We Dropped Delta: The Truth About Dropping PPOs

What's up everybody and welcome to another episode of the Automatic Patient Podcast. I am your co-host today. With me as usual, Dr. Dan Nelson. Dan, what's up man? How you doing? Woohoo! We both got our We both got our >> Matching shirts. >> We're wearing our Hawaii shirts today, which is awesome. And uh before we recorded I was talking about the I'm a little nervous because we got the category one hurricane hitting Kona, which I've got property there and I have a guest showing up today.

So I'm like, "Uh good luck, buddy." >> [laughter] >> I'm like, "Yeah." He like messaged me 1:00 in the morning and he's like, "Hey, what do I do?" I'm like, "You When you land, if you're still going to plan your trip, go straight to the store and get like 14 days of supplies just in case. Good luck. Maybe I'll DoorDash you some stuff cuz I feel bad cuz your trip is ruined." >> [laughter] >> That's so bad. >> Your trip to paradise is going to suck.

>> It's going to suck. Yeah, he probably. Well, I guess it won't be too bad in the on the Kona side, but it still will be rough. >> It'll be >> Anyways, so that's what I woke up dealing with today. Um but today I want to talk uh Dan and I had lunch yesterday. He was in town. We hung out a little bit. And uh You're got You guys are what? 6 months in being out of network with Delta? >> 7 months. >> 7 months now?

Um so let's kind of talk about the current status of what's been happening in the practice and you know, how it how it's been for patients, how it's been for the practice owners, and uh as a as a coach or consultant, like how do you see things? >> Yeah, I mean, it's It's actually 7 months um completely out of network. So we We're out of network now. We're a fee-for- >> Yeah, with everybody, right? So completely out of network, but Delta was the big the big

one this year that you you guys decided to to cut, right? >> Yeah, and I and I think for us Delta would represent like a cuz Delta was 51% of our patient base. >> Okay, so like majority of the patients, yeah? >> Yeah, like massive, right? So like you know, looking at I you know, I think with all the offices that we work with I would say most offices are probably in that 80 20 70 30 range where they're Sure. They're some of them are more

upward of 100% on their patient base, but uh being, you know, in >> see that as a risk? >> Oh, yeah, it's massive risk. >> Because it's like our our reimbursements are tied to one PPO plan or or one one company essentially, right? That we don't control. >> Uh well, we've never seen it just to clarify, we've never seen somebody be under unless they're doing like Carrington or something like that, which is more relevant anyway. Yeah. And anybody just under one insurance like 100% close to

one. >> But that would be a massive liability. That would be huge. But even if you're on, you know, you still have there's still a lot of liability involved with the changes that are going on because again, I mean you you have some semblance of control, you know, you know, on what you can do on like renegotiations depending on who the insurance companies are. But with the current state and the reason that, you know, just to be clear why we went fee for service you know,

where we live and we've talked about this before on the podcast before, where we live our overhead is so high between mostly payroll, honestly. Like it just costs so much to live here. We have to pay our people at times. >> guys are like in a higher, I mean, at least what I'm hearing in Utah and you guys are like in a Park City type >> Yeah. >> uh economy over there. >> Or Vail Park City type, yep. >> Yeah. So it's a higher higher higher

uh cost of living and all that stuff over there. >> Yeah, it's it's the median home price is like double what most people, you know, would look at even Mountain West. And if you compare it to the Midwest, we're about three times as much. So, you know, so you can look at it like we work with an office a couple offices in California in Southern California. Malibu is the most expensive office we've seen and >> Interesting. That makes sense, though. >> Yeah, the cost of living

here is about the same as like Malibu. >> Wow. >> Except well, almost. But, the reimbursement rates are a fraction of what they get in Malibu. So, >> So, would you like Okay, that's actually interesting. Like in cities like that, Malibu, Hailey, uh probably Park City or I'm sure there's there's a ton of cities we can talk about across the United States. LA, yeah. What Do you see most of the practice in practices in those types of cities that they end up going fee for service

or are they kind of stuck? >> Most of them are stuck. We're working >> No, rat race, yeah. >> It's awful. Like we're working with a PPO office right now in San Diego that they are I mean, they're writing off the I think we had a couple of them that they're basically writing off 100% of what they're any profitability that was left, there's no meat on the bone. A lot of 70% write off. It was pretty painful to go through the growth report with the owner,

you know, and just show them how bad that they're getting beat up. So, the difference is is that and and this is what people want to look at is even as a fee for service office, are you seeing ours are are actually lower here because we live in Idaho even though it's a resort town because it's in Idaho. Um the and this is what's maddening is that you you can say, "Yeah, I still I have absolute control over my pricing." But, you can price yourself out

really quickly, too. So, you have to Sure. like what other offices are charging to an extent um and what we're seeing is like like if you take um just the top 20 fees in our area, we're actually cheaper than like we're we're quite a bit cheaper than like um Phoenix, Arizona, or even like Podunk, Wyoming. >> Yeah. >> We're actually lower there. So, we had to we we're having to do a gradual increase of our fees. We you can't do a big jump. >> You can't

No, no, no. You kind of Like would you recommend like what? What percentage? >> Well, you should start with a Like So, one of the things that we do is and this is a at Elevation Association, one of the things we do and you can just contact So, we'll be happy to give you this is that we can give you a market report for your area and that includes what the UCR fees are based on zip code. So, it's called zip code pricing, right? So, >>

Yep. >> we can give you your zip code pricing and then from there, we've looked at it and I've gone it's just it's just not enough where we're at, you know, just to cover everything even though we are fee-for-service. So, what we would say is take a look at that and then evaluate it based off, you know, go to your P&L and look go through your overhead and make sure that you're covering everything and then if it's still tight, you probably need to do it an

inch up, you know, just slowly like you can either do it throughout the year or you can do an annual increase, you know, the old dumb rule of like oh, 2% annual increase, that doesn't work post-COVID. So, you have to take >> Yeah, with the inflation rates. Yeah. Well, cuz I was reading the ADA report earlier this month on the financial state of the industry and it's like revenue has grown 1.4% over the last 5 years and expenses have grown 4.9% on average across dentistry. Right

now, that's a 30,000-ft view of the you know, landscape of dentistry. Not every practice is probably feeling that, but you're probably seeing expenses go up and if you're not if you're only doing like a 2% increase in in your pricing, it's probably not sufficient to cover the expenses. >> No, not even close. And I mean and I I talked about this I think it was on your podcast. >> Yeah, we've talked about this a couple times. >> Yeah, but we [clears throat] we we've seen um

talked about this quite a bit, so if you've heard me recently, you've heard me kind of ramble out these numbers, but we've seen upwards of of 20% plus on payroll um because of the the cost >> Yeah, yeah, yeah. Uh with like hygiene primarily? >> The bidding it be there was a bidding war in about in 2020 3 the hygienists basically uh for example, we have a an office that we've worked with in the past uh again in Southern California, and um now poor doc was

like he was basically he had a hygienist that had been with him for like 10 15 years, and all of a sudden he found that he was out looking it was a male hygienist, and he was out like >> Job hunting? >> creating a bidding war for and so where he landed was and I'm not I wish I was making this up. He's $90 an hour, 90 to $95 an hour. >> Wow. >> is what and I said you're losing money on this, and the owner's

like, well, I know, but it's a lot I have to treat it like a loss leader because I can't not have hygiene, you know, and it's like >> Sure. >> Well, maybe you could find a different workaround, you know, >> It's like is a doctor cheaper than that now? >> [laughter] >> Joking. That's That's crazy. >> That's the highest we've ever heard, but even in even in areas that were traditionally, you know, significantly lower, um and it's settling out now because, you know, a lot of

the >> It never stays that way. Like we saw something similar to in in my ecosystem here with sales people in like 2021 2022, where same thing happened uh salaries went through the roof and uh bidding wars and it it was kind of it was a joke. >> Yeah. >> Right? But it they never last, right? They they're they're kind of these booms and then they they they they're not sustainable. They pop eventually. >> Well, and then it is a balloon state right now. Like if

you look at the overall like everything's kind of in a balloon state. We're still we're still playing catch-up even, you know, 7 years later we're still behind the eight ball with a lot of things in the in the economy and and it's affecting the dental world quite a bit. So >> Sure. >> Just all of that uh all of the nonsense that we've been dealing with over the last few years is finally starting to settle out a little bit, but it's still it's still there. Every

Yeah, I mean just think about supplies, you know, if you look at supply and and we've seen a upward between and it's a big broad range, but anywhere from like 7% increase all the way up again to the 20% increase. >> Yeah, I've seen top talking to my dad and my brother at the dental lab, that's exactly what they're seeing too with their supplies and that just passes on to the the patient, right? >> Yep. >> And in the practice, so it's like, man, yeah, supplies

supplies are kind of getting out of whack. So >> So as it pertains to overhead, I mean you really it's really imperative right now that the owners are going through and looking at their P&L and making sure, you know, checking their top line, checking their bottom line, and then tracking, being granular, looking down, you know, the line and saying, "Okay, well, where where are we getting abused on on our P&L and what can we do?" Um and that's the difference that we have being out of

network is that we can actually look at stuff and go, "You know, maybe we'd make maybe we would do a $2 increase on instead of a percentage, maybe we look at our most, you know, the highest of volume code that we code out every >> Okay. >> Yep. Say, "Okay, so >> The revenue producer. >> Yeah, we just you know, we do a thousand, you know, or we do, you know, 4,000 you know, limited or whatever and let's increase that by five bucks, you know, or

you know, whatever and just take these codes that are a low little code to begin with and maybe increase it to two to five bucks. >> Smart. Yeah. >> We can do that because we have that freedom where we immediately see that revenue come in where if you know, um if you're strapped by insurance, you raise your codes all day and that does help. >> Yeah. >> I'm a big proponent of actually keeping up with market inflation [clears throat] and stuff, but but at the end

of the day, you know, and and I and we get this a lot from from docs that are like, "Well, what's the point? I'm just writing it off anyway." Well, there's a huge point to it and part of it is market, right? Like you need to push that market. If you don't continue to adjust for inflation, why would insurance adjust for inflation? They'll just tell you to >> Absolutely. That Well, yeah, if you're if you're not adjusting for inflation, then you don't and and your market,

let's say your zip code is the other dentist in your zip code aren't adjust- adjusting for inflation, the insurance company's not motivated because they're going to look at data of that zip code and say, "Well, we're doing just fine in your zip code, right?" If you're not adjusting or if if I think we've talked about this, too, or if if practices are only recording the adjustments um in their practice management system and not uh you know, submitting the the their higher UCR fee to the insurance

companies, which happens a lot, sadly. Um you know, so no, that's really interesting. Okay. So, yeah, don't look at the write-off and say, "Well, I'm writing it off anyways." Like I think there's a lot of optimization to do in dentistry. Given the state of the industry is expenses are increasing, revenue's not increasing as fast enough, right? For most offices. So, no, that's really interesting, Dan. What um with uh like for from the patient experience, going out of network, what like what's the biggest thing you guys

had to change? From verbiage to like mindset within your office, like have have you noticed a big shift there? Or were you guys kind of already doing stuff? >> We were already doing stuff, but I but the the biggest shift what's been interesting with with this whole transition >> Mhm. >> is there's two big You should have in the years prior be be setting up to exit, right? So you start to have >> Yeah. >> conversations and you're preparing the patients for the inevitable change, right?

And the reality is is you're going you you can pretty much predict who you're going to lose. Like you can look at it and go >> Interesting. >> you know We break ours down by employers. So we look underneath the So we looked under the Delta umbrella and we said, "Okay, let's break this down by employer. Who do we have?" And >> Oh, interesting. This is Ryan's in the back doing all this stuff, right? >> [laughter] >> Yeah, I can see it. >> We we break

it down and we look We actually have an app built into our software suite our EAOS our Elevation Association Operating System or operating software. We actually have an app that's built in that will give you an insurance analysis. And so within that app and within that insurance analysis, we go and we look and we say, "Okay, who's paying what under like say Delta for example. There's a lot of different plans that an employer can sign up for. It's not just one, right? >> Yeah, sure. >>

Delta and that's all there is. >> Yeah, they've got many. >> Yeah. So and what you'll find when you go out of network is that some of the plans pay pretty good out of network. Like shocker. >> Sure. >> So what we were able to do with that is we look and we said, "Okay, which ones pay sucky and which ones pay pretty good?" And you can then look at it and go, "Well, like for us it's the school district, right? The school district and the

>> Yeah, of course. >> So our police officers, you know, our our first responders, our teachers >> So the plan that they're on is is good out of network? It's terrible out of network. Okay, got you. >> Of course it is, right? Because why would we not treat our educators better? >> Right, jeez. >> So which is frustrating, right? So, anyway, we we look at that and we go, well, you know, typically, you know, they're going to probably pretty be pretty insurance driven. And so, >>

Most likely. >> and because their policy kind of sucks out of network, it's not great in network either, but it's especially bad out of network, we can effectively say we're going to unless they have, you know, another source of income or another a secondary insurance or the Delta is the secondary insurance, we're probably going to lose a lot of those patients. So, we basically can look and say, okay, we need to prepare for impact. What's it going to look like and how many of these patients

can we predictably assume that we're going to lose? Because you do have to expect the worst going into it. >> Of course, yeah. >> So, you have to modify things for that. Um, you know, and adjust for it. And one of the biggest things we do and and, you know, this is beating a dead horse on this, but it's so important is that we began to really push and build up our patient benefit plan. >> Yeah. >> Uh, that was massive for us because we wanted

people that were especially under these So, Delta has a a self insurance. It's really bad. It's actually a >> Sure it is. >> Yeah, it's terrible. >> Most financial products like that are really bad. >> It's terrible. I've never been happy with them. >> Oh. >> So, >> [laughter] >> they pay too much, they get no coverage and they get the the the group out of the three between the insurance company, the patient and the provider, the one that takes it in the chin the most

is the provider, right? So, the provider provide the most off, has to make the most consignments and concessions. It just isn't good. So, what we looked at that and we tried to move as many of those people over to our our in-house membership program. It was better coverage, plus they could stay with us, you know, >> Yeah, it's a direct relationship. >> Yep. Yep. So, we really built that up and that wasn't just the year before. We've been working on that for, you know, a long

time. But, we pushed pretty hard on some marketing campaigns and pushed it to the forefront of our website and and social media um to kind of gear that up. But where it really came down to the nuts and bolts was the conversations that you have in the office. >> Yeah. Yeah, I would imagine. >> media and we were >> We were talking about marketing yesterday at lunch and you know, it's it's it's all a relationship business. You know, even even my business like running a software

company is heavy relationships, right? So, it's like yeah, this the social media stuff helps like amplify or uh accelerate kind of your messaging, but until you sit down with a patient one-on-one, that's really where the where where where it happens. >> And we have posters up and stuff and >> Yeah. >> we have handouts and you basically can't turn a corner in our office without running into something about our patient benefit plan. >> Yeah. >> Somebody about our patient. So, like it was big that that

the assistants talked to them about it, the front desk talked to them about it, the financial coordinator talked to them about it, the treatment coordinator talked to them about it. You know what I mean? The hygienist talked to them about it. >> Yeah. >> So, the it becomes it becomes you can't just rely on your marketing to take care of the business. >> No, like the >> the house. >> Damn, this is how boring I am. Um I went to some of our practices that were

like growing their membership plans like the fastest and the best, right? And I just sat in their waiting room for like hours and just watched the patient journey. And ex- exactly what you're saying is exactly what the the best practices do. The assistant talks about it, the the hygienist, the the the doc, and then the the front office, right? So, it's like and then of course they got everywhere they turn there's information about it. So, that's what I noticed in in the sat in several offices

for few hours and I've just watched patient flow. The doctors were cool to let me do that, right? I'm like, "Hey, this is a weird request, but uh I'm kind of a nerd about this stuff. Can I just come and sit? >> [laughter] >> Yeah, like can I come and sit and I'll bring you guys like lunch and everything? And I've done that a few times um because I guess I'm a geek. I don't know, Dan. But no, you're absolutely right. That's what I've witnessed across

multiple practices that are growing really well and and taking it a little bit serious. And all of them all these offices that I sat in are That's the plan is to you know, reduce insurance completely. So it's that's the right mindset. >> Yep. Yeah, and it's I mean, it's so huge. No new patient and no patient that is either uninsured or is on a self plan or whatever should leave our office without a pamphlet in their hands. I don't care if they have three of them

at their house. They should every time they come in. >> Every time. Yeah. Cuz that's repetition is what's going to get them like, "Oh, you know what? I should just switch to this." I mean, I I've I even have a membership plan for myself and all my employees here. >> Yep. >> Right? To the doctor. And then this is how crazy I am. I'm like, "I'm not going to do uh traditional health insurance. I'm going to do a catastrophic plan and I'm going to build an

HSA. I'm not going to touch the HSA for 5 years and I'm going to build a fund that that pays for my my my health care for the the medical doctor and all that stuff, right?" Because it's just when you look at these financial products and and and insurance products, right? They just aren't that valuable uh to most people. Like I think my plan, my just regular health plan was going to go up a little over $2,000 a month. And it and I looked at like

the the increase from the year before it was maybe $1,500 a month. And I'm like, "This is insane. I would be better off if if I took that same amount of money and put it in an HSA fund and invest it and let it grow over a you know, a 5-year uh term without touching it and then going out of pocket, which is is kind of crazy. But, that's what I'm doing because when you look at these financial products and insurance products, they just aren't that

valuable anymore and they're asking uh patients to pay so much from dental insurance to health care. It's like, what is going on? They're asking so much money and then they're hoarding the cash and saying, "We're only going to spit out a little bit and then we're going to put the rest in the market and grow it for ourselves, right?" Like, it's it's insane, but that's that's kind of why I'm like, "I'm not doing this this insurance stuff. I'm going to build my own fund because it's

not it doesn't make financial or logical sense anymore, at least for me. >> Well, >> [laughter] >> you bring up a good point is that you can fund your in-house membership plan through others they can spend their HSA money on >> Absolutely. >> Yeah. It It It's not precluded from from use. So, >> Yeah. >> we're seeing more and more patients come in. It's pretty cool like that are A, they're signing up for our patient benefit plan and then B, they're funding they're paying for everything

through their HSA. >> Yeah. >> It It's It's cool to see that trend and it's probably that they've probably already been I don't know if that's like an uptick in actually like people taking out the you know, and starting HSAs or what, but >> Sure. >> what we are seeing is that we're our patient base is increasing those types of patients are increasing in our >> Interesting. >> Yeah, so And And you know, >> Well, maybe I should come up be your patient. >> [laughter] >>

Yeah, yeah, come up. I should come up see you guys. >> The The other thing that that you know, we There's a a part of this that it's not all it's hard, right? Like the the exit is difficult and >> Sure. >> I feel like we're more prepared than >> Most practices. >> Yeah, I mean, we're consultants, so we should know what we're doing, right? But, >> Yeah. >> but the reality is is that you can prepare for war, but once you're in war, like it's

war still hard, right? Like you can be super prepared. >> Um we've been really fortunate that you know, we've maintained our course. We've actually just brought in an associate. We opened another office, you know, we've been >> Yeah, congrats. That's awesome. >> Yeah. Um but the the the couple things that happen and I could just kind of want to like warn somebody that's like, "Okay, we're going to go straight fee for service. We're going to jump out, go cold turkey, and jump in, you know, to

>> I've heard practices do that. We like in the few years ago we had a practice that called me up. They're like, "We're starting the membership plan and we're cutting everything this month." I'm like, "Whoa, like have you prepared for this?" Like, "Nope, we're just doing it." Okay. Learn a learn as you go, I guess. >> [laughter] >> If you've got, you know, financial reserves and you've got a low overhead, I think that there's ways to do that for sure where you could >> Sure. >>

like cut loose and let let it run, but but for most of us, we need to have some preparation. And what's going to happen uh the one of the things that you have to prepare for is to be prepared to pay your hygienist to do nothing. And >> Oh, interesting. >> figure like for us, 51% of our patient base is Delta, right? So, we can effectively look at that and then based out of that 51%, we looked at how many we thought, "Okay, we're going to

lose probably 50% of that 50%." Does that make sense? So, 25% >> Yeah, yeah, cuz yeah, yeah, cuz you got your your total patient base of a few thousand, I would imagine. >> Yep. >> What, like three, 4,000 depending on your size? >> 3,000, yep. >> Yeah, and then um so 50% of that, whatever that number is, 1,500, and then you said 50% of that cohort. So, >> 1,500, yeah. >> 750, got it. >> Which is what we anticipated. We're like, "Okay, let's we we're going

to prepare to lose 1,500. We're going to anticipate 750." Does that make sense? So, >> Yep, yeah, yeah. >> Um and what will happen is that you're going to get a lot that you talk to that you will say, well, we'll see how well the cookie crumbles, see if we can afford to stay here. And there's a portion of your patients that legitimately they when they do their financials, they can't afford to pay for preventative stuff, especially if they have a big family or whatever, you

know. And so they >> Yeah, of course. >> go where the you know, where that somebody's in network. So, those are the ones you're probably going to lose right off the bat. But they're all going to be some ones that love you, love your you know, your your staff, and they're going to be like, we're going to try to make it work. They're going to get their first bill. So, they're going to come in, you know, you saw them in October, you prepped them in October,

and then they come in the next year in April, now you're out of network. >> They're going to get their bill and they're going to go, we can't do this, and they're going to bail. Okay? So, you have two cycles then of exodus. You have the initial one from let's let's say that you have your October. They come in in October and you've got these two cycles. You have the one that's like, I'm this is my last time here, I'm not coming again. Okay? So, they

won't reschedule. Which makes it easier when they do that because then you you can actually fill in the with the spot that their appointment would have taken in April, you can put something else in there, somebody else in there. The ones that are hard are the ones that are like, I think I'd like to try to make this work. So, maybe they keep their appointment. Okay? Come in in April and they're like, I can't afford to do this again, and so they cut free. So, you

have to look and say, okay, that's going to be another vacancy >> That makes sense. >> The ones that are really tough are the ones that think they want to do it, get cold feet, and bail the week of, the day before. >> The silent ones, yeah, that don't really aren't talking with you guys, yeah. >> Those are hard because then that leaves a vacancy in your hygiene schedule. >> Sure, got it. >> They they just don't show up or they cancel last minute, right? And

so So, what what we've seen is we're running for the first 6 months we ran 75%. I did the numbers on it. We ran 75% capacity in hygiene. >> Okay. >> So, we're typically at 90% capacity hygiene. >> Yeah, sure. >> Right? Cuz you do have people get sick, people travel, people forget, people die. >> yeah. >> Whatever. You know, and so fall out in hygiene is normal. But we were we were running about 25% on any given day. >> So, you're seeing a little bit

of decline there. >> Yeah, but you still got to pay your people. >> Still got to pay your people. Uh Uh my first thought is you guys have built a financial safety net with the magnitude of active membership patients that probably aid with that. >> Right. >> And then two, the patients that do stay, what is the revenue per patient metric? Is that increased? >> Yeah. >> Right, if you know that. I don't I don't know if you know it on the top of your head,

but >> Yeah, yeah. >> I would imagine you're tracking that with Ryan back there doing all this stuff. Is that what he looks like? >> And I would say anyone that's listening to this go back to a podcast that Jordan and I did on the Automatic Patient Podcast. We talked about um we talked talked about a couple key point indicators that are my favorites. And um annual patient value is one of my favorite uh key point indicators. And I believe you were talking to uh we

were talking about her last night uh or yesterday at lunch that she brought that up. And I maybe Mark Costes you were talking about it as well because and you're going to hear it over and over from the experts in the field because that's a massive um it it's a great way to measure like the value that different people will bring a patient base will bring into your practice. So, >> Yeah. >> to answer your question, our patient benefit plan members, so those people, are worth

double what a Delta patient was worth. >> Sure. >> So, and they're worth about 50% more than a cash patient. >> Yeah, yeah, yeah. The cash patient always surprises me because everyone idealizes the cash patients, but it's like it's good like it's a like mentally I know how docs think about it because because I've been in the industry for so long. It's like, "Oh, I got a cash patient. They're my precious cash patient." But then when you look at the data, right? From what you guys

are seeing, it's like from a revenue per patient efficiency metric, uh they're they're actually not as as valuable as you think, right? From a from a financial uh production standpoint. >> Yeah. And this is just our office. We've actually seen it in other places and I believe it was talked about Again, you guys were chatting about it the other day on your podcast was uh as much as three times as much depending on your market. So, you >> Yeah, it just depends on the market. Absolutely.

>> Uh you know, we were in Alaska for we we went up for one of our summits and we went up to we did a fishing excursion for um one of our CE summits uh in last month in July. And uh it was awesome. I was with a couple I was fishing with a couple docs from >> [clears throat] >> Indiana. And uh >> That's cool. >> One of them he's a freaking genius like seriously one of the smartest guys I've ever met in my life.

He He's borderline savant and he's he's like, "There's no way that a patient benefit plan member's worth more than twice than a ca- or a um regular patient." I'm like, >> A cash patient, right? Is what he's saying? >> than even an insurance patient. I'm >> Got it. Got it. Yeah. >> Bro, it's real. And he's like, "No way." And I was like, Okay. And one of the docs like gets on his phone as we're out there fishing. He's like texting his office manager. He's like,

"Could you look and see how much" >> [laughter] >> Yeah. >> He's like He's like, "Sure enough it's He's like, we're more than double." And the other guy was like, "No, there's no way that this is how it is." And then he's So, he uh texted me about a week after we got back. He's like, "All right. You're right." >> [laughter] >> Yep. >> He's like, "Tell me more about this. How do I start one? What do I need to do?" You know, >> So good.

>> Yeah. [laughter] But I mean the reality is is that um there's this whole, you know, you I think they call the Amazon Prime effect, you know, where it's >> Yeah. Or the Costco effect is what I see. It's like When you go to Costco, you're like, "Okay, I'm only going to go in for that prime steak cuz I'm going to go get dinner tonight." This is what happens to me every week. And I go in and then I leave with like $300 to $400 of

of of of that I wasn't planning on buying, >> [laughter] >> right? Right? And I'm like, "Okay, every time I do this, I say I'm going to go to just going to go get the steak and maybe some potatoes for dinner, and then I come out with $300 to $400 worth of of products." >> Yeah, it's interesting how your list grows the minute you walk through the door. You're like, "Steak and potatoes." You're like, "Oh." Your wife's like, "Steak and potatoes." You're like, "Yes, steak and

potatoes." And then you get through the door, you're like, "Steak, potatoes, and TV." >> Yeah, >> [laughter] >> and TV. >> Steak, potatoes, and TV, and a water bed. >> I came out with a new PlayStation 5? What's going What's going on? It's that new Grand Theft Auto's coming out. I got to get a new PlayStation 5. >> [laughter] >> I bought 600 light bulbs. >> Yeah, whatever. Yeah, it's just it's the nature of it. No, that's the that is the effect, right? Cuz >> It

is and and that's the psychology behind it. You know, we joke about it, but it that's the problem. >> it's so true. Like even even Amazon Prime, like when they started their average member was paying like three to four times more than just a regular Amazon user, and today it's like six times more cuz they just keep learning how to dial it in, right? >> Yeah, the more it works. >> It really works, right? From Costco to And I know some doctors may be like, "Well,

I don't want to be a Costco type practice or a Amazon type practice." I'm like, "That's not what we're saying here. We're saying that this is a more efficient revenue model both for the practice and the patient. Not Not You're not becoming like a Netflix dental office, right? Sometimes that's a a comment that I hear from practice owners like, 'I don't want to be like a Netflix office or anything.' It's like, whatever, Blockbuster went out of business, bro. So, So let Yeah. It's like it's a

good model. >> [laughter] >> Yeah, I don't I don't I don't know you why you'd spit at that. But that Yeah, it seems a little >> Yeah, I mean we hear lots of different reasons why the people may be scared of it cuz >> It's fear, right? >> It's a fear It's all fear like we talked about this on one of our episodes, too. It's fear and even like I had Howard Farran on one of our shows and Howard spent a lot of time on fear,

which which was actually surprising to me cuz and it was actually a lot of practical practical advice from Howard. And but he spent a lot of time on fear and if we could only just get rid of our fear, we'll make better decisions and look at the data, like what you guys are doing. You're only going to make better decisions for your practice and your patients, right? And that ultimately was like the message. I know you and I have talked about this many times. >> Yeah,

I mean it's [laughter] part of that model that I you know, I've been working on that you know, the [clears throat] the the five barriers of success. >> Yeah. The >> Here's the thing and and and bringing this back to the conversation about holes in the hygiene schedule. You know, cuz the hygiene feeds your operative side, right? >> Yes. >> We did create an app. So I got frustrated to the point and it was kind of freaking out, too. It's part of you know, speaking of

fear. Um There was a point where I was having So Ryan meets with our front office and then he comes back and we have a leadership meeting and he reports on what we talk about, right? What they talk about. And I would say a lot, "Hey, tell me what's going on with um recare. What are we doing on recare?" And he's like, "They say they're working on it." And I'd say, "What does that mean? I don't I don't know what that means." And he's like, "Well,

they're working through lists." And I said, "What lists?" And so, you know, with in Dental Intel they have lists that you can go through for your lost patients or your recare patients or whatever. And I said, "Okay, well, how are we working through this list?" And it was hard because Ryan's like had a had a hard time qualifying and quantifying how they were working through the list. So, what I did was I created an algorithm um kind of like an ACLS algorithm that says go here

and then I I I base it off of psychology and communication expert. >> Cuz that's your background, yeah. >> My background, yeah. >> [laughter] >> So, I said, "Okay, let's find out what is the most effective way of communication?" And And what we found was the most effective way by far um 70% better uh than any other form of communication is texting. People respond better to text >> Yeah. >> the other way. >> I always do. >> Yeah, so much better. So, we said, "Okay, in

this algorithm, we're going to create a text message and it's going to say" and then we put the barriers in, right? So, that What What are the barriers to keep somebody from rescheduling or getting scheduled? And I created this algorithm and then Ryan, being Ryan, looks at it and he's like, "Dude, we can do better than this." And so, he actually again in our in-suite apps, it takes an app, yeah. >> I didn't know that back there. I can only imagine. >> I didn't know that

>> [laughter] >> back then. I was like, "What'd you do?" And he's like, "Oh, you're going to like this." So, we actually have an app in our EOS suite that will [snorts] allow the front desk to It populates the list of any active patients that are not currently scheduled for hygiene, any of them. So, and then we can reduce it down to um how many months it's been since they've been in or whatever, but we typically go Active is defined as someone that's been in in

the last 18 months. So, any patient that's been in in the last 18 months that is not currently scheduled for hygiene, it populates that list. Our front desk can then take click on a patient and start to work the algorithm and it'll literally send them They can take the information, send them the first text message. >> Yep. >> And then based on the response either they get a response or they don't get a response. If they don't get a response, they get >> another reminder or

something? >> three text messages before it gets shuffled off into another pile where it says, "We're going to leave this dormant for 90 days." >> And then re-market it after that? >> come back to it again. But, >> they're not going to spend any more time on those patients cuz they're not getting threes they're not getting responses after three times. So now what it does is if they get a response it it goes down the algorithm so that they will be able to generate a text.

They don't have to think through it. They literally copy it, paste it, text it. And we've seen a huge turnaround in patients that we haven't seen in these 18 months filling up those gaps. So um now where these are patients that are are okay with us being fee for service, right? And we're we're actively moving through our patient base and the the boon here for me is that I can pull that app up anytime and look and I don't need to ask what are they doing

cuz I hate the phrase they're working through it. I was like, I have no idea what that means. And so now I can look at it and go, oh, they are working through it. They have had contacted, you know, 300 of the patients. They've scheduled 200 of them or whatever and I can actually, you know, 150 are now on the dormant list, you know, whatever. I can actually look at it and I don't need for them to come and report and go through these lists of

like, oh, well, we talk talk to these people and these people. I can see who they've talked to. >> Sure. >> See where it's stalled out. I can see where it's effective. Um so that's been a huge thing for us um because one of the the biggest I guess saying one of the biggest trials and struggles that we've had from going to fee for service is is yeah, we know we're going to lose patients, but it's trying to fill those gaps up, fill the whole hygiene

schedule before they become problematic. And so um if if if you're doing this, if you've exited in even any of them and you're struggling to fill those holes, usually you have like a quick fill list or something like that, but it's something if you're doing >> Sure. >> if you're doing a big exodus like we did with half our patients, it's going to be a struggle. You need to have something that's smarter than just a you know, I talk about these lists, you know, I love

I love a good data set, but >> Yeah, sure. Me too. >> an Excel spreadsheet or, you know, um you know, a hand hand written list. So, so it's something that's been really we again, you know, necessity is the mother of invention, right? So, we've been able to create some some cool stuff, but Yeah, I mean I >> Right. >> That that that's been a huge that's been a huge challenge on that front. Um but yeah, you know, I want to go back and answer your

question a little bit better, too, is like how do is our communication go? The flip side of the preparation conversations, now we're on this side of the conversation as far as treatment planning and presenting. Remember, I'm an Air Force doc. I was in the Air Force wasn't an issue. Like it wasn't brought up. We did what was ever best for the patient every time. >> Sure. >> It's a little refreshing to be able to go back to that and go, "Look, we need to do what's

best for you. Here are your treatment plan options." And now it's not dictated, "Well, will my insurance cover that?" You know. >> Yes. Yeah, you can be like, "Hey, this is what you need. Here are the options. Here's like if if you can't do it all uh in you know, this month or whatever, you can string it out over a couple quarters. Hi, Dina. Let me Let me I'm just finishing up this podcast. I'll bring you on a minute. [laughter] Dina's partnering with us right now.

So, >> [laughter] >> thanks. I'll see you in a sec. >> That was ultimate podcast bomb. There's photo bomb and >> That was a we had a podcast bomb. So, good friend Dina Zohs just said hi to us cuz she's on our the podcast next. >> [laughter] >> That was a nice That was a slick promo for the next podcast, like >> Right. Now I got to put make sure her podcast follows this one. Yes. >> [laughter] >> Don't make it weird. >> Sorry, Dan. Keep

going. >> No, I mean that was kind of it. I mean, her timing was excellent. >> Yes. Sweet. Awesome. So, uh just to recap, um build the financial safety net is kind of the what I've been telling practices that are doing this, right? Like what you guys have done, cuz you guys are an excellent example of that. Um it's not going to be free of challenges. You're always going to have challenges. Typically, when it comes to hygiene reappointments. >> Yeah. >> Right? But making sure you

have a system like you you talked about from how you talk about to patients, but also a a follow-up system that's robust. Um so that you you're fixing those problems. And then uh I would I would also say we didn't talk about this, but I know how you guys operate. You guys use an operating system. You're probably identifying these problems that you're seeing and you're you're solving them as a team. Uh where most practices don't do that, right? Um and that's a whole other episode I'm

sure we can do on how you how you guys operate, cuz you guys operate very closely to how we operate here at BoomCloud. Um you know, with a with a we use EOS. I know you guys have your own doctor version of that. Um that you guys have developed, which is kind of cool. So, awesome. Uh so, final thought for our listeners today. Like it's can be scary. It's full of challenges still, but it's still an amazing way to practice dentistry. What's your final thought for

all of our listeners today? >> Yeah, my and and what I really wanted to get across on this episode was just, you know, that the the one of the I wanted to address up front the challenges the >> Of course, yeah. >> But I wanted to be specific about one of the things that we've watched uh first hand and be able to pass that on, and that's the hygiene schedule, cuz that's the freak you out when that happens. And it's like there are things that you

can be doing, uh obviously, to prepare for it. So, again, the things that you named off are are huge in preparation. It's huge. But also, like there's a point where no matter what, you know, I love the the quote that Mike Tyson said that everyone [clears throat] has a plan till they get punched in the face, right? >> Yeah. I get punched in the face every at least once a year, Dan. >> Right. >> Got to figure it out. >> [laughter] >> But you should have

a plan for when you get punched in the face, right? So and that's the whole thing is is that at some point you're going to try to be preventive as possible, but you're going to have to be reactive also. And so knowing the counter punch is huge and being able to look at it and say I'm not just going to randomly be reactive and panic and be led by all these barriers, you know. >> Yeah. >> I'm actually going to look at this. I'm standing in

the face of these barriers and I'm going to have a reaction that is proactive, that is something that has a I'm going to make lemonade out of these lemons. And there are so many people out there that can help with this kind of stuff. And this is what really blows my mind is how many offices just try to go it alone, you know what I mean? >> Yeah. >> Try to grind it out and and what ends up happening is some of them slide right back

into insurance because they just give up because they're freaking out and they don't let things happen. And the the other little tidbit of advice I would give as we're wrapping up is reach out to the other docs that have already done this. >> Yeah, I agree. >> colleagues thousand percent. They they will be able to help guide you through the turmoil because there is going to be a lot of of turmoil following any exit. So >> Yeah. >> Talk to somebody that's done it before. They're

going to give you some reassurance. They're going to give you some guidance. They're going to you know, be able to point you in the right direction in a lot of ways. And then Judas, work with this work with a good consultant, you know, work with somebody, you know, and obviously like I'm an owner but I am a consultant. >> Yeah. >> But when you work with somebody that gives you those two things both as a peer that also as a professional, that's going to help you

so much. So anyway, yeah, that's kind of my shot there. >> Uh like I do this with with I'm a part of a mastermind. Uh I have a coach and consultant. Hi Lisa, we're just finishing up. We just >> [laughter] >> The we're just having a party today Dan. Everyone just wants to join the show. >> [laughter] >> I didn't either. Sorry. I didn't know that's how it worked, but that's okay. >> The podcast is coming with all of us on there. >> It's like >>

It's a party. >> This is a >> We did that. So if you remember Jordan, we did that we did a big panel and when we were in El Salvador for one of our summits, we did a big panel that we had like James Heaton on there, Mark Costas was on there. >> Oh yeah, yeah. >> Eric Hill was on there. We had Ryan Isaac, Matt Mulcock. Like we had this giant panel. So dude, it's coming. Jordan's going to orchestrate. He's going [laughter] to He's going

to pull all of us together into a single podcast. It's going to be >> That would be actually pretty fun. So with we're going to end here Lisa. So you more than happy to chill with us and be a pretty face on our screens. But with with that said Dan, I think masterminds are important. I'm a part of a mastermind. I've always been one. You guys do at Elevation Association, you guys do that. And Yeah, which is awesome. I highly encourage our listeners to go check

out Elevation Association. If you don't have a membership plan cuz membership patients spend way more than cash and PPO patients, come check us out at BoomCloud. We got some cool things that we're doing to help practices in this time of weird economic stress. So check us out there and Dan, with that said man, we hope everyone has a rocking day. >> Right on. Cheers.