EP42: How to Create Clinical & Business Excellence with Dr. Scott Leune

A truly world-class practice relies on delivering both clinical and business excellence. The team must provide an exceptional patient experience and uphold a high standard of care while ensuring that the future of the business is bright.

In this episode of the Double Your Production Podcast, Dr. John Meis and Wendy Briggs are sitting down with Dr. Scott Leune to talk about how to strike this balance in an office. You don’t have to choose between efficiency and a great patient experience, you can have both with Scott’s advice.

[music] Welcome to the Double Your Production Podcast with the Team Training Institute. The one place designed for dentists and their staff who want to grow their practices by following in the footsteps of those that have done it, who were in the trenches, who know exactly what you’re going through. And now your leaders, the stars of the podcast, Dr. John Meis and Wendy Briggs. [music]

Hey, everyone. And welcome to the Double Your Production Podcast today. I wanted to start out by saying I'm sorry, apologizing for the week delay in giving this episode up and running with Dr. Leune. We had all hands on deck at our Orlando meeting, our latest summit annual meeting for our members. It really was an awesome meeting. A lot of great information shared. And if you would like to be included in that, we do have some meetings coming up, so go ahead and give our website a look at www.theteamtraininginstitute.com/podcast. Should have a few banners and different ways that you can get in contact with us if you want to be included in those future meetings. So today, we've got Dr. Scott Leune on with us with Dr. John and Wendy. So I'm going to turn the time over to them here. He really is a great business mind, and like I said, Dr. Scott Leune here with Dr. John and Wendy. Hope you enjoy this episode.

We've gotten to know Dr. Leune very well. He's such a good friend and such an important influencer in dentistry. I'm really excited that we are able to put this podcast together. The first time I saw you speak, Scott, was at our event and you got up and you spoke, and Wendy had known you quite well before that, and it was like, "Gosh, this guy is speaking my language. This is perfect. These are the same things that I say." And you and I have never met. We really have very different backgrounds, but we came to a lot of the same conclusions. So I want to dig in to some of those but also look at what might be some differences in the way you look at things and the way I do, so I'm really excited for this.

Excellent. Yeah. I am too. And it was kind of interesting. Business can be very complicated. Every practice is different. Every area can be different. Every dentist has a different set of skills, experiences. And those differences sometimes create a lot of noise. As a dentist, I think I've got to do something different than everyone else. But when we [inaudible] the noise, there's a whole lot of truths just to the business side.

Yup. So true.

I think we share some of those truths that at least on my end, I had to come through some blood, sweat, and tears.

Oh, me too [laughter].

Yeah. Me too. No. I totally agree. And a lot of the noise is the people stuff. The people are the complexity in dentistry. The processes really aren't that complex. There aren't that many. There's a handful of things that you have to do well. And you and I have talked about this before that a lot of people think that they have to get creative and do something really, really different, kind of have outside of the box thinking. And in some industries, maybe that's necessary, but in dentistry, I think we have to have really good in the box thinking and just block and tackle [laughter] well, just do the basics well, and things work out really well.

Yeah. That's true. And unfortunately, when we try something out for the first time, that means we're getting all the errors and all the think wrong that anyone would have when you do something the first time. If there's 20, 30, 40 years of people figuring out how to do the very important things very well, the challenge isn't finding some new [way?] [inaudible] of doing something. The challenge is being disciplined enough to do what you know you got to get done the right way. And I think we get lost in that sometimes. [You know what?]? Actually, I don't think in dentistry, you don't even have to do a whole lot of things really well. Sometimes it's just a handful of stuff that changes the financial future, and life is just so much better, in my opinion, when things are simple and things are successful.

Oh, I totally agree. When I look at really the innovation in dentistry over the last 10 or 15 years, certainly, there's been technology advances, but in the basic running of a practice, the biggest innovation has been listening to your customer and give your customer what they want. To me, that's the kind of the biggest thing. 10 years ago, a lot of practices weren't really focusing on that, but that's really, really evolved in a short period of time.

Yeah. I agree. And I'm also seeing dentists go and elevate their level of business maturity. So it used to be that dentists never talked about metrics, case acceptance, rates or reappointment rates, or things like that. And now, we really have matured as a profession on the business side of it. We're focusing on the customer, and we're more self-aware about what we need to focus on in the business side. And I think that's been a big change in the last 10 years.

I know that the-- I would say the successful dentists are focusing on those things, right? There's still a lot of dentists who need to shift their focus and realize how important those fundamentals are. But I would say, the successful dentists are starting to elevate their maturity [inaudible]. [I would agree with that?]. Very much so.

One of the things that blows my mind in dentistry has to be one of the very few professions that has this, but most dentists cannot tell you what the business of their practice earns. They have no idea what their business makes or loses every year. They have an idea of what their combined income is an owner and a provider, but they have no idea what their income is as an owner. And that's kind of I think the next step into evolution of business understanding is when dentists really understand the metrics from an accounting and finance side, particularly those who are growing, particularly those that are considering multiple locations. Really important you have to [inaudible] [down?], isn't it?

It is. And I think results of not understanding the finance side, the business side of practice is that a lot of dentists are working really hard and not making more so that deep down inside, they know that, "Gosh. There is more to be made, but where is it? What happened? Because I'm working so hard." And it's really because the lenses they're wearing are the lenses of owning their own job as opposed to the lenses of a CEO running a healthcare business. And so I think that's kind of a-- that is at least what I see on my end is a lot of dentists that own their own job and that seemed to be working harder without making more.

Yup. And the human condition I think is that everyone thinks they are working harder and making less. [I mean, that's kind of?]-- if you ask anybody, you're working harder than you used to, almost anybody would tell you, "Yeah." "You're making more?" "No, I'm making less." [Whether?] they are, they are. Whether they know the numbers. Whether those are facts or not. It's kind of how people feel in general. But in dentistry, the facts [inaudible] that out, that there is a segment of dentistry that is working harder and making less, and looks to be making less even more as the future unfolds what we, as dentists, on average, we've made less money every year since 2005. Only in the last two years has it kind of flatlined, but we're still not up to 2005's levels, so I mean there's definitely a big chunk of our profession that's making less.


And we kind of attack that in many ways. I mean we try to grow practices. We also try to not just grow what we might call top line revenue or collections, but we also, of course, try to grow the bottom line or the profit or the net income by looking at the expense side as well. And I think that in many offices, the costs are pretty fixed. Whether we collect a million of 500 grand, we still need a dental assistant, we still need a receptionist, we still pay rent. And so a lot of success, I think, financially does have to do with top line growth. Growing the top line while maintaining the bottom-- or the costs, excuse me, while maintaining the costs. So when we look at a formula for growth, we really try to simplify it because we can make it very complicated if we choose to. That's easy. But we try to simplify it, and when we look at the possible dentistry that can be done in a practice, it's really a function of three simple things. It is how many people are we seeing multiplied by how much we diagnose on average per person multiplied by what percent of the people actually say yes. So patient flow times diagnosis times case acceptance. And those three simple buckets are obviously made up of a list of things. Patient flow's not just made up of new patients, it's also made up of reappointed patients. Diagnosis isn't just made up of did we diagnose a crown or not, but what kinds of procedures did we learn, the extra procedures that allow us to always diagnose more on average. There's a lot of things that influence case acceptance, but if we stay focused on those three things, maybe we'll block out the noise of Joann's not getting along with Susan, and my computer's not working in room six, and I got a stain on the carpet in the lobby. Right? Those things are noisy. They obviously have some importance, but we don't want those noisy things to deafen us from patient flow diagnosis case acceptance.

Yeah. I know one of the principles that you and I share is that we're a little disturbed by the over-focus on new patient flow and how practices are spending more and more and more to attract new patients. When I ask an audience what the cost of acquisition of a patient is, they're practices where they're spending 3, 4, 500 dollars to get a new patient, and they think that doing more of that is the secret to success. And part of that is they don't know what else to do, and part of it is they want to keep doing what they're doing and have different results. So the patient flow numbers is relatively easy to move, but the other two are so much more impactful. There's so much more leverage with the diagnosis and the case acceptance piece, and it's such a important component that people understand how to move those that we're actually doing a niche of that this summer for 20 docs where we're doing through the whole diagnosis and case acceptance process that we teach our clients because it really is a thing that dentists don't come to on their own very easily.

Yeah. You're right. And see, the beautiful thing about our formula is those three buckets are equal which means if we want to double our production we could double how much we're diagnosing. That gets us there. Or if we've got a practice that's struggling with an associate's case acceptance, we can make up for that by doing additional clinical procedures, which raises diagnosis, and by being better at reappointing our patients, which raises patient flow. Those three ways, that when one's down the other two can make up for it. But it's amazing, I think, that we just don't look at diagnosis and case acceptance as heavily as, like what you said, as like just new patients. When I'm telling dentists what CE to take, I really feel we should weigh clinical excellence on the same level as business excellence, so they're equal.

And if I were to look at clinical excellence, I would love to prioritize learning new clinical procedures that allow me to diagnose more, as opposed to taking things that might almost be like a hobby. I mean, you could maybe-- I hope I don't offend too many people with this comment [laughter], but you could maybe say, gosh, taking a lot of occlusion courses is almost like a hobby. Yes, there's benefit, obviously.  But, no, it's not necessarily adding a lot of new procedures to our diagnosis.

Right. Yep.

And I think, too-- honestly, what I find fascinating is Dr. John was talking about how cost of acquisition-- and they're just dumping money into marketing but they don't look at the back-end systems. Right? And so that's one thing that's really unique about your business master's course is, I think you are so excellent at helping doctors and their teams see that it's not just about the phone ringing. Right?

There's other barriers to getting patients through the door that often they don't want to focus on because fixing some of those things-- maybe they don't know how, or where to begin, or maybe it means that today's team is not the team for tomorrow's practice. Some really hard decisions. There's so many other barriers that have an impact on flow that most dentists and their teams don't even think about. Right? Their solution is dumping more money into the marketing budget but--


--those can have a huge impact on flow, to the negative, that they often aren't thinking about. And I think that's really what Dr. John was getting to when he said, "You know, we believe that new patients aren't always the answer. There's other issues, often, that the practice can focus on that can turn those buckets - or fill up those buckets - faster."

Yes. Well I think it--I think new patients is kind of like crack, you can never get enough. And Wendy and I worked with a practice that was getting 400-and-some new patients, which means they would have to add a hygenist every, what, six days or so to keep up with that growth. But they weren't adding any. So they were getting 400-and-some coming in but they were losing 400-and-some too - that didn't make any sense - because they weren't talking about what you do, Dr. [Lunis?], is the retention. Are we reappointing and are we retaining our patients?

Yep. And it's interesting too, is not only is there too big of a focus on new patient flow, in respect to everything else, but new patient flow alone is really the lead generation. The call. That's one number and that's where we spend a lot of money, "Let's get more calls." That's three, four hundred bucks a patient, so we're spending a lot of money on call. But then, do we answer? And then, if we answer, do they schedule? Those are, all three, equal [laughter]. So dentists are spending a fortune to generate the call, and ignoring and spending nothing to perfect the answering of it and perfect the conversion of it, and they're all equal in the formula. So there's another kind of weird aspect of our profession that we just haven't grown up to yet.

The first time I saw you speak, you had the metrics on something that I had learned by observation, and that is dentists don't answer their phones very well, not even pick them up much less convert that into an appointment. And it's crazy how much opportunity that exists in pretty much every single practice. Because most practices, I think, kind of, our numbers are [if?] if you're not really focusing on it, you don't really understand, and you don't' have systems, and you don't have health, you're probably going to be in the 55 to 60 percent answering range during normal business hours, which is crazy.

Yep. The national average for a practice that collects less than $1 million a year is that if they missed 38% of their calls.

38, yeah.

Then, the 62 that they do answer, only 42 percent of that turns into an appointment. So let me say it in a different way, if 100 new patients call, you end up with 27 appointments because the rest were not answered or if they were, they were converted. So, here we are spending a fortune into a funnel where most of the money falls out through the hole, right? We bought 100 calls to only get 27 appointments. So, yes, on the new patient side, there's ample opportunity to grow without spending more marketing. And then, if you take a look at the team training institute kind of processes and training on how to reappoint those patients and how to keep them in the practice. And, of course, how to turn that patient into a healthy happy patient that gets a lot of hygiene and lots of restorative done. I mean, there's an immense amount of financial opportunity to focus on what we do after they show up as opposed to only looking at trying to bring in more people. And I kind of look at the hygiene side of what you all teach which I didn't even learn about you until I hired you, so [laughter]. I hired you and I thought, "Oh my gosh, in one day of training, you got more accomplished than what I was trying to get done over years." And part of it is you got the system, and part of it is because you got the message. And I, my system wasn't as good and if someone else says it outside of my company, they're going to be really effective if I say it's 1 out of 100 they're got to listen to me say all the time.

Right, yep.

So, it was amazing and really our hygienists started doing more procedures that they already knew they were supposed to be doing to begin with whether it was X-rays that they just were not doing or skipping or whether it was preventative work or [inaudible]. And it's just amazing how you just focus on the simple core things in the practice and get that right. And there's so much opportunity there as opposed to these weird construed funnels of this and manipulation of scripting and message of that in playing the insurance game, I mean, that's all very complicated. You get hygiene right, you treat people well, you answer the phone, you diagnose plenty of [inaudible] of the patient needs, and you get them to say yes with some pretty simple methods, suddenly life is so much bigger and better.

We could not agree more. And the truth is in the results, right? One of the things that we love about working with regularly practices, practices that follow your model of everything from start to finish. Even [inaudible], design, all that. The reason that Dr. [inaudible] works together is because we found that practices that incorporated our system on the hygiene side and his systems on the restorative side, [inaudible] with a faster pace than our clients that were working definitive of each other. We find the same thing with your practices, Dr. [inaudible]. The practices that follow your own models of setting things up, doing the phones, marketing, once they bring us in and we focus on the hygiene and some of the restorative things, man, the results are crazy. We look at the results that practices half our shared expertise working together, and it's really mind-blowing what they're accomplishing day-to-day. The one [inaudible] I can think  three years in was doing 1.7 million a year. And I know you probably have far more practices that you could share success stories on that, but that's not even the critical thing. Yes, they were producing 1.7 million a year, but the doctor's take-home was crazy good. So there's got to be truth in what they're doing every single day to get results like that, right, and I think that's what so exciting is when you have practices that follow the principles that you've proven to be effective that then add in what we teach, that the growth that they actually realize is really exciting to me.

Yeah. I kind of view our end of this spectrum as we kind of get into the nitty gritty details of actually like what exactly do you say on a call. How are you resubmitting the claim, just the really like detailed granular stuff. And that's only part of the success formula, though. Doing the right thing is one thing, but when I look at what y'all are so good at, you are so good at the leadership side and how an owner can really better design their practice and how to operate, which flows into their life. Because a lack of leadership focus will also be a factor that stunts the growth and stunts the ability for the practice to succeed. And y'all are so good at taking a dentist-- or at least, our dentists. Our dentists have a very deep foundational understanding of the operations of a practice, and many times their limiting factor is them. Like the way they think, their ability to communicate, their ability to lead. They know what's needed, yet they're not there. And y'all are able in a very effective manner to build an environment around them with the other members and of course with yourselves and the experience where they grow internally, like themselves. They grow. And when you combine the two of this foundational level of operational excellence with this leadership and growth and communication, when you combine the two, the dentist that's ready to hit a home run hits a home run. And it's been amazing. And so for the listeners on this, at one point we were consulting with a lot of dentists and they were doing very well, but they were really kind of flatlining. So flatlining at a high level but not growing more, and we as an organization sought out the companies in dentistry that we felt were the best ones that could help our clients do better. In other words, we went to what you can maybe even argue is our competitors in a way. Other consultants, and we plucked out the best to help our own clients go to the next level. And we literally handed off our clients. So one they maxed out their success with us, we handed them off and we chose you. And that's why we share these clients, and it's been a wonderful thing to see. And my company, we do a lot of things. Consulting is one thing we do, but there's 14, basically, companies in our company. And so we're really in the business of this kind of all-rounded holistic approach to helping a practice and so we, from time to time, work with other companies to try to grow a practice or to train a dentist. And y'all are some of the best of the best, and I know this is almost sounding like I'm kind of kissing up to y'all on this podcast, but it's true. And general, I don't really like a lot of consultants out there. The whole kind of Facebook dentist celebrities, the overnight sensations that are out there. Y'all are like the best of the best, and I really do appreciate what y'all have done for our clients that we've then handed off to you. It's been amazing to see.

Well, [crosstalk]

Well, I appreciate your saying that, and the respect is certainly mutual. We love your, like you said, the operational principles that you teach. And so many of the clients that we see that have been through your staff or the people that we have that we send to your staff, really, it's a great partnership and relationship, and we sure are grateful for all the things that we're able to do together as it sure have been fun.

Yeah. Yeah, well, let's keep doing it [laughter].

All right. Let's do. All right.


So another thing I'd like to say is on back to growing a practice and [leveling?] the production. What I found is that one level is kind of influencing patient flow, influencing diagnostics, influencing case acceptance, and those things can be listed. What influences case acceptance? Well, your payment options, the form you show a patient, what you say to the patient's dentist, what you say to the patient's treatment coordinator. Even, we found, by the way, we measured it, and we did a split testing study, and we found that if you present finances in the operatory, case acceptance is a little better than if you present it in the front desk area. So there's a list of things that can influence that number. But in learning the list of things, ideally, is working with companies like team trainers too, or like my company, Bricketwood Practice, to relearn those things. But after you learn them, there's this whole other layer that says you actually do them. It is at the [dirty?] thing that no one really addresses well. And just because I know what to do doesn't mean I do. And so for everyone listening to this, I am a heavy spender myself on consultant and coaching. And even outside of business, I have my meals made for me, I have a personal trainer because if I don't, I don't eat right, and I do not work out. I want to, I know how to, but without someone there helping to lead me, I won't do it. I'll follow the wrong path. So in this formula for growth, part of it is learning the knowledge. What do you need to do to increase case acceptance? But then, part of it is a commitment to it, and being in a community or attached to a coach that will help lift us up and get us to do it.

Yeah, and it's so true. The execution side is really harder than the knowledge side. And getting people to do-- even getting ourselves, like you said, to do what we know we should be doing is hard. And then trying to influence, and encourage, and embrace other people to be doing those things, it's tough. It's the hardest part of the industry, I think, is the people side.

The biggest thing I do all year long is, in my seminar company, Bricketwood Seminars, is what we call the transformation retreat, and it is a Thursday evening through Sunday morning small group, really deep kind of event. The only people that are even allowed to go to it have had to have a minimal level of kind of business training. But in that retreat it was interesting because it connects to this topic, is we spend our time about half the time looking at life design and half the time looking at business design and connecting the two. And it's amazing the transformation that occurs when someone is led to reevaluate the life side and then reverse engineer the business side. And part of that retreat is after they're done, and they leave, we have to have them surrounded by a community of like-minded people because when things get that deep into life and business, or you can even argue health or love or relationships, it's important to have continuous feedback, to have a continuous connection, a community to tap into. Even something as simple as a Facebook group is a community that gives us the drive and reassures us that these changes are going well and that we need to stick to this path. And so it's interesting that I see that. Otherwise, we  become the dentist that hops from place to place to place and learns all these things, and we do nothing. And that can also be cracked for some dentists. They're hooked on the intellectual side of talking about dentistry and business, yet, they do nothing. And so we got to break out of that. Yup.

I agree. Well, [crosstalk]. I'm sure [inaudible] for all the amazing insights that you've shared with them today. And I know we have something really incredible coming up. So maybe we have you back on a few episodes down the road so that you can share a little bit more about this thing that we're working on putting together that's going to be unlike anything else the dentistry has ever seen. I'm really excited about it. I know you are as well. So maybe we have you come back on in a few weeks and we talk about that.

Yeah. Well, we're finalizing some details, so I won't give too many details right now. But what you're alluding to is going to be what I call the 12 giants of dental practice management. Creating an event that is going to be like no other is literally 42 sessions and lectures immersing everyone into the business of dentistry by the world's experts. It's a no BS - excuse me - kind of event. And I know that we are hoping and praying and wanting your group to be connected to that because it's just going to be great for everyone to be involved in this. So as soon as we've got the details finalized, if you want to talk about it then, and what it means maybe to your members, whether it's on this podcast or just your members, it's a big deal. It's the most exciting thing I've done in years, and I'm just dying to talk about it. But I got to work out the final details first. You know how it is. It's like a big product release, like, "Oh, we can't release it quite yet," but it is coming. It is coming.

Well, you're close. And it's going to be amazing, and we're really excited to be involved because it's going to be really unlike anything that's happened in dentistry in the years that I've been in it. So it's going to be fantastic. So I want to thank you, Dr. Scott Luna, for being our guest today. And we'll be back on together here shortly when we can talk about that event. And we'll pick a few more things that we can pick apart as far as making your practices' future bigger than its past.

Excellent. Thank you so much, you two, for having me. It's always fun to do this. Let's keep doing it.

Yeah, sounds good. Thanks for all you do for us. And we sure appreciate working with you, Scott.

Thank you.

So that's it for this Double Your Production podcast. We'll see you next time.

Thanks for listening, everybody. [music]


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