Time to Rethink the Dental Meeting

By | Insights

Perhaps you attend your local or state annual session, or the association meeting for your specialty. Maybe you’re planning on joining us in Denver, Colorado, this fall for the American Dental Association annual meeting. These annual sessions and meetings can indeed be a good time to connect with colleagues and earn extra continuing education credits.

But what if there’s more out there?

Here are three meetings of dental minds that can’t be missed, one a proposed meeting:

Seattle Study Club Symposium. Members from more than 250 clubs around the world will come together in January 25-28, 2017, in Orlando, Florida, to “shed the comfort of convention, in favor of more ‘cutting edge’ learning opportunities,” as the organization explains on its website. Dentistry Unchained partner Wendy O’Donovan Phillips attended the organization’s Regional Symposium a few years ago, and reports that you can’t find a better meeting to truly unite general dentists and specialists in unparalleled hands-on workshops. “The level of camaraderie and collaboration among dentists is unmatched,” she adds.

OrthoVOICE. Orthodontists are branching out from the American Association of Orthodontists annual meeting in favor of this avant-garde conference, coming up September 29-Oct 1, 2016, in Las Vegas, Nevada. Orthodontist Dr. Clarke Stevens started the event four years ago, and has since built it to have “a brilliant reputation for vetting new ideas and targeting speakers to transform your practice,” according to the website. Phillips attended OrthoVOICE in 2015 and will return this year, saying, “Of all of the dental meetings I have attended over the last nine years, this one is the highest energy. Attendees truly engage with one another and with speakers for takeaways that help them produce ‘hard core results,’ as they say.”

Dentistry Unchained, Denver 2016? What if a group of independent dentists met on a yearly basis to advance collective objectives? If you’re interested in helping to form such a meeting, contact us.

 

 

 

 

BREAKING NEWS: Call for General Dentists to Declare Their Independence from the American Dental Association

By | Insights

DENVER, July 5, 2016 /PRNewswire-USNewswire/ — Inspired by America’s Declaration of Independence, a group of dentists and other concerned healthcare professionals are calling on all general dentists in the United States to drop their membership in the American Dental Association.

TEAM 1500, a coalition of more than 1,500 healthcare providers and concerned citizens, issued the call on July 4, 2016, in response to more than a decade of what the group believes has been malfeasance on the part of the ADA’s Board of Trustees and the ADA’s influential committee chairs.

Channeling the original Declaration of Independence, which spelled out the complaints of the American colonists against the British Crown, TEAM 1500 members issued their own statement, declaring:

“We hold these truths to be self-evident, that all dentists have equal standing, that they are endowed by their training with certain unalienable Rights, that among these are service to patients, dedication to safety, reliance on science, and commerce free of unreasonable interference.

“That to secure these rights, professional associations are instituted among individuals, deriving their just powers from the consent of the members.

“That whenever any Form of association becomes destructive of these ends, it is the Right of the general membership to alter or to abolish it, and to institute a new organization, laying its foundation on such principles and organizing its powers in such form, as to them shall seem most likely to effect their public service and practice.

“Such has been the patient sufferance of general dentists; and such is now the necessity which constrains them to alter their former Systems of association.

“The history of the present ADA Board of Trustees and entrusted council chairs is a history of repeated self-dealing and usurpations, all having in direct object the establishment of an absolute Tyranny over the general membership.”

Read the full article here to learn the specific grievances cited.

Top 5 Reasons DSOs Exist (And How Best to Compete)

By | Insights

 

Historically dentistry was great for doctors who wanted autonomy and freedom. Increasingly, it’s hard for dentists to be independent and successful.

In past decades, a dentist would graduate from school, became an associate and buy out a practice as a partner. Today, the rise of the Dental Support Organization (DSO)[1] has more and more dentists electing to join existing DSO-supported practices.

Why?

  1. History repeats itself. Dental industry trends follow the healthcare industry with about a 10- to 15-year lag. America witnessed the consolidation of healthcare providers at the turn of the 21st Century, and dentistry is following suit.
  2. Dental schools are expanding. According to the U.S. National Institutes of Health’s National Library of Medicine, there were 42 dental schools in 1950.[2] Today, there are closer to 65. This means that the marketplace is flooded with new dentists looking for work.
  3. Debt is climbing. The average dentist is $280,000 in debt. A bank is not apt to loan the average new dentist $750,000 to open their own practice. Therefore, new dentists are more likely to seek out a career with a DSO than go into solo practice.
  4. Guaranteed pay. DSOs offer a guaranteed salary, which has more and more dentists going this route.
  5. Business support. Dentists working in a DSO have all of the accounting, marketing and other business strategies handled for them. They just show up and do dentistry.

The last one is the best place for independent dentists to compete. Independent dentistry can indeed still be a profitable business, if the dentist gets help on the business side.

As dentists, we hear this all the time. But where to start?

First, understand what “business side” means. Simply, put, the business side is comprised of these functions:

  • Human Resources
  • Practice Management
  • Payroll
  • Marketing and Branding
  • Accounting and Tax Strategies
  • Recruiting
  • Risk Management
  • Information Technology

Next, nix altogether the do-it-yourself approach to these functions. The point is that you spend more time with patients, not more time working in the business or reading books and manuals on these areas of expertise.

It’s important to use experts in each field. It’s like medicine – you don’t go to a cardiologist for your foot.

Avoid the idea that “none of this really applies to me.” Policies, procedures, risk management, human resources… it’s enough to make someone glaze over. You don’t know what you don’t know; get out there and explore the possibilities for truly safeguarding your practice.

Don’t wait until it hurts. An employee lawsuit, cash flow slippage that costs the practice tens of thousands of dollars over the years, attracting new patients only to have them leave the practice before their next recall appointment – all of these things are 100% preventable, but can kill a practice if left “untreated.”

As in dentistry, an ounce of prevention is worth a pound of cure.

Written based upon an interview with Quinn Dufurrena, DDS, JD, the President/CEO of Avitus Dental Management Solutions.

[1] May also be referred to as Dental Practice Management Company (DPMC), Dental Management Service Organization (DMSO), Group Dental Organization (GDO), or Group Practice Organization (GPO).

[2] What’s Going on in Dental Education?

The Power of “No”

By | Insights

In my nine-year career in serving dentists, I have worked with executives from some of the largest dental organizations and corporations in the nation – the Big Dogs. In that time, I have said no to some of the most powerful, influential people in the industry.

One asked if my firm would build a 100-page website pro-bono in exchange for lecturing opportunities. I said no.

Another asked for perpetual license to publish my content without my byline or bio. I said no.

A third offered an exclusive deal if we promised not to work with their competitors. We said no.

Each time that I said no, I did so in person or on the phone. Each time, I was prepared with a well-though-out, intelligent reason why the answer was no. Each time, I made clear that I still had the intention of working with them, just on different terms.

And each time, the Big Dog reevaluated their position, continued to work with me on more even terms, and kept the door open for further collaboration. In every case, it felt that the Big Dog actually respected me more.

The Big Dogs aren’t against us Little Guys. They are simply making decisions in a completely different environment than we do. Many answer not to their customer first, but to their shareholder. They are under the gun to make a profit quarter after quarter, year after year. They are conditioned to chase money, and that sometimes clouds the collective judgment.

Others answer to a board of directors first, which may mean that the dentist comes second. Individual intentions are good, and bureaucracy muddies the waters.

When we say no, either individually or collectively, the influence and power shift. Influence and power shift even more when lots of Little Guys say no. When the Little Guys become disruptors, challenging the status quo and ask the Big Dogs to think differently, then real change happens.

Earlier this year it was reported that, “ordinary dentists across the country have filed over a dozen lawsuits” against the “Big 3” suppliers for price fixing. The article continues, “These are all class action suits, meaning that every dentist who bought from one of the Big 3 could be entitled to a piece of the settlement.”[1]

Just last month, news broke of another class-action lawsuit, this time “against 3M over faulty dental crowns.” The claim is that 3M’s Lava Ultimate crowns “de-bond inside patients’ mouths,” and that “dentists have been forced to cover the cost of replacing the crowns.”[2]

Often saying “no” doesn’t have to involve a long, arduous and expensive lawsuit. Symposiums and study clubs are held all the time to collaborate on clinical care. Imagine similar collaboration, except on challenges in the dentistry industry. Imagine how powerful the collective voice would be.

What do you say “no” to in the dentistry industry? What is still happening in your world of dentistry that is no longer acceptable? How can we come together for positive change?

Written based upon an interview with Wendy O’Donovan Phillips, co-founder of Dentistry Unchained and founder of Big Buzz.

[1] Schein, Patterson, and Benco Sued for Price Fixing

[2] Dentists File Class-Action Lawsuit Against 3M over Faulty Dental Crowns

 

Top 6 Ways to Improve Cash Flow

By | Insights

Why is the practice profitable but I don’t have enough money to take home?

Why can’t I seem to pay down the practice debt as fast as I want to?

Why are we busy but we’re still having trouble paying bills?

These are just a few cash flow questions that dentists ask themselves on a regular basis.

Here are the top six actions that any dentist can take to improve cash flow in the practice:

  1. Think like a CEO, not a CPA. The CPA, or certified public accountant, wants to get net profit as low as possible to minimize tax exposure. Put yourself, as practice owner, in the seat of CEO. The CEO wants net profit higher so cash flow is strong. The CEO regularly asks, “How is the practice performing?” The CEO regularly examines how to decrease expenses and increase profits. A CEO needs to be proactive in looking at the financials, and find a balance between cash flow strategies and tax strategies.
  2. Stay on Top of Debt Servicing. Just to open the doors, a dental practice may take on $500,000 in debt (or more). That may add up to thousands of dollars a month payback that is not being reported on the Profit and Loss. Many practices are under the false impression that 15 to 20% profit margin is sufficient. In fact, net profit may needs to be closer to 30 to 50%. It’s important to understand how to read the profit and loss and the balance sheet. These financial reports will help to explain why you can be making a profit but having trouble paying bills or paying yourself on a regular basis.
  3. Follow the Money. Oftentimes the dental software shows collections, but that doesn’t translate to the accounting software. In order to have a clear picture of how much money is coming into the practice, connect the dots to the revenue in your accounting system. Beyond that, always have clarity on what is outstanding for 60 days and 90 days. Have a good accounts receivable process. Money coming into the practice needs to come in as quickly as possible on a regular basis.
  4. Leave home at home. Resist the temptation to pay bills as you do at home. That approach does not serve the practice well. Business vendors will often offer payment terms, allowing a practice to pay over time. For strong cash flow, hold onto your money for as long as possible. Have a good accounts payable process and know your risks for being a victim to embezzlement.
  5. Forecast the future. A cash flow forecast provides insight into what the practice’s financials will look like up to eight months in the future. It follows your current financials and is a moving projection month-to-month based on how your business is trending. It empowers you to fully prepare before hiring a new employee, paying yourself more or paying more money toward debt. A good cash flow forecast shows much more than total expenses. It shows total cash outlay, which includes loan payments and owner distributions against projected revenues. Most importantly, a cash flow forecast will alert you to any potential shortages coming in the future, based on your current outlay of cash each month. It educates you on what you don’t know that you don’t know about your financials.
  6. Face Uncle Sam head on. Be proactive about tax liabilities for the year. Talk to your CPA about filing quarterly, and avoid being surprised on how much you owe. Start the conversation about what you will owe in April of next year in June of this year, and put the tax estimates into your forecast. Become proactive with your tax planning using not only your CPA, but also your financial planner, cash flow consultant and banker. Look at strategies throughout the year to to offset taxes and to get more money into your pocket in the long term. Don’t guess. Create strategies now with your team of trusted advisors.

Written based upon an interview with Debra Robinson of Centennial Revenue Management. To learn more, attend the Dentistry Unchained webinar, The Dirty Little Secrets of Cash Flow: Why Net Profits Don’t Always Equal Good Cash Flow on June 2, 2016. Click here for details.

 

The Real Skinny on Dentistry Real Estate

By | Insights

Are you paying too much for your lease?

There is no rule for setting lease rates. It all comes down to what you can negotiate. Many dentists are not aware that they can negotiate, even on an existing or long-term lease.

Let’s explore a few scenarios that have dentists paying too much…

Dr. Smith is on a 5-year lease, and rent has been raised $1 per square foot each year. He’s writing checks every month, and he’s not even realizing that there has been incremental increase. It’s just another little thing he does to keep his practice running.

Dr. Garcia paid the same flat lease rate for her first 5 years, and didn’t question a $2 per square foot bump in rate for the next five years.

Dr. Jones asked other tenants in the building what they were paying. He learned that the tenant downstairs is paying $2 more per square foot, so he figured he’s getting a good deal and he let the matter go. He didn’t ask the tenant upstairs, who is paying $6 less. And he didn’t negotiate with the landlord, who would have been willing to $7 less to keep him in the building. What he didn’t know is that lease rates can vary $10-$15 per square foot in the same building.

It seems such a small amount. What’s the big deal?

Let’s look at another scenario to see what this adds up to over the long term.

Dr. Williams negotiated what he thought was a fair lease rate when he moved his office five years ago, and didn’t realize that the landlord was charging 4% more each year. His original $5,000-per-month lease is now costing him an additional $7,200 per year – and climbing. That’s money he could have taken home!

When it comes to leases, the rate of increase often outruns the rate of inflation and cost of living. When you get that renewal, realize that you have every right to negotiate down the lease rate. In fact, you don’t even have to wait until the lease is up for renewal. It’s your right to renegotiate anytime. 

Here are just a few examples of deals that dentists have negotiated:

  • Free rent – Lease was signed on December 31 and the dentist negotiated three months of free rent. First payment was April 1.
  • Tenant improvement money – Upon renewal, the dentist negotiated to receive funds for free fresh paint and light fixtures.
  • Lower lease rate – The dentist dropped more to the bottom line thanks to a lower monthly rent payment.
  • Assignability clause – The doctor was preparing to transition out of the practice, and wrote in a clause to break the lease early or transfer the lease to a new owner.

Set a meeting with your landlord today. One dentist did just that and saved $15 per square foot in a 3,000-square-foot practice. That’s $3,700 per month!

You never know what you’ll learn if you don’t ask.

Written based upon an interview with Ryan Nolan of Carr Healthcare Realty. To learn more, attend the Dentistry Unchained webinar, Winning in Commercial Real Estate: Essential Strategies to Maximize Profits on Thursday, May 26, 2016. Click here for details.

 

 

 

 

Decoding Corporate Dental Propaganda

By | Insights

The corporate dental propaganda that arrives on my desk almost weekly paints a curious picture. It suggests that if I sell my practice to them then I will instantly realize my dream life: no responsibility, an endless support structure for “my practice” (which really then becomes “their practice”), the same income, and a seemingly endless amount of time to go play golf and vacation. It’s all about what I gain by selling out to them.

Does that picture depict reality? I think not.

Plus, there is something conspicuously missing from these brochures: a list of what I would be giving up by selling out. Perhaps that would-be list might read:

  • Vision
  • Autonomy
  • Freedom
  • Voice
  • Control
  • Long-term assets
  • Ownership

Corporations are looking to buy because they see significant profit in the transaction. If corporations are so eager to buy independent practices then that indicates that the independent dentists has a valuable and profitable asset under individual ownership and control.

The main message in this propaganda is that a dentist needs only to get training or help from other professionals regarding the business side of the practice. While running a business isn’t easy, it isn’t rocket science either. It certainly isn’t as hard as getting through dental school.

This is not to say that the independent dentist has to fly solo. In fact, most highly successful independent dentists hire experts smarter than themselves to handle the business and administration of their practices. For example, one practice might have each of these three experts on hand to help:

  • Financial firm to handle bookkeeping, accounting and payroll
  • Human resources expert to handle staffing, including hiring and firing
  • Marketing firm to handle internal and external communications

Not sure where to start? Begin with a practice consultant who can help uncover which experts are most needed, and who can help forge those relationships. (Many have an arsenal of experts they can refer where and when needed.)

There is no silver bullet for making an independent dental practice profitable and fulfilling. But in my opinion, selling out to corporate certainly is not an option.

 

 

 

 

 

Swallowed Up

By | Insights

The Vancouver Sun reported last week that dental corporations are “swallowing up” British Columbia dental practices.[1] The phenomenon is relatively new to our northern neighbors with just 2% of practices being corporations, but it’s been widely prevalent in America for some time. The American Dental Association reported in 2013 that “The number of multi‐unit dental firms with 10 or more locations grew fivefold between 1992 and 2007, as the number of dental establishments that they operate rose from 157 to 3009. They are now taking a greater percentage of total receipts ‐‐ from eight percent in 1992 to 11 percent in 2007.”[2]

Sun reporter Bethany Lindsay writes, “[Corporate dental practices] have scooped up hundreds of practices in the U.S. and Australia in recent decades. They work by centralizing clinic management and relying on economy of scale — they’re basically the Walmarts of the dentistry world.”

Her article goes on to explore ownership of dental practices. “Only dentists are allowed to own dental practices in Canada and most parts of the U.S.,” continues Lindsay, yet Heartland, for one, operates 375 locations in the U.S.

How is this possible?

Nadean Burkett, a dental management specialist who has dedicated her career to combating the corporate influence on dentistry in Canada, offers an answer in Lindsay’s article. “What I learned was … they have what they call nominee dentists, which are registered with the regulatory body as the owner of that practice. They will buy the assets out of a company owned by a dentist, stripping it clean of all of the assets, but the (nominee dentist) still stays registered with the college.”

Is it time for the laws regarding practice ownership to be changed?

Should it be required that a practice be owned by a dentist and that the assets of that practice must be dentist-owned?

Should corporate practices be required to inform the public that they are part of a corporation?

How can the members of Dentistry Unchained use strength in numbers to prevent from being swallowed up?

[1] Corporations swallowing up B.C. dental practices

[2] CRITICAL TRENDS AFFECTING THE FUTURE OF DENTISTRY: Assessing the Shifting Landscape

 

Burning Questions Answered!

By | Insights

What is a Group Purchasing Organization (GPO)?

A GPO is a group that helps healthcare providers (hospitals, nursing homes, etc.) realize savings and efficiencies by purchasing in bulk and by negotiating discounts with manufacturers, distributors and other vendors.[1]

For example, Henry Schein is a self-proclaimed “authorized distributor of most major Group Purchasing Organizations.” Here’s how they define a GPO:

…an entity that helps health care providers realize savings and efficiencies by aggregating purchasing volume of their members and using that leverage to negotiate discounts with manufacturers, distributors, and other vendors.[2]

Approximately 72 percent of hospital purchases are made through GPO

Contracts, with the first GPO established in 1910 by the Hospital Bureau of New York. Becker Hospital Review reports that, “In a recent HSCA report, healthcare economists at Dobson DaVanzo & Associates found GPOs could help reduce overall healthcare spending by up to $864.4 billion by 2022, approximately $55 billion every year.” Over the years, lawmakers have examined GPO’s administrative fees and potential conflicts with anti-trust regulations.[3]

What is is a buying group?

A buying group is a membership organization that pools the purchasing power of all its members to negotiate discounts with vendors. Typically the member works directly with the vendors and is privy to the discount by virtue of their membership credentials.

How is Dentistry Unchained different?

Dentistry Unchained is not your uncle’s dental group. In fact, it’s not even a dental buying group in the traditional sense. The vision is so much larger than that.

Certainly, there is a savings component. Soon Dentistry Unchained will roll out its proprietary Members-Only Marketplace. All members in good standing can visit the online marketplace and select from a variety of benefits, which may include:

  • The same lab discounts that are already available to members
  • Savings on supplies
  • Software and equipment savings
  • Savings on human resources services such as staffing support
  • Savings on marketing strategy services
  • Lease savings offerings

More than that, Dentistry Unchained is working hard on members’ behalf to secure all the support that corporate dental gets and that you, as an independent dentist, need to execute your business goals and offer excellent patient care.

Plus, Dentistry Unchained is the only group of its kind to offer a robust educational webinar series. The experts delivering these webinars get paid top dollar to lecture across the nation, which makes the combined value of these webinars in the tens of thousands of dollars. What’s more, they pack the power to help you drop tens of thousands of dollars to your bottom line.

Finally, Dentistry Unchained makes it an everyday mission to offer educational content in the form of articles like this one. We are challenging the status quo on behalf of independent dentists, sharing facts and raising questions that, until now, are largely only discussed behind closed doors.

This is not a matter of us against them, independent versus corporate. It is more a matter of the survival of the fittest. Dentistry Unchained is uniquely positioned to help the independent dentist become as fit as possible in a marketplace that demands it.

Join the revolution.

 

[1] Healthcare Supply Chain Association

[2] Overview GPOs

[3] 50 things to know about the country’s largest GPOs

 

Should I drop an insurance plan?

By | Insights

These are questions that we as independent practice owners ask ourselves and need to answer for ourselves:

  • If I drop a particular insurance plan, will I increase my profits?
  • What’s the best way to evaluate an insurance plan?
  • How does taking a reduction in fees affect my profitability?
  • How do I go about dropping an insurance plan?

Let me be clear: I am not advocating any course of action for your practice, but offering up for discussion what I am considering doing with mine.

I have dropped many PPO insurance plans over the years. I find that the key is to drop one at a time.

Here’s my process:

First, I identify the plan I am currently contracted with that requires the greatest reduction in my fee. Let’s call it Plan 1. I research how many of my current patients are on Plan 1. In this case, 200 patients or 10% of my current patient base. Once I have established the same number of new patients not on Plan 1, I would drop the plan.

In the example of Plan 1, we typically see 30% of patients leave the practice, which may sound daunting.

But think of it this way: Even if every patient on Plan 1 leaves, the practice will still be more profitable. Why? Because we have the same number of patients we had before, and we are now getting a higher fee per patient.

This approach will not work for the PPO I am now considering dropping. Let’s call it Plan 2. 40% of my current patients carry Plan 2, so it’s too risky to just drop it. Instead, patients on Plan 2 will still be able to use their insurance in my practice, but it will be considered out of network.

In order to determine how Plan 2 is affecting my practice’s profitability, I need know my practice overhead and net. My practice operates on an approximately 65% overhead and 35% net. What this means is that for every $100,000 we make, $65,000 will go to expenses and $35,000 will be profit.

Let’s say I do a number of procedures for a fee-for-service patient including an exam, x-rays, prophy, two fillings, and a build up and crown, totaling $2,300 over 4 hours. With 65% overhead, my cost is $1,495. That makes my profit $805, or approximately $200 per hour.

Plan 2 requires me to accept a 25% reduction in my fee. Let’s look at what that does to my profitability. Our regular fee for these procedures is $2,300, but with a 25% reduction, our fee is now $1,725. Our overhead stays at $1,495 because I still use the same lab, materials, facility, and staff. That makes my profit $230, or approximately $58 per hour.

Looking at my participation in Plan 2 from this perspective is pretty sobering to me. I am only receiving $230 profit for 4 hours of hard work. I have to do four times the amount of work for the same amount of profit.  

While I admit that I am nervous to drop Plan 2, I realize that by accepting their fees I am working for very little profit. I feel my time, training and expertise is worth more than $58 per hour. I am fortunate that in my practice we currently have a capacity problem, meaning that we are booked out a few months in advance and it is likely that even when we drop this insurance plan we will maintain a fairly full schedule.

But I have to ask myself: Even if we were less busy, would it really matter? Wouldn’t it make more sense to simply work a few days less per month and make the same amount of profit?

After all, it’s not what you make, but what you keep.