Chris Pistorius (00:04):

Hi everyone. This is Chris Pistorius, again, with the Dental & Orthodontic Marketing Podcast here for another great episode this week. Today, we’ve got Eric Vickery of Vickery Coaching. Eric has worked with over 250 dental practices throughout the country and just coaching, helping out with a multitude of things, but one of his specialties is case acceptance. Once you present a need to the patient on what your recommendations are in terms of what type of service and treatment they should get, how do we get more of those people to say yes and come back for that? So, Eric, thanks so much for being on the show today.

Eric Vickery (00:47):

It’s great, Chris. I’m so thankful that I get to be on here and talk to you about case acceptance. This is great.

Chris Pistorius (00:53):

Yeah. Well, I know it’s a big need in the market. We have clients all the time. Our job as a marketing company is to bring in new patients, new cases for our clients. Then once we bring them in there, there’re some things that we can do to help, but that’s always that next step. We’ve got them in there. We recommend treatment. How do we get more of those people to raise their hand and say, “Yeah. Let’s go for that.” That’s something that you specialize in, right?

Eric Vickery (01:21):

Yeah. It’s funny that you say raise your hand. I do a two day seminar on case acceptance and at the beginning, I’ll say, “All right, raise your hand. Who likes to sell? Who likes selling dentistry?” There’ll be one or two administrative people in the room that will raise their hand, and by the end of the two days, I do that same thing again and they raise their hand. Here’s the thing, selling is a bad word. It’s an S word. Sell, it’s a four-letter S word and we can disguise it however we want. We can call it case acceptance, case presentation, what have you. But at end of the day, we’re exchanging information to the patient. They’re buying something from us. We’re exchanging a service for financial profit, and hopefully we’re doing it in a profitable way.So what we don’t like about the S word, sell, is that people feel pressured.

Eric Vickery (02:10):

They feel like, “I don’t want to be someone who’s a pressure salesman.” They don’t want to get into that mode. So what I train offices on for the last 20 years is how to sell in a way that there’s no pressure. In fact, we call it mutual agreement. They feel they got good advice from somebody they trust. Closing has this negative connotation to it, just pressure and understanding how to do that in a way that is comfortable for you as the dental team member, the doctor, or for the patient. Nobody in either side of that feels they’re being pressured into something. In fact, to me, this is what pressure sales sounds like and I hear this all the time. Quote, “You need a crown. Go up front and see Jenny and she’ll get you scheduled. Have any questions for me? Nope. All right. You’re all set. We’ll see you for your next visit.”

Eric Vickery (03:03):

That’s it. To me that is telling someone what they need to do. When you’re pushing and you’re telling someone, that’d be like you saying, “Hey, you need to upgrade your website.” “No, I don’t want to have one.” You don’t ever approach someone that way. You approach someone with some real basis, and we want to transition from telling people what they need to provide them with something that they want. They’re not there on accident. We just need to do more investigating and work on our soft skills to figure out what it is that’s really driving them… their butt sitting in your seat right now.

Chris Pistorius (03:33):

Yeah, yeah. Totally agree. I tell dentists all the time that you’re not selling dental services. You’re not selling dental products. You’re really selling, and it is selling, you’re right, you’re selling a solution to a problem. Tooth pain, you don’t like how your teeth look, whatever it may be. You’re trying to get somebody to that place where they want to be whether it’s out of pain, or a beautiful smile, whatever it is. If we can focus on marketing that, that checks a lot of the boxes and it’s all about, I think, selling the value. What are some tips and some things that you teach to your teams about this?

Eric Vickery (04:18):

Yeah. So there’s two rules in sales that I abide in. The first one is people buy for their reasons, not your reasons. So you can have all the initials after your name. You could be DDS, DMD, MAGD, AACD, whatever you want. They don’t know what any of that means. At the end of the day, they’re going to be making this decision and again, back to not pressuring them. So if you can discover what their reasons are. So, I’ll talk about that in a moment. Number two, people don’t buy a solution to a problem they don’t perceive to have. So if I live on a dirt floor and the door to door salesman comes to my door with a vacuum, I’m not buying a vacuum from him because I’m comfortable walking around barefoot on my dirt floor.

Eric Vickery (05:00):

But all of a sudden, he shows me his vacuum and he shows me what’s underneath the dirt floor. There’s beautiful wood floors under there. “Oh, wow. I didn’t even realize that was an issue. I wasn’t feeling any pain.” So I’ll use it all the time where I say, “No pain, no problem, no pay.” The patient’s perception is, “No pain, no problem. Therefore, I’m not going to pay.” That’s why… ask your admin team whether they can finish the sentence. They make the call out for a… the courtesy call two days before their crown appointment and the patient says, “Oh, I’m so glad you called me. I was just getting ready to call you. You know what? That tooth’s not even bothering me. So, I’m going to go ahead and wait.” I guarantee you your administrative person has heard that before.

Eric Vickery (05:38):

If so, that means they don’t understand the problem, the condition of what’s going on and there’s something chairside that we can do to fix that. All of this stems from these two rules that I have abide in. It stems from want versus need and most purchases we make in our lives fall into either one of those categories. “I need to go get gasoline for my car. I need to go buy groceries. I need to pay the bills. I need a new dishwasher. I need a new fill in the blank.” Those are the things that life thrust on you in a need for… it’s called push. It’s like it’s pushed onto you. It’s a need. Most people I would rather be in the pull category, the want. “I want to go on vacation. I want to go out to eat. I want to go to dinner.”

Eric Vickery (06:29):

Most people don’t wake up in the morning and go, “Oh, I really want a new crown today. You know what? I’m going to give Dr. Smith a call and get that scheduled.” So what we have to figure out is what do they want, and you mentioned it. They want, so you do back, to number one, people buy for their reasons, not your reasons. So you would do an interview with them, a tool that I use, and you would ask the right questions. You’d set it up properly before you ever look in their mouth and you’d find out what it is they are looking for, what they like, what they don’t like, what they’re looking for. The kicker is to find out why they’re looking for that. What’s important about that to them? You’ll hear things like, “My son’s getting married in a month and I want to whiten my teeth. I don’t like my smile. There’s going to be wedding photos.”

Eric Vickery (07:12):

Whatever it is, you’re going to hear, “Potential job promotion, but I don’t smile enough at work. I keep getting overlooked.” That was one we heard from an MDNA employee back east. We’ve had a grandpa brown tooth before. There’s just people who have this attached emotion to a justification. People buy with emotion, justify with logic. So there’s something there that’s driving them to you and they may not verbalize it upfront, may or may not, but a lot of dentists or team members get confused and they say, “Oh, this person really wants to brighten their smile or change their smile or fix this.” Well, that’s a what they want, but that’s not the driving force behind that to decide why they want that.

Eric Vickery (07:55):

So we’ll use this question. “Chris, why is having that so important to you?” You discover that your grandpa lost his teeth and you don’t want to end up like that. So everything that we diagnose clinically now becomes in relationship to that. It’s the center of the table setting at Thanksgiving dinner, and everything has to match to that. It points to that main thing, the main dish. So if we find something you were unaware of, gum disease, fractured teeth, whatever that might be, we’re relating that back to how that connects to losing your teeth like grandpa probably did or how that could affect the photographs or whatever. So for, I don’t know, 14 years and longer. I’ve been doing this 20 years, but about 14 years ago, I started to really perfect the verbiage of how you represent this to the patient in a case presentation formula.

Eric Vickery (08:48):

I train it and teach it all over it, but it takes the summation of what they said they wanted and why. So let’s use this example. “I don’t want to lose my teeth like grandpa did.” Okay. Then we take our diagnosis that they fully understand, eliminate all the technical jargon. We put those two things together and it goes like this. I say, “Chris, earlier, you shared with me it was really important for you to have peace of mind knowing that you weren’t going to lose teeth like other family members have. Keeping that in mind to the exam, I’m concerned about the infection of your gums, the decay, the cavities, and how those things cause people to lose their teeth. So how concerned are you with that?” You get that test the buy-in right there to see, do they really buy in for their own reasons? Did they solve both those two rules? Did they buy the problem and did they buy it for their reasons?

Eric Vickery (09:38):

When you make that connection, it’s like when the patient asks you, “Oh my gosh, I didn’t realize it was so bad. What do I got to do to fix it?” That’s a very small percentage of time that that question gets asked by the patient. Usually you hear things like, “Don’t find anything today, doc,” when you walk in the room. So this is a way to get the patient to get to the want side of it. You told me this was really important for you. Here’s something standing in the way. How concerned are you OF this? Yes? Okay, great. Would it makes sense… do you want to talk about a plan on how we can take care of this?

Eric Vickery (10:11):

When you say, “Yeah, I want to talk about a plan,” then you finally have the right… you’ve earned the right to now talk about treatment. Before that I never talked about zoom, implants, crown and bridge, anything. It’s all been condition and emotion focused. Then they’re saying, “Yeah, what do I do to fix it?” Now you get to talk about treatment plan. I still never say, “Need.” Need is a four-letter word, but at the end, we would talk about mutual agreement and close. So, that’s a big overview. It’s a lot of information at once, but does that make sense?

Chris Pistorius (10:39):

Yeah, absolutely. It’s like the old… when I first got in professional sales or my career long time ago, they taught us it was the feature, function, benefit, tie-down It all came from the original consultative sales approach where you ask… still today, when I bring on new clients, that first meeting is all about them. I want to find out what sparked the call, why they think that they need help marketing, what do they think they need help marketing in? Then they start telling me those things that builds a story. Okay, three more patients a month would mean that the doctor and his family can spend six more days together on vacation a year.

Eric Vickery (11:22):

There’s a benefit.

Chris Pistorius (11:23):

Absolutely. So once you have that approach, you presented as three more cases a month and you’re on the beach an extra week with your family, what would that do for not only your bottom line, but your quality of life? If you can build a story and refer back to that, it’s amazing.

Eric Vickery (11:43):

It’s the anchor.

Chris Pistorius (11:44):

Yeah, absolutely. I can tell you there’s, geez, a low percentage of dentists that are doing that today, I believe. Because in dental school they do a great job of teaching these folks how to be dentist, but so little about business and marketing and selling and things like that which leads me to my next question. When you go in and you help somebody and you take on a new practice, are you training the entire staff, just the dentist, just the hygienists, or what does that look like?

Eric Vickery (12:18):

Well, so the phone call is a great second impression and you know that from what you do because they’ve already seen the website. They’ve already been referred by someone. So I believe that case acceptance starts with the second impression, which is how you answer that phone. Unfortunately, you know this as well, almost two thirds of dental offices don’t ask for the appointment. They just they’re helpers, they’re… they problem solve and they’re just there to help people. They don’t take the time to really ask, “Would you like to go ahead and get that scheduled?” So from the phone call, I’ll say this to team members all the time. I’ll say, “All right. You’re asking questions on the phone. That’s great. What’s the most important question you ask? You have to earn the right to get there, but it’s…”

Eric Vickery (12:58):

I hear their name, the marketing source, the website, primary issue, how long it’s been, all of these things. Then I’ll keep waiting. “Those are all good questions. What other questions?” Finally, I’ll say, “All right. What’s the goal of every new patient phone call?” They’ll say, “Well, to schedule them.” Okay. So therefore, the most important question is the last question. “Would it make sense to go ahead and get you an appointment scheduled with our office?” So getting the team’s whole psyche on board with case acceptance and how we then prepare the clinical team for that patient’s arrival at morning huddle so the doctor doesn’t walk in the room or the hygienist or the assistant and go, “So what brings you in today?” That’s shooting ourselves in the foot. We just built all this rapport on the phone and then we just… we just drop it.

Chris Pistorius (13:45):

No idea why they’re there.

Eric Vickery (13:46):

Yeah. We walk in and say, “Oh, Chris. It’s great to meet you. I heard a lot about you from Jenny. I know you talked on the phone. She told me that.” You replay those things. All the gurus that you and I probably both listened to talk about credibility. If you don’t have credibility, they’re not doing business with you. They’re not conscious of it necessarily, but there are things that either create confidence in your competence or decreases confidence in your competence. Seating them on time versus late or early. Were you interrupted and put on hold a bunch on the phone? Did you walk in the room and say, “So what brings you in today?” He calls you Carl or something instead of Chris. It’s… are we on the right page? Do we really know what we’re doing? This is what creates that credibility. Your every interaction is creating confidence in your competence.

Eric Vickery (14:40):

So you have to have all of the soft skills. The system set up, you mentioned dental school and preparing them. Dental school prepares dentists this way. Where does your success come from? 15% is your foundation. That is your clinical expertise. You’re constantly doing clinical CE, but it literally is only 15% of your success. If you stood out front of your office with a sign that says, “I’m a great dentist, come see me.” It’s not going to carry any weight. People got to talk about you. You have to have bedside manner. You have to have these skills. So 85%, this is from Mellon University, Carnegie and all those guys, 85% comes from your people skills and your systems and how you do this.

Eric Vickery (15:19):

So I focus on training the whole team, the entire team on how to get case acceptance from the phone call, to the doctor walking in the room, to transferring that patient back to a clinical team member who then transfers that person back out the front, to financial arrangements, to scheduling. It’s a process, and if everybody, it’s a team, if everybody’s not on the same page, it will… you’ll get tripped up pretty easily.

Chris Pistorius (15:45):

Yeah. It’s important. You can get as many new patients as you want, but if we’re not getting them in for the treatments that you recommend, it doesn’t really matter a whole lot.

Eric Vickery (15:56):

Yeah, exactly. They tell me they sell 50 new patients and I just want to know how many of them have a future appointment, and you bring up a great point. I’ll ask doctors all the time, I’ll say, “Well, what is the goal for case acceptance?” They’ll go, “80, 85%.” Well, 85% of what? What does that mean? It’s really specific. So we use a case presentation tracker, a case acceptance tracker, and it’ll track existing and new patients, their name, the type of procedure, the dollar amount. Then if they scheduled or not. If so, how much of that dollar amount? If there’s nothing scheduled, there’s a follow-up column. We’re looking at three things. One is 80% of the people are scheduling something. So that’s, you would think, “Oh, 100% of people scheduling something.” That’s not going to happen.

Eric Vickery (16:44):

We’re we’re being realistic with this. 80% of the people are scheduling something. That could be a cleaning down the line. It could be a supervised neglect. I don’t know what would define what that is. Something in the future. We need to maintain relationship with this person, but 60% of the dollars are being scheduled at the time of presentation. A lot of doctors would be shocked to see how low that number is when they actually track it. So, I love KPIs. I love advanced tracking and I love good old fashioned hand counting and looking at it and getting the team involved in owning that and being a part of the culture. If you were to hire a hygienist, you’re interviewing two hygienists and you say, “All right, so I want the one that has 100% case acceptance or the one that has 50% case acceptance.” Part of us goes, Well, I think 100%, but it must be a trick question.” It’s a hundred percent of what?

Chris Pistorius (17:37):

Yeah. It’s the old adage, what is it? What gets measured gets done.

Eric Vickery (17:42):

What you measure you improve.

Chris Pistorius (17:43):

Absolutely because I talk about it all the time. I’m like, “All right.” So one of the things that we do are reactivation campaigns. Maybe a patient hasn’t been in in nine months. That’s off a red flag in some system, somewhere, it gets to us and we take them through a marketing process to try to get them back in. So one of the initial questions is, “All right, what percentage of your patients are inactive versus?” That’s a pretty easy number to find if you have a system. A lot of times I get the glossy eyes like, “Oh, I don’t know.”

Eric Vickery (18:13):

Yeah. Nobody wants to touch that.

Chris Pistorius (18:15):

Any business owner, and this applies for dentist, auto repair guy, whatever it may be, you got to know your numbers. When you know your numbers, that makes running your business that much easier. Would you agree with that?

Eric Vickery (18:26):

Absolutely. In fact, the dentist, I find, that our most successful know their numbers because here’s what happens. It’s not just, this’ll get really deep now Chris, it’s not just about what I’m getting from case acceptance and dollars coming in. That means patient, by the way, I’m not a money hungry type of coach. I know that when the dollars hit a certain number, patients are getting healthier faster. That’s what this is about. The good news is we’re selling health, but it’s not just about what’s coming in. It’s also about what’s going out. So the most successful doctors are really paying attention to both. They know how to balance both. They know how to reward their team the best for not having turnover. They know how to appreciate. There’s intangible and tangible things that we do with those numbers. If you look at a number and you go, “Wow, my production per patient hygiene is… gosh, it’s 140. Oh, what does that mean Eric?”

Eric Vickery (19:16):

I can look at Perio percentage. I can look at production per hour and say, “Oh, there’s open time versus production per patient.” We compare all those things and then we say, “Here’s how you turn that dial up. Here’s how you can fix that,” with an actual verbal skill and system to fix your periodontal percentage that’s at 20% or lower. We want it at 35% or higher so… and there’re exceptions to that, but for the industry standard, we know where we ought to be and with tracking, we can actually coach from a position of numbers and the doctors love it and the team loves it. It’s not like, “Oh, more money, money, money, money, money.” It’s not like that. It’s… we’re being as efficient and effective as we possibly can by understanding what these numbers mean and getting… not somebody just going, “Oh, that number’s low. Go fix it.” But having somebody who says, “This is how you fix that number.”

Chris Pistorius (20:01):

Right.

Eric Vickery (20:02):

Yep. Yep.

Chris Pistorius (20:03):

It makes sense. It’s like in marketing. When we first start working at people, we’re like, “Okay, what’s working best for you now marketing wise? It’s just like, “Ugh, I don’t know.’ They’re just throwing money and stuff up against a wall and hoping something sticks versus having an actual plan in place. We’re like, “All right, we’re going to track everything and we’re going to know where it’s coming from and budget according to that.” So I know you do a lot with case acceptance, but we were talking a little bit offline too about your work with insurance as well. Could you maybe expand on that a little bit and how you can help practices in that role?

Eric Vickery (20:37):

Yeah, yeah. So my father-in-law’s a dentist and that’s how I got my start. That’s how I got here. I managed his practice for six years and we dropped Delta Dental in that time. We used a consultant and a coach to do that, and I learned through helping clients over the last 20 years, how to do that in a way that is actually better for the practice. When you’re getting a 42% write-off rate, I was doing a fee analysis with a client in New York and she was showing me, it was anywhere from 40% to 53% write-off rate. Well, when your profitability is, depending on how long you’ve been a dentist and how much debt you’ve paid off, is somewhere between 25 and 40%, you’re actually paying that patient to come in if you’re going to provide high quality dentistry. An hour long hygiene appointment and spending time with these patients.

Eric Vickery (21:23):

So insurance participation was built around group clinical setting procedures and process and speed. When you’re a high quality dentist, you’re not built in those same regards. So, my client load, I’m probably helping somewhere between six and a dozen clients at a time take six months to drop an insurance plan from any participation all the way to Delta. That’s hard to do. So, you have to have really good insulators in place to make sure all your systems are in place. You have new patient flow from the right source for the right dollar. All of these things play a role, and not only that, but how you say it to the patient over that six month process. You’re not going to… please, please, if you’re listening to this, you never send a letter to your patient base and saying you’re out of network with something. You’ll never see them.

Eric Vickery (22:13):

Do it right. Have a one-on-one conversation with them the right way. I just take teams through that. Hygienists become a huge player in that game because they’re doing this conversation chairside and hygienist will go, “Well, I don’t know anything about insurance. I don’t want to talk about insurance.” It’s not about that. It’s about relationship and connection and quality. Who do they have the best relationship in the practice? A lot of times it’s the hygienist and it’s also we know that we’re seeing them every six months. So we actually track, there’s another tracker. We track all the names in that insurance plan. You export that out of your software and you go, “All right, we’ve talked with Ricky Bobby, we’ve talked with Betty White, we’ve talked with all of these people.” What was their reaction to that conversation? Was it positive or was it negative?

Eric Vickery (22:52):

At the end of the six months, we could look at it and say, “All right, we’ve got a great result in that conversation. Everybody was really positive. All the people scheduled their next six month hygiene visit. Let’s go ahead and let the insurance company know we’re going to move out of network.” The key thing is to know this Chris, whatever percentage your write-off is with that plan. So let’s say it’s really conservative. Let’s say it’s 20% write-off. That means you can handle losing 20% of that patient base of that insurance plan and still be at at least a break even and probably better than that. You will see fewer patients making 20% more on the 80% who stay. Math always works. So I have a client that dropped six plans at once, which was big.

Eric Vickery (23:35):

I usually try to deal with about 15 to 20% of the patient population at times. So I have a tracker that we put together and it says, “All right, you have 1500 patients in Aetna, you have this percentage. In Cigna, you have this percentage. We add up a couple of groups. We get to about 15%. We say, “All right, we’re going to handle those three for six months. Then we’re going to handle the next 15% of the population the next six months.” It starts to help the… that way, I’m not having this conversation, every single patient all day long and we’re not changing everything at once. It’s a slow roll and it works beautifully. I love this system that I’ve created and it just works well with practices.

Eric Vickery (24:08):

I’ve never had anyone… I’ve had one client go, I take that back. I’ve had one client in Nebraska go back into Blue Cross and Blue Shield because Lincoln, Nebraska is the hub and it’s just so many patients. It’s amazing how it works and the doctor realizes, “Wow, there’s so much more money left at the end of my month now to pay my team more, to reinvest in my practice, to invest in myself in CE.” To do that extra vacation you’re talking about, whatever it is, a team event and not feel so strapped.

Chris Pistorius (24:42):

Just eliminate some of the stress with trying to bill insurances and just keep all of that stuff straight. Wow. So basically what you’re saying is somebody could hire you to increase their case acceptance rates and decrease their dependency on in-network insurance. Is that about right? Where do you sign up?

Eric Vickery (25:02):

Yeah, yeah. It’s definitely doable, but you got to put… you got to have all the insulators in place to do those things. Meaning I need to see the numbers. I need to see what you’re doing now. I might look at it and say… I have clients who are in-network with insurance and it’s working beautifully because we’ve created systems around that process to make it work. So it’s not for everybody. It depends on where you live. I have a client in San Francisco. It just… .it’s a different game you got to… so a lot of young dentists come out of school thinking, “Oh, I’m just going to sign up for every plan. I’m going to get in-network with everything. Then later on if I want to I’ll drop it.” They don’t really understand the depth and the deal they’re making right there.

Chris Pistorius (25:40):

Deal with the devil right, that’s right.

Eric Vickery (25:43):

That’s right. So it’s big. So if I could first say, if you’re young and listening to this, I’m happy for free to talk to you if you’re right out of school and tell you, please don’t sign up for every plan. Take a slower time to get patients who pay you the full cost. You have so many expenses from an overhead standpoint, you need to be getting a hundred pennies on the dollar. Not 60, not 50. So… but yeah, I’m happy to help. They can reach out to me. I love helping people be able to reach more patients and help more people. So…

Chris Pistorius (26:15):

Yeah. Well, let’s talk about that, Eric. I appreciate you taking the time to be here. I know how busy you are, but I know you live in California, right?

Eric Vickery (26:24):

Yes.

Chris Pistorius (26:24):

But you work with practices all over the country and in other countries too, right?

Eric Vickery (26:30):

Yeah. So, because my father-in-law’s in Maine, I actually lived in Maine for six years. So I have a lot of east coast clientele, but I now live in California where I grew up. My family now lives here. So I have clients in Alaska. I once had a client in Newfoundland. I work with clients in Canada. I’ve been all over traveling. A lot more Zoom nowadays than traveling, but it works great and keeps costs down for clients. So I found a win-win in this too, but I’m all over the place. Yeah.

Chris Pistorius (27:04):

Yeah. So what can you offer, maybe somebody that’s listening to this or watching this, what can you… what’s the first step? How do they reach out to you? Do you do a free consultation of any sort or?

Eric Vickery (27:14):

Yeah. If they’ve listened to this and they like what they heard, they can just mention it. I’m happy to give out my phone number, or you can just text me, that’s a quick way. You can text me there. If you’d rather you can email me either way, but you can go to my website, VickeryDentalConsulting.com. You can go there. You can text me at my phone or email me either one.

Chris Pistorius (27:37):

Awesome. Do you want to give your phone out or?

Eric Vickery (27:39):

Yeah. Yeah. Sure, sure. Yeah. The phone number is 530-356-4011. For all the east coast clients, just remember I’m on the west coast when you text me. 8:00 AM your time is 5:00 AM mine. So, 530-356-4011. Or you can email me. Yeah, you can email me through the website at ericyourcoach@charter.net. I’m happy to help answer any questions you have. It’s what I do. I love what I do. So yeah.

Chris Pistorius (28:08):

Well, Eric, thanks so much, man. This has been incredibly helpful to me just to learn more about it, but I can’t imagine how helpful and valuable this is to somebody maybe just starting out, or maybe it’s been somebody that’s been in business for 20 years and is tired of the insurance game and is tired of losing patients that are hard enough by themselves to get it on the door that are not accepting the cases. So thanks so much for taking the time to be with us today.

Eric Vickery (28:33):

No, thank you. It’s been a blessing. Appreciate it.

Chris Pistorius (28:35):

Awesome. Everybody, thanks for tuning into another episode of the Dental & Orthodontic Marketing Podcast. Be sure to check in next week as we’ll have another awesome guests that will help you grow your practice. Thanks and we’ll talk to you soon.

 

Chris Pistorius (00:04):

Hey everybody. This is Chris Pistorius again with the Dental and Orthodontic Marketing podcast. Today we have got a super awesome guest. We have Mr. Brandon Rogers from the Verber Dental Group out in Pennsylvania. He is the chief financial officer there and we’ve interviewed several DSO presidents and CEOs, but never a CFO. So Brandon, welcome to the show.

Brandon Rogers (00:34):

Thanks so much for having me. I appreciate the opportunity.

Chris Pistorius (00:37):

Absolutely. So I just said that we typically will interview CEOs, marketing guys, but never a financial guy and maybe possibly you’re the most important part of that whole core, right?

Brandon Rogers (00:52):

Well I saw you at important. It’s like the members of the body. I mean, everybody’s got a different function, but specifically around watching COVID happen and certainly people got a little bit tighter and a little bit scared. I think-

Chris Pistorius (01:07):

Yeah.

Brandon Rogers (01:07):

I think we saw finance jump out and people with a decent macroeconomic understanding of the world were able to capitalize and I feel very fortunate that we were in that group.

Chris Pistorius (01:18):

Yeah. Absolutely. And off air we were talking a little bit about the landscape of now we’re coming out of COVID hopefully, knock on wood and people’s behaviors and how we’re starting to see some rebounding. Why don’t you, first of all, I guess, let me back up. Tell me a little bit about Verber and what your goals are and just a little bit about the organization.

Brandon Rogers (01:39):

Sure. So Verber Dental Group’s been around for a while. We started as a single prop as most dentists typically do, but then we’ve got a great visionary CEO, Dr. Michael Verber. He’s brilliant, he’s got a great visionary mind, and that really kind of set us all in motion. So I’m the newest of the executives and partners of the 13 partners we have and over 150 employees, but they got moving, they started to grow and said, “Hey. In 10 years wouldn’t it be great to have five locations?” And that happened within, I think, three. So growth is one thing, but what makes Verber such an amazing brand and product really is the way that we connect with our community. So we do a lot of community outreach.

Brandon Rogers (02:32):

We’re very big on giving back. We talk about the holistic approach to dentistry and how that impacts the people. So people understand when they come in, there’s a concierge service model that we provide, but we don’t over diagnose, we don’t under diagnose, we give you what we know is important for you to know and then we talk about it. It’s a very conversational interaction and I think that just goes to speak to our wonderful staff of clinicians and everyone from our TCS, our front desk to the admin team. Everybody works to make this work well and again, we’re in a space now where we feel like we just want to continue to increase our influence and be able to do that for more.

Chris Pistorius (03:17):

Yeah. I think those are awesome points and we talked a little bit also about how DSOs typically kind of have this negative tone to them when you talk about them in the industry. And I’ve spoken with several leaders in the industry and could you talk a little bit about that, about why maybe there’s a little bit of that negative attitude towards DSOs in the industry and how you guys are trying to change that?

Brandon Rogers (03:46):

Sure. By definition a DSO is a Dental Support Organization. The concept is about shared services and I’ve worked in different environments where they do have that. Sort of like a hub and spoke FedEx model. The difference though is that most DSOs they centralize what they think is the core and then they take the opportunity for the producers, the dentists, and they create the spokes and then they have all these accesses. What makes us different, I would first remove the DSO acronym and put a DHS acronym.

Brandon Rogers (04:19):

So that allows us to talk about what a dental health system is. And dental health system for Verber Dental group is more about having the holistic approach much like what the Mayo Clinic might do. So we have all of the specialties right now with the exception of orthodontics so that when we have someone internal that has a big case and there’s everything from the K to a crown to a root canal and veneers and everything, surgery, we have them end to end covered because it’s important for us to understand that they’re not a product, we’re not referring out.

Brandon Rogers (04:53):

This isn’t a dollar sign to us. This is a person looking for holistic care and we want to be able to provide that. So the DSO gets a little bit of a bad rap and some people use the definition by proxy of growth and numbers when in reality what we are creating is anything, but that. We’re creating something of a closed system so that we can protect the product more sufficiently.

Chris Pistorius (05:18):

Yeah. So I think that’s an interesting analogy when you mention the Mayo Clinic and it just kind of hit me. So if somebody has a complex case, we’ll say in one location, you guys have the ability to bring the entire team together, specialists and whoever, and talk about a particular case to help that patient. Am I on the right track there?

Brandon Rogers (05:38):

You’re 100% spot on. Yeah. I mean, the connectivity of the managing partners, the other associates, the doctors, we’re extremely communicative. And I think as everyone scales, as you grow, you want to keep that communication strong. But for sure, having a big workup with a lot of different moving parts requires collaboration, requires good conversation, and friction. We’re not afraid to disagree with one another. We’re not afraid to push one way or the other. And that, to be honest, is what makes a familial organization like ours so successful and poised for such good growth because we’re not afraid to fight a little bit to make sure that we’re doing what’s best for the patient.

Chris Pistorius (06:19):

That’s awesome. And I think that you hit it right on the head. People think DSOs, they think companies that come in and take over a community, offer $19 cleaning and x-ray and churn and burn, right?

Brandon Rogers (06:32):

That’s right.

Chris Pistorius (06:33):

And this is really the first time that I’ve heard somebody explain it as it doesn’t have to be that way. It can be a holistic, very personalized care, and, “Oh, by the way, you’re not just getting one doctor or two doctors.” You’re getting a team of specialists all around the area that can help at any given time that they’re needed.

Brandon Rogers (06:50):

Exactly.

Chris Pistorius (06:51):

I think that’s really cool. So tell me a little bit as a CFO, obviously the financial guy, you got to make sure that you’re growing responsibly, I think is probably the best way to put that. What are you seeing now that we’re coming out of COVID? Are you seeing a rebound? Are you seeing your organizations starting to rebound a little bit?

Brandon Rogers (07:10):

Absolutely. Not just a rebound. Fiscally I can see that happen. What happened with COVID was an interesting, it’s going to be talked about for years and I’m an economics interest. I wouldn’t say aficionado. No one’s that good, but I love them. And so I think studying macro micro trends in any industry, but specific to dental, it was an opportunity for us to look at something like this pandemic and try to figure out, “All right. What are our lessons learned?” And there is a remarkable rebound, but people are rebounding for different reasons. Before it was a mentality of, “We need to do this to maintain.” We’ve changed the narrative here a good bit. It’s not about maintenance, it’s about prevention, it’s about understanding the whole. We recognize that a lot of COVID patients there was preventative opportunities from the source of the mouth.

Brandon Rogers (08:08):

So we have dentists being able to get in there and do some preventative measures or even identified some opportunities. So the rebound is coming in what I think is illustrating more of what dentistry is as a whole unit. It’s not just microcosm of health. It is truly the gateway to the whole body, through the mouth and we do a lot with it. I mean, we’ve got doctors here that are advancing sleep studies as it relates to your oral care and it’s pretty remarkable. So I would say we took this time to stop, pause, spend a year making sure that financially we were solvent and we were positioned to grow, but more than that, I think we re-evaluated what’s important to our organization and how we get there.

Chris Pistorius (08:52):

Yeah. That’s good to hear and that’s why I really was excited about having you on the show is the financial side of things because I think when dentists come out of school, they know a lot about dentistry, but sometimes we find that they don’t always know everything about business. Certainly marketing from my perspective and how to run a business and how to understand the economics of a business. And I think it’s important, not every dentist is going to be able to bring in a CFO certainly, but it’s great to get a perspective on where the market is now kind of post-COVID and where you think it’s headed. And so I want to get into that. What do you think the next 12 months to 24 months looks like in dentistry?

Brandon Rogers (09:36):

Sure. No. It’s an interesting juxtaposition right now. COVID being one part of that variable, but the other part of it’s just happenstance on timing. You’ve got a whole generation of single providers that are just aging out. They’re ready to retire and COVID maybe was an accelerant, but it was inevitable nonetheless. And then you’ve got people that are just remarkably interested. This is why you see DSOs such a recurring theme because they want to gobble up and make sure they’re giving these sole props this great premium. What we’re trying to do is a little bit different. We see that the market’s consolidating, but we understand that the consumer’s still looking for quality of care and they’re still looking for trust. I mean, that’s a big thing when you’re handling anything that has to do with your body, but specifically the form and what can be seen.

Brandon Rogers (10:29):

So we see the opportunity as consolidation, not slowly, but I think strategically and consolidation in a way that allows other people to recognize that we’re not looking to grow for profit over patient. In fact, it’s always patient first, profit is always a secondary variable. It’s always secondary. If you’re doing the former first, the latter, is handles itself.

Chris Pistorius (10:54):

Right.

Brandon Rogers (10:55):

The market at the end of the day is moving to a place where if we can marry those two things well, we’ll actually have providers preferring to sell to us because you preserve their brand, which is what we do. It’s a big thing here at Verber. We’ve got all of our locations have their own brand. They have their own unique style and look, even when you walk into one and every doctor their own and we encourage them to stay that way. We don’t want them to be different. I mean, we don’t want them to stay the same, we want them to be different.

Chris Pistorius (11:23):

Right.

Brandon Rogers (11:24):

As an admin and me and my role, my job is to support that. My job is to make sure that they have the tools fiscally, the tools operationally to do their job well and to maintain that brand identity. And I think that’s what is going to allow us to flourish.

Chris Pistorius (11:41):

Yeah. I think that’s a great strategy. I’m going to put you on the spot a little bit here and I know this isn’t your deal, but it sort of is. So you’re the CFO of a large DSO. Talk to me about if you had an individual practice, right, and you’ve been in business for a few years, what are some tips that you can give somebody that’s looking at their financials? What should they be looking at? What kind of strategies would you suggest to a smaller network?

Brandon Rogers (12:08):

Sure. Yeah. So it’s all about the balance sheet really. The balance sheets a funny thing. People get scared when you talk about financial statements. They think about income statements and it’s all about debt coverage ratios, debt to equity ratios, those things matter, but really you can simplify it. It doesn’t have to be that difficult. It’s much like the way that you were raised and this is kind of how I approach finance in general. what is your income? Understanding taxation and those kinds of things. What’s your income and what are your expenses? How do you deploy the excess when there is excess and how do you create a safety net?

Brandon Rogers (12:44):

So for those that are single prop that may not have the acumen that they would want to pay for it otherwise I would say look at the way that you’re growing or look at the way that you’re maintaining what you have. Treat it the same way you do your personal budget, your grocery list. Prices go up and your personal rate of income doesn’t move in tandem with that. So what do you do? Well, you make concessions here. I do a lot of personal negotiations with a lot of the vendors to make sure that they’re keeping up with what we’re keeping up. So negotiations important and it’s not about beating up people for price. It’s about making sure that everybody’s winning. Going back to that concept I was talking about earlier. Nash equilibrium is a very real thing and you can create it when you’re talking honestly and openly.

Brandon Rogers (13:32):

So for those that are wanting to get a better sense of their finances, take a look at the relationships you have, keep them honest and make sure they’re keeping you honest, and then make sure that when you are deploying capital that you’re doing it in a way that’s from a fiduciary perspective, enabling the whole and not just yourself. When you take care of the people that are taking care of you, your hygienists and assistants and your front desk, make sure that they’re taking that because they work harder, they work better, you grow. It’s a nice cycle.

Chris Pistorius (14:01):

Yeah. That’s great advice. If you’re a dentist that’s looking to age out or retire, maybe they’re looking at a couple of different DSO options, what should a dentist have in place and ready to go so that they can make a sound financial decision about selling their practice?

Brandon Rogers (14:19):

Sure. It’s a great one. So I’d say always have your collections ready to go. 2020 was this big black hole that nobody really understands, but you can study trends and understand where things are going. And then you make adjustments to your point about the rebound in ’21 post-COVID, what that rebound looks like and then you apply a certain multiplier or a premium to help understand where the trend dipped in 2020. However, I would say that they come to the table with their collections, their patient base, more importantly than that their loss ratio on retention from their patient base. Those are very good indicators. For me, I’m looking for guys and girls, females and males in this industry, they have high retention, they’ve got a solid patient base.

Brandon Rogers (15:08):

Long-term because we don’t want to come in and take over, want to come in and empower. Keep doing your job well. If you want an associate we can provide an associate, but those people are there because you’re there. So if they’re looking to sell, we’re also saying, “We’re willing to pay a premium if you stay on for 12 or 24 months,” because that way it’s the best win for everyone. We learn your patients-

Chris Pistorius (15:31):

Yeah.

Brandon Rogers (15:31):

They kind of adjust to you and to us. And then they understand that this isn’t a transaction. This is a transition much like the Baton in an Olympic race. We’re not done our piece. It’s still required that all the other legs are keeping up their end and that’s very much part of it. So it’s a relational dance when we talk about acquisition or purchasing because on both sides they’ve got to be transparent, they’ve got to be okay to talk the numbers, and then they’ve got to understand that for all of us, the money means nothing. When you’re talking about the products you’re buying the goodwill and you’re buying the brand equity of the organization.

Chris Pistorius (16:10):

Yeah. That’s great. That’s great. Let me ask you a little bit about your organization. You have eight locations now, is that right?

Brandon Rogers (16:17):

Correct. Yeah.

Chris Pistorius (16:18):

All in Pennsylvania?

Brandon Rogers (16:18):

All in Pennsylvania.

Chris Pistorius (16:21):

Tell us what are your growth plans for the next year or two? Where do you plan on being?

Brandon Rogers (16:24):

So there’s opportunities all over. We want to keep the footprint, I think, within a certain radial mileage. That’s a partner conversation we’re still discussing, but I don’t think anything’s off the table as far as geography. I think what kind of drives those decisions, expansion is going to happen, growth is going to happen, is where we can have product control. QA QC. We want to be able to shore quality and we want to be able to control the quality. The whole is only as good as the sum of its parts and we got to make sure all of those parts are moving in tandem synchronously and they’re also moving in a way that allows refinement and some friction, I mentioned that earlier.

Brandon Rogers (17:13):

You’ve got to be okay being able to look at a different way. And so for us, our growth is also internal. What are we doing differently? What could we be changing? And at the end of the day, what needs to be done? Everybody’s got a different playbook in all those locations, who’s got the best play on this one? And we take our cues from them.

Chris Pistorius (17:35):

Yeah. That’s awesome. It’s so exciting to start talking about growth again, isn’t it?

Brandon Rogers (17:40):

It is. One is I’ll tell you, this world, we can do a lot for the consumer in a post-COVID world, not just about the dentistry. It’s also helping them work through some of the anxiety about what just happened. A lot of people are still reeling, not unlike what happened in the crash of 2008. What happened in 2001. You can keep going down, but everything has one common denominator and that’s that people, they get scared and they have three responses. They flight, they freezer, or they fight. And Verber Dental Group that were fighters. We push through because we don’t know another way and we want to continue to stay loyal to our organization and our people.

Chris Pistorius (18:26):

Wow. Well Brandon, I got to thank you for being on. You’ve given myself and I’m sure everybody that’s going to watch this a very fresh perspective on the whole DSO landscape and how you are doing things a little bit differently. So thank you so much for your time today. I really appreciate it.

Brandon Rogers (18:45):

I appreciate your time Chris, and thanks for having me on.

Chris Pistorius (18:47):

Great. And thanks to everybody for listening to this episode. Make sure you tune in next week for another great guest. Thanks again.

Chris Pistorius:
Hi, everyone. This is Chris Pistorius again with The Dental and Orthodontic Marketing Podcast. We have got a super cool guest with us today. We have Melissa Turner, who quite frankly, does a little bit of everything in dentistry, but she is known as a dental influencer, a dental consultant, and she’s also, I think this is really cool, the Co-Founder of The National Mobile & Teledentistry Conference. So Melissa, thanks so much for taking the time to be with us today.

Melissa Turner:
Chris, thank you so much. What is up, everybody? Honored to be here, so honored.

Chris Pistorius:
Yeah, I feel like I should be getting an autograph or something, because everywhere I look with dentistry, you seem to pop up. So you’re doing a great job in something I’m trying to learn from, so thanks again. Melissa, we’ve got quite a few clients around the country and we do marketing for them, and during the pandemic especially, and even a little bit before that, we started getting questions around mobile, teledentistry. “How could we use that? Is it possible to use that in a dental practice?” Can you just start us off by telling us all right, what is mobile, what is teledentistry? Fill us in on the latest on what’s going on with all of that?

Melissa Turner:
Chris, I would love to. So this is something now, we were talking before and I told you I’ve kind of been preaching the same message for about six years now, and the message is basic, the message is dentistry is changing, our patients are changing, the dental consumer is changing, and as an industry, we have to adapt to the changing times. And so, one of the things that’s super important is changing the way that we deliver our care. So, in the past, I’ve been a dental hygienist for going on almost 20 years now, and it’s one of these things where we’re so used to the patient walking through our front door, we’re so used to that mindset. You come to us. Sure, we’ll send you a mailer. Sure, we’ll be active on Facebook, and you can friend us and whatever, but you come to us. And especially since the pandemic, we’ve realized that the dental consumer, wants us as the dental professional, to come to them.

Melissa Turner:
So mobile delivery of dental care, virtual delivery of dental care, we lump that together, in everything that I do. We have a conference called The National Mobile & Teledentistry Conference, and we use those two terms because it’s healthcare delivery outside of the four walls of the dental practice, and you can have mobile dentistry without teledentistry, but they really do go hand in hand. They’re like peanut butter and jelly. The mobile clinician can go more mobile, and stay better connected using teledentistry. You can have fixed dental practices that just have a virtual arm into the patient’s phone, and that’s getting the care outside of the traditional brick and mortar, and that’s where we’re headed. So that’s the long and short, that’s the 60 second spiel of what mobile and telehealth is about right now.

Chris Pistorius:
Nice. That is exciting stuff, and it kind of changes the whole concept of this traditional dentistry as we think about it now. So, and I think certainly, people, I talk about this with our clients, look, not everybody wants to communicate with you by phone, right? And some people want to do a chat online, they want to text you, they want to do whatever, so why not open up your website and all of your other marketing assets to communicate in different ways with different people, based on how they prefer to communicate?

Chris Pistorius:
And we still get some of the traditional people that say, “Oh no, nobody wants to use that stuff. They just want to pick up the phone and call,” and I struggle with that, because I get frustrated sometimes and I’m like, “Look, it’s not about how you do things, it’s about how the rest of the world does things,” right? And I think that that’s where we are with some of our more traditional dentists now, and the thought of mobile and teledentistry, they’re just kind of like, “We do it this way, and that’s the way.” Are you seeing some of that? Is that pretty consistent where you are too?

Melissa Turner:
Mm-hmm (affirmative). Yeah. I mean, right now, we’re seeing adoption as either the practice owners are for it, completely or they’re not for it completely. Over the shutdown when dental practices were forced to close their doors and forced to find ways to find other touchpoints with the patients, they dabbled in virtual care. Many of them did it wrong, and got upset. Many of them did it right, and now it’s a regular part of their practice. And I’ll tell you two things, Chris, the first thing is when dental providers think about teledentistry and what that could mean, there’s so many times when they simply think that it means a live video chat like we’re doing right now. That’s what they think it is, and that’s well and that’s good, but the secret sauce is the asynchronous stuff, the stuff that doesn’t have to be live, the stuff that’s more flexible.

Melissa Turner:
So I know a practice owner who, over the shutdown, his hygiene department was backed up. They were just trying to get as many hygiene patients in and in as fast as possible, they had so many to get in, and what ended up happening was he was getting so tired, because during his crown prep, he’d have to get up four different times to go check hygiene patients. Well, that’s just a really inefficient business model anyway. So what he did was he started to use the asynchronous teledentistry aspect of his practice management software, and the hygienists would collect all the data, they’d do a scan, they’d do video and photos of the mouth, and the dentist at the end of the day, would just zoom through all the hygiene checks asynchronously without the patient in the chair, and he was able to catch up, and that’s efficiency.

Melissa Turner:
That’s something that not many dentists are thinking about right now. They’re thinking, “Oh, I got to go do the hygiene check,” they want to connect with that patient, but what if that patient doesn’t care about connecting with the dentist, right, that’s kind of where we are. They get that connection with the dental hygienists anyway. Yeah, and then there was a second thing, but I don’t really remember what the second thing was.

Chris Pistorius:
That’s all right. You’re like me, it’ll pop up in a few minutes.

Melissa Turner:
It’ll come back, yeah.

Chris Pistorius:
No problem. Yeah. Well, cool. So let’s talk about that a little bit, because I told you off air, we’ve kind of played with teledentistry with our marketing campaigns, and I think that there’s a lot to learn there, based on what you just said, and we going into it, kind of thought that way too, we’re like, “Okay, so we’re going to do a Zoom, a HIPAA secured Zoom with new patients,” and that’s some of the feedback that we got and they were kind of like, “You know what? Yeah, you can put it on the website, but I don’t think it’s going to work.”

Chris Pistorius:
And we had a lot of kind of, I don’t want to say pushback, but a lot of doubts. I mean, they’d say, “Yeah, we could see how that could work for a regular doctor to prescribe medication or look at something basic, but we could never do this. We could never make this work in a dental practice, but you can try it if you want.” So can you talk about that a little bit? And I know you touched on part of it, but what would you say to somebody telling you that?

Melissa Turner:
Mm-hmm (affirmative). I would say take a look at health . Dentistry has it easy, because we are typically about 10 years behind healthcare, and telehealth, they’re in a telehealth boom right now. And it’s one of these things where in dentistry, we’re still in the early adopter phases, we’re still in the pioneering phases of finding the right technology, putting together all the right pieces of technology to really make virtual care take off. But I’ll tell you this, if a dental practice owner starts to use virtual care and does it correctly, they’re going to find their schedule is open now, they can bring in those full day cases, they can bring in traveling specialists, and house their referrals under one roof.

Melissa Turner:
Their time just starts to open up, and it’s one of these things where… So the easy answer is, okay, so if you have an emergency, you can triage them via live FaceTime, or Zoom, or whatever platform, HIPAA compliant platform you use. You can do a post-op procedure, which opens up your clinical chair time. You can do a [inaudible 00:09:10] exam. You can do all these live things, but there’s also tons of not live things, asynchronous things that you can do in the background, and that’s where it’s a learning curve right now for dental practice owners and their team. They don’t understand that maybe there is a better way to do this. Intraoral scanners are really entering both the mobile and the telehealth market right now.

Melissa Turner:
What we’re finding is dentists, let’s say we have a hygienist who’s offsite at a patient’s house, providing a cleaning and an exam. That hygienist really could do a scan, if they’re in a mobile unit, and they could do a video of intraoral photos of the mouth, and even just that data alone is mostly enough to create a diagnosis or a prediagnosis, let alone having the radiographs, let alone having the perio charts, let alone having the salivary testing. Down the road, we have remote patient monitoring, we have mHealth, mobile health. We’ve got all these apps that are coming down the road that we see in healthcare, that are now being applied in dentistry.

Melissa Turner:
There’s a great one for bruxism, and you wear a strap around your head and it measures the temporalis muscle. This is the patient is doing this, right? And so, then the patient on their app, they get to see their clenching and grinding that happens during the day, but then that information also gets sent to the doctor or the hygienist on the other side of the app, on the clinical part of the app, and that right there is virtual care, right? But we’re not thinking like that yet. We’re not thinking like that, but we are, it’s a learning curve, and we have to adopt it industry-wide. But we’re there, COVID-19, the shutdown really accelerated the way we think.

Chris Pistorius:
Yeah, yeah.

Melissa Turner:
Yeah, yeah.

Chris Pistorius:
I agree. I totally agree, and like I told you, we’d tested some of this before the pandemic, and then the pandemic hits and we’re like, “Uh-oh, we might need to think about this a little further.” So, and I guarantee there’s a lot of dentists out there that thought that same way. So that’s awesome. So what does all of this look like five years from now, in your opinion?

Melissa Turner:
Mm-hmm (affirmative). Yeah, that’s when I really start to get excited, because I think when a dental practice owner hears the word “mobile dentistry,” they’re either going to be like, “Yay!” or “Nay.” We’re so used to hearing mobile dentistry, mobile delivery as a public health thing, something that our patients don’t really want, but that is changing, and starting to implement virtual care teledentistry in a dental practice, is the first step. It’s kind of the gateway drug to thinking outside of the practice.

Melissa Turner:
So I know some dental practice owners who started implementing virtual care and now they’re like, “Well, why don’t I just send my associate out to the workplace down the street that has a hundred employees? Why don’t I go to them? Why don’t I drag portable units? Why don’t I buy a van?” You can get these great Mercedes Sprinter vans, low cost, low overhead. We’re seeing dental students coming out of dental school not wanting to purchase a practice, not wanting to be an associate. They can purchase these vans, they can pimp out a pod, a trailer for much lower overhead than a fixed practice. And the thing is, the patients want this, they want us to come to them. If I could have a dentist come to my house right now and see my two kids, me, my life partner, I’m like, “I will love you forever,” right?

Melissa Turner:
And so, that’s the thing, once a dental practice starts to implement virtual care, they start to think beyond the four walls of their fixed practice, and then the next step is to start sending their providers out. And then I can’t tell you how much chair time you’ll have for the more lucrative procedures, for the referrals that you don’t want to send to somebody else, you want to keep in house so you can keep on brand, so that you can retain that patient relationship.

Chris Pistorius:
Yeah. So I have probably a dumb question here, but when you talk about mobile dentistry, are you seeing doctors do mobile only, or are you seeing them have a brick and mortar and they kind of have a mobile unit, if you will, or could you do it both ways?

Melissa Turner:
Mm-hmm (affirmative). So I’ll tell you what I see right now, and then I’ll tell you what I see down the road, and that’s what’s exciting. So right now, I call them the sexy mobile dental companies. So for years, mobile dentistry has been known to go into nursing homes, school, and public health, giving away free dentistry. And whether that’s a dental RV on wheels, whether that’s portable units you drag in somewhere in a suitcase, that’s what it’s known for.

Melissa Turner:
About four or five years ago, we started seeing outside funding, VC funding, angel investors coming in. We started seeing non-dental business owners become interested in providing mobile dentistry. So right now, there’s this whole slew of companies of sexy mobile dentistry companies who are only mobile, and they take care into workplaces like Amazon Headquarters, Nike. We’ve got Floss Bar, Jet Dental, Onsite Dental, HENRY The Dentist, Studio Dental. I mean, the list goes on and on, and they rely on big time marketing, they rely on great branding to get them where they need to go, and they scale fast, they scale fast. They start on one end and before you know it, they’re all across the country.

Melissa Turner:
So that’s what we’re seeing now, and that’s kind of a phenomenon. That’s kind of a separate subgroup of business models. But what I see in five to 10 years, Chris, is the traditional fixed dental practice will have the virtual arm into the community, and then it will have the mobile arm. And whether it’s simply a provider carrying in dental units in a suitcase, the portable dental units, there’s a time and place for that, but then there’s also a time and place to pimp out an RV, and to make it look sexy and good, and start doing Invisalign, or Candid, or any of the aligners on there, and start doing sleep dentistry on there. And so, we’re seeing it, we’re seeing some companies, they get architects to design the inside of these RVs, and they look sleek, and they look good, and then they stay at a corporate facility for like a month, and they build a deck, and they build it into the area, and then they move on the next month, and it’s really working well, and it’s what the consumer wants right now.

Chris Pistorius:
Yeah, that’s amazing. You mentioned earlier, “If they do teledentistry correctly,” right? And I wrote that down, because what does that mean? What is correct? What’s the correct way to use teledentistry?

Melissa Turner:
Yeah. So if the word for 2020 was “pivot,” everybody was saying that, the word for 2021 is “flexibility,” having a business model that’s flexible. So teledentistry, if somebody implements teledentistry, it makes them more flexible, it makes their business more flexible, but not necessarily the live video chat. And this is kind of circling back to what we talked about earlier, because if I am a dentist and I have to be on live video chat all day long, how is that creating flexibility? How is that really any different than just having the patient in my chair? Except it opens up an op, which is different. But so, the flexible part of it is thinking, “What can I do? How can I use virtual care to expand my practice model, to reach new patients without me, the dentist, having to stare in front of a computer screen and spend time with the patient?” And that is the asynchronous, the store and forward teledentistry component. And honestly, if a dental practice has a practice management system that’s cloud-based, a lot of that can be done through that. Mm-hmm (affirmative). Mm-hmm (affirmative).

Chris Pistorius:
Right. That’s amazing. Do you have any stats or statistics, and if you don’t have them now, maybe you could send them to me later and I can include them with this, but about mobile and teledentistry, how many people are adopting it? You talked a lot about that’s what people want, I totally agree. Do you have any stats or numbers on that? Are we to a point yet where we’re even tracking that kind of stuff?

Melissa Turner:
We are tracking and we are collecting data at this point, The American Mobile & Teledentistry Alliance is working hard on that. What I can say, as far as teledentistry during the shutdown, there were numbers of up to 80% of dental practices who were using it at some points, and that would fluctuate down to 30, up to 80, back and forth, back and forth. So stats, we’re not there yet, but the easy answer is to look at the telehealth community, look at the stats in the telehealth community and see their adoption, because while we are more in-person clinical than many of our healthcare colleagues, it is still possible to do a lot virtually with our patients. Mm-hmm (affirmative).

Chris Pistorius:
Right. Are there any insurance implications here? I mean, does anything change as far as dental coverage with your insurance to use these types of services?

Melissa Turner:
Mm-hmm (affirmative). So what we’re seeing, well, to get into the weeds, there are regulations that you have to work around. And so, if someone is interested in potentially using telehealth in their dental practice, or even mobile delivery, you have to take a look at your state practice act, you have to take a look at what definitions they use, even the definition of a comprehensive evaluation. Do they say it has to be tactile? Do they say you have to be in-person? The practice acts are a little bit behind the times, but then the third-party payers also place their own restrictions on, and some of them have none, and some of them will only perhaps cover part of a live video chat.

Melissa Turner:
So these things, we saw a lot of movement in the last year, and even with the CDT codes, procedure codes for dentistry, we’ve seen a lot of movement with that to more teledental codes and virtual care codes going into those as well. So things are moving, but yes, definitely check with your third-party payer, check with your state practice act. State boards won’t even be able to give you an answer, so I’m happy if somebody needs me [inaudible 00:20:12].

Chris Pistorius:
Yeah, yeah. Awesome. So I want to hit you up on, what about HIPAA? Did anything really change there? I mean, you just got to lock down your systems if they’re mobile, and I’m assuming all the rules still kind of apply the same way, right?

Melissa Turner:
Yeah, if not, they’re stricter because of technology, and as technology advances, we’re seeing new rules and new things come that way. We’re going to have some pretty good education coming up at the conference in March at The National Mobile & Teledentistry Conference in March, regarding HIPAA and what to look for, and because there’s platforms out there that say they’re HIPAA compliant, but you will have to do your due diligence, and double and triple check that.

Chris Pistorius:
Don’t take their word for it-

Melissa Turner:
No.

Chris Pistorius:
… because that can be a problem, we’ve seen it.

Melissa Turner:
Mm-hmm (affirmative).

Chris Pistorius:
Let’s talk about this conference, it sounds exciting, all I heard was Vegas. So, but maybe you can talk to us about the conference coming up in March, and where it is, and the details, and all that stuff, please.

Melissa Turner:
Sure. So on March 3rd through the 5th of 2022, we will have our third annual conference, and it is a great time. So it’s two full days of courses, and then on Thursday, the day before we have a teledentistry workshop, so that day is completely devoted to teledentistry, getting as hands on as possible. We have the mobile dental RVs, we have the portable units that come, you can tour them, you can get hands on. We’re going to have some rooftop action this year, which is going to be amazing. And then the final night, we close out the conference with a separate event, but it’s an amazing event, it’s called The Denobi Awards, and The Denobi Awards is an awards program for all of dentistry, not just mobile and teledentistry, but the gala takes place on the closing night, and it’s like the dental Oscars. So it’s a time to celebrate everyone in dentistry. Nominations are happening now, and then people get shortlisted, and then the final list is announced, the final 10 winners are announced that night.

Chris Pistorius:
Wow, that’s awesome. That sounds like a really cool event. If people are interested, how can they find out more and get signed up, that kind of stuff?

Melissa Turner:
Yeah. So we’ll start with The Denobi Awards, it’s D-E-N-O-B-I, denobiawards.com. You can go there, you can purchase a ticket. If you attend the Mobile Conference, then your admission to The Denobi Awards is free. So the Mobile Conference, the website is www.N-M, D as in David, nmdconference.com. We’ve got early bird tickets happening until June 30th, and we do have exhibitor and sponsor opportunities too, which is really great, and we usually sell out. And the conference itself, it’s been hybrid all three years, so we always have a virtual component if you can’t make it there to Vegas in person, but who wouldn’t want to, right?

Chris Pistorius:
Right.

Melissa Turner:
Yeah.

Chris Pistorius:
What kind of numbers are we talking here? How many people? I mean, I know it’s going to be weird coming out of COVID, but what traditionally have you seen?

Melissa Turner:
So, you know what? So it’s all a story. So the first conference, we were happy if there were two people in the room, right? This was pre-COVID, we were like, “We’re just going to get this started, because it’s necessary,” and it ended up, we had 300 people for our first conference, and then another hundred or so online. And that was right before COVID, we came home, and the world shut down. And then we had a full year to plan for the second conference and we said, “We’re okay if there’s two people in the room again.” We were like, “You know what? It just needs to happen.” And so, we ended up having another in-person and virtual conference just in March, and we had probably another two or 300 in person, and then we had about 500 online.

Chris Pistorius:
Wow.

Melissa Turner:
So who the heck knows what we’re going to get into this next year?

Chris Pistorius:
That’s cool. Nice.

Melissa Turner:
Yeah. But what we know is that large conferences are kind of going by the wayside. We’re talking like thousands and thousands of people. And so, our perfect conference would be somewhere around 500 people, where you can still literally talk to everybody in the room if you want to, where the vendors get to know the people intimately, and where it’s a conversation, and not a show. Although we do have some fun things going on too.

Chris Pistorius:
Oh yeah, for sure.

Melissa Turner:
Yeah.

Chris Pistorius:
Well, Melissa, thank you so much. This has been a lot of great information, and I got to tell you, usually when I do these interviews, I already know quite a bit about the subject matter, but I’ve learned a ton in this short amount of time. So, and this is something that I think is going to continue changing, and probably change pretty quickly. Would it be okay if we checked in with you in a few months and just get a litmus test to what’s going on and what we’re seeing in the industry?

Melissa Turner:
Absolutely. And up until the shutdown, the pioneers were talking about mobile dentistry, about teledentistry, and then everyone was forced to talk about it. And so, what we’re seeing now are intentional conversations coming from it, from the third-party payers, from the DSOs, from the big brands, they’re talking about these things, and this is where it starts to get fun.

Chris Pistorius:
Yeah, yup.

Melissa Turner:
So yes, we’d be happy to come back and give an update.

Chris Pistorius:
Yeah, once you get those guys starting to talk about things, that’s when change happens pretty quickly, right?

Melissa Turner:
That’s right, that’s absolutely right.

Chris Pistorius:
So that’s awesome, and it kind of gets me excited too, because I think that’s probably going to be an arm off of us as well. How do we get involved with this and make sure that our clients stay on the top of that curve?

Melissa Turner:
Yeah.

Chris Pistorius:
So, great information, Melissa. Thanks again so much for joining us. I wish you the best of luck for the conference, and I have every intention of being there and being as much of a participant as possible, so thank you for that too.

Melissa Turner:
Thank you, Chris.

Chris Pistorius:
Okay. Well, thanks everybody else for tuning in this week. We’ll have another great guest next week.

Chris Pistorius:

Hi, everyone. This is Chris Pistorius with the Dental and Orthodontic Marketing Podcast. Thanks for tuning in today, or downloading, or however you listen to this. Today, we’ve got a great, great guest. I’m with Dr. Chad Johnson of Veranda Dentistry in Iowa. Dr. Johnson has three locations, and we’re going to talk a lot today about his success and how he kind of went from starting this, all the way up to three locations now, but Dr. Johnson, thanks so much for being a part of the show today.

Dr. Chad Johnson:

Yeah. Glad to join. Hey, everybody.

Chris Pistorius:

Yeah. So we, here at Kickstart, we obviously talk a lot about growth, right? Because dentists typically hire us to help them grow, right? And sometimes they just want to have a little bit more new patient flow for their existing practice, but there’s a lot of folks that are looking a little beyond that, opening up another practice. And I know there’s a lot of stressors, if you will, to go with that, but why don’t you tell us a little bit about your practice and how you got started originally?

Dr. Chad Johnson:

Sure. So I graduated the University of Iowa College of Dentistry in 2005. And so, at this point of the recording, I’ll have been open 16 years this summer. And so I just opened right out of school. It was still pre-2009, pre-2008 regulation stuff, that on a handshake while I was in dental school, I was able to get alone and open up as a hometown boy back in Pleasant Hill, Iowa. And so then I, just at age 40 last year, got done paying off my debts for the original practice loans and whatnot. And so I thought to myself, “Do I want to continue on kind of easy street after having paid all those off? Or do I double down and start investing in growing the brand that I had created?”

Dr. Chad Johnson:

So before COVID had hit, I thought it would be a genius idea to buy another practice. And while I was looking, basically another guy was like, “I really wish you’d buy mine too.” And so I ended up buying two practices and having the deal solidified legally right as COVID hit. So then I was kind of locked in to making it happen. And so for a year now, I’ve had three practices, two new ones. And so I have one on the north side of Des Moines, one on the west side of Des Moines and one on the east side of Des Moines.

Chris Pistorius:

Very cool. Nice. Take us back to 16 years ago or so when you started your first one. Were you thinking, “You know what? One’s great, but I want more,” or was one kind of the plan and this kind of all came together?

Dr. Chad Johnson:

I think my answer at that time probably would have been, “I’m open to thinking there could be more, but I just doubt it.” I think I was content with the thought of just opening up my own business. I don’t know. It’d be if you went back to Biden or Trump or anything like that, I’m throwing those key words in there, so if this gets transcripted, yeah, it’ll be a hot topic.

Chris Pistorius:

I like it.

Dr. Chad Johnson:

Yeah. If you go back to any of those presidents back when they were 20, and if you said, “Do you think you’ll be president someday?” They’d be like, “Well, I mean, I don’t want to rule it out, but I mean, I don’t know why I would be.” So, and then sure enough, after the fact, they get there. So, no, 16 years ago, that wasn’t on my radar. I don’t think I would have ruled it out if you would have said, “Do you bet that someday you might own three practices?” I’d be like, “I mean, I suppose, but it’s just not something that I want to, or care to, think about much right now.” That’s probably how I would have answered it at the time.

Chris Pistorius:

Yeah. I think that’s probably fair, and probably how most people think about that. Let me ask. So did you start the first one from scratch or did you buy an existing one?

Dr. Chad Johnson:

Nope. It was from scratch.

Chris Pistorius:

Okay. Got you. So you’re staring at a blank sheet of paper on your appointment calendar, day one, right?

Dr. Chad Johnson:

Yes.

Chris Pistorius:

And what is it that you did to go from nothing, to get to a point to where you can expand? How did you grow that patient base? How long did it take you? Maybe get into some of that.

Dr. Chad Johnson:

Sure. And I’ll even split it up into how I did it, versus how I wish I would’ve done it.

Chris Pistorius:

Okay, great. Great.

Dr. Chad Johnson:

Yeah. So how I did it was, we sent out mailers. My brother is a realtor, and at the time, he’s three years younger, he had already started his own real estate company and stuff. And so we thought, “Let’s split the difference on doing a mailer together for all the people that we know from around town and stuff like that. Let’s just kind of combine our resources of who we know, and let’s mail those people.” Basically we mailed them a Christmas letter saying, “Merry Christmas, and then here’s a magnet calendar.” Realtors are good at that kind of stuff. Especially 20 years ago, for 20 years ago. So we mailed out a mailer, a calendar, and it was a magnetic one that would stick on people’s refrigerators back when people did that, and these days, refrigerators are too pretty. But so we mailed those out and I think each of us spent $800 bucks on that we split the cost and mailed it out to, I don’t know, 500 or 1,000 people, or something like that, and we did that for a few years.

Dr. Chad Johnson:

What else did I do? For example, I coached a fifth grade basketball team around here, I joined the booster club, kind of some of your quintessential small town stuff that you would do. And I was well-known enough. I think also what doesn’t really help some people out, unless you’re really thinking ahead, is your reputation can precede you. And so if you have a good reputation, or let’s just broaden it out. If you don’t, or you don’t feel like you do, and you’re starting off in a new town, is you create the brand of who you are and what your public perception is.

Dr. Chad Johnson:

Now, what’s best, I suppose, is when there’s harmony between reality and what you’re trying to have people perceive. Then, you’ve got sincerity to your story. If you’re trying to portray yourself as a nice guy, but you’re a jerk, I suppose it’s going to play out after a while. But then again, what I’m saying is, if you want to be known as the guy who’s always helping with the sports teams and stuff like that, but you don’t love sports, well, that’s going to be dumb. But if you do have sports and you do love getting involved with that, well, then there’s going to be integrity to that, sincerity and integrity to that marketing.

Dr. Chad Johnson:

Now, what I also wish I would have done differently, but the there’s a dilemma in it. So I’ll get to that in a second. What I wish I would have done is, later on in my career, let’s see, that would have been about seven years ago, I started having a marketing manager. And so they’re in charge of reviewing my ROIs and tracking our data and putting phone numbers on stuff, so that way, we can see where our calls are coming from and working with the front desk people on how we’re answering the phones. So there was a lot smarter way to do it and more effective way to do it, and so that way we could track it. The only downfall to that is, on day one out of school, and I don’t really have a marketing budget, so that was the dilemma. I think if I went back and I said, “Chad, you should do this.” I’d be like, “Older Chad, listen, that’s cute and all, but I don’t have any money.” And I’d be like, “Oh yeah, good point.”

Dr. Chad Johnson:

So finding that dilemma of when you first can have someone that can oversee your marketing, but whether you have someone, I guess, to oversee it or not, then if I were to go back and say, “Okay, let’s compromise. Set up some phone numbers to be able to track where you’re getting your leads from, track it in your office when those patients finally do come in, and then also set aside money for a marketing budget.” If your marketing budget is 0% or 1%, then you’re probably not going to have that big of a return on the investment, as opposed to, let’s say that you spent 5%, so five times more than your 1% budget. You spent 5% budget in 2022, and you set up for that. You’re going to spend 5%, and that’s five times more than you had been doing before. You’re going to get more than a five fold increase on your marketing ROI, your return on investment.

Dr. Chad Johnson:

That’s just my opinion. And I imagine that matters from area to area, but it’s a synergistic outcome of being able to saturate your market with multiple media ideas. So for example, whether you’re doing Facebook and Instagram and YouTube and Google ads and mailers and radio and the local ball team’s banner at the little league ball field, that you’re hitting a few different venues of how people are seeing and thinking about you to keep your brand on their mind.

Chris Pistorius:

Yeah.

Dr. Chad Johnson:

Way long answer. My apologies.

Chris Pistorius:

No, no, no, no. I think you hit the nail on the head there. In fact, it doesn’t work for every market, but in some of the smaller markets, in terms of local community marketing, we actually, part of our service is that we will, on behalf of our client, we’ll actually reach out to little league teams, churches, events, anything that we can try to get involved with, and try to get some sort of sponsorship opportunities out of that. And it helps two-fold, in number one, what you talked about. They start seeing that brand kind of in the local community, which I think is awesome, but on SEO part of it, search engine optimization, which is getting your website to rank highly, you can get links from these events and from these organizations to your website, and that can just absolutely, incredibly boost your SEO positions, because Google loves to see those local community type back links coming in. And so it really is a twofold strategy where you get more exposure in a local market, but you might as well help your Google rankings while you can.

Dr. Chad Johnson:

Yeah, I like that, because you’re not only getting the PR that you want, but then you’re self promoting, in a way. And that sounds negative, but it’s just, well, take it for what it is. You’re using the PR that comes out and you’re trying to basically stir it, so that way it shows up in your LinkedIn, in your YouTube, in your Instagram, in your Facebook, all that kind of stuff. Or even if you’re small enough, your local town paper, perhaps. But just something, so that way, you’re recycling it. So that way, people are saturated with knowing. The humility thing, that’s fine, but at the same time, you have to have someone doing that for you. So self promotion might too strong of a word, but that’s why someone like you could go in there and do the promotion, and then it doesn’t necessarily have to come across like you’re promoting yourself.

Chris Pistorius:

Right, yeah. You’ve got it. And I still know dentists, I live in Denver, but I still have clients here that go to a weekly leads meeting, like BNI, for instance. They still get a great stream of new patients from doing kind of just grassroots marketing stuff like that. Did you do any of that or do you do any of that now?

Dr. Chad Johnson:

No. I think part of the reason why is, I mean, because my quick answer was going to be, “I’m not really a fan of doing that,” but I think the reason why is because I’m so extroverted anyway, that I don’t need too much of a platform to do that kind of stuff. I do feel like that probably helps some people out that otherwise naturally wouldn’t be finding those venues, but I’m really that quintessential guy that actually goes up to you and shakes your hand at a wedding and says, “I feel like I should know you, but I don’t know why.” And I’ll just strum up a talk that way. So for me to put it down might be a little quick shooting from the hip when, in fact, it might just be that my personality affords me to naturally meet enough people the way that I do, so yeah.

Chris Pistorius:

Makes sense. Well, when I started this business, I was kind of like you, I’d quit a pretty good paying job and had two little kids at the time. And all of a sudden, I’ve got a piece of paper in front of me with no clients on it and no income. So I’m like, “All right, I need to kind of go do the Mark Cuban approach, and you just grind and work and do everything you can to get in front of people and talk to people.” And I know dental practices that do that, and they have a lot of success with it, but you’re right. I mean, you can’t fake it, because if you don’t to go network and talk to people and be outgoing, it’s not going to work for you.

Dr. Chad Johnson:

Yeah. And if it’s not for you, call it like it is, because that might actually hurt your business if you go to those things and you’re just kind of a bah-humbug little fly on the wall, people are going to be like, “I don’t know what’s wrong, but he doesn’t seem to like us,” so it could actually work against you. I don’t know if that’s the case with most dentists, but probably at least, I don’t know, let’s just say a third of us, that a third of us dentists probably would not benefit from that, because you’re so shy and stuff like that, that if you stayed with online presence, then you’re able to craft more of an intimate, introverted story, and that authenticity would come out too, in a good way.

Chris Pistorius:

Yeah. And I just want to put in there that you are not a client of ours. In fact, we just spoke for the first time ten minutes ago, right?

Dr. Chad Johnson:

Right.

Chris Pistorius:

So could you tell me and everybody that’s listening, current day, three locations, post COVID, are you doing Google stuff? It looks you’ve got an awesome website, but what’s your strategy now, and what do you see that’s working the best right now for you?

Dr. Chad Johnson:

Internal marketing is still and always the best. So what we do is we have plaques on the wall, and this would depend from state to state, that say, “We love getting referrals and we’d to thank you for your referrals.” We basically are implying that we’re giving out gift cards of thanks for those that refer people, and for the people that got referred here. And so we have a choice of three or four different small gift card ideas that are up in each operatory showing on the plaque what we offer. And we also hand out little cards that say, “Thank you for choosing us. If you had a great visit, we’d love if you referred someone,” and it’s actually perforated where they can keep one side and give the other side to someone else saying, “I loved coming to Veranda, and I’d love if you were to give them a call and schedule a visit as well.”

Dr. Chad Johnson:

So internal referring, I think, so when we count our dollars, we count our dollars for how much we spend on something, and then how much return a treatment plan completed that we do for that, so to calculate our ROI. And it’s over 90 to one on internal referrals, because that kind of stuff, there’s a little cost upfront. And by little, I’m just saying, those plaques might be, shoot, I don’t know. It’s been a while. I don’t know. Let’s just say $1,000 bucks. And then if we spend for printing those cards and others, and the printing of the cards is probably $200 bucks. And then the gift cards that go with it, $25 bucks per person, so that’s $50 bucks. And then times, let’s just say, 10 a month. So that’s $500 bucks.

Dr. Chad Johnson:

So you’re still under $2,000 at first, that first month. And then from every month thereafter, another $500 bucks, because you have everything printed. So at the end of the year, if you spent $6,000 bucks, but you got $60,000, or after a while, $600,000. We get a huge return, because if those cards last for four years, let’s say we did a print of 1,000 of them, and you’re handing them out little by little, and the next year and the next year and the next year, basically it’s just like fuel economy. After you filled up, and then if you’re coasting downhill from Denver down to wherever, going down the hill, you’re stacking your fuel economy, miles per gallon, in your advantage to where then when you review that.

Dr. Chad Johnson:

So internal referrals, that is our hugest return on investment, but you have to be proactive and willing and talking with your team, grooming them to understand the importance of it and how to talk about it and why to talk about it. They need to love your brand anyway. If they don’t like you as the boss and stuff like that, they’re not going to do that. So that would be another thing for you to figure out. Does your team love your brand? And by brand, I kind of mean you.

Dr. Chad Johnson:

And after internal referrals, another good return on investment for us is Google ads and SEO kind of stuff. I have to admit, I’m not the best at understanding the minutia differences between the two, because it seems like STO is a smidge different, but we kind of group those together and I think we get a 10 to one, and then I do radio. And I think our radio, and the reason why is I’ve got three offices that, in essence, if you did a 20 minute drive between each one, it creates this triangle in the Des Moines area. So they’re not necessarily close to one another. They’re, let’s say, 15 miles from each one.

Chris Pistorius:

But they’re not far apart either, right?

Dr. Chad Johnson:

What’s that now?

Chris Pistorius:

They’re not far apart either though.

Dr. Chad Johnson:

No, close enough that I can easily get to, so by spreading it out, when I do radio for one office, there’s a lot of people on another side of town that might not come over to see me. But when I have three locations, in essence, what I’m doing is I’m splitting the cost. So that’s where the economy of scale can help me out by doing three offices and doing radio. For example, if McDonald’s does a radio ad, every McDonald’s is going to have advantage of that. Now, if you have a ma pa hardware store, only maybe within 10 miles, is anyone going to go to your hardware store, so it’s kind of a waste of money for a ma pa hardware shop. Exactly. But McDonald’s, that’s why Wells Fargo and big companies that have a national presence go on TV, is because they’re taking advantage of, if I put something on TV, it’d be a waste of money, especially during the Super Bowl. Who in the world in New Jersey is going to come to Des Moines, Iowa, right?

Dr. Chad Johnson:

So it just doesn’t make sense for me to spend $1 million on an ad when it makes sense for Burger King to spend $1 million on an ad. So radio is about, I think, a four to one return on investment. We do mailers. I think that gets a three to one return on investment.

Chris Pistorius:

Right. I think what you’re detailing here is a strategy. It’s not a, “Let’s put all of our eggs in one basket and hopefully it hits,” right?

Dr. Chad Johnson:

And the coolness is, I didn’t come up with that, so that’s where having someone to manage that helps, where they’re looking over the strategy, because I’m not smart at this. I’m basically kind of parroting what I’ve learned along the way.

Chris Pistorius:

Right. Yeah. And it’s not about putting all your eggs in one basket, it’s creating six or seven different baskets and putting one egg in each, because there’s no magic bullet, right? You’ve got to have a strategy. For instance, with SEO, okay? You’re at Google’s mercy. You could rank number one on the page and be doing great, and then the next day, Google changes their algorithm on how people rank, and you might be on page three. And so if you’re relying just on that, you’re in trouble. So that’s exactly what we talk about when we talk with dentists, is let’s have an overall actual strategy. Let’s not just try this or try that. Let’s put a lot of different things into play and see what we can do. And something that’s very intriguing by me by looking at your website and just a little bit of your background, is that you actually do a podcast too, is that right?

Dr. Chad Johnson:

Yes. So I’m with a consulting group called Productive Dentist Academy. And Bruce Baird is the head dentist that runs that. And so when I first went to Productive Dentist Academy, it was amazing listening and learning under him, how he markets. He markets at 8%. And that blew me away, because at the time, I was like, “Well, I’m kind of proud of the fact that I do 0%.”

Chris Pistorius:

Right?

Dr. Chad Johnson:

I’m kind of one of those guys. And there’s a big camp of dentists that are proud of the fact that, “I don’t market. I just let my name speak for myself,” and stuff like that. And I used to be that way. And so the more I got into that, they, just in the last couple of years, asked if I would come on and talk. Our podcast is called Everyday Practices, where we don’t talk about the drill and fill stuff. We talk about the importance of family, of taking time for yourself. How do you make the best of when you’re in the office, so that way, when you’re not in the office, you can enjoy life too? So it’s kind of a bigger picture of dentistry.

Chris Pistorius:

Got you. Kind of that work-life balance type stuff.

Dr. Chad Johnson:

That’s right. That’s right.

Chris Pistorius:

I think everybody struggles with, so that’s great. That’s awesome. Okay. Well, I don’t want to take up too much of your time here. In fact, I’ll just ask you right now, maybe in a month or two, we could do this again, because there’s a lot of stuff that we can learn from you. And this is just a fraction of it. But one last topic I do want to hit though, is it seems a lot of our clients right now are having an issue with hiring. How to get people, how to keep people, especially. We have several clients that are in kind of this churn of hire, then they leave or they get fired, and you got to train somebody new, and they can’t get ahead because they’re constantly training. And it seems like there’s two schools of thought here. You either bring somebody in with a lot of experience, or you bring in off the street that has no dental experience and you train them. What do you think of all this? What have you done in the past to be able to hire and retain successfully?

Dr. Chad Johnson:

I’ll admit that I’m in the same boat as everyone else. In real time, I don’t know any better than anyone else the perfect answer to that. And the reason why is we’re not a national company that’s hiring hundreds or thousands, or tens of thousands of people, right? If you hire tens of thousands of people, then you learn pretty quick how to hit the percentile that you need. Dentists are hiring one person every five years, typically. So let’s say this COVID year that someone needed to hire five people, that’s five years of hiring one. Now, Wells Fargo might hire five people in one hour. They might hire 10,000 people in a year. I don’t know. But they’re on a different scale. They have an HR department.

Dr. Chad Johnson:

So this HR question then is tricky because when I admit that I don’t know, I’m just basically trying to identify with a lot of dentists. I think both camps have a good strategy in that if you run across a waitress that is quintessentially a people person, and perfect for the front desk, and they are willing to give it a shot, then go for it. But at the same time, I think hiring someone that has no experience, and let’s say everything else being equal, that someone that has no experience, but someone else that wants $2 more an hour and has 15 years of experience, and you like them, so that factor in there, then hire for experience for two bucks more. Now, if they want $20 an hour more, then you’re going, “Well…”

Dr. Chad Johnson:

So those things, listen, everyone has to weigh out. And I’m not in the A or B camp on that. I’ll tell you my creative way around it. You’ll have to look at the bigger picture on this, audience. But one of the things that I thought about in Iowa, Iowa is 49th in the nation in pay for nursing. So I told my office manager this last year, I said, “If we need another assistant, I want to try and get a nurse, an RN, to work as an assistant, because they would love our hours, love our job.” Now, if you’re in the state that’s number two in the nation for nursing pay, then you’re not going to want to hire a nurse for an assistant. But in Iowa, where we’re 49th in the nation and some nurses are starting the graveyard shift from 11:00 to 7:00 on weekend nights and stuff like that, if they’re getting started at $22 an hour, and then my assistants are in that same range, these nurses would love, the ones that’ll think outside the box, to take a job like what we have available.

Chris Pistorius:

Friday off, in a lot of cases.

Dr. Chad Johnson:

Absolutely. It’s a day clinic. In nursing terms, it’s a day clinic, and they would love the hours. They’re like, “Wait a second. So I don’t have to clean up any poop. I don’t have to…” Assisting would be cake. So think about that. Find out where you sit on that. But here’s the bigger picture. If nursing isn’t your thing in your state, find out what it is. Do you work right next to Disney, and you’re like, “Man, I wish I could hire people.” Well, Disney just laid off people and they’re wonderful on customer service. Hire a Disney person. So whatever it is.

Chris Pistorius:

Yeah. Yeah. I totally get that, because you can teach a lot, but you can’t necessarily teach customer service…

Dr. Chad Johnson:

Personality.

Chris Pistorius:

Yes. The personality. Yeah, exactly. Being an outgoing person that that has that voice of care. You can’t teach that, right?

Dr. Chad Johnson:

Right. And they’re at the coffee shop.

Chris Pistorius:

Yeah. [crosstalk 00:27:41].

Dr. Chad Johnson:

Yep.

Chris Pistorius:

Absolutely. Well, that’s exactly what I was thinking too, and it’s great to hear your thoughts on that as well. But Dr. Johnson, I just want to wrap up here. Thank you so much for your time. And again, I do want you to come back very soon and I want to kind of attack another topic or two, if you’re willing to do that, for sure.

Dr. Chad Johnson:

Why not? If someone’s willing to listen to me, I guess I’m willing to talk.

Chris Pistorius:

Well, hey, thanks again. And thanks everybody out there for tuning in this week. We’ll have another great guest for you next week, but if you have any questions for Dr. Johnson, I’ll leave some of his contact info here as well.

Dr. Chad Johnson:

Yeah, please do.

Chris Pistorius:

And I would appreciate any feedback that you guys have on this interview, just so that we can make our podcasts a little bit better. Thanks again, and we’ll talk to you all soon.

Bill Orth:	Hello everyone. This is Bill Orth with Kickstart Dental Marketing, and thank you for joining us on our consultant network. Today, we have Leslie Icenogle of Dental Implant Auxiliary Training, and also insurance billing outsourcing. Thank you very much for joining us today.
Leslie Icenogle:	Thank you Bill.
Bill Orth:   [00:00:30]	She brings over 25 years experience in the dental industry, having been an implant coordinator and a practice manager. And now you’re primarily working as a consultant and also a speaker to audience across the US on various topics regarding dental. You know what, before we get started today Leslie, why don’t you give us a few details on how you got started in your consulting business and the various aspects?
Leslie Icenogle:   [00:01:00]           [00:01:30]	Yes. Thank you. Actually, you mentioned [inaudible 00:00:48] than in oral surgery and implant coordinating for so many years and that’s back when implants first became popular in the United States in the mid eighties. And what I’ve found is that a lot of dental team members were not very comfortable with the implant process as a specialty practice, working with referrals. I noticed right off that if a hygienist had an implant or was comfortable with an implant, you would have more referrals of implant cases. So I realized right off that it was the lack of comfort with the auxiliary as to why patients were not getting referred for needed implant treatment. So that’s already had a huge impact on referring the patients out for an evaluation to see if they’re an implant candidate or not.
[00:02:00]	So basically I started my consulting business about six years ago. We do primarily work with specialty practices on the six month Step to Success program on growing the implant practice, which does help educate the restorative team so that they get that comfort level. And there’s not a little feeling in their stomach when they have that on the schedule, they’re more competent and talking to patients and educating patients about it. So I also work with the general dentist practice too, and educating them directly if they just want to increase their restorations, or maybe they want to do the placement and restoration themselves. So basically I saw the void of education in that area is why I started to consult.
Bill Orth:	Gotcha. And now why don’t you tell us a little bit about the insurance aspect too. And we’ll get into both of these in a little bit more detail.
[00:02:30] Leslie Icenogle:           [00:03:00]	Yes. And I’ll tell you, I have been speaking on medical insurance and the dental practice for years, and the most common response I would get is, oh I just wish you could do this for me. So about two years ago, I decided why not? Let’s just go ahead and start doing it for the dental practitioners and take that frustrating path off of them. Insurance companies are really becoming more of a challenge and more time consuming than they were in the past. So we do the verification of benefits on the patient, the practice’s specific form, if they would like. We post the explanation of benefits, make sure that the proper write-offs are being made. We also file and call on the accounts receivable. That is fun.
[00:03:30]	And [inaudible 00:03:13] you can really see somebody’s accounts receivable go down fast. And when a doctor gets their cashflow tripled, the next month they’re super excited and it feels really good to help eliminate the frustrating path from the front office and improve the doctor’s cashflow. So one of the added benefits that our clients are telling us is that they’ve actually seen an increase in case acceptance because their team is more available to build relationships and talk with the patient. And one of our goals is to help reduce the turnover because it’s so high in the front office. And usually when you ask a team member why, it’s because of insurance.
Bill Orth: [00:04:00]         [00:04:30]	Well, I mean, that’s a very unique opportunity that you have here. You’re actually working in two of the hottest trending aspects of dental right now. From a dental implant over the last several decades, it’s really trending towards the number one solution for tooth replacement. I know that when I was much younger, those weren’t the options. It was a bridge or dentures seemed to be the thing. And I know that implants, there’s been a lot more growth as far as expansion of insurance coverage and also just the longevity and the aesthetics of a dental implant rather than the other solutions seems to be more of the forefront. Even to the point where it’s actually a main focus in curriculum and dental education these days, which it wasn’t in the past.
[00:05:00]       [00:05:30]	I saw this unique thing a couple of months ago as one of my clients several of them who weren’t doing dental implants are now growing. It seems to be a very popular profit option and a very valuable solution to be offering for their clients or their patients. But I saw this interesting fact that over 70%, just over 70% of adults, by the time they reach 44 years old, have at least lost one permanent tooth via accident, gum disease, a failed root canal, or tooth decay. So I’ve seen this large growth in dental implants.
Leslie Icenogle:         [00:06:00]           [00:06:30]	Yes. And we’re just actually outliving our teeth. And so having a third set of teeth when you age with 50% of our population soon going to be over 65 years of age, it’s a very important service to offer the patient. And then also the education, I think that’s the best service that the auxiliary can offer their patients is the education, not only on the treatment but the consequences of non-treatment, which is extremely important as well. And I find that a lot of the auxiliary members have at least 28, if not 32 functional, beautiful teeth. And it’s hard for them to relate to the partially or the fully [inaudible 00:06:09] patients where I have seen it for 30 years and I see the problems that patients experience. So it’s really a great service that you can offer your patients, that they will never regret that they made that decision. So it’s very personally and professionally rewarding when you can transform someone’s life into functional. So yes, it’s a great service.
Bill Orth:         [00:07:00]	Well you know, I really liked your program too. We’ve talked about it a little bit. A six month program, coaching program and you’re going through a lot of aspects, but you keep highlighting one of the things that I think is very critical in this. When you get in their dental practice, the procedure itself, it’s all based on education and you really focus on taking that education to the actual patient when they’re making a decision on what’s the best option for my situation. I need to replace a tooth, what’s my best option doing this? And continuing that education, the benefits to it, so they can make a great decision for themselves.
[00:07:30]	And also what’s the best thing for them from a longevity standpoint and stuff like that. And I think that is something that is typically not a focal point from a dental practice standpoint. They’re just saying, this is what we recommend. And a lot of times there’s not the why we’re recommending this and stuff like that. So I think it’s a really good dynamic that that is a central focus of what you’re trying to do, not just with the dentist itself, but the associated team when going through procedures like this.
Leslie Icenogle:     [00:08:00]           [00:08:30]	Yes. And Bill, you really hit the nail on the head when you said that because the dentist, first of all, you have PPO networks and everybody really kind of straining them. They don’t have time to do the patient education. So being able to delegate that to a properly trained team member is not only better perceived by the patient, but also more cost effective because the dentist is getting paid to diagnose and treat, which is what they’re supposed to do. And also a lot of the dental teams are not aware that the congenitally missing teeth and the severely [inaudible 00:08:18] or the trauma cases are covered under the medical insurance. So you see a lot of coverage getting wasted, things that patients are entitled to that aren’t getting utilized. So that’s kind of important for the team to know as well.
Bill Orth:           [00:09:00]	That’s great. So when you look at your coaching program, I know that there’s some different variables, I wanted to sort of go over them a little bit. I know that you do some onsite work with the team. I’ve seen that you’ve done one and two day onsite, but you also do a lot of stuff via phone, tele-coaching as you’d call it, conference calls, continual monitoring and support. And you have a really great webinar series, for those of you we’ll share her website at the end, take a look at that. She covers really good topics in her webinar series, so we’ll talk a little bit about that. But typically, how is that from a proximity standpoint? I know that you speak across the country for your services and stuff like this. Is there a geographic boundary for the services, or can you work with practices throughout the US?
Leslie Icenogle:   [00:09:30]           [00:10:00]	I work with the practices throughout the US. I do have a full day program that come in and teach your team how to file medical insurance. Now the six month coaching does start out with two days onsite. Then I come back for a day onsite at three months and six months. Then there’s three hours of tele-coaching, the odd months, as well as monitoring. But you’re right, I do have a series of four webinars for those that do not feel they really need somebody on site, that goes over the roles of an implant coordinator, the financial discussion, the case presentation, scripting, and all of those wonderful things that will really make the team more confident to discuss the type of treatment with the patient and know the real risks of non-treatment. So yes, there’s a series of four webinars. You may find one of them convenient or you may want a series of all four, or the coaching typically does need some onsite just to see where people are. But of course, reviewing numbers and things ahead of time to see where we could be most beneficial to that since it’s in our team.
[00:10:30] Bill Orth:           [00:11:00]	Okay. For those of you listening, before we get into the insurance billing outsourcing, I want to highlight that if you want some more information regarding what Leslie’s offering, you can find her at www.teamimplants.com. Like I said, you’ll find all of the details regarding the coaching, her availability to speak at different events, and also the webinar series that we just mentioned. You’ll find it a very dynamic thing, very profitable. So if you are currently doing implants or wanting to add that to your solutions as a practice, I definitely recommend you checking out that website and getting some more information.
[00:11:30]	All right. So now let’s transition a little bit to a very common headache, AR. Just aspects of AR, specifically insurance, is always the big headache, and it doesn’t matter what type of practice it’s something that impacts every practice. How can you help me get paid faster, more efficiently, stop the headache and the churn of my front office? And so let’s talk a little bit about that.
Leslie Icenogle:         [00:12:00]	Yes, that is actually becoming very, very popular as far as outsourcing. And we do offer the medical and dental, but how we can help is the accounts receivable, you may have a team member that’s extremely dedicated and a great person come in in the morning and think, okay, I’m going to make 25 calls or get through this page of AR today. And then the day gets busy, they get emergencies and things happen and they go home without making those phone calls. So what’s unique about outsourcing is you have somebody, a specialist that’s on your team, that is making calls all day long without interruption. And so they can get more done. So you can see your 90 days disappear, your 60 days start to disappear very quickly because somebody is focusing on getting those results.
[00:12:30]           [00:13:00]	Another very time-consuming task for the team is the verification of benefits. Some dentists really like to know some specifics on codes, frequencies, and things like that. And we find that one verification can take up to 20 minutes per patient, depending on how much we tell the business at once. So the nice thing about outsourcing it is they’re not really paying a salary and all the taxes and stuff involved with that. It’s now become a business expense for your practice, so it’s less costly. So the medical field has been doing this for a while. You may have seen your own primary care physician go from having an insurance team to outsourcing it. They find it more cost efficient. So our goal, to get you paid faster, is to file the claims properly the first time, with the correct attachments, we know what code needs what for which insurance company, and we also follow up on those right away.
[00:13:30]             [00:14:00]	So we file up to four insurance companies, more if the patient has it. It’s typically two medical, two dental. We did have a recent client that does a lot of frenectomies, but didn’t realize those were covered under medical. She’s been with us for about five months now, and we’ve collected over $26,000 in medical benefits for her frenectomies. And I have a full list of procedures that are covered by medical carriers. If you want to contact me, I’d be happy to share that with you. So we get paid faster. We also utilize the medical insurance benefits and also really review those explanation of benefits. We don’t want a dentist tricked into taking a write-up that they don’t need to or an insurance company trying to down code a code. We really appeal that right away. And we actually work with an insurance collection agency. If the insurance companies are not doing what they are legally supposed to do, then we can send the insurance company to a collection agency.
Bill Orth:     [00:14:30]         [00:15:00]	Sure. Well, that’s awesome. You touched on a couple of points that I want to reiterate for our listeners out there. You know, you’re incurring an expense in this capacity as a practice anyway. The problem is, at least a lot of our clients, it’s a headache that they really don’t want to deal with. You know? So one of the unique things about your expertise, especially when it comes to AR, it’s the gaps in AR are the biggest crux to profitability, to a practice. I know that speaking with several people in the space, the dramatic drop-off from what happens after the 60 days. You get a very high pay rate in the first one through 30, and then it continues through 60. Once you get to that 60 to 90, you start to see a dramatic decline. And if you get out there towards the 120, it’s deemed in a lot of cases, not very likely that you’re going to actually get those receivables. And so-
Leslie Icenogle:	Yes, and-
Bill Orth:	Go ahead.
Leslie Icenogle: [00:15:30]           [00:16:00]	Oh, and one issue that we’re finding too, is that a lot of dentists are inheriting these problems. For instance, if you purchase a practice and you now have their accounts receivable, and a lot of it is 90, 120 days, like you were just explaining Bill, it’s really hard to recuperate, especially with insurance companies. A lot of them are starting to go to this 90 day, timely filing. So you really have to stay on top of it. And a lot of times the team members are really, their heart’s in the right place, and they’re treating the patient and being that first person that the patient sees when they arrive, they don’t need to be on hold with an insurance company, fighting.
Bill Orth:           [00:16:30]	That’s great. Well, like I said, for those listeners out there, if you’re having a problem in this area, or you’re not even actually sure how well you’re doing in this area, definitely reach out to Leslie and her team of experts that can give you an assessment on exactly what those gaps are, how they can improve it, and possibly even just take that role and responsibility away from you, freeing up more of your time and your resources for other aspects and just improve your overall receivables and the focus on that aspect of your practice. You can find out some more information there at www.insurancebillingoutsourcing.com. Leslie, thank you so much for your time today. It’s been great having you. A lot of great information that’s going to be useful to our listeners and those people who have practices or involved in their practices. I really appreciate having you on the call today and look forward to being able to work with you in the future.
[00:17:00] Leslie Icenogle:	Thank you. Thank you. And a shout out to Kickstart Dental Marketing. You guys do an awesome job, I get great feedback from clients. So thank you.
Bill Orth:	Thank you. Bye bye.
Leslie Icenogle:	Great.