Episode 243 – The Blueprint: Successfully Moving Out of Network with Your PPO

“It was starting to affect my health, just the stress and trying to keep the whole world happy.” ~Dr. Gwendolyn Buck

If you have ever dreamed of going out of network and becoming a fee-for-service dental practice, you do not want to miss this episode. Everyday Practices Dental Podcast co-hosts Regan Robertson and Dr. Chad Johnson welcome PDA Investment Grade Practices Business Advisor Christine Uhen, GDH, BA, and Dr. Gwendolyn Buck, owner and dentist at Northern Trails Dental Care in Gwinn, Michigan, for an illuminating discussion about Dr. Buck’s transition to becoming a fee-for-service practice in merely seven months.

The decision to move out of network from Delta Dental Insurance was not made lightly. The COVID-19 pandemic had taken a significant toll on Dr. Buck’s team, leading to turnover levels her team had never experienced before. Determined to provide her patients with the highest quality dental care while also ensuring that she could support and retain her outstanding team, Dr. Buck knew a change was necessary. By transitioning to a fee-for-service model, she aimed to regain control over her practice’s financial health and deliver personalized, uncompromised care to her patients.

In this episode Christine Uhen shares the game plan that PDA developed with Dr. Buck, detailing the strategic steps and support provided to navigate this transition. You will gain invaluable insights into the challenges and triumphs of shifting to a fee-for-service model, learning how Dr. Buck successfully managed the process, and the positive impact it had on her practice. 

As you listen to this episode, we want you to think about the following questions:

• What challenges or frustrations am I facing with my current insurance network, and how is it affecting my team and patient care?
• Do I have the resources and support such as dental practice coaching, to help navigate this transition effectively?
• How will this change impact my financial health, team retention, and ability to provide high-quality dental care?
• How can business coaching for dentists assist in developing a strategic plan for transitioning out of network and ensuring long-term success for my practice?
• What specific aspects of coaching for dentists have been most beneficial in helping practices like Dr. Buck’s smoothly transition to a fee-for-service model?

EPISODE TRANSCRIPT

Regan Robertson: Doctor, do you ever peek over the fence and wonder what your life and practice could look like if you dropped PPOs? It’s an enticing, sizzling subject. Chad is giving fist bumps today, but it can be a little bit scary. It is not without risk. And we have An extremely exciting firsthand account of what that looks like in today’s podcast. Welcome to Everyday Practices Dental Podcast. I am your host, Regan Robertson here with the wonderful Dr. Chad Johnson, who also just adores PPOs. He wears them like a proud vest every day.

Dr. Chad Johnson: I think they’re great for other people.

Regan Robertson: Joining us today is Dr. Gwen Buck from Northern Trails Dental Care out of Gwinn, Michigan. It’s Gwen in Gwinn and with her is our PDA business advisor, Christine Uhen, who works with Dr. Buck. Welcome both to the show.

Dr. Gwen Buck: Thank you so much.

Christine Uhen: Hey, Chris.

Dr. Chad Johnson: Hi guys.

Good to be here.

Dr. Chad Johnson: Nice and early for you.

Christine Uhen: For Gwen in Gwinn, I will always get up early.

Dr. Gwen Buck: I appreciate it, Chris. You’re the best.

Regan Robertson: So, Dr. Buck, can you be our listeners eyes and ears and tell us what type of dental practice you have and the type of patients that you love serving?

Dr. Gwen Buck: Absolutely. So I’ve been in practice 16 years and I bought a practice straight out of my AEGD residency and it was a small town practice. The town’s got about 2, 000 people. Uh, zip codes got about 4, 500 people and then we’re about 20 miles south of Marquette, Michigan, where that’s got about 20, 25, 000 people in the area. So it’s a great town in the woods. Uh, we do a lot of outdoor things, four wheeling, snowmobiling, berry pickin um, kayaking, you know, all Yeah, where are you? You got it. So, um, yeah, really, um, just great, um, people in our community. Um, so, um, definitely small town. Um, you know, when that song comes on, we’re, we’re smiling. Um, so

Dr. Chad Johnson: Are you originally from the area?

Dr. Gwen Buck: Sorry?

Dr. Chad Johnson: Are you originally from the area?

Dr. Gwen Buck: Yeah, that’s where I’m from. So that’s why I love to be here. Um, yeah, and I don’t, I can’t handle hot weather much. So the North is really good for me.

Dr. Chad Johnson: Last week, my family was in Isle Royale. So,

Dr. Gwen Buck: Yeah, I’d love to get up to Isle Royale someday, but I’ve got to bring a lot of mosquito repellent. So we’ll see if I ever get there. It’s gotta be a tough place if you don’t have protection against that, but

Dr. Chad Johnson: I got off of Amazon and net.

Dr. Gwen Buck: Yes, yes, the net. Did you get the hat?

Dr. Chad Johnson: I have a hat and I wore the net over it. Yes, I was full-fledged. Yes, I had

Christine Uhen: That’s when I went to Texas.

Dr. Chad Johnson: Oh, yeah, we call them dad hats cause you know, they just, they kind of quintessentially look like a dad hat.

Dr. Gwen Buck: Yeah. It doesn’t make you look cooler, but you are more comfortable.

Dr. Chad Johnson: Absolutely. I’m over cool, man. No, thanks.

Dr. Gwen Buck: So my practice was really a small town. Um, and, um, there was 1994. So we had some retirees from the area, um, but just a lot of great, you know, uh, blue collar people. Um, jobs have always been a little bit tough in the upper peninsula of Michigan. So, um, you know, that’s just something that, you know, we try our best to look for good employment. Um, but we love the area so much. We love being rural and so that’s something that’s worth it for our, our community.

Regan Robertson: Uhm, go ahead

Dr. Gwen Buck: Oh, I was just going to describe my practice. So we had, um, we moved from a small, um, office of just a, a couple operatories that we built a building in 2011, and that’s got six treatment rooms. We’ve got two hygiene rooms and four doctor rooms. Um, so two hygienists right now, we’ve got three assistants and three front desk. And, um, yeah, it’s just a great, great office right now. I moved from going four days a week to three and a half days a week back in 2012. Um, so I had an associate for about three years from 2012 to 2015 and, um, that was a wonderful, wonderful relationship. Um, And I’ve always dreamed of going out of network with Delta. So that was something that, um, you know, I thought, “What would that be like one day I’ll get the guts to do that?” Uh, and I decided, “Okay, well, first I’ll try an associate.” So I did that first. And next time we got to that point in our business, I promised myself we would, we would go out and network with Delta.

Dr. Chad Johnson: Good for you.

Regan Robertson: So what factors, Gwen, did you consider and how did your PDA business advisor help you navigate these challenges? So it sounds like it’s been a dream for over, over a decade. It’s been a long-standing dream of yours.

Dr. Gwen Buck: I have always dreamed of that. In fact, I, it’s hard to imagine a dentist who doesn’t dream of going out of network with Delta. Um, you know, we love that our patients can have dental insurance and use it to help them, but it’s very hard to pay our team members the wages that they require in America today, um, with being under, under network with Delta and if you want the kind of team that’s always. Going in and out the door and you got to train, train, train new people, um, then, you know, that’s the way to go, but I didn’t want that kind of team and we really never had a high overhead. Um, or I’m sorry, a high, uh, turnover until the pandemic and we had definitely not the highest turnover of any dental office in the pandemic, but it was higher than I was used to and I really didn’t like that. So, um, thank you pandemic for, uh, helping me be fed up.

Dr. Chad Johnson: That’s right.

Dr. Gwen Buck: You know, and I did, I did actually have a dentist who, once they shut down, that’s when they gave the letter to Delta. Um, I don’t know if that was a PDA client as well, but anyway, I was, I was envious because that, that was, that was the best idea ever but, um, it, it just took me some time and, and, you know, of course that was hard on, on everybody in dentistry and, you know, pretty much everybody in the world. But. Um,

Dr. Chad Johnson:  Yeah, that was me and it was hard.

Regan Robertson: I was just going to say, I think that was Chad.

Dr. Chad Johnson: I sent off, like we were closed for nine weeks and of course at the time, you don’t know, it’s going to be nine weeks, but when we closed, we all had an office, you know, an office wide meeting in our front reception area, and I said, “We’re going on a network, you know, just burn the ships, we’re done,” and I said,”You know, by the time we get our 30 days,” which turns out it was 60 days, but at the time I remember saying, “By the time our 30 days are over, we, we might still be in this closure kind of thing.” Sure enough, even 60 days, we were still in the closure thing and uh, so when we, uh, opened back up, we had spent a few weeks fielding phone calls and addressing the matter and everything like that, and when we opened back up, we were service fee- for-service.

Dr. Gwen Buck: That’s awesome. Yeah, kudos to you. I mean, that’s, that is great, Chad. I, uh, I really admire you.

Dr. Chad Johnson: You as well. I think this is awesome. Keep going.

Dr. Gwen Buck: So, um, you know, you can, um, do it that way if you’ve got that kind of opportunity, which is amazing. Um, what I did was, as I got fed up enough and I saw my team overhead raising so much and my being so incredibly high, um, we, we formulated a strategy and coach Chris was really instrumental in that and guiding my team through it. Um, they say the ideal timeframe is about 18 months and I was not willing to do that. So I had a little over six months to go on and out. I was not willing to do that. Nope.

Christine Uhen: I could not talk her into that. She was at that point and she was ready but she also didn’t just pull the plug.

Dr. Gwen Buck: Right, exactly. I mean, really it was starting to affect my health, um, just the stress and, and, you know, trying to keep the whole world happy. Um, so, um, so yeah, and I used to, um, I used to love my job so much that the thought of retirement just really wasn’t even there. Um, and you know, after the pandemic, it was really sad to feel like, feel that heavy weight on my shoulders and, and you know, that, um, you know, it was just the final straw to say, I can’t, I just can’t if I’m going to provide the quality of care that I want for my patients and to be able to spend the time I want to with my patients, um, because relationships in our practice are really important. You know, if you imagine a small town dentistry, you know, we see your parents and we see you and we see your kids and we see your siblings and we see your cousins and I mean, we just, you know, it’s, we’re part of the community and we love it and we love just hearing about people’s lives and what they’re up to and what’s new and, um, yeah, we’re not the type of office that say, um, impersonal. “All right. What do you need done? Let’s do it. Okay, bye.” Um, so yeah

Regan Robertson: You know, Gwen, Chad and I were actually going over his, uh, it was a new patient list in particular over the past few months. Chad can tell you a story about almost, if not all, like every patient.

Dr. Gwen Buck: Wow.

Regan Robertson: It was incredible and that level of care and then also I honor your bravery for honoring, not for honoring, for respecting yourself and, and knowing where your limits are and telling yourself, you know, I I’m deserving a life that’s different, not just for me, but also for my team as well.

Dr. Gwen Buck: Right and they deserve to have that happy dentist back who’s got that, you know, energy and smile and, you know, “Hey, we can get through this, you know, tough day or this situation will make it work,” and, um, yeah, and I’m, I’m seeing that again, which is just lovely.

Regan Robertson: So, so you, uh, you set your goal timeline, you decided I’m, I’m this, this is so productive of you. This is very PDA in my opinion, because to say, okay, right, Chris, the book says 18 months, I know I’m going to do it in six, but, but walk us through together how you prepared the team. What steps did you take? So you shorten that runway and I know the spoiler alert is Chris has brought stats with us. So clearly this was a very successful move for you. What steps did you take for the doctors that are listening right now and they are starting to salivate and think I deserve this too?

Dr. Gwen Buck: We met in May with the goal of January, [00:17:00] the following January 1st being our out-of-network date. Okay and what the, the thing with Delta, I think this is nationwide. I don’t think it’s just in my state, but when you go out of network with Delta, they don’t send the check to you anymore for the insurance payment. So they send the check to the patient and if you want to continue to be able to pay your bills, you do have to ask for the patients to pay for their portion, their full portion at the time of their visit and not trust that however much you love your patients and however much they love you, that they’re going to run right to the post office with that check once they get it and drop everything and give it to you, um, because it’s just not going to happen. So, um, so that was the big thing in terms of like, that’s holding you back from like, “Oh gosh, I have to tell our patients we have, they have to pay at the time of visit.” Um, you know, which everybody calls it upfront. We try not to use the word upfront because, have to pay ahead of time, you just have to pay at the time of service. So, um, some of it was the wording that we would, um, talk with our, our team about, um, and, you know, we really wanted to just look professional, um, through it. And it was really neat to have my team support too, um, obviously my coaches support. Um, so, yeah

Dr. Chad Johnson: I want to kind of expound on one thing that you mentioned, but other people might not fully have caught it after you do it, you realize that, but you said, “Okay, so the next time I was thinking, should I bring on an associate?” Because you had an extra amount of on an economics curve, you had an extra amount of supply your patients, uh, no demand and you were thinking, okay, what should I do about this extra demand, should I need it with more supply of personnel or should I limit the amount of people coming in by letting them, you know, decide for themselves and naturally. Either 0 percent  or a hundred percent or somewhere in between of your insurance-based patients are going to say, “Hey, wait a minute, I don’t like this. I’m out of here,” and then the other per, you know, percentage of people go, “Hey, wait a minute, I don’t like this cause it’s different, but I have brand, I have brand,” um, what’s the word for it? Um, loyalty,

Dr. Gwen Buck: Recognition

Dr. Chad Johnson: And brand loyalty to where it’s like, “No, I value my brand loyalty, uh, to Dr.Gwen’s office over my brand loyalty to Delta Dental. So I’m going to stay, even if this means that it costs me an extra hundred dollars a year or an extra 10 a year or whatever I’m sticking thick and thin through it.” So you got rid of your demand problem, um, by changing your supply curve. Uh, with, with the, you know, going out of network and letting patients decide, which then allows for you to, you know, even if you do lose a certain percentage, when that percentage is all everyone wishes, they could know what that percentage is, but you can’t, unless you do it because yours is going to be different than anyone else’s, Um, but then when you made that decision, so were you feeling kind of the pinch? You were like going to work on, “man, we’re booked out X weeks and. You know, for cleanings, we’re booked out this long for stuff and I started, you know, like, is that what you were realizing? You were like, man, we’re full. That’s exactly it.

Dr. Gwen Buck: Cool.

Dr. Chad Johnson: Good.

Dr. Gwen Buck: Definitely, you know, above capacity.

Dr. Chad Johnson: So the take home then is for the doctors that are going, wait a minute, I’m so full, but we should build an extra room. That’s a possibility, you know, to meet it with that or the other, or we should add another doctor. That’s another possibility. There’s all these possibilities, but on the table is to go, why don’t you self-limit and get your best payers, the most brand loyal people to stay with you by uh, declaring that you’re, um, you know, no longer in network, uh, and what, you know, all the, the, the proper verbiage for it, um, to do that. So you were feeling that pinch and you pulled the trigger and the six months was, you could have waited 18 months. You could have, but you just decided to, you know, to do the six months and accelerate that even at the cost of uh an ideal 18 months might help the landing runway but you still wanted to land the plane in six months rather than on a runway, uh glide path of 18 months, correct?

Dr. Gwen Buck: Yep. Yep, and that’s right. You got that correct. Um big picture of the business in that as well

Dr. Chad Johnson: I did it. I knew it. Yeah

Regan Robertson: Christine is dying. Christine has got to say something.

Christine Uhen: I have to get in here because first of all, yes, this would so a couple things Dr. Buck is not giving herself enough credit to the amount of work that she put into this. But the truth is, this is a decision nobody should take lightly. This is a, there’s a business impact related to It’s a risk-reward conversation. So I would say, Gwen, wouldn’t you say we talked about this for years before we did this, we were running the numbers, we were looking at patient base. It was a capacity issue. She had, and again, so thinking about those options on the table, she has a standalone practice that could not support adding another operatory she’s. She works out of three, if not four rooms, so even looking at, when we were looking at capacity and hygiene, could we add hygiene, it would have negatively impacted her personal productivity by giving, taking one room away. Another option was, yes, let’s bring, let’s expand vertically with ours, change that up, bring in another doctor, other hygienists, which probably would add more administrative support as well. So, but as we were doing that, I mean, we took months and months and months looking at all of these options and the, the real decision was to go with removing ourselves and it’s going out of network with Delta, please do not say drop. So we don’t drop anything. We are not saying we’re not going to see you, but you still see them, Chad, right? They, you’re just, it’s a different relationship. The second piece she downgraded was the amount of work she and her team put into this. Gwen’s biggest motivation of doing this was. I’m not going to compromise my care, nor am I going to not reward my team and it got to the point as we were looking at the P&Ls that she was going to have to do one or the other or both to stay profitable. And she said, “No,” just flat out, “We’re not doing that. I’m not doing that to my patients. I’m not doing that to my team.” So, yes, with a very deep inhalation of we’re going to do this the time that she put into this and it was actually seven months because we had two cycles of hygiene.

Regan Robertson: Okay.

Christine Uhen: We had the, and again, she started the conversation with more relationship based. These were [00:24:00] one on one conversations with every patient that had Delta that went in.

Regan Robertson: That’s so good

Christine Uhen: And we spent, we had team meetings every month. We had it before we did the, we started the conversation with the teams of this, and it was Gwen saying, “Guys, here’s the reality of things and, and that I can’t, I don’t want to compromise my care, nor do I want to reduce your compensation, I want to actually add into this.” Yeah,

Regan Robertson: Yeah I, you have more and I want to give you more. I just want to underline what you just said with such seriousness, one on one conversations. I sat in a dental practice that went out of network. Thank you also for the not dropped, but the out-of-network because the languaging is critically important. You are so spot on. I sat in a waiting room and listened to multiple phone calls and one person at the very end of the visit who, uh, It was, it was disgruntled patients saying, “I had no idea. Um, what do you mean you don’t take my insurance [00:25:00] anymore?” And you could tell people were irate on the phone and in person and I was floored and the first thing I thought was this practice needs PDA so bad, like, or at least some support, like, did they, did they think this through carefully? And, and I, so I just wanted to slow that down and underline that for a minute.

Christine Uhen: And that’s what the training was about with the team. that we talked through this. Um, we had five or six questions that we knew patients would ask. Why are you doing this? Can I still come see you? How is the compensation going to going to change? Will I still be able to use my insurance here? Is there anything that you aren’t going to be able to take care of for me now? And that was what the, it was monthly coaching with the team, with Dr. Buck, she led that charge, but it was definitely team driven down to the point that we literally physically had a little code that said, DD Delta dental conversation, DD one, the first conversation happened and then when we came back around to the next six months, it was DD two actually happened. We talked to them twice before the outbound letter then went and that letter went before Delta’s letter to the patients. So they were very prepared ahead of time, to me to actually have this change happen.

Regan Robertson: I’m going to pause our recording really quick. I will bring us back, back around. So Gwen, just to bring you up to speed, Christine kind of slowed it down for us, right when you dropped off and, and, um, was giving you credit and talking about how powerful your team was and how they had even coded it DD1 for dental, uh, insurance, like discussion one and discussion two.

Dr. Gwen Buck: Awesome.

Regan Robertson: Yeah. So, um, so. Chris, clap, clap, clap back in. Christine, you also brought some stats with us. Can you share with us the, the growth or the change, the transform that’s happened in the, my part two, Gwen is for you, how has the patient experience or sentiment changed? So we’ll do data first, emotion and health second.

Christine Uhen: Well, because we know data plus emotion is where momentum happens. Yeah. So I will say, I’ll use some generics, some general conversation that again, looking at the Delta impact on her practice, it was over 50 percent of her patients that were on Delta Dental. She was averaging over 30 percent write-offs. So, as we move, so for the whole office, it was about at 24 percent adjustments from gross production to net production. So, it was roughly 45, 000 a month that she was writing off before we did this. So, throughout the year of 2022, the conversations happened. So, come 2023, this is a very interesting statistic. Her write-offs went from 24 percent to 7 percent total for the office that and here’s the really very this was the celebration or gross production did not change, but because of the reduction in write-offs or net production went up, you know 25, 000 a month. So we did nothing different in service wise.

Dr. Chad Johnson: And how did that make you feel?

Dr. Gwen Buck: Oh, it was just, I, you know, I felt like I could breathe, you know, it’s like, you know, people, um, rely on dentists so much and, you know, they keep, you know, asking for help and asking for help and asking for help. And, you know, you want to say yes all the time, but, and there comes a limit when, you know, if you don’t take care of yourself, you can’t take care of anyone at all.

Christine Uhen: A couple of other things that changed on average, she was getting 19 new patients a month in 2022 in capacity now to address your question earlier, Chad, she now in 23 is seeing 30 new patients a month.

Dr. Gwen Buck: Ooh.

Christine Uhen: So that happened in 2023. Now her total patient base did drop. So let’s not deny that there was roughly, you know, a 20 percent loss of patients. Go back to that gross production, the top line, she still did as much as she did the year before and took home more.

Dr. Chad Johnson: Well, because In that case, Chris, the way I see it, and I might be wrong, but the way I see it is if your insurance write-off was. Um, more than 20 percent then it’s all a wash and most people’s it is more than 20%.

Christine Uhen: You’re right. So again, always a wash is where the risk-reward question comes in but I think your, your reward is more likely the risk is reduced when you put the work in a front. So the process paid off is the message here that I really want to say and I will also just say in 2024, she is picking it. Second half of 23, we started doing a little bit more marketing adding some more bigger cases. I’ll let Dr. Buck talk about the service mix that she’s adding in. She has the same amount of write-offs the first six months of this year her patient base is now growing over, we’re now netting more at the 30s still 30 new patients a month for productivity per hour is up almost 200 an hour

Regan Robertson: Wow

Christine Uhen: So this wasn’t a fluke. I guess like that’s also the message I want to say, is it sustainable This business decision is impacting hers on the second year afterwards, even better than the first year after we did this. So, and how many weeks did you take off so far this year, Dr. Buck, in the first six months of the year?

Dr. Gwen Buck: Oh my gosh

Christine Uhen: Solo practitioner.

Dr. Gwen Buck: One, two, three, um, it’s going to be a six full weeks. Plus, you know, part of Thanksgiving, part of 4th of July, part of Christmas. So, you know, you can call it seven and a half if you want to. Um, it’s lovely. It’s about the limit of maybe a dentist should be away from their practice, if they’re the only one there.

Dr. Chad Johnson: But you know, some of the things that I think of,

Christine Uhen: That production per hour is what’s making that she’s more productive this year. She will, she’ll do 2 million herself this year.

Dr. Chad Johnson: And if we ever calculated out, not just production per hour, collections per hour. So

Christine Uhen: She’s at a hundred percent collections.

Dr. Chad Johnson: Well, right, right but see, sometimes like I used to think, man, I’m, I’m producing this per hour and I’d have to, but then after you factored in a write-off, the actual, like collections per hour was more abysmal because of what Delta or any insurance company was doing to that.

Christine Uhen: So, and again, we can look at that gross per hour and net per hour. We can look at that. That’s important because then that’s the money that actually is collectible, right? That’s what pays the bills is what’s collectible. So there’s that other You know, learning piece of gross production is effort. That’s how much effort and work you’re putting in, right. Well, that production is what’s collectible after you’ve written enough, whatever it is.

Dr. Chad Johnson: Another intangible is when your facilities and your supplies are not being, um, eaten up by the locust. That, you know, because of volume. So, you know, like if you’re not doing a hundred patient bibs per day, you’re only doing 50 or, you know, your drill actually isn’t, the handpiece is not getting, you know, so much torque and, and where applied to it. Those kinds of things add up to, you know, when your ciric machine isn’t, you know, doing 10 crowns a day, but it’s, uh, you know, want, want, it’s only doing four, but those four are making just as much money as the 10, you know, you’re not having to service your equipment as much and, you know, your hands and, you know, like on, on the dentist’s body, aren’t getting as much torture and stuff too, like that all adds up when, how did that make you feel?

Dr. Gwen Buck: I’m definitely healthier. I mean, you know, my, my muscles were, were worse and of course we’re all another day older. So that’s, you know, you just feel it more and more every day and, um, that’s something that if I want to keep practicing, I’ve really got to take care of myself. So yeah, um, that’s true too. Um, that’s, that’s definitely a factor. I, um, it’s, it’s, it’s good all around. Just one of those decisions that you wish you had done sooner.

Regan Robertson: Victoria and I were talking about scheduling to productivity the other day, and she was talking about really the, the two different levels, the, the growth mindset where you’re increasing the 300 an hour and where you’re at in your career and then she talked about once you get above your profitability incentive point, uh, really the variable becoming time and both of you, thank you. You just gave a really crystal clear definition of what that means time with your family, time to take off, but also, um, very important spatial time for your own body as well. So being able to do higher quality, less quantity, perhaps, and what that means, not even did you engineered it all the way down, Chad, to servicing the machine itself and the parts. I didn’t even go that far in my brain.

Dr. Chad Johnson: So that there’s a lot of intangibles because I’ve not calculated it before, but there are intangibles that will add up over time.

Regan Robertson: Christine, you spoke

Christine Uhen: Both tangible and intangible

Regan Robertson: About marketing a little bit. You said, I think it was end of 2023 or so, maybe Q4, you were, you did some changes in marketing, how did your marketing message shift and your, your strategy and your tactics to support this change?

Dr. Gwen Buck: So we came up with a another goal with Coach Chris and for our business and as we were supporting that growth goal, we thought of what services can we let our patients know that we can provide and even though I  had placed implants in my residency, there wasn’t really enough demand in my area that I felt that I could add that into 2020. So since we were doing more implants and our patients were asking for them more, I wanted to, um, just really let patients know how amazing overdentures can be because of course, especially a lower denture is just a tough quality of life and when you can snap that into bone and actually get something that can chew some corn on the cob, your life can really change daily. Um, so that was one of the big things that we wanted to let our patients know, um, and really tried to focus on, you know, several different areas of marketing, including of course, social media and me doing some, you know, just some videos on it.

Regan Robertson: Oh, video. Very nice. That sounds nice and authentic. Christine, you, you look like you have something to add.

Christine Uhen: Well, I think too, just if the message of going out of network, we never really marketed that they took a lot of insurances and that wasn’t really a leading marketing message, but they also did invest in a membership plan. That is also another marketing opportunity where they have a clear that’s actually, you know, another way to help patients afford their, their dental work. So I think that’s been an impact to where we’re helping people find a way to afford the dentistry they want to have done and again, when you’re out of that, well, my insurance doesn’t cover it mindset, it’s a whole different conversation. So I think that opened things up with the team as well when it came to presenting care, we have other options for them. So I think that made a big difference too and that’s another, a lot of people might not think of that as a marketing opportunity and it really is.

Regan Robertson: I don’t know if I’m allowed to ask this. Uh, we’ll see, we’ll edit it out if I’m not, well, I’m just, I’m genuinely very curious, did this change the way you treatment planned and did it change the way you approached, um, you know, yeah, your patient’s health, their health plan in general, their total plan?

Dr. Gwen Buck: Well, I guess I wouldn’t say it’s a direct change, but an overall big picture change that goes with it absolutely is, um, being more honest with a patient than if you were really looking at their insurance benefits, because people tell us all the time, you know, “I want to do what my insurance covers or I want to do this or this is so expensive,” and, you know, dentists try our best to make things work for patients but what they really deserve, what our patients really deserve is for us to tell them what they need, and then for them to figure out, “Okay, how do I make this work? How can my dental insurance help? Um, how do we do this over time so that it works for me?” Um, and really, you know, when you listen to what your patient wants and then focus on that. Then we can create a great health, great plan for their health, their smile, their function, whatever it happens to be.

Regan Robertson: I think that’s another very powerful element to underline in your success. It gets back to relationship again. Uh, I asked that question because I’ve had two different instances where different doctors entirely have mentioned to me almost in their own inner dialogue when I’m in the room,  “I could test her for this insurance. Isn’t going to cover this. I could do this procedure, insurance isn’t going to cover it,” and I had two different realizations in those moments where I thought to myself, Gwen, am I being limited in my Like I want what’s best for my health. I don’t, I don’t want you having to truncate or change your treatment plan based off of what insurance would cover and, and picture me as, as a very ignorant patient, even though I’m at PDA, but, but picture me as medically ignorant when it comes to insurance. So I had this kind of sort of like dawning moment or aha moment where I thought, how is this affecting, uh, you know, how, how clinicians are presenting treatment to me? And I thought that was really fascinating. So thank you for answering that. I was, I was genuinely curious.

Dr. Gwen Buck: Well, now that you bring that up, I think, I think you’re right that I did, I did change, change my recommendations and have more freedom to, because you kind of don’t feel that those constraints, um, I If a patient’s insurance company doesn’t cover what the procedure was, um, you know, they can’t come back and yell at us as much as if, you know, we had to tell them, “Hey, your insurance doesn’t pay as much.” It’s like, “No, the check went to them, you know, then, you know, it’s just what their insurance contract was willing to cover.” Um, you know, it’s not as though we have no disregard for that whatsoever, but I am, I do not have those chains as much. You’re absolutely right.

Dr. Chad Johnson: Dr. Gwinn, tell me if this resonates. In my practice, after going out of network, becoming 100 percent fee for service and dropping the last contract, um, there would be times when, for example, I was crowning number 19, and if I saw distal, I’m sorry, mesial carries on 18, I would tell the patient, “Hey, here’s the deal, I saw some hidden carries right there,” and this actually is another intangible in that it makes me feel good to do this. Um, I’ll, I’ll just say, “So here’s the deal, I went ahead and I just, I did that, uh, cavity right here cause I can do it direct. It’s almost like cheating that I don’t have to drill from the top of the tooth down. So I took care of that real quick. Now you might be thinking, Dr. Chad, you’re just trying to find extra work to charge me more. Here’s the deal. I didn’t even charge you for it. I just wanted to do that because now is the best time to take care of that and I don’t want to go back later and have to, you know, have you miss work again, rename you drill from the top and make it bigger. So, but I wanted you to know, you know, that I want to take care of that.” Sometimes I’ll tell them before the fact, after the fact, it kind of depends on how comfortable I am with the person, but. Um, but I’ll just be like, “I don’t want you to think that this is me, you know, trying to find extra work, it’s really not. You could, one way of looking at it is I’m actually trying to be lazy and just do it right now, the first time the right way, rather than later, you know, like, so it’s an efficiency factor, um, two sides of the same coin, right, lazy and efficient,” and have you ever found that you’ll, you’ll do something like, cause here’s the deal, like, for example, I like this sounds, but let’s get down to brass tacks. I’m charging twice what. You know, the in network is allowing. So I put a stupid little filling in right next to it that, and it took me an extra four minutes and it cost me, you know, 20 worth of material and I gave it to him for free. It’s just like free quote, unquote, do you get what I’m saying Dr. Gwen, have you ever found yourself kind of, you know, offering something because you actually have margin now?

Dr. Gwen Buck: Oh, yeah, there’s way more freedom in that, you know, not like we’re, you know, trying to give everything away, of course, but you’re right in that right situation when you can really just, um,

Dr. Chad Johnson: Yeah, just do the right thing.

Dr. Gwen Buck: Yeah, exactly. Exactly. Yeah. Yeah. And it all comes, I mean, it’s, I just keep thinking about, you know, chains on my wrists, you know, versus not having the chains on my wrists. It’s really, it’s really that freedom.

Regan Robertson: What, were there any challenges or surprises along this, this journey? It sounds to me like the preparedness was so strong that you may have handled any objectives, objections before they became objections, or was there any sort of little hiccups that you experienced that surprised you?

Dr. Gwen Buck: Oh, you know, I think we did expect people to go, um, to, to leave our practice. Um, and I think especially with, um, families with children, that tends to be something that, um, parents of course are, it’s, it’s very, very expensive to raise children. So, um, you know, that was one of the segments of the, um, demographic that we lost more of, um, was, was kids. Um, so, but yeah, we expected them to go. We expected some of them to come back too, and they definitely have and that’s, you know,  we, we always said, “You’re going to be welcome back with a smile if you do, um, you know, if you go somewhere else and you, and you do want to come back here,” we always let all our patients know that, and so our our desk team was just great at that. I think for me, it wasn’t necessarily a patient thing. That was a surprise. Um, but I, I made a couple, um, decisions that weren’t great business wise that, um, were not my coach’s idea. Um, she didn’t, she, she’s got great business ideas. I don’t necessarily always, but when I announced the going on a network with Delta, I offered a cost of living raise with, for my team, um, and, and that really, that really shot me in the foot. I really wanted to just do that for them because it was an emotional thing. I was, I was like, “Well, it’s hard on you. I want to do this. Life’s expensive for everybody.” I learned after that you really, really should never, ever, ever, ever, ever do that in a business um, if I was ever going to do that, what you need to do is tell every employee individually, secretly that they’re getting a little raise because when it’s the cost of living raise, they didn’t appreciate it. I don’t think as much. Um, and then they still wanted to raise, “Well, when’s the last time I got a raise? Well, it was a few months ago and I want to raise now a few months from now.” It’s like, “No, everybody got that raise.” Like this is more expensive every single hour now. So I will never do that again and I do recommend that no dentist ever gives a cost to living rights. If you’re going to ever give something that really is that, like I said, give it secretly and let them appreciate it as an individual, not as a group. Um, secondly, I raised their health stipend and I told him I was going to raise their health stipend, um, the day we went on a network with Delta that we were going to do that and it really should have been not in advance. It should have been like, “Okay, now, once we start to see in our collections that we’re growing, I’m going to look at what I can do for you.” Um, so I think I, you know, and that’s just part of my nature is I love my team and I want to take the best care of them as I can, um, but I did get myself in a situation where the team overhead was really unreasonable and that’s one of the reasons why we had our most recent growth goal, um, with my coach. Um, and so we’re addressing that and my team’s, um, still doing great and of course they’re already highly compensated. So that’s good too.

Regan Robertson: That’s phenomenal and, and, and what’s nice about it too, is you have support. I know Victoria Peterson says, and I say it often on this podcast, “Success requires support and, and nobody’s perfect,” and I love that your mistakes were definitely heart-driven also, you know, it was a

Christine Uhen: Hundred percent, yeah.

Regan Robertson: Yeah. So Christine, you’re there, you know, supporting alongside Dr. Gwen. So you mentioned a growth goal in, in relation. So, um, this is also what I find very normal about highly successful entrepreneurs, dentists, is it’s never just this reached the pinnacle of success and then it’s smooth sailing from there, I always find that the challenges, they just, they keep coming and that’s why support is so awesome to have around you. So Chris, if I heard correctly, you helped Dr. Gwen reset and say, “Okay, now we’ve got this overhead to tackle and we’re going to create new goals around that.”

Christine Uhen: Yes and again, it’s it, right. It’s been right siding itself, certainly, um, as things were collecting more after, um, going out of network but really what we did is we followed our PDA objective of creating a mission statement with a timeline and a financial goal to it and in addition to that, though, the team went through the entire BMS extra Business Made Simple exercise of not just Gwen creating the mission statement and identifying the key characteristics of who the team is going to be, and then the team got involved.nd so what are my actions to demonstrate those key characteristics? And, uh, myself and Jody B, Jody Boni, we’re working with the team on getting their commitment to the critical actions that will then show the patient how, you know, knowledgeable and experienced and compassionate they are in order to reach the financial goal. This team embraced that, and again, with Gwen’s leadership, they’ve had team meetings about it. They helped develop the actions, they’re holding each other accountable to the actions. She is currently on a 15 percent growth goal for 20. It’s a 12-month period that ends in October, and she’s on track for it

Regan Robertson: Wow. Congratulations.

Dr. Gwen Buck: Thank you.

Christine Uhen: And the team, the team overhead is definitely right-sizing itself. So when I’m going to share what you said to me the other day. I’ve never had such a great team. She has never felt as connected with them. They’re working together as a group and it’s showing in the patient care that they’re providing, which happens to have a dollar value attached to it.

Dr. Gwen Buck: You got it

Christine Uhen: So they’re taking great care of patients. They’re taking great care of each other and they’re being productive and profitable while they’re doing it.

Regan Robertson: Thank you so much. This is going to bring incredible value to all of our listeners. Dr. Gwen, would you ever go back? Would you go back to PPOs again?

Dr. Gwen Buck: No way. If I had a time machine, I would go back to the very beginning of my career and tell myself, do it sooner. Well,

Regan Robertson: Thank you both. Thank you, Christine. Thank you, Dr. Gwen. It has been incredible.

Dr. Gwen Buck: Thanks, Regan.

Christine Uhen: Great to be here.

Regan Robertson: And if you’re a curious listener about, uh, how Dr. Gwen has discovered her journey and discovered PDA, you can always join us at our 20th Anniversary conference this September 12th to the 14th in Frisco, Texas, which Chad likes to point out is in the Dallas Fort Worth Metroplex. There’s lots of fun, extra things to do as well. It is going to have the PDA hall of fame celebration, special guest speakers, like Emmett Smith, the pro football hall of famer and successful entrepreneurial individual. I think he was on dancing with the stars. Also. Thank you.

Dr. Chad Johnson: You’re right. I forgot about that. Yeah.

Regan Robertson: Yes. So it’s going to be amazing. Go to productivedentist.com and register. We’re almost sold out, but we’ve got some seats left. Thank you everybody.