Speaker 1:
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 are 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.
Dr. John Meis:
Hey everybody. Welcome to this edition of the Double Your Dental production podcast. I'm Dr. John Meis here with Wendy Briggs. Hey, Wendy.
Wendy Briggs:
Hey, Dr. John. Good to see everybody.
Dr. John Meis:
Good to see you too. Go ahead and introduce our guest. I'm so excited.
Wendy Briggs:
Yeah, this is going to be a great podcast today so we have with us Paul Lowry from the Dental Menu and let me explain why we invited him on the podcast today. We recently held a quarterly practice growth retreat in Raleigh, North Carolina, and the topic of that retreat was maximizing opportunity. One of the sessions we had in that retreat, we were talking about the four cornerstones to creating patient loyalty. One of those cornerstones was give patients what they want. Especially where we are in today's world with inflation concerns, insurance companies reducing reimbursement rates and causing a lot of stress and anxiety for dentists, we've heard from more dentists than ever that they have an interest in adding some kind of benefit plan into their practice to give patients without insurance or patients with terrible insurance an alternative option, right?
When we look at that trend that's part of our reality in industry today and we consider all of the reasons why we want to give patients what they want, that's when I reached out to Paul and said, "Hey, you know what? I think our listeners would really benefit learning about how Dental Menu enables dentists to have the best of both worlds." They're able to have a benefit plan that makes sense for the practice, but they're also able to allow a high level of customization and personalization to the patients. That's why we have Paul on today. And certainly we'd love to have Paul introduce himself to our listeners as well.
Paul Lowry:
Yeah. Thanks, John and Wendy. Appreciate you having me on. Yeah, we do what Wendy talks about. Really the way we got into this business, we were doing marketing for offices years ago and if you look at those patients, as they flowed through that funnel, patients without dental insurance don't stick as often, and a lot of offices we work with, they get frustrated because over time they become very inundated with insurance patients.
One way to look at it that's very interesting, one of the examples I like to use is a farming analogy. If you look at a caveman, the way he gets his food is he's running after whatever there is, he hits it over the head and kills it, and he eats for that day or that week, but then when that's gone, he's got to run after it again, right? He's got to run after and get more food. That's like a dentist chasing production. I've got to get big cases, I got to get more production, and you're almost trying to force the production.
Well, if you look at the caveman, when it changed from that and he turned into a farmer, he built a fence, he planted seeds, he's growing his peach trees, he's got his corn, he's raising his cows, and he moves into that system there, then the harvest is a lot more natural. You're not going to harvest the corn until it's ready to harvest, but it will eventually grow and it'll be ready for harvest. You're not going to harvest your animals until they're ready and so things become more natural. Your hygiene department is really your farm, is you're putting people through hygiene, that's the stuff you're growing. Well, if you look at your hygiene department, if everybody you're putting through hygiene is PPO insurance patients, what are you going to harvest? You're going to mainly harvest PPO insurance patients.
Well, if you took a group of patients, 100 patients that have insurance, which means they have a prepaid benefit so they get an exam cleaning x-rays, that's included for quote unquote "free," their employer's paying or something like that, how many of those are going to bring a point versus you take patients without dental insurance, you're trying to get them to pre-appoint, you're basically saying, "Hey, come back in, spend another $300." They don't pre-appoint at a very high rate because they don't have this included preventive benefit. SO your membership plan for uninsured patients has got to include some sort of preventive benefit to get them to come back in and to get them to schedule their hygiene visits otherwise, if you take a scratch start ...
We looked at data on 250,000 patients. If you fast forward five years, we looked at new patients without dental insurance, only 12% of them after five years were pre-appointing versus insurance patients were at 64%. It's not very hard to run that experiment forward and just say, "Look, if you have patients coming in without dental insurance, they never pre-appoint. You have patients coming in with dental insurance that do preappoint and your schedule gets full and your hygiene gets full and you're at capacity, you're full of insurance patients because you haven't created a good product."
The interesting thing about that study we did years ago is almost everybody involved in that study had an in-house benefits plan, they had a membership plan, but they still only had 12% of those uninsured patients being pre-appointed so clearly something was broken. That's why we created Dental Menu was really to solve some of the issues that are out there with membership plans.
Dr. John Meis:
Yeah, very good. I like the analogy and Wendy and I always talk about the core thing that drives practices that are bread and butter dentistry taking care of families is hygiene and the flow of hygiene really dictates how the rest of the practice does.
Paul Lowry:
Yeah.
Dr. John Meis:
So this is a mechanism to keep more of them in and that retention of those patients is highly correlated with practice profitability.
Paul Lowry:
Mm-hmm.
Dr. John Meis:
Tell us a little bit about how Dental Menu helps practices.
Paul Lowry:
Sure. Yeah. So essentially, you can do your own membership plan and that's great. We're even happy to chat with you if you want to do your own plan and just share with some of the things we've learned, we're very willing to share. If you look at your membership plan, it's got to offer some things to the patient. It's got to offer some options for them so they're going to buy it.
What we see a lot with membership plans is they're sold merely on a discount on treatment and so when a patient comes in, they have a treatment plan of $6,000, it's easy to say, "Hey, sign up for our membership plan. You're going to save 20% off," and they sign up that year, but they don't necessarily renew. We like to try to get people to shift their mindset instead of trying to sell exam cleaning x-rays at 12 months and then get them to renew at 12 months, you're making them make this buying decision, whether you're charging them annually or monthly, most offices are still saying, "Hey, do you want to buy our membership plan for 12 months? It gives you a set of x-rays to exams, two cleanings, and a discount on treatment." But if you look at successful membership recurring models, Netflix doesn't call you and say, "Hey, Wendy, how have you enjoyed our content? Have you watched it in a while? Do you want to renew for another year?"
If they did that, you'd be like, "You know what? I haven't even turned it on for two months. I think I'll cancel and then when I'm ready to buy it again, I'll resign up."
Wendy Briggs:
Right.
Paul Lowry:
You got to run your membership plan a little bit more where, "Hey, look, you have teeth. I know you need these services on a regular basis so you pay me X amount a month you're going to have access to these services at these intervals." With Dental Menu, it helps you set up that system, it's very flexible. You can offer different kinds of plans. Let's just take a perio plan for instance. Wendy, you got a hygiene background. Should somebody come in for perio maintenance every three months or every four months?
Wendy Briggs:
It depends on the patient, right?
Paul Lowry:
Yeah. Depends on the patient, so it's crazy because most offices, some of them don't have a perio plan, which is crazy. You've got someone with a disease, they don't have dental insurance. If you look at treatment acceptance for people that don't have dental insurance and they've got periodontal disease, it's really low, which is sad. You have a product to service them but you haven't packaged it in a way that they can consume. With our platform, you can offer a perio plan that has the maintenance every three months and every four months, so that you can actually say, "Based on what you're seeing in their mouth, this is what I recommend. I recommend you come in for perio maintenance every three months, and then hopefully we can transition you to four."
A lot of our patients don't want to come in every six months and so if you look at ... I see offices that price their plans so low as a new patient generation tool, but there's no reason you can't offer a plan every nine months or every 12 months for those included preventive services. Uninsured patients are coming in every five years when something hurts.
Same thing on the other end of the spectrum. We've got pedo offices, people that see a lot of older patients and they'll have a cleaning frequency every four months. It's not perio, but my kids don't clean their teeth so I would rather come in every nine months myself and send them in every four months. It's very customizable. We help you walk through what's going to fit your practice, help you build kind of a robust plan.
The other thing that you can do at Dental Menu, which really increases the profitability, you guys I know have your whitening for life program but if you think of things like fluoride, nitrous, emergency exams, emergency x-rays, bleach gel, different things like that, you can create some add-on packages where patients customize their plan. We've got groups that sell a premium plan for 15 bucks a month that include some of these ancillary services with really high margin. You get somebody to come in at your plan at 30 bucks a month, $15 more a month, they upgrade to having access to the pano and emergency exams, x-rays, and maybe some nitrous that's really profitable for your practice, but you're also letting patients, like you talked about, consume your service in an easy way versus, "Hey, Paul, you need this pano." The first thing I'm going to ask if I don't have insurance, is how much does it cost?
"Well, it's $300."
"Well, I don't want to pay $300."
Well, the doctor's over here saying, "Well, I can't diagnose you properly without this pano," so then you've got the assistant who's like, "Well, do I just take the pano and then I'll just kind, not really say anything and I'll let Susie at the front desk bring it up to him."
Now Susie at the front desk is like, "Great. I either adjust it off and doctors PO'ed at me or I push to charge the patient and they're not happy with me." It's not a good setup and so by default, insurance is working better in practices even though it's not better for the practice long term, but it's just all the systems, the practice management software, the training, it's all set up around dental insurance and these membership plans seem to always have these different hacks in the practice management softwares and different ...
I talked to an office today and it's a bigger office and the office manager said, "Well, everything's working, but if I get hit by a car tomorrow, it's going to just implode. Or if I leave or I quit, it won't function anymore because it's all running through me. There's not really a good system for it." Dental Menu will help set up some systems that make sense, we'll help you analyze the profitability, and then our back end software is going to help manage everything a lot more effectively.
Dr. John Meis:
Tell us a little bit about how you help, I'm sorry, Wendy. Go ahead.
Wendy Briggs:
That's okay. I was going to say that's one thing I really, really love about what you bring to the table is historically when we look at a practice's benefit plan, the practice is putting the things together.
Paul Lowry:
Yeah. Yeah.
Wendy Briggs:
And so it may or may not be, be what the patient wants at all.
Paul Lowry:
Yeah.
Wendy Briggs:
What I love about Dental Menu is the practice can determine what their base plans are, but then the patients get to choose. How awesome for a patient to say, "Hey, I'm willing to pay a little bit extra to have some emergency care." In other benefit plans that's not even an option. So the practice isn't even getting that opportunity for increased revenue. I love that and I love the fact that when patients hold the iPad and they're clicking what they want, they're much more likely to be retained and to stay with the practice because they've chosen the plan that best suits them at the time. I think that whole concept can take practices so much farther ahead than a one size fits all structured benefit plan. That's one of the things that I really love about Dental Menu. Go ahead, Dr. John.
Dr. John Meis:
Well, I was just going to ask when people set up their own plans, there's some challenges with that, because the rules on what's legal vary from state to state.
Wendy Briggs:
Yeah.
Dr. John Meis:
We do know states that are very difficult to get approval for this kind of thing. But one of the things that when they set up themselves, they generally don't check which is the regulatory body in their state that regulates these things and then design it in a way that's going to comply with all of the regulations. Next thing is when they design their own plan, I've seen them be designed in a way that is a loss for the practice.
Paul Lowry:
Yeah.
Dr. John Meis:
Tell us a little bit about how you think about the pricing to put on it and how you think about profitability and how Dental Menu helps practices with that.
Paul Lowry:
Yeah. Yeah. Even if you're going to do your own plan, this is a good recommendation to price it is if you are going to accept, let's say I'm starting an insurance company and I'm presenting to you, Dr. John, saying, "Hey, do you want to accept this insurance?" What are you going to ask me for?
Dr. John Meis:
I'm going to ask you for fee schedule, reimbursement rate. I want to know what your acceptance of certain procedures are going to be. I want to know how quickly I can get paid. I want to know if you can handle ... There would be a whole list of things-
Paul Lowry:
Sure.
Dr. John Meis:
... I would want-
Paul Lowry:
So the first-
Dr. John Meis:
... do you handle electronic claims?
Paul Lowry:
Really that first issue is the answer is, well, first I want to know what am I going to get paid? When am I going to get reimbursed? Because if I'm only going to get $10 for a cleaning and $2 for an exam and $2 for x-rays, sorry, I don't want to do it. If you think about pricing your plan, you've got to figure out what do you actually want to make with those included benefits? Everybody always says, "Well, should I price it at 25 or 28?"
It's like, "What? That's the wrong question to ask." The question to be asked is how much do you want to get paid every time you do a cleaning, exam, x-rays? If you look at your UCRs over here and you look at your average PPO reimbursements over here, and maybe you are willing to take a loss because you're a scratch start and you're trying to get butts in the chair and you're trying to get production, that's okay, but you need to know that's what you're doing. If you're at capacity and you have no more room in hygiene and you're making less on your membership plan than you are on PPO plans in your hygiene room, why in the heck are you even doing it?
If you look at how much do you want to make for cleaning, exam, x-rays, the other mistake that people make and we're the only software out there that keeps track of this. If we were going to start an insurance company and we said, "Hey, we're only going to keep track of premiums, which is money coming in. We're going to ignore our expenses or our claims, which is money going out," how are you going to know how profitable you are? Everybody in the space does a really good job helping you bill monthly, and hey, here's all the money you brought in and hey, you got a recurring revenue model, and hey, look at all this money and beat our chest, and we got this much coming in. Well, how much do you have going out? What's the usage of those benefits?
With Dental Menu, you're actually keeping track of the usage of benefits. We can tell you, "Here's the revenue you brought in, but here's how many exams, cleaning, x-rays you administered. Here's an actual dollar amount that we've attached to that when we did the onboarding so you can get a true profitability." Now, again, this is thinking of it different than you're selling two exams, two cleanings, a set of x-rays once a year. This is a membership plan. If you look at insurance companies, they make a ton of money on breakage. This isn't a capitation plan, but I'll tell you right now, if you sell it this way, how many of you listening get a call where it's like, "Well, hey, I've got my cleaning schedule for next Wednesday, but I'm going out of town. Can I bump it two weeks?"
You're like, "Well, sure, we'll bump it two weeks." If you run your membership plan this way, they bump it two weeks, you're getting revenue for that instead of, well, they still get two a year. You don't make any additional revenue. Imagine you have $10,000 a month coming in every month and people bump their cleanings on average two weeks or three weeks each time. Well, you just added 10 grand of profit to your bottom line by running it this way, as well as you're giving the patient a better option because you're not making them commit. You're just saying, "Pay this monthly fee and get access."
When you run it that way, Dr. John, then you keep track of the claim so to speak, the usage of benefits, then you're able to actually see your true profitability on your plans, which is a whole lot better than just flying blind.
I always like to ask, and if you really look internally, ask this question to yourself, "Are our plans profitable in the hygiene department, yes or no?" Most of the time it's, "I don't know," and if you do know, then ask yourself is, "Are our plans more profitable than our top PPO insurance plans?" You should be able to ask those questions and answer them otherwise you're kind of flying blind and you're leaving money on the table potentially.
Where this really comes into play as well, when you sell or transition to practice, it shouldn't be a liability when you transition those patients but oftentime it is because there's so much unknown. It's like, "How many free cleanings do I have to give by taking on this group of patients?" instead of, "Hey, I've got this recurring revenue. I want you to pay me double for that because they're going to stick with the practice."
Wendy Briggs:
Yeah, that makes a lot of sense except I'm going to ask you a question about the elephant in the room. A lot of our hygiene providers are set up on a production based compensation plan so one of the biggest challenges we hear about with benefit plans is the office doesn't necessarily know how to allocate those funds and the most common thing that I see is they just zero them out so the providers get zero credit for those patients coming in, which leads to an undercurrent of frustration and bitterness.
Paul Lowry:
Yeah.
Wendy Briggs:
They don't want to see those patients on this schedule when they really should be celebrating these are retained patients, they're they're good patients. How do you guys help with those headaches? The side of, "Okay, where is this production allocated? How do we compensate our team that are on production based compensations? Or even a team bonus structure?"
Paul Lowry:
Yeah.
Wendy Briggs:
How do help practice sort that mess out?
Paul Lowry:
Yeah, and that is a big mess. A lot of offices say, "Oh, I'm not going to charge monthly because I want to be able to figure this out the other way." Our software handles all that and really what it does, in fact, let me just share this one little slide here. See if this'll work. It doesn't. Can you guys see it here?
Wendy Briggs:
Here. Yeah.
Paul Lowry:
If you guys think about how dental insurance works, patient pays the dental insurance company every month, no office is reconciling anything, the dental insurance company's getting that revenue. When you provide services, you file a claim to the insurance company, and then they send you a payment with an EOB report saying, "Hey, here's a check for $1000 and now it breaks down to pay for these services." We set up a flow similar like this for our offices where we set up a practice membership account, it's a merchant account. When those monthly payments get charged, they're really prepayments and/or unearned revenue. We hold those in the merchant account and then when services are provided, we do have integrations, you can do it manually or if you want the integrations. When you check that patient out in Open Dental, and you say, "Hey, Wendy got an exam, cleaning, x-rays," it actually pings this account and it sends a payment into your operating account, into your bank account, and gives you a report that looks similar to this that says, "Hey, you just had $400 get put in your operating account," and now there's actual revenue attributed with that you're going to put for the cleaning, exam, x-rays just like you would with dental insurance.
You set it up as a dental insurance in Open Dental, you've got the fee schedule, stop adjusting stuff off to zero. It messes up your KPIs if you're using Dental Intelligence or something else. They're not zeros, they just paid for it in a different way, and so we'll be determining on our onboarding, what these amounts are going to be, that's what kicks out the pricing, and then as patients are paying, you're not reconciling anything. You're checking the patient out, you're getting a deposit in your operating account, now your bank statement and your ledger matches up, and now you've got an amount going into production collections for your hygiene team.
Now, if a doctor's really intelligent and smart with this hygienist, and a lot of our guys do this, they'll actually decrease the amount for exams or sometimes even for x-rays, and I've seen them goose up the amount on the reimbursement for the cleaning. Imagine if you're a hygienist being paid on production collections and you can get double the amount of production collections on a membership patient versus a PPO insurance patient. Every person that comes through that is eligible to buy these plans, a hygienist is going to try to sell them because they're increasing the amount of money they're making. In addition, it's not like it's additional revenue that the owner's got to come up with. Te reason we build it this way is you don't have to run separate, weird reports with different hacks. If you're already set up this way with an insurance company, you're just setting up your plan like an insurance company and it operates all the same. Your teams, it's business as usual, they check that patient out, deposit comes in with essentially an EOB, and they record that revenue in, and away you go. That's part of the kind of the magic with the Dental Menu software.
Wendy Briggs:
Yeah.
Dr. John Meis:
Very good.
Wendy Briggs:
I love that solution. I think a lot of our providers, again, once you get into that production based compensation mindset, you do look at the numbers and that is important to you. It's not the only thing. We don't do things for the production, but it is a nice benefit to know your production numbers are increasing as you're elevating patient care, so I think this goes hand in hand with that.
Paul Lowry:
Yeah.
Wendy Briggs:
The more patients we can retain and the more services we can offer patients that are non-insured, especially compared with the average that doesn't get a lot of service at all, the better it is for everybody. We're able to care for our patients at a much higher level and if we can minimize some of the headaches on the back end, that makes life easier for the team, which we all know makes life easier for the doctors.
Paul Lowry:
Yeah.
Wendy Briggs:
That's a win, win, win all the way.
Paul Lowry:
Yeah. Yep. For sure. Yeah, it's really nice that way and then, because we're keeping track of benefits that are used up, then it allows us on the KPI side of things to actually tell you, like you were talking about, Dr. John, is, "Yeah, here's the revenue that came in. That's great. That's what everybody kind of keeps track of, but here's the value of services that were used that month." You're actually able to see that, well, here's the plan revenue that came in, here's the value of services used so therefore there's my actual profit for running the plan beyond the included benefits. Over time you're able to see, is it negative or is it positive? What's going on here? It's just a lot more accurate that way. You got to think of it as kind of running a business within a business. You got to set it up properly, you got to run it properly so that it all works.
If you don't have the software and some of those things, the other end of the spectrum is always you better have a really super simple plan and you just charge annually and that's what most people do to do it themselves. It's not as great for patients, but without somebody helping you with this, you probably can't do it.
Dr. John Meis:
Well, nobody has the level of customization that you have. You can't really do that on your own without some tool and this is a great tool for doing that.
Paul Lowry:
Yeah.
Dr. John Meis:
The other piece is that when you do it the other way as Wendy mentioned, you may be undercompensating your providers ...
Paul Lowry:
Yeah.
Dr. John Meis:
Which you don't want to do. It's got to be a win, win, win so we can't under undercompensate our providers and we'd like to think of things as win, win, win. It's got to win for the patients, it's got to win for the team, it's got to win for the practice.
Paul Lowry:
Yeah.
Dr. John Meis:
Now we've got patient retention improves, also case acceptance improves, and we can talk about that in a minute. You have the patient's dental health improving over time.
Paul Lowry:
Yeah.
Wendy Briggs:
Right.
Dr. John Meis:
So the patient wins, team wins as long as we set it up in a way that they're fairly compensated, and the practice wins because we have more through throughput of revenue.
Paul Lowry:
Yeah.
Wendy Briggs:
One last thing too, you mentioned some people can manage it on their own. Yeah, that's fine if they have one location, but often when practices grow beyond that and end up with multiple locations and all of a sudden they're managing ... Those that have the vision to do that, that's part of what we help practices do.
Paul Lowry:
Yeah.
Wendy Briggs:
Then there's a level of complexity that becomes unsustainable over time and it's too easy to create this quagmire of problems. As you mentioned, at some point we're going to need to look at valuation of the practice and the more streamlined and open and transparent all those systems are the better the valuation will be and the more attractive that group becomes to an outside, I guess, interested party, so all those things do matter.
Dr. John Meis:
Getting multiple locations to administer a loosely laid out plan in the same way consistently is a tall task.
Paul Lowry:
Yeah.
Dr. John Meis:
That's just not likely to happen very well so this is a way that groups can manage it in a way that they can watch it very closely, they can make sure that's being administratored the same and you could just measure the execution.
Paul Lowry:
Yeah.
Dr. John Meis:
You can see who are the stars that are getting a lot of patients on the plan and who are the ones that aren't.
Wendy Briggs:
Yeah.
Dr. John Meis:
Now you know where to put some of your effort in improving the performance.
Paul Lowry:
Yeah.
Wendy Briggs:
Another thing, I mentioned at the very, very beginning, the previous retreat that we had, and interestingly enough, our next retreat, we're going to be talking about the eight Rs, so recall, recovery, reactivation, retention, reviews, reappointment, referrals, and the latest added R, recruitment. We talk about always be recruiting. Dr. John added that to the mix and I was like, "You know what? That fits."
The reason I bring that up is because we have invited you to come and be present at this retreat, because it is such an important fit. If you think about where Dental Menu fits in there, you fit in several of those Rs. You fit in recall because we're going to have a higher level of recall if we have patients with plans. You fit in retention, you fit in reappointment.
Paul Lowry:
Yeah.
Wendy Briggs:
You fit in a lot of those buckets and so we'd love to have you come and be there. Also, I just wanted to let our listeners know that we've recently begun inviting a few handpicked practices to join us at these retreats. This might be something, if you're listening to this podcast, you've been listening for a while and you think, "Hey, I'd really like to go see what these retreats are all about," we want you to know that we have a mechanism now where you can apply to possibly attend one of those retreats. We'd love to have you join us and meet Paul in person and hear about all the other amazing systems that drive those Rs. What we'll do is we're going to put a couple things in the show notes. We're going to have a link to a webpage where if you're interested in becoming a retreat guest, you can click that and watch a video from Dr. John and see if you might be a fit. You can actually request a quick call to see if you are a fit and get all the information about our next retreat, which is in October in Chicago. Or you can visit that link to find out when the next upcoming retreat is if you're listening to this podcast a little bit later on.
That's an awesome way for people to come and learn. All of those systems are critically important and like we said, that's why we invited you on the podcast today because we know Dental Menu helped solve a few of those challenges that practices are having in those areas.
Paul Lowry:
Yeah. Yeah. Excited to come. Thanks for having me on, happy to chat. Like I say, we're very abundance mindset so even if we chat and we can help you with your current plan, that's good too. If we're a good fit for you, great. If not, hopefully we can give you some good ideas to help you with some things.
Wendy Briggs:
Paul, if people want to see a demo, can you give us a link for that as well that we can put on our homepage?
Paul Lowry:
Yep. Yep. Our website's just dentalmenu.com. You can schedule in there and I'll send you a link too.
Wendy Briggs:
Great.
Paul Lowry:
Okay.
Dr. John Meis:
All right. Terrific. Well, Paul, thank you so much for being with us today. Appreciate all the information that you have, appreciate seeing you at our next retreat.
Paul Lowry:
Yeah.
Dr. John Meis:
That's it for this episode of the Double Your Production Podcast. Thanks.
Paul Lowry:
Thank you.
Wendy Briggs:
Thanks for listening, everyone.
