128: Adding Specialties to Your Thriving General Dentistry

Welcome to DSO Secrets. I know what it's like to be an entrepreneur in the dental industry. I've had my ups and downs just like you. There's so much opportunity to be excited about, but so few resources to get answers. From here on DSO Secrets, we get you those answers so you can change the lives you're meant to bless and achieve your personal success.

When I was working as an associate right out of school, I never imagined I could own these many practices with this amount of support. So thank you.

You have helped build my marketing mind

to a whole new level. You have this natural talent, this unique ability. Happy day to you and welcome to another episode of DSO Secrets. I am Ken Kaufman, your host for today and so, so excited for this event. For this podcast, I made connection with our guest at the Fall DEO Summit. We did some great brainstorming on some ideas and realized there's a lot of great content here that everyone listening will be able to benefit from. So let me make the introduction. Santosh Patel, President and co founder of Complete Specialty Solutions, is committed to driving collaboration between General Dennis and specialists by bringing a turnkey solution to provide in house specialty services. Graduated with an MBA and Healthcare Admin Master's from the University of Georgia, he's located in Dallas, Texas. He has 15 years of large scale operations experience in and outside of the dental and medical industry. Santosh, can't thank you enough for joining the podcast today.

Hey Ken, thank you so much for having me. I'm super excited about being here.

Yeah, this is going to be a great one, I think so. I always like to start, Santosh by asking this question and it is what led you into this DSO industry and what in the world are you still doing here?

Yeah. Yeah, that's a great question. So what led me into. So you know, originally I was from the medical space where there is kind of similar pattern patterns of growth and consolidation and my wife's a dentist, so kind of learned more about the dental world because of that she had a solo practice and just learning more about the kind of solo practice and how do you start to really compete against the larger DSOs right in group practices and what they're doing. Just learning about fragmentation of services. And one thing that was kind of pretty prominent was more in house services within the medical space and want to figure out how do we operationalize that in dental? As I continue to learn about it, just learn that there's the need was always there. The patients were demanding it. But how do we make it sticky? How do you make it work and how does it become really a win win for all involved? So that's what kept me in. Right. Just constantly trying to evolve and innovate. And I got some great partners that we were working through, both on the operational, clinical and technology side.

That sounds awesome. Okay, great. We're hearing a lot of buzz right now. I'd say in the last five to 10 years, I have not heard as much buzz about adding specialties in as I'm hearing right now on paper, or having this initial sort of grand view. Of course, that makes sense. We already have these patients that we're treating and taking care of, and so why don't we just offer these extra things rather than refer these things out? Walk me through. Because I know a lot who have jumped in and tried and failed or kind of, you know, just stubbed their toe, really, really struggled with figuring out how to make this happen and make it work. What are some of the main challenges you find general dentists running into when they have this great idea and it could bring a great value to their existing patients and their customers? What are some of the primary challenges that they start to run into that become massive roadblocks to actually being able to execute on a strategy like this?

Yeah, you know, I think a couple things. One is, you know, understanding the business enough to know that adding specialty is essentially a business within a business. It's not generated exactly the same way as a general practice operates. Actually, in many ways, a general practice is very complex in the way it operates. Specialty is not as complex, but it does require a lot of attention and focus in specific areas. Right. And so when you're having the same team focus on both sides, that's sometimes where, you know, items get pushed to the back burner. Things can fall through the cracks. And so that's where we've seen, I mean, kudos to the ones who jumped in and tried it. Right. I mean, I think that's part of the. Probably the learning process and evolving through the industry. But I think, you know, many of them will say they've jumped in, they tried it, they realize it's a distraction to their core business. The steps are different. Either it didn't work because of the communication gap between the specialists and expectations were not met across the board. They gave up, it was okay. It's too much work to restart it. That's essentially what we're seeing in terms of what are the biggest pain points is how to get the process going. Really looking at it from an operational perspective, just like anything else within the business, then also finding the core culture fit of the specialist. Right. You know, I think there's always even on the marketing side, everyone talks about who's your avatar. Well, you know, you kind of got to understand, well, who is the right specialist mix for the practice and really kind of going out and recruiting that fit.

Awesome. So I'm hearing you talk about sort of two disciplines that get impacted. There's first, the clinical side of things and those in a dental practice who are supporting the clinician. When a specialist comes in, that specialist often needs things done in a different order. They need different handpieces, they need different equipment, different tools, and the staff may or may not know how to support. They need different supplies. They're perhaps working with different types of labs externally, depending on what's happening. All of these things are different. And we're asking this staff member who's used to doing everything in a general dentistry practice, which there's a lot of decodes that are being hit there, really narrow niche of a specialty where maybe there's, you know, five to 10 total decodes that would ever get billed. But the Clint, the clinical support or the true chair side support. It's really, really hard to transition team members from general dentistry over to specialty. Did I hear that correctly?

Yeah, that's definitely a big aspect of it. The other aspect of it is the workup to the actual surgery or production day. Right. It's a communication gaps between if you're having specialty once a month, how many days per month is a team working on specialty? Is it once a month or maybe two days a month right before the specialist comes in, or is it a continuous effort to build up that production day and a continuous effort to have communication? Really, it's having the right supplies and equipment and providing that level of support so you can offer the same specialty care in your practice that a specialist would within their own kind of brick and mortar location. Yeah, it's a great communication. Yeah.

Getting all that lined up so that clinically things can be executed well. And then the other thing I heard you talking about and starting to hint at was then you have all of the back office functions. Not dental office. I'm talking about administrative functions like billing for specialty services can be very different. Collections can be the entire revenue cycle. Management, credentialing, hiring. Like we could go all the way down the list, maybe share some of the places where you see the biggest challenges arising.

Yeah, absolutely. It's, you know, again, it's a business within a business. So how are you presenting these Fees to patients. So a lot of these fees are at a higher cost point per treatment than, you know, a filling or a crown. So understanding the case acceptance discussion, understanding how to promote the need of the treatment to patients and you know, why it's important for their overall health and how do you incorporate that into the actual exam and the visit. Right. It's, you know, understanding just the core focus around preparation for, you know, the provider to be there and the operatory space that's need the time allotment for their schedule for specific procedures, medical history review, those kind of things, you know, just so critical as you start preparing for those days.

Interesting. Yeah. We've even found in our business the required effort for pre op and post op relative to just a standard general dentistry day versus if you're bringing some type of surgical element into the practice, that is the intensity around that and the patients really need that focus and that level of commitment on the pre and the post side to really make sure that the experience is right and to help them if there are emergencies or anything that come up along the way. Just all these extra complexities that you don't think about until you get there and then they can be overwhelming.

Well, again, and we hear that again all the time from offices who've tried it before. You know, they say, well, we had a surgeon who came in and if there was any questions around the sedation, then our team members just didn't know the answer. So then there was a lot of back and forth and contacting the specialist and trying to get those answers and calling the patient where the patient ultimately just didn't feel confident that it was really a cohesive service and comprehensive service within the practice. And so it came down to the comfort and confidence level of the team members understanding the specialties specifically for the pre and the post. Right. So the post is something that I think sometimes it's neglected. That's some of the most important aspects of, of the overall treatment is how's the patient doing, how are they recovering and setting those realistic expectations for the patient and also having an outlet for them to call and speak with a clinical team member that understands what they're going through as well as the specialists themselves.

That's right, yeah. So I'm going to drop a phrase in here. I think that will hopefully help summarize this concept. And it is, when you are bringing specialty in, it is a different business model model and you have to think about it as a completely different business model and perhaps hire people just to run that business model. Separate from the ones who are running your general dentistry practice.

Fair.

Is that a fair way to describe it, do you think?

That's a fair way? I mean, if you think about some of the largest DSOs out there, right, that that's, they've committed to adding specialty directors and specialty assistants and just specialty treatment coordinators and managers. I mean, they've invested heavily and I'm sure there's kind of at some point a break even point where they have to hit 12, 13 offices before they really start to justify the expense and investment that they've put in. But there's an infrastructure that has to be built if you're kind of going to do a make versus buy scenario. And we've always felt that this is a service that patients, and it's just consumerism, patients are demanding, kind of the one stop shop. So how do you, how do you figure this out for multiple groups within, within a market? And again, patients are starting to become more and more keen to the ability to stay in one place.

Yeah, that's right. So as an entrepreneur yourself, obviously you completed Complete special or you, I'm sorry, you founded Complete Specialty Solutions, or we'll call it css. You founded it because you obviously saw some need in the marketplace. You were aware of these challenges that general dentists were hitting and you're trying to come into the space, solve it. So maybe could you walk us through how you've thought about how to solve some of these main challenges for General Dennis who have a desire to try to do more and bring more services to their patients?

Sure, sure. Yeah, exactly. As an entrepreneur, we've learned quickly. Right. Like you try different AB testing along the way. Initially, when we started the business, we had our network of specialists and we provided some supplies and equipment. And then we were dependent on the office to actually build the schedule. So they were sending referrals, they're trying to communicate. And then we realized very quickly that was quite difficult to keep a core focus for practice. When they're evolving, they're growing, they have expansion plans. So we started to take on more of the operational responsibilities because that was again a demand from our clients. And they said, well, could you help us with X, Y and Z? Could you help us contact the patients? Could you help us with scheduling, could you help us with billing? Could you help us coordinate all the different functions around, even marketing for this procedure? So we've taken on really the comprehensive role of it just by virtue of listening. And we're just, you know, we're sitting back and listening to our clients. And our clients are telling us this is what we need help. If we want this to be successful, this is where we need help. And we're able to operationalize a lot of those steps and even from that alone. Right. So we started the services model and then from DSOs that are in different parts of the country, they've come and reached out, say, are you in, are you in our market? And say, well, we're not in your market yet. Right. Because we have to have a full operations team and a network of specialists in each market. But by virtue of that, we realized the technology that we built for our own business is something that can now be utilized in groups who are, you know, try to incorporate their own specialty services and you know, operationalize it and create a lot of transparency. And so, you know, just by evolving the business of a full services, we're also going to be able to offer like a tech and services where, you know, we can provide some operation support and be the operation operations partner with these groups that, you know, again are very eager and excited about adding specialty. Just need kind of the right format to be able to do it.

Yeah, it's really fascinating. So you're becoming tech enabled and that's something that folks could just use on a standalone basis or they could bring your services in with. So walk us through what is it that practice management software is not currently doing or any other software solution on the market? What are they not doing and what are they missing that you're figuring out? Hey, we need to automate this.

Yeah, So a couple things, right? A lot of practice management systems, you can have a referred out report and that's it, right? So you just have a list of patients. Our technology, it really kind of determines how many patients have been referred. And now where are they at in that life cycle? Have they been scheduled? Why have they not been scheduled? What is the follow up mechanism? Here's a quick way to generate a list of Here are the patients we need to follow up today because this is their follow up due date. It then also allows specialists and really the technology was built with the specialist in mind. Right. So they kind of told us their pain points on why they despised or hated traveling. In the past, they hated traveling because of lack of communication. So we built this software where on their mobile device they can actually see the schedule, the medical history, the panos, the imaging, all on their phone. They see the schedule itself, how many patients they can click and call a patient if they had a medical complication question. Right. So it's very simple for them to do that versus a lot of times offices are sending emails to specialists and they get bombarded with emails and they don't know which patients for which office or it's fragmented. And if they do have remote access. Right. So a lot of DSOs will come back and say, well, we give our doctors remote access. We went out and asked a lot of specialists and they actually just don't remote in. Right. And so that would require them to open up the laptop VPN and actually go navigate through the different platforms to see the imaging medical history and hunt for it. So this is really built for the specialists in mind because if they're better prepared, the patient has an overall better experience. Right?

Yeah. It's a fascinating thought process because we've always Talked about the DSO's customer is the dentist. And in this case what you're saying is your customer is the specialist. You want to attract the best specialist to your organization so then you can source them out and you're working on building up solutions that just make their life as easy and as simple as possible, like just doing the best you can to serve your customer.

Right.

And you've realized, hey, there's a technology gap. Let's fill that with our own technology. It's pretty cool.

Yeah, yeah. So one of my business partners, Omar Alvi, I mean that's kind of where his career started. He was in the healthcare tech space around referral management and scheduling and workflow. So we've, so we've kind of digitized what we do on a day to day basis, but then also incorporating, you know, important checklists that are vital for patient safety. Right. That are compliant with a lot of different state regulations, as well as just making sure we're operating at the best level possible. Right. And so, you know, we were a big believer in checklists. We also understand that those need to be consolidated because otherwise no one will check off the checklist. So it's, you know, it's a function of making sure we're streamlining that flow and also in a very compliant way. And again, just is the transparency holds everyone, everyone accountable for their actions.

Very nice. Okay, so let's suppose I'm a general dentist, which by the way, to be clear, I'm not. Even though I seem to get a lot of marketing emails that introduced me as Dr. Kaufman, they clearly haven't gotten the memo. I'm not a dentist. But supposing I was a general dentist and I'm hearing all this buzz about ADD specialties, It's great for same store growth. It's high margin. I hear all these great things about it. What would you recommend? What's the first thing I should do to decide? Do I need to decide which specialty or what would you recommend that general dentist do to start to take some steps forward and what order would you put those steps in?

Yeah, great question. So I would say some of the, probably the very first step is identifying your ability to discuss the treatment options with patients. And then how many of those patients are you referring out in a given month? Right. I would probably track that for 90 days at least. You know, not one month is not good enough typically, because then we have recency theory. So, you know, a solid 90 days. And. But when you're doing that, go through the process of engaging the team. Let them, let the team be part of that solution. Right. Let them understand why you're kind of trying to capture more of this data. One of, one of the questions, and my wife would hear this, and I was actually in the office with her when a patient said this when they were being referred out was, well, why can't I do that here? Have your hygienist, have your clinical teams, have your front, your treatment coordinator tally up and make a note of each patient that has said that, and you'll be astounded. It's essentially every day someone in the office hears that comment when they're being referred away. Taking note of that and understanding what is your, you know, what is your kind of referral specialty. Right. Are you referring out more indo or referring out more os, more ortho, more perio, and then tracking to see how many of those patients have actually been referred out over a 90 day period.

Well, I like that and I love how you brought up recency bias because oftentimes when you talk to dentists, they'll say, oh, I must be referring out 30 oral surgery cases a month.

Right.

Because maybe they referred two or three yesterday. Right. But actually just get the hard data for 90 days and look and say, actually it was only 10 over a 90 day period, but you're referring out 50 perio cases or, you know, or ortho cases or whatever. So I love that idea. It's don't, don't go based on, hey, the thrill of let's just get a specialty in here. It's, let's be methodical, let's figure out what it is. The other thing I wanted to layer in too, Santosh, I'm interested in your perspective on this is to some degree, general dentists when they know that they're not offering the service, sometimes it ends up being excluded from the comprehensive treatment planning process. And so walk me through, like, how do you coach general dentists to think about their diagnosis process and the comprehensive nature of it when they start to think about specialty and having those conversations with patients?

Yeah, so that's patient identification and discussion is really the first domino to fall when you think about this. Right. So we as an organization, we actually go into the offices, we spend time with the team members, the hygienists, the RDAs, and talk through how to preheat all those discussions. It's also really important. You know, for example, our specialists will go and meet with the general practice as part of one of our activation meetings. They'll go over 10 to 15 Panos and Pas and allow the general dentist to see how the specialist would treatment plan that, look at it from their lens. Then also the specialists to understand how the general dentist is going to treatment plan it from a restorative standpoint as well. So having that collaboration is very, very important and going through just examples is critical. Think about it as associate general dentist coming and join practices. We hear more and more in DEO where practice owners are sitting down with the general dentist and they're saying, okay, let's talk about these cases. Right. And why is that? It's because we want to make sure everyone's clinically aligned, philosophies are aligned. And also sometimes it's how you say it and that's extremely important, especially when it comes to the in house specialty program.

So you're bringing up another point that's interesting and that is when you engage with a specialist or you know, with an organization like yours that helps to source all of that, you end up creating a little bit of a study club in terms of how each party is thinking about diagnosis, how each party is thinking about treatment, and then getting an understanding of how the other parties that might be treating that patient are thinking about the same thing. It's really fascinating. I imagine at some point there's some CE credits that could be earned just by taking this time and spending so much time thinking through the diagnosis and treatment planning.

Absolutely. So we're not a staffing company, we're not a locum agency. Right. We actually want to view this as a long term partnership. Where we are, our specialists are seen as associates within the practice and a lot of the general dentists are out there and they're working to the top of their license and they're getting training on implants and you know, we're big believers on the more you do, the more you can diagnose. Right. So the more you're able to see from a specialty perspective, the more you'll be able to provide a comprehensive solution to your patients just by virtue of that. I mean, a lot of times we are actually in the offices providing perio and oral surgery services where the general dentist is either watching, learning, observing and in many cases sometimes in the operatory next door doing their own bone graft, replacing their own implant. It can be a simple implant, but it's knowing that they have some support in that collaboration with the specialist is critical. Right. I mean, I think ultimately, I think everybody wins in that scenario and it's just built in that way.

Yeah, this is fantastic. I think our listeners are getting a great perspective right now about how to think about starting into specialty or if you started, how do you really try to enhance it and grow it?

So I want to add, obviously data tells us a lot. Right. So you know, my background in the healthcare space started really in the finance space where it's taking data and trying to slice it down to where it makes sense. Right. So we were able to do that just over the course of analyzing practices for two years. You know, we'll plug in a practice into like a Jarvis or a Dental intel or a program where we can gather data, determine how many active patients, how many patients within a certain age range. If you're looking at Ortho, 7 to 20, if you're looking at wisdom teeth, 14 to 25 and just kind of basing a certain percentage of those patients are going to be referred and what percentage of those patients are going to accept treatment. And just doing the math. Right. So we actually do a lot of these opportunity assessments. We do it because we also want to go back to the specialist and let them know that this is going to be a good opportunity for them. We don't want to kind of paint a picture that's not realistic. I think that's setting false expectations leads to resentment. And so we want to make sure we're fair and across the board. So we found that to be really valuable. Yes, we're tracking, we're making those tally marks and how many are being referred out. And actually our tech solution is going to help with offices, kind of track some of their referrals. But the other component is are we actually understanding what the patient based opportunity is and how do we go from there?

Yeah, so, so important, so critical. It's just, it's not enough to just say, I'm offering specialty if you want to do it right. And you really. Because if your motivation is, I want to be able to do more for my patients and I want to be able to meet their. Meet the demands of the market, which is, you know, why can't I have this done here? There's so, so much opportunity. Okay, so, Santosh, this is where we pause and we're going to jump over into the lightning round. All of the guests that I have on the show get to answer these same seven questions. So are you ready to go?

I'm ready to go.

All right, lightning round. Here we go. What are you currently working on?

So from our platform, really the technology side, we're extremely excited about the technology piece of our business. We think we can have a greater reach to help more folks expand.

Yeah. So you're learning a lot about software development, right?

A lot, A lot, A lot about software development.

Are you a coder yet? Are you doing any JavaScript?

I'm not a coder. You know, I'm a big believer in design thinking, and that's really looking at your end user. And so actually, a lot of our tech platform has been built from front desk employees telling us what they would be willing to do and then specialists on what they would be willing to do. Right. So if you kind of take those different pieces and say, okay, let's not overcomplicate this. Let's make it simple. So it's really helped drive a lot of our adoption and utilization. Yeah.

Awesome. All right, what are you the most proud of?

Yeah, personally. Right. Just, you know, just the family support around kind of starting this business and venture. I would say, you know, this is obviously, it's a leap of faith and takes a full, full team effort. I have just phenomenal partners as well. Right. I mean, kind of view them just like family. So extremely proud of the fact that we have just a great team, both family and business partners, to continue to innovate and work through this.

Yeah, it's a journey, isn't it? All right. Favorite sports team.

So, you know, this is a little bit tough because we go up and down a little bit, but I'm a Cowboys fan, right. So, born and raised in Dallas. I lived through the 90s, which were great years, and we're still trying to relive those sometimes. We still hold on to those things, those years. But, you know, we. We started off hot and then we. We got a little bit cold. But, you know, I'm just assuming we're going to go for the strong finish. There you go.

Should I bring up anything about the tight labor market for head coaches, or is it too soon for that?

A little too soon right now, yeah.

All right.

All right.

I didn't say all right. Your favorite hobby.

You know, honestly, like, so one of the things I do enjoy doing is with my kids, I actually enjoy storytelling. So it's kind of ad libbing. I'm not a comedian by any stretch of imagination. You know, I'm not an actor by any stretch of imagination. But being able to kind of, you know, take a step back and relive through some. Some storytelling and make up some stories that have some meaningful, you know, impact, but also somewhat entertaining. And so. And I'll know. I got a tough crowd sometimes, so I'll know if it's entertaining or not.

Oh, that's cool. I love it. All right. Favorite app on your phone?

My favorite app on my phone. Let me think about that. I mean, I'm always on Facebook, Right. So that's obviously one famous or popular app. I actually do like the Nextdoor app. Right. I learned a lot about my community in the area that's going around. I don't know if you kind of follow Nextdoor. It's just really a community app where there's, you know, information and education about what's going on. Sometimes it gets a little crazy, but, you know, for the most part, it's nice to see a lot of small businesses, you know, kind of thriving within the community. So to figure out how to continue to help support small businesses.

Very nice. That sounds cool. I'll have to check it out. And last one especially, because I know you have a finance background. Your favorite spreadsheet function.

I could not survive without, you know, Vlookups for sure. So I, you know, pivot tables are great, but, you know, we do a lot of. We use kind of, you know, we have our own essential call center insure services team. Right. We match up a lot of data to see, you know, the frequency of calls and how many times will be contacted offices and patients. And so the Vlookup functionality has been. Has been great for us.

Outstanding. All right. As we're getting toward wrapping up the episode, what. What parting advice do you have for emerging groups of practices or emerging DSOs that are trying to grow and especially figure out this specialty thing. What, what advice do you have to share for them?

You know, I think it's a matter of being willing to be vulnerable and just accept that this is kind of the trend in the industry. Right. And it may be a little bit, you know, harder to kind of get started, but there is definitely the conversations that need to, to have started and then taking the steps to understand, like what is the platform to determine am I ready today? And if you're not ready today, that's okay. When will I be ready? Or how do I get ready within six months. Right. So then kind of going through that course of action. But it's just like anything else, it's just kind of diving in. That's why I mentioned earlier when you said a lot of folks have tried it and it failed, but you got to try it. Right. And it's either you try it by yourself, you try it with a partner like us, you try it in some capacity, but it's taking the steps and acknowledging that patients are asking for this and they're pretty loud about it now. They are asking for this. We have. And I think I'll send something out as well. We have an ebook that just talks about the industry overall in a multi specialty kind of fashion. And so that has some checklist items in there to kind of think through. And I'm happy to post that to the DSO Secrets app as well.

Yeah, that'd be awesome if you'd put it on DSO Secrets. And then why don't you go ahead and give. Give our listeners the best ways to contact you and what instructions you'd want them to follow if they wanted to request that. That ebook.

Yeah, absolutely. So you know, my email address is Santosh S A N T O S H completespecialty. Feel free to email me. I'd love to set up some time to just chat again, even if we're not in your market today, I think there's a lot of services that we can provide to help you kind of stand up your program, you know, just again, from a tech and services standpoint. And then you know, Our website is completespecialty.com we also have an area there, just a contact form. And then lastly by the end of today, I'll add the link just to the ebook as well. So happy to send that out just to be able to share more knowledge within what we've seen in the industry and how it's continued to evolve.

Santosh, we cannot thank you enough for joining the podcast today and sharing some of these insights and learnings that you've had as you've been trying to figure out how to help General Dennis really implement their specialty strategy. So again, thank you so much for all of your amazing insights and being with us. Today.

Well, thank you so much for having me. I mean, this is. You do a great job of trying to, you know, get information throughout the industry and pull it together and see if it's a right fit for groups. And so enjoy being on here. And again, I appreciate the time.

Awesome. Yeah, it's been great. Some of my key takeaways from today, just to share with the listeners. It's really easy to fail at this when you think of it as the same business model that you're running as a general dentist. Think about specialty as a different business model and making investments in the right people and systems and processes in order to execute it. And of course, reach out to Santosh. He's got a lot of wisdom and knowledge in this area. So many, many thanks to all of you for joining today. This is a wrap for adding specialties to your general dentistry practice. Happy day.

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