Dr. John Meis: Hey everybody, I’m Dr. John Meis with the Spark Dental Network and I’m here with Dr. Jason Howell. Dr. Howell has a lot of experience in group practices and DSOs, was a clinician and doctor/mentor in 2 very large DSOs, and also helped develop a program to help develop young doctors for one of them, and he has a lot of practice experience and clinical experience. He’s worked in a startup, worked in a single-doctor office, a multi-doctor office, and moved from office to office changing the results, improving the results every place he goes. So, he’s a wealth of experience and a wealth of knowledge, and welcome, I’m glad you’re here Jason.
Dr. Jason Howell: Thanks John, good to be here.
Dr. John Meis: So, we’re going to talk about the challenges that happen sometimes between clinicians and management and different ways that we’ve found to effectively manage those. So, one of the things that we see is conversations with doctors that go something like this... “I’m not getting paid enough, so I want to change the way I get paid.”
Dr. Jason Howell: We hear that very often, you’re exactly right.
Dr. John Meis: So, most doctors are paid on a percentage of collections, right? And, often the way they want to change how they’re getting paid is to increase their percentage, that’s the most common solution that they suggest.
Dr. Jason Howell: Right, “Can I increase my percentage, but not do any more dentistry? That’s what I want.” (laughs)
Dr. John Meis: Right, and from a management standpoint, what we want to do is we want to roll our eyes and say, “well let’s just get to treating more patients and you’ll earn all you want to,” right? That’s what want to say. But, we can’t let what we want to say interfere with what we want to accomplish.
Dr. Jason Howell: That’s exactly right.
Dr. John Meis: So, when I hear this statement, my response is always exactly the same, it’s always, “oh, you’d like to earn more,” and when they have some affirmative response, I say, “well great, I want you to earn more too, let’s figure out how to do it.” So, what you do is you’re not drawing a line in the sand. You want to say, “Oh yeah, you signed a contract and that contract’s valid and you’re not going to get paid any more than...” You want to say all those things, but they end up having you be on 2 sides of an issue, and I’d rather step over whatever line is there. I want to step over it and get on their side and talk about how we can help them earn more.
Dr. Jason Howell: Right, that’s a great way to put it because ultimately the statement that we’re looking at, it’s not saying that, “I don’t want to do more work,” or “I don’t want to see patients,” what it’s really saying is, “I’d like to earn more, how can you help me?” And, we as leaders it’s our job to say, “Fantastic, we want you to earn more too, these are some ways that I see that could help you achieve the goal that both you and I want.
Dr. John Meis: So, when I was a kid and I would ask my parents for something, one or the other of them would say something to the effect of, “well, do you think money grows on trees?” And, it’s kind of our natural reaction to come back with something maybe too assertive and creating conflict that doesn’t need to be there.
Dr. Jason Howell: Your parents said that too? (Laughs)
Dr. John Meis: Oh, absolutely (laughs).
Dr. Jason Howell: Mine must have went to the same school as yours did, because I heard that numerous times.
Dr. John Meis: Yep (laughs). So, what we wanted to talk about today is what we’ve found the fastest way to help doctors get to that place where they’re earning more. And, the fastest way that we’ve found to get people to earn more is to help getting more patients to say yes.
Dr. Jason Howell: Yeah, this is a great topic to be looking at, especially in today’s day and age. But, the quickest way that we see, and for me as well, is you’re going to earn more when you produce more, see more patients, and when every patient you see tends to have more treatment plan acceptance. So, how do we get patients to say yes?
Dr. John Meis: And so, what you just said, every manager knows that, right? They know it in their being because they think like a business person and they think in numbers. And I’ve been just very, very surprised, and I continue to be surprised that many dentists just don’t think that way, right? They think about their profession, they think about their craft, they think about their quality treatment, and they don’t necessarily connect the dots on earning more. So, one of the things I always want to start out with is, “You want to earn more. How much do you want to earn?” Try to get a number from them, because then that allows you to back up and go through the metrics with them and the math.
Dr. Jason Howell: That’s a great point. “I want to earn more.” Well, how much more do you want to earn? Is it 10%, is it 20%, is it 50%? Where would you like to be? Because we need to always be able to come back and say, “this is where we are, how do we reach where we want to be?” And, what we like to coach, or what I like to teach, is that a lot of times if it’s 10% more or 15% more, those are very achievable. And, this is very achievable without really doing much different than what you’re doing already. What it comes down to a lot of times is being more in tune with the patient, with what their wants, needs, and desires are, and simply presenting the treatment that they want, which sounds like an interesting concept. Then, being open-minded and open and willing to just do some same-day treatment. Same-day treatment is one of the quickest, easiest ways to increase your production by 10-12-15%. Have you seen that?
Dr. John Meis: Oh yeah, absolutely a very, very easy way. And, that’s worth another whole episode right there, same-day. So, if we focus on case acceptance and changing that, that really is somewhat of a first step of them getting same-day clinic-ing. You’re getting more yeses at the chair and you’ve got more to work with as far as same-day. So, when you get the clinician to really be open and honest with you about what they want, and how much do they want to earn. And, then you go backwards and figure out what the math is, and show them the math. You know, “this is where we have to get to earn that, so let’s figure out how we do that.” Now, we are doing our job as support, we are helping them understand and helping them get in the right frame of mind and now when they’re at that point, when they see us trying to help them get what they want, it’s a lot more of a receptive person to maybe making some modifications in some of the things they do.
Dr. Jason Howell: Yep, and I think it’s important for us to be able to help them see really how achievable those goals are. And, another thing that we can talk about as we get into this is with the team leaders and the office managers. I always encourage doctors, when we say we want to earn more, typically the more we want to earn more, the more we’re up front wondering why patients didn’t schedule. And so, I always encourage doctors and team leaders as well, that is a great opportunity when we can ask the team leaders, “What concerns did the patient have? Was there information that I may have left out that could have gotten them to say yes and to move forward with treatment?” And really, it’s a team effort in regard to this, and we’ll get a little bit more into how we get to this point. But I want to just make a point that the doctors have to be open and willing 1) to talk to us about wanting to earn more and then 2) talk to whoever’s treatment planning and presenting cases as to, “what information did I maybe leave out? Was there something I could have done a little better to help that patient move forward?”
Dr. John Meis: If we don’t help our doctors understand this, and if we aren’t seen as support in helping them do that, they can be picked off by competitors. And, there is a tremendous amount of that going on right now, where people are trying to pick off other people’s providers. And, by just promising them a little bit more in some way or another, maybe it’s even just a signing bonus, a one-time payment, is enough to draw people away. So, this is really a doctor retention strategy, and the reason why I wanted to talk to you about it is because I know your path, and I know that one of the offices that you worked in and one of the DSOs that you worked in, you were the #1 provider, you collected more than any other doctor in the company. You’d never say this because you’re a humble guy, but I’m going to say it so that people understand the expertise that you have. Not only were you the #1, but the demographics of the area that you were serving was relatively low income and a significant percentage of your patient population had Medicaid. Not that you were really a Medicaid office, but you had a significant amount of Medicaid in your office. So, for you to be #1 and to be dealing with reimbursement rates that were so low tells me that you’ve got this figured out. So, I want to hear the magic, and then once we hear the magic let’s talk about how we as managers help our clinicians understand this and help them to move towards it.
Dr. Jason Howell: You’re exactly right. What I’ve found, and this didn’t happen overnight and it’s a process, but what I’ve found is that we can create a process and it’s repeatable, it’s something that you can model. And, for me the biggest “lightbulb” so to speak when I was in that particular office, it occurred to me that it didn’t matter what insurance a patient had, it didn’t matter what income level a patient had, all the patients we see have certain wants, needs, and desires. So, what I did with myself and my team is we made it a point to really find what that patient’s wants, needs, and desires were. Every single new patient that came in, regardless of income or insurance. And, then the second part of that is that we got very, very diligent on every new patient that came in, we did the exact same thing. We took intraoral photos, we took full mouth X-rays, we perio charted, we treated every single patient, regardless of insurance or not, the exact same way. And what that did was it allowed us to gather enough information to sit down and go over everything with the patient and intraoral photos became such a key because we found that so many patients didn’t really know or understand what was going on dental-wise in their life. And, then we really did something completely different, we started focusing on specific areas of treatment for them, and we would use a formula, what we call PCS which is Problem-Consequence-Solution. I’ve always been a firm believer that we as dentists are so good at presenting a problem. We can tell a patient, “You need 4 fillings and 6 crowns.” We can tell a patient, “You have gum disease.” But, we’re not that great at informing patients of what the consequence of that problem is. And, what I found as we were talking to patients is that key little point, the consequence, the consequence will drive treatment, but the other point is that we have to provide a solution. We would tell them a problem, “you have cavities,” and a solution, “you need a crown.” But, we never, ever came to the consequence. So, what we found was that patients don’t need a solution for a problem they don’t perceive to have. So, that consequence would help them understand that this is not just a problem, there’s going to be something that gets worse, and the good news is that there’s a solution for it today.
Dr. John Meis: Let me stop you there, let’s put on our manager hat here. So, if we’re going to help to coach our clinicians about the things that you already talked about, one of them is a commitment to a new patient standard. That this is the standard, we’re going to do it every time, to everybody, unless a patient absolutely refuses obviously. But, that doesn’t happen very often. One of the things that I see, and one of the things for us on development when we’re doing mergers and acquisitions, one of the evaluations that we do of a practice is that we look at their ratio of comp exams to limited exams. So, in some practices a new patient gets a limited exam, some minor treatment, and then they come back for a full exam. And, when I see that, I know that this is a great opportunity. So, what you’re saying is we’re not having this limited vs. comprehensive thing. We are doing the comprehensive unless we have a reason not to.
Dr. Jason Howell: That’s correct. So every new patient that walks in our door gets a comprehensive exam, just like you said, unless there is a specific reason we cannot do it. So, in our practice we have kind of an outline of the way we like to do things and one of them is every new patient gets a comprehensive exam and the limit is if they’re in pain to the point that they can’t sit and take a full-mouth set of X-rays. So, in pain or swollen to the point that they can’t open, we want to be respectful of the patient. But, if they are okay and can sit through a full-mouth set of X-rays, we’ll take intraoral photos and X-rays on every single new patient. And, how we like to talk to the patient is, “Dr. Howell’s going to come in, take a good peek at ya, we’re definitely going to focus on the main concern you have today that brought you in, however he’d like to gather as much information so he can make a good decision about the treatment you need.”
Dr. John Meis: When you hear clinicians say, “My patients refuse comprehensive exams.” They’re not refusing comprehensive exams, they’re fearful that you’re not going to deal with their primary concern.
Dr. Jason Howell: That’s exactly right.
Dr. John Meis: So, you eliminate that fear so they know that you’re going to focus on what’s most important to them. So, as managers we can help our practices develop their standard. We see this as being really transformational for an office, when they commit to those 2 things: comprehensive exams and gathering the same information on every single patient. That alone is probably at most practices 10%.
Dr. Jason Howell: And it will transform your patient experience, it will transform the amount of dentistry you’re doing immediately because there’s so much more dentistry that needs to be done that’s just not being seen or diagnosed because we simply don’t have the right information.
Dr. John Meis: And the second thing that you said, and I agree with it so much and wish I understood it better when I was practicing, is that consequence piece. Everybody that we see has all kinds of things that they want to do with whatever resources they have. And, they don’t know really what importance to put on dentistry unless you describe the consequences of not treating whatever they have. And, that allows them to rank among their needs where dentistry really belongs. And, if we don’t share that with people, we’re really robbing them of the ability to make a good decision. And, I’m a firm believer that whatever patients decide I have to live with and support that and understand it, and even if I don’t like it I have to act like I like it.
Dr. Jason Howell: If we’ve given them enough information.
Dr. John Meis: Exactly.
Dr. Jason Howell: And, I will tell you, the 2 things that you just mentioned: that every exam is a comp exam and every comp exam we’re going to do the same thing and Problem-Consequence-Solution are the 2 biggest things that changed my career overnight. And, I’d like to relate it to myself too, the more I understood Problem-Consequence-Solution, it was amazing because I started realizing that a lot of the decisions I make in my daily life are based on the same Problem-Consequence-Solution, and why we don’t put that together with dentistry I’m not sure. But, as you talk to more patients and you explain the consequences, it’s just amazing. And, I think we as dentists and we as the health care we just think that the general public knows how dentistry works, and so we forget to tell them. But as you explain those consequences there’s so many times that patients will say, “I just wish somebody would have explained that to me before.” And, a lightbulb goes off.
Dr. John Meis: So, as a manager and you’re trying to get people to talk in this Problem-Consequence-Solution type of framework, I’ve found that if you introduce the concept, people understand the concept, and they go back to their offices, they continue to do exactly what they’ve always done, that just talking about it isn’t enough. So, what I’ve found to be more effective is if you sit them down and right now, this is a team meeting, and you probably only need to know maybe 10-12 procedures, the most common procedures. And if everybody uses the same language, trust from the patient goes way up. Understanding of the patient goes up. So, we actually kind of script them out, not that everybody’s going to say it exactly the same way every time, but you want to get as close to that as you can without sounding like a bunch of robots. So as a management team we can help them by putting them in the context in which they have the time and the place for them to think through this. So maybe it’s at a weekly team meeting, you do one a week for 10 weeks and you’ve got it done. But, in my experience I just haven’t seen it happen in practices just by introducing the concept, except for your star performers that are pick up everything.
Dr. Jason Howell: You’re exactly right, it doesn’t happen overnight, and it takes diligence and effort just like most good things do. And, one thing I suggest for a lot of team leaders is, just as you mentioned, having some team meetings, presenting the concept, and then each person writing down a few procedures and what are some consequences if you don’t do anything. And, helping them to get it in their own words, their own verbs. And, then what we always do, about one morning a week we have our morning huddle, and about one morning a week we’ll just flip up an X-ray or a picture and we’ll just point to somebody, PCS. And let them go through the Problem-Consequence-Solution of that. It’s kind of fun, it could be anybody.
Dr. John Meis: And this could be a front desk person, if the janitor happens to walk through, everybody on the team, there’s no reason for everybody not to know.
Dr. Jason Howell: It could be me. It could be anybody. It’s actually kind of fun because what’s interesting is everybody has their verbiage, and so you get to pick up key verbs, key phrases, but it’s just a fun thing to do and it keeps everybody on their toes.
Dr. John Meis: So, creating space and time for people to do that is how management can support a practice. And then, there’s one other thing in observing your practice that I saw that you did that was I think maybe a little unique from many practices was that you would go over all the treatment that patient needs, you’d go over the consequence of not doing it, you would make all the problems visual - which is another thing I wanted to go back to. So making the problems visual, so people can see, seeing is believing, right? So making whatever problem they had visual, then Problem-Consequence-Solution, but then when you went to make financial arrangements and appoint the next time, you do something that’s different than a lot of practices.
Dr. Jason Howell: Yeah, we do what’s called a focused treatment plan. What we like to do is we make sure the patient is aware of all the treatment needed, we’ve looked at photos together. But, I’m a firm believer in that sometimes too much information makes things difficult, it complicates things. So, once the patient understands everything going on, we like to use different word pictures and verbal cues, but I’ll let the patient know we’ll come right back to what was their chief complaint, what was the #1 thing that made them call in, if it was a limited exam. And, if that’s the case, we’re going to present that area and we’re going to start on that today. If it’s a patient that didn’t have a chief complaint and they just came in because they needed a cleaning and needed an exam, what we’ll usually do is based on the photos we’ll say, “why don’t we start in this area, it’s definitely the worst area.” Or, usually I’ll phrase, “This is the first area that I see that may cause you pain or fracture or break or lose a tooth.” But, the key is that I always let the patient know that there’s other work to do but we’re going to focus on this specific area. And, when I have my treatment plan coordinators go over the plan, we present what we call the next step treatment plan. And, the next step may be today, maybe we’re going to convert it today and do same-day treatment. It may be next week. But I always let the patient know we’re going to go over our next step treatment plan, and focus just on that. What we’ve found over time, and we’ve been doing the focused treatment plan now for almost 10 years, is that patients tend to get more treatment done in a shorter amount of time than when we used to do a full-page treatment plan of every single thing that needs to be done. What I found was no matter how many times you talked about what the next appointment was, once you went over the whole treatment plan it was very difficult for the patient to not be so concerned or worried about treatment plan or appointment 4, 5, or 6. We always like to use the phrase in our practices, “we can’t get to step 3, 4, or 5 if we never get to step 1.” So, let’s get step 1 done and get this taken care of and then we’ll move as quickly or slowly as you may like to every other step. And, our treatment plan coordinators are fantastic with that, but it made a huge difference in the amount of dentistry our patients were accepting and wanting to move forward with.
Dr. John Meis: So, what we see very often with practices is that they present all the treatment, the total cost, they kind of shock people. And shocked people often say, “I’ve got to think about this.” And, once they think about it, once they hit the door, your chances of getting them back are reduced dramatically. Rather than having a little piece, “Okay, yeah I can move forward with that.” And then if you start on it that day, that’s even another piece that keeps them in. But, we see what we call “one-and-done’s” where we see the new patient, they’ve presented this big treatment plan, and they never see the patient again. And, in some practices that measure that, it could be maybe 30-40% of their new patients and so this helps eliminate the “one-and-done’s”.
Dr. Jason Howell: It makes a huge difference in that we don’t have nearly as many “one-and-done’s” and again, we have more patients that move forward quicker with more treatment than when we present an entire treatment plan. Now, for the viewing audience I will say there are a few procedures that we’re going to present the whole treatment plan. There are some things that we need to make sure we go over everything because it really is an “all or nothing”, extractions and dentures, we’re going to do the whole thing.
Dr. John Meis: Severe wear cases, there are some things that you can’t do piece by piece. But, that’s maybe 10% of a practice, if that.
Dr. Jason Howell: Yes, it’s very small. And, what you will see with this, back to the very first slide, “I want to make more money,” you will see your production, the office production, they hygienist production, the profitably, all of these things in the practice will increase simply because patients are getting the treatment they want, need, and deserve more often than leaving without doing the work. So, it’s really a win-win for everybody.
Dr. John Meis: And so, as a management team you can support a practice moving to that by talking about it. What does an area of focus look like? Is that a geographic area of the mouth? It might even be somewhat determined by a dollar amount. Maybe you want to keep a neighborhood under a certain amount of money. I’ve seen practices do that as well. And, that money might be different if you’re in a neighborhood like you were practicing in that was a lower-income area. That number might be different than if you were practicing in a more affluent area. It may not be different, but it may be. And so, you can help a practice kind of zero in on that, and then follow the case acceptance rate. So, what is the percentage of people that are moving forward with something? That’s the key number, again highly correlated with profitability. That is how we get the best patient care, because they’re moving forward with something, they’re on the step to being stable, healthy, and on track.
Dr. Jason Howell: And, from a management side, that’s something that’s very measurable. You can really look back and see what was the case acceptance and which of those cases were focus treatment plans versus an entire treatment plan printed.
