenience aspect is important because it means it is easier for a patient to come and see you. The easier it is for them the more likely they will be to choose you now and in the future.

I also wanted to know what he recommends doing when you get a negative review. He broke it down into 3 steps:

1. Respond calmly and from a detached perspective.
The person responding to the review should be detached from the situation and not emotionally involved. If that is not possible then make sure the person responding is level-headed and doesn’t get defensive. Of course it’s easy to become emotional about it because it’s your business and your livelihood but it won’t help the situation if you become defensive in your response.

2. Apologize and move the conversation offline.
As we said in step one, avoid defensive responses when you respond. Also when you respond apologize for the person’s experience and move the conversation offline. Offer to talk about it offline or via email. Give them a phone number and email address so they can communicate with you and your office.

This is good for the relationship with the reviewer but it also shows potential patients you will address their needs and work with them to right any wrong that may happen when they come to you.

3. Actually have the conversation offline.
Chat with patient offline either via email or on the phone, and hopefully come to a resolution. At this ponit you can often have them add another review or leave a follow up comment on their original review sharing how the issue was resolved.

On this episode we also talk about where you should focus on getting more reviews online, what it means to “gate” a patient and why you shouldn’t do it, and why collecting reviews should be done on an on-going basis. We finish up with details of Podium’s services including costs and contracts. Join us to hear all of those details on the 83rd edition of Business of Dentistry.

Tweetable: “Adjust your practice based on feedback from online reviews.”

Episode Resources

Podium’s web site
Podium’s blog
Email Nico
Voices of Dentistry Summit 2018
Email me

Business of Dentistry on Facebook

Connect with me on Twitter
Leave a review and subscribe on iTunes