E64: Podcast: Motivation

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After 35 years, I’d like to share with how I keep my employees motivated.

It’s a combination of things that will work based on your team members’ personalities. I think it’s critical as “the leader” of your team that you lead by example. If you come in with an angry demeanor, if you come in upset and aggravated, you’re not leading by example, you’re leading by failure. Somehow, you have to get up every single day, put your best foot forward, and provide the best example you can to your team.

I also think it’s critical that you offer your team members the opportunity for advancement – make the training and the time available to discuss with them their personal wants and needs. You have to physically make time in your schedule to meet one-on-one with your team members. I suggest you do not delegate to the management team. I suggest you take the time to meet with your individuals one-on-one.

E63: Podcast: When is Enough…Enough?

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The entire Dental profession realizes approximately 5,000 dentists will be graduating in the next few weeks and entering into the market force. Most of these young men and women will have very little clinical experience, but some wonderful educational background. The vast majority of these individuals will be bypassing specialty programs, bypassing residency programs, and going directly into the dental market or job and career areas. The question is: When is enough is enough?

Today the incredible debt of private education and the downward forces from insurance companies and DSO’s and MSO’s make it extremely difficult for these individuals to make it in the real market place. I would strongly recommend negotiating your best contract but be realistic in what you ask for.

My personal opinion is in those first 12 to 24 months focus on education training, development of process and procedures, and make sure you have a mentor in the practice that can work you through the difficulties that all of us, as dentists, deal with when we first start our career.

E62: Podcast: Becoming More Efficient and More Effective Without Burning Out

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Kevin:This is Dr. Kevin Coughlin. You’re listening to Ascent Dental Solutions with a focus on knowledge, education, training and development. I want to give special thanks to VOCO dental supply company for their expertise in training and providing the supplies to allow dentists to provide the highest level of care and service in the dental profession. I also want to give special thanks to Mr. David Wolf for his expertise in developing these podcasts.

Tonight’s topic is how do we become more efficient and more effective without burning out? I am getting prepared for a meeting of approximately fifty team members in my organization this week, and what we’ve done is we’ve taken a cold, hard look at really what the bottom line is. It’s something we all talk about, but very seldom ever do. There’s a big debate and, like most debates, there’s some truth in all parties, but do you accept all dental insurance plans? Do you only accept certain dental plans? How do you decide? And basically, I think every healthcare professional would love to see one thing: control of their fees.

Right now, most dental plans, and certainly medical plans, there is absolutely no control of our fees. It’s almost laughable that you would be in a business, and a business owner at that, and have zero control of the fees. The insurance companies are dictating what fees we have. We’ll take a cold, hard look. And in the real world, most general dentists or specialist dentists accept most dental plans out of necessity. It’s nice for the few that can say they have concierge practices and they only accept fee for service. But I think for the bulk of healthcare professionals, we accept what comes in the door. To me, the real question is how to manage it. And I strongly suggest that you consider some simple approaches that may make your life easier.

In the state of Massachusetts, it amazes me that under government-subsidized programs, such as Common Care Alliance or MassHealth, sometimes the reimbursement for restorations, composites particularly, can be somewhere between $60 and $90. I think most dentists know that when you’re doing a composite and you want to do it at a high level with high level of materials and expertise, it is almost impossible to do these restorations for that type of fee schedule and stay in business. I personally pay our dental hygienist $40 an hour plus approximately $8 to $9 in benefits and all my dental assistants or team members are paid $30 an hour with, again, approximately $8 to $9 in benefits. So if you just add up the two assistants assisting me plus myself doing a restoration for thirty minutes that’s going to give us a reimbursement of between $60 and $90, you can immediately see that you either have to see a hundred patients an hour or you’re going to go out of business.

The simple fact is, the following things, it at least helped me in the state of Massachusetts and perhaps may help you manage your practice and take the stress and reduce some of the financial pain. As you know, many states allow dental hygienists to (unclear 04:01) locally anesthetic. I can tell you for the last six months, in almost all cases, my floating dental hygienists, which takes walk-ins, call-ins, people who are behind in their hygiene recall or recare program, are doing my local anesthetic. I can also tell you that with the Triodent Matrix System, the matrix systems are set up, everything is prepped and ready, the DryShield, which I’m using as a rubber dam, is ready and set, that I have been able to reduce my composite times down in, I believe, a high degree of success, very little to no sensitivity, and very little occlusal adjustments, down to about eight minutes.

What that means is the patient is still booked for twenty or thirty minutes, but the actual clinical chair time that I’m in there, providing that service, is about seven to eight minutes. Although I’d still like to see a compensatory return on my training and expertise, somewhere between $300 and $400 for a posterior or anterior composite, many times, insurance companies have dictated the fees closer to that $60 to $100 rate, and perhaps the techniques of delegating and providing a system for your composites along with other areas of dentistry will help your bottom line.

If you find these topics and other topics interesting, please contact me at Ascent Dental Solutions. My name is Dr. Kevin Coughlin. I’m still practicing full-time. I’ve been practicing for thirty-six years. I grew and built fifteen general dental practices, sold to a managed service organization, and now currently have fifty team members in three offices here in Massachusetts. I want to give special thanks to VOCO for their expertise in providing the supplies and trainings to provide high level of care and service in our practice, Ascent Dental Care, and I want to give special thanks to Mr. David Wolf for his expertise in producing these podcasts. My name is Dr. Kevin Coughlin. I look forward to chatting with you in the near future. Thanks for listening and have a great evening.

E61: Podcast: Breaking up is hard to do with MSOs

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Kevin: Welcome. This is Dr. Kevin Coughlin. You’re listening to Ascent Dental Solutions with a focus on knowledge, training, education, and development. I want to give special thanks to Mr. David Wolf for his production of these podcasts. The following episode is a combination of a variety of things as I’d like to think I’m an expert or have significant knowledge with managed service organizations, dental service organizations, because we’ve developed over fifteen practices over my thirty-six-year career. I’ve dealt with the DSOs, created my own DSOs and sold these DSOs to MSOs. For the new listeners, basically the difference is, one is venture capital and equity-backed group and the other is generally a dental-backed group. Both, along with private practices, have the same goals; that’s to expand their business, make them more efficient and effective for a better bottom line.

 

I’m not here to push you one way or the other, but lately for the last several weeks, I’ve been listening to the news and listening to the cost of what’s been going on with attorneys and lawyers and the representation of their clients. I also was privileged to listen to Elizabeth Holmes and what’s been going on with Theranos in the amount of money, in excess of over $300 million in legal expenses for them to defend their business, which is now less than zero as far as their net worth is concerned. And the reason I bring this up is I’ve had some difficulties with managed service organizations. Perhaps some of those difficulties were brought on by myself, perhaps it was brought on by them, or a combination of both. But that’s beside the point. The cost to litigate these differences were in the hundreds of thousands of dollars. The hours and time wasted has been enormous. In my thirty-six-year career, I have had partnership problems, employment-ship problems, a combination of problems along with managed service organizations.

 

And for our listeners, I can tell you this straight up: if you’re going to pick a fight, make sure you pick a fight with a group that you know you can at least control the finances. I can tell you with the MSOs, there’s almost an unlimited, bottomless pit of money, experts, and accountants, and attorneys and they can bury you in time and effort. I would tell the listeners, before you join an MSO, before you consider signing papers with MSOs, it is critical that you have a team that supports you that are experts in the managed service organizations. If you don’t have that, trust me, if a problem occurs, the ability to litigate, the ability to continue the fight, and the ability to come out winning or ahead or even breaking even is actually almost impossible. I can recall walking into several meetings where there were no less than four certified public accountants, six lawyers, and other expert testimonies. I can just tell you that as an average dentist, most of us will not have the financial means to put up the fight. So even though you may be clinically correct, even though your business may be clinically correct, in the end, if you don’t have the time, finances, and expertise, you’re probably going to lose the battle. Or if you’re fortunate enough to win, when you look at the actual cost of that litigation and your time and effort, I would think that in the end you’d say to yourself, you still got the hell beat out of you.

So the message today in this particular podcast is we hope that all discussions, all issues, and all contracts lead to an amiable reconciliation where both parties give a little bit, both parties take a little bit, but in the end there’s a compromise and a solution to the problem. But if anybody’s been through a divorce, if anybody’s been through partnership disputes, I think we all know that in the real world it can get personal, it can get mean, it can get ugly, it can be drawn out.

What the MSOs are particularly concerned about is protecting their reputation because if they allow one dentist, one partner, one individual to break away, that leaves the door open to potentially hundreds, if not thousands of other partners or investors. Their main concern is most of them know that their situation is they want to control, as tightly as possible, the management and the day-to-day workflow along with the production and collection. But as most dentists know, in most states, at least thirty-eight states, an MSO cannot own a dental practice. It is up to the dentist. So in many cases what they’re looking for is a managing dentist, and I don’t mean this in a derogatory manner, but basically someone that they can push and manipulate to do what they want. So the orders are coming from a non-dentist to a dentist and that dentist understands, without it so clear in the contract, that there are certain things that have to be done, certain ways that things have to be done. And if they’re not, trust me, you probably will not find yourself the managing partner.

As far as this podcast is concerned, I would like to say if you have questions, if you need information, I have been doing my consulting business now for five years and I find it extremely rewarding. I am still a full-time practicing dentist. I have now three practices since I sold the fifteen practices to a managed service organization, and I’d like to think that I’m non-biased and I could try to help you if you’re considering joining, competing against, or working with an MSO. The name of my consulting is Ascent Dental Solutions with a focus on knowledge, education, and management. I’d like to give special thanks to VOCO, supply company who provides the expertise, training, and education along with the materials to provide a high level of dentistry on a day-to-day basis. I also want to say special thanks again to Mr. David Wolf and his expertise in producing these podcasts. This is Dr. Kevin Coughlin. Have a great night and I look forward to speaking to you soon.

E60: Podcast: Marketing insights with Erin Rosario

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Hello and welcome to Ascent Dental Radio, a program dedicated to the balance between the clinical aspect of healthcare and the business of healthcare. And now, here’s your host, Dr. Kevin Coughlin.

Kevin: Welcome. This is Dr. Kevin Coughlin. You’re listening to Ascent Dental Solutions with a focus on education, development, training, and knowledge. I want to give special thanks to Mr. Doug Foresta and Mr. Dave Wolf who provide the producing of these podcasts. I also want to thank our sponsor, VOCO Dental Supply Company. It’s an international and worldwide company providing excellent support, training, and education for some of the world’s best dental supplies anywhere available for our restorative needs. With that said, we have a special guest today. Her name is Mrs. Erin Rosario. Erin, thank you so much for joining us help the dental community along with other businesses and how can we improve our marketing material and address our customers and patient base in the most efficient and effective manner.

Erin: Thank you so much for having me here.

Kevin:] You’re quite welcome. Tell us a little bit about yourself and your business and how you’re helping dentists all over the country and other businesses with your business.

Erin: My business is called Rose & Gold. We’re a digital marketing agency and we provide a full range of marketing services for clients, specifically logo and website development. We do a lot of brand identity and brand strategy. The biggest thing right now in today’s advertising world is social media, which is very important for people to be advertising there today ,so that’s a big key of what we do as well.

Kevin: Erin, with these SEOs, et cetera, et cetera, Yelp, Google, how do I get my company, and other dentists with their companies, get the best reviews besides just being great to your customer base or patient base? Once you’ve had an excellent customer experience or patient experience, how does that relate to improving our Google Reviews? What’s the most efficient and effective way to get the highest rankings?

Erin: In my opinion, to get the feedback from your customers would be to do some sort of email campaigns after their visits. There’s a lot of different systems that can be used. We particularly use constant contact with our clients in terms of setting up an account that stores emails and sending a wide variety of different email campaigns to them after their appointment. You’re fresh in their mind, that way when they open it, they’ll be amped to give the feedback of their appointment to you and those will get pushed to Google and Yelp depending on how it’s set up so that now, that review is out on the World Wide Web for others to see as well.
Kevin: What happens, Erin, with a negative review? The owner of the business, do they have any control? Whether it’s through constant contact or another social media, that review was less than ideal. Is there a way that the owners can prevent that from going out or controlling that message?

Erin: It depends on which network. Some, there are and some, there just aren’t. What we typically tell people, if it’s on Google, if you have a poor review, you need to find ten good customers to give you good reviews and it’ll boost you back up. Of course, no business is perfect. Typically, we like to recommend that you follow up with that negative review in a positive way so it shows that you are interacting and want to make that relationship better. If it’s unable to be brought down, that will publicly show that you’re willing to work with this customer and make them have a better experience the next time.

Kevin: For the listeners who aren’t aware of it, I’ve owned group practices since 1983. I had a patient base of close to forty thousand active patients with multiple locations here in Massachusetts. I cannot emphasize the importance with managed service organizations, higher competition, doctors that are more market savvy than some of our older dentists, in my opinion, the ability to team up with a firm such as Erin’s opens up a tremendous amount of possibilities. Can you explain for a small business, medium business, or large business, what you would expect to be a reasonable cost per month for services for companies such as yours, Erin?

Erin: Sure. We work with small businesses and very large businesses. What we typically do is in our first appointment, we’ll sit down and figure out the goals of that particular client and, whether using their marketing budget or using what they’re looking to have done, come up with a really customized package. Because every business is so different from each other, there’s always different needs so we really try to customize everybody. But I would say, typically, a range would be anywhere from $500 a month for a social media package. It could go up to $5,000 a month depending on what type of campaigns they want, whether it’s emails and blogging, media coordinating. There’s many other services we provide so you could really get in at a reasonable cost for the smaller business, or if it is a large business, it’s all relative in terms of the services that would be provided for the larger expense. But at the end of the day, hiring an agency like us tends to be less than hiring a marketing full-time staff with benefits and where we’re trained in everything that we do, we find that our clients have been very happy with our services on that we’ve provided them with.

Kevin: Erin, is there truth, at least in the dental field, that most dentists should earmark between 2% and 4% of their gross revenues to marketing? For example, a majority of dentists’ solo practices are usually right around that eight hundred thousand to $1 million a year in revenue. 4% would be roughly $40,000 earmarked for that. We’re roughly about $3100, $3,200 a month. Is there a rhyme or reason to that? Does that seem, in your experience, to be relatively accurate?

Erin: I think three is kind of the lowest in terms of gross revenue, 3%. But I really think it depends on what exactly they’re looking for in that type of revenue. I would say probably a little bit more expense would need to go into it just based on having a larger business and wanting to reach more people to grow. A smaller business can grow smaller but a larger business would particularly want to grow faster. It’s typically the way it works.

Kevin: My expertise is really in dentistry. I do think I have other business knowledge but as a general term, I always felt that to get a new patient into the practice, the cost of that practice ranges right around $200 to $250. For our listeners, each time you see a new patient, if you were to just assess the cost to get that new client or patient in the practice, that range is around $250 so I can’t emphasize to some of our newer dentists just starting their business how critical it is to not just focus in on getting new customers or new patients, but to maintain everything possible, the existing clientele. Because once you’ve obtained them, it is much more cost effective to maintain them and use their goodwill to generate your new patient base. Would you agree with that assessment or want to add anything to that?

Erin: No, I think that that’s absolutely correct. I think just in terms of the marketing side of that, that’s where social media really comes into play right now because that’s the place right now where people are engaging and kind of getting to know more of the personal side of businesses. People are shopping there first prior to searching online. I think that keys into it because the relationship-building can continue after the appointment on social media as they’re seeing things going on in the office and everything like that. We see that that really builds relationships even more so than just your appointment every six months or that kind of thing.

Kevin: Erin, can you take some time and discuss your company’s philosophy? Do you find it easier to just charge your clients a fixed monthly fee or do you feel that you look for a return on investment? What is generally your company’s philosophy?

Erin: Our company is set up so that we have monthly clients and then we also have clients that are on retainer in terms of if they want us to work four hours a month for them just to do miscellaneous tasks. We have a variety of different ways we set it up and it really depends on what the client is looking for. We try to really customize it to fit their needs. For instance, a social media package is a monthly thing and that would be every month consistently until they want to change that package or if they want to add something to it. Typically things like that are monthly. We also do a lot of graphic design and website development. Those, of course, are one-off, project-type based services.
Kevin: And based on your experience in the dental market, what would be an average fee that a client could expect to, let’s say, develop a logo?

Erin: The way we set it up is it’s typically anywhere from $800 to $1,500 but that would include a variety of edits and initial content, logo generation, so that you have an option of different choices that you can do. With that also comes all of the files. We provide the files that you can have put on a t shirt or up to the size of the billboard so you would never have to come back to us for any additional sizing or anything down the road. That’s typically for logo development, where it comes from, and then we’ll always bundle that in with a website. If a website development is part of the package, we’ll group that in with the website and make it more of a customized package.

Kevin: Well, I can tell you in full disclosure, I am familiar with Erin’s business. Their reputation is exceptional. Their service has been over the top and I have not heard any bad reviews. I can tell you that whether you use Erin’s company or a company similar to hers, I think it’s imperative in today’s market that we as dentists take our heads out of the dental operatory periodically, look what’s around us, know that big companies and corporations are constantly taking over and pushing the smaller mom and pop shops around. You have to be smarter, nimble, and you have to be able to beat them on service and care. My motto has always been better care, better service for better results and companies like Erin, I believe, can truly achieve this. Erin, can you tell our listeners what’s the best way for them to reach out and get additional information? How can they reach you? Give us your website, telephone number, and contact information.

Erin: Oh, sure. Our website is roseandgold.com. And they could contact me directly. It’s erin, E-R-I-N@roseandgold.com. Our phone is 413 224 3363.

Kevin: Erin, thank you so much. I know your business is growing in leaps and bounds. I know how busy you are. I appreciate you educating our dental listeners and also other business owner listeners. You’ve been listening to Ascent Dental Solutions with a focus on education, development, training, and knowledge. Our guest has been Mrs. Erin Rosario and her company is Rose & Gold. Today’s topic was the marketing of your practice and the crucial needs for it. I want to give special thanks again to VOCO Dental Supply Company and their expertise and support to the dental profession. Thanks for listening. I look forward to speaking to you in the near future. Enjoy your evening and enjoy your profession.

E59: Podcast: What Is Your Time Worth?

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Hello and welcome to Ascent Dental Radio, a program dedicated to the balance between the clinical aspect of healthcare and the business of healthcare. And now here’s your host, Dr. Kevin Coughlin.

Good evening. This is Dr. Kevin Coughlin. You’re listening to Ascent Dental Solutions with a focus on knowledge, education, development, and training. I want to give special thanks to Mr. David Wolf and Mr. Doug Foresta for helping me produce these podcasts. Without their expertise, these podcasts would not be possible. I also would like to send out a shout to VOCO who’s been providing me with the best in most up-to-date supplies, education, and training for my general dental practice and I can’t thank them enough for their expertise and also their ability to sponsor me for these podcasts.

Today the topic is “What is our time worth?” Many years ago, I went to a business seminar and I was told the difference between a laborer and a professional is that a laborer uses their brawn, their muscles, their back. A professional uses their brain. I’ve been practicing clinical dentistry for thirty-six years. As a matter of fact, I just completed another twelve and a half hour day, nonstop, doing orthodontics, implant surgery, temporomandibular joint treatment, surgical extractions. As a matter of fact, I removed twenty-two impacted wisdom teeth just today. The point of this is not to try to impress you with my knowledge or work ethics, but to tell you that my last patient today spent fifty minutes and out of that fifty minutes of conversation, 99% of it was based on what the insurance was going to pay and what it wasn’t going to pay, what was going to be covered and what wasn’t going to be covered. And I can tell you after thirty-six years of practicing extremely hard, like most of my compadres, it’s exhausting, day in and day out, to spend more and more time discussing what some individual’s insurance will or will not cover.

I’d love to tell you that I’m at a position financially that I don’t need to take any insurance. I actually don’t even have to clinically work anymore. I’m sixty years old. I have fifteen different dental practices. I have Ascent Dental Solutions. I’ve sold and resold to two managed service organizations, but I do enjoy practicing. But the frustrations of dealing with the day-to-day aggravation that I’m sure all of my listeners can relate to and appreciate. And the question comes in is during the last twelve months I’ve had an extensive amount of time dealing with lawyers, business attorneys, investment attorneys, financial attorneys, and the one thing that amazed me is they all billed by quarter hours. Whatever the fee is, whether it’s two hundred, three hundred, six hundred, or a thousand dollars an hour, they’re billed for their time. In dentistry, as in medicine, most of us are not compensated for our time. What we’re compensated is if our high speed is spinning. We’re either removing teeth, filling teeth, root canaling teeth, straightening teeth, and that’s how we’re compensated. And in my personal opinion, our expertise and knowledge, which is the treatment plan formulation, the diagnosis, is almost completely non-compensated for.

Here in the western Massachusetts area, basically, we have a limited exam, a periodic exam, and a comprehensive exam with a patient base of which about 65 to 85% are insurance-based patients. There is a standard fee and whether we agree with it or disagree with it, once you accept that insurance plan, you’re obligated to accept that fee. So in an evening appointment, like tonight, where fifty-some odd minutes were spent in the consultation, the reimbursement was $69. If you’re paying your dental assistant, like I am, between 25 and $32 an hour and then another $4 to $8 in benefits, and your dental hygienist between $40 and $44 per hour plus benefits of four to $8 on top of that, you realize how ludicrous it is to be able to spend fifty minutes on a consultation and be reimbursed $69. I would hope that the individuals listening to this get as much aggravation as I am and say -when do we stop and honestly say to ourselves, “We should be compensated for our time, our expertise and our knowledge.”? And that means whatever that fee is, my personal opinion is, adjust that fee based on your overhead, the amount of time you believe you should be compensated for and that fee should be set. If the insurance company decides not to cover it, then that patient is responsible for the balance and the free market will determine whether Mr. and Mrs. Smith want to stay with you or go somewhere else. I think all of us as businessmen and businesswomen in the practice of dentistry understand that you can’t spend fifty minutes and do an excellent comprehensive treatment plan exam and a development of a relationship and be compensated for $69, $49, $39, or even a $125 because mathematically it doesn’t make sense.

The answer is not simple. I personally believe the best approach for all practitioners, along with the patients receiving care, is to allow the market to dictate the fees and you set your fees based on your overhead, your expertise, and the value you place on your time. The patient will make a determination whether they’d rather have a five or a ten minute consultation that only addresses a single tooth rather than a comprehensive plan and that individual may only end up being reimbursed or paying that dental office the $69 fee. I do think that most people are looking for a fair treatment, a high value, on that treatment. In my opinion right now, I believe our profession is being treated more as laborers than professionals. I believe in my heart and in my soul, this is a mistake for the patient base and it’s a mistake for our profession. As we see the managed service organizations and dental service organizations growing at a rate of 18-25%, the reason for this is they’re taking advantage of our lack of acumen when it comes to business. They’re taking advantage of our inability to realize what’s going on outside our four walls. I think that our profession should be shaken up a little bit. They should realize what’s going on and say to themselves, “Enough is enough. We need to band together.” Realize what the strength, weaknesses, opportunities, and threats are to our profession and start saying to ourself, by educating our patient base, that, “It’s your insurance, it’s not ours. As a courtesy, we’re providing the information, knowledge and expertise to handle your forms, but ultimately, you’re paying us for our expertise and our knowledge.”

I realize during this podcast that I’m a little hot under the collar. I realize I’m slightly aggravated and I think you could sense that in my feel. However, in my opinion, there’s no one to blame but myself. No one is twisting my arm to accept these plans, no one is twisting my arm to not just give up and retire. I’ve elected to do it and hopefully share my thoughts and my recommendations to the profession through the podcast.

I would like to say, if you’re interested in feedback and more information, please feel free to email me at kevincoughlin@ascentdentalcare.com. I’d love to hear from you. Perhaps maybe instead of me always giving advice, I can receive some advice from some of our listeners.

It’s important that we take care of our profession because our profession is taking care of us. But I believe when we leave it to large corporations and organizations and insurance companies that may not have our best interest at heart, I feel we’re going to come out on the short end of the stick. I’ve been practicing, as I said, for thirty-six years, and I believe that it is a rewarding and wonderful profession, but some days it just gets to me as I’m sure it gets to you. In my personal opinion is action steps needed to be taken by me, have to be taken by me, if you want a change.

I hope you listened to this little rant and appreciate that although I come across as an expert, I have the same stresses, problems, and aggravation that all practices have. If you’re interested in more information, contact me through Ascent Dental Solutions with a focus on knowledge, education, development, and training. I want to give special thanks again to Mr. Doug Foresta and Mr. David Wolf for their expertise and providing the knowledge to provide these podcasts to you. And I also want to say special thanks to VOCO, continuing their good work and providing us with outstanding processes, procedures, equipment, and supplies so that we can provide the highest level of care and treatment. Thanks again for listening. My name is Dr. Kevin Coughlin. I look forward to speaking to you soon.