181: Navigating Inflation in Dental: Unique Solutions To Save on Labor & Billing Costs

Dentistry, we've always said, is recession proof. I don't think we ever said it was inflation proof. And we're getting. We're getting proof now that it's not and that we've got a lot of work to do to be true business owners, to be true leaders in figuring out the best way to provide the highest value. Hi, I'm Emmett Scott, and just like you, I've had my ups and downs in the dental industry, but times are changing. The DEO has built a map of how to succeed in one of the most challenging industries to navig. On this show, we talk to dental industry leaders, solve problems, and get you the answers you need to face these challenging times and thrive. Welcome to DEO's Growth Secrets podcast for dental organizations. Now let's get started. Hello, everyone, and welcome to another episode of DEO Growth Secrets. I'm your fearless host, Emmett Scott, and I've got the whole team here, like the leadership gurus of Support dds, Tom, in this podcast. And I'm excited to take on something we all know that we're running into, but just giving it the context and maybe the resources and answers that we're starting to come up with. You know, when inflation hits, like, unless you grew up in Venezuela, you're just not used to this as an American, especially going so fast on the cost front. And I think dentistry, we've always said, is recession proof. I don't think we ever said it was inflation proof. And we're getting proof now that it's not and that we've got a lot of work to do to be true business owners, to be true leaders in figuring out the best way to provide the highest value to our patients, to our associates, and to our staff. And this means we have to think outside of maybe the traditional boxes that we're used to, especially in dentistry. And this is where I think Support DDS has just been magical and really educating the industry, bringing direct resources in how to insource team members to get us to that next level. So, anyway, I want to welcome jw, Victoria and Brenda, all from Support dds. I'll let you all kind of introduce yourselves as you make comments, if you don't mind. Just make it more efficient here. But I want to start off, and maybe, Brenda, this is for you. Just give us a little bit of a flavor for those who haven't looked at Support DDS and what this type of resource means. I mean, I think if I said Henry Schein, Patterson, Dennis, know that, but support services is kind of A new concept even in the dental field. Right. Where dental support organizations started to come in. But the way you all support is unique. Tell us a little bit about how dentists are utilizing you already today.

Well, thank you for that question, Emmett, because it's ever changing. Right. When we initially started it was all the mundane tasks like insurance verification, claims, follow up and it was basically behind the scenes. And what we have found now is not only are they in front of patients, they can be taking phone calls, being the director of first impressions, so many different roles. But we've also found that they've been elevated into more of almost C suite positions where they're handling ap, they are handling AR and the whole revenue cycle management piece and even acting as executive assistants for our dentists because you're wearing way too many hats. So basically, if it can be done remotely, we have team members doing it remotely from Zimbabwe with a beautiful Ritz Carlton sounding voice. We have found that the more that they talk to people, patients, the more the offices love it. So many things are slipping through the cracks and with us at support dds, we're getting the team members there to really fulfill everything that the office needs or that the office doesn't have time to do.

Well, you hit on something that I think, you know, the post Covid world is we all got a lot more creative of what could be done virtually. And once that door is kicked open, then we realized that location doesn't matter as much. And once we kind of understand that, then we say, okay, so we're in the US and then we're like, wait, could we go global and what would that look like? Right. So our mind just starts stacking these on top of each other and we start to look at labor markets by country and then we look at capabilities and talents by country and we find that whether we're a small practice or multi location, we're almost acting like a global company kind of out of the gate and using resources and team and talent that might be better than our even local resources could be. So jw, obviously you starting this. I'd love for you to explain a little bit of the insourcing versus outsourcing concept that you talk about. Because I do think that's an important part, that this isn't a set it and forget it type relationship.

Yeah, you know Emmett, there's, there's, there's kind of three if you. It's funny, you were talking about the global markets. You've always had the onshore, which is obviously within the US confines and Then you've had the nearshore, where you maybe went to Central America, Mexico, things nearby. And then you had the Offshore. And many times the Offshore put in some, some difficult areas. Number one was language. Right. And number two was, was time zones. And so we think we've solved that and have, as Brenda pointed out, some beautiful language. The Queen's English, I guess the King's English, as it may be now that we refer to it. But what we've done is we have kind of tried to flip the script, so to speak. And instead of calling it outsourcing, it was coined actually by my good friend Bruce Baird and Victoria. They actually said, gosh, this is more like insourcing, not outsourcing. And when you think about it, that's what we are. We are bringing team members, talented team members, trained people in all levels, as Brenda mentioned, even up to kind of controller levels and then down to our dental coordinators. But they actually work for the office full time. They're there 40 hours a week. They're dedicated to you. So you're not. It's not a call center scenario where you're working from multiple offices. And Emmett, we really stress and man, I mean I do this on every call. I'm like, they have to become part of your culture and part of your team. Keep them on those morning huddles, keep them in those weekly meetings, celebrate birthdays, anniversaries, send them swag when you do those things and they become part of your organization. That's hence where the insourcing came in.

Yeah, I think when we at Community Dental Partners first started working with you, it was pretty revolutionary concept and it took a lot of system thinking to go, how do you include people who are virtual? I think post Covid is like, we're all still trying to figure that out to some degree, but we're all trying to figure it out. It's not like some one off type thing which is, yeah, how are we inclusive on a virtual basis? I know some groups and it or others will literally have a zoom up with everybody on it all day long and be asking questions and working together. Some of them, like you said, will send out birthday cards or celebrate kind of virtually together, have after hour time together. So a lot of this is getting solved. But I think you hit on an important part of support DDS and any of this good insourcing solutions is you need to be thinking about how do I bring them into the team. This isn't like especially, I think a lot of the outsourcing solutions didn't work because they had their own way, but the practice has their own way. And what's so great about the support DDS insourcing is you're taking a team member and matching it to your custom way of doing things. Did I have that right?

Yeah, I think Brenda coined that. You know, your system's your way and we can do a hybrid of that. We, we can definitely just provide the teams. You do it, your systems, your way. We can hybrid that where we'll help you with best practices. And then some people saying, look, I just, I want to be hands off. I would just like for you to handle this. Which is, which is some of the RCM that we're doing now as well as some of the accounting processes. So you're right, it's, it's, it definitely is, is a way, but, but it's a new way of thinking too. And I think you're right. When you, when you heard the traditional word, word outsourcing or offshore, you automatically said, oh, you know, well, they're going to be over there, they're going to be working in the midnight, you know, middle of the night and I'm going to be working in the day. And there was all sorts of problems that came to mind, but that's what's been flipped a little bit as well.

Yeah. Just to give a little bit of, relative to how many dentists are now utilizing this. I mean, I think when we first started years ago, I don't know how many was a support, let's call it 30, 60, something like that. Now you're almost a thousand individuals that are supporting dental practices and you have some large DSOs that are really going deep with you all as well, Correct?

Yeah, we've got, we've got groups that have completely turned over all of their accounting processes literally from as I mentioned, kind of the assistant CFO controller level all the way down to accounts payable, accounts receivable. And we're seeing large and small groups as they, as they look to leverage that. And yeah, you're right, we've, we've grown to almost 1,000. We'll expect to be over that this year. And that's been a lot attributed to our growth there in Zimbabwe and our new center in Costa Rica, which is just helped us with the bilingual, Spanish speaking which as you know, is growing in the US quite rapidly.

So if I was, you know, if I was just kind of brainstorming where my current problems are, can you give me just a buffet list of, you know, you mentioned this quickly, Brenda but start with like the basics, even where you all started. So if I was just starting to think through like, okay, what have other dentists done as far as insourcing solutions? Can you give me just kind of a list? Simple to most innovative, let's say sure.

Simple is the insurance verification, then claims follow up. We do inbound and outbound calls for recare reactivation. Then comes a little bit more complex, which would be your director first impressions. It's not complex, but it requires a certain personality for that as well as collection calls. We all know every office hates doing collection calls, but the way that we train our team members, they're actually very, very, very successful in collecting money by placing collection calls. Then we move up into social media management, maybe even blog writing and helping with any of their marketing, followed by the RCM management with all the aspects. Not only cleaning up the software system to make sure that the insurance is in there correctly, we're working on the credentialing piece as well as payment posting adjustments, balancing ledgers, working credit balance reports, doing the rest of RCM complete with like JW said, the controller. And all of those aspects are much higher level, but we're doing it all. And I'd love to see the teams really embrace this and the leaders go to their teams and saying, what are you doing right now that you feel is below you or that you feel is a waste of your time? And then if you weren't doing that, what could you be doing? And you're going to find out what's slipping through the cracks. And that's really where we start with most offices, is finding out what the team really needs to be motivated to have a remote team and to be more successful. And then we can move up from there. As you know, Emmett, everybody is university educated that we hire. So sometimes they'll start off in a role like insurance verification and they'll realize what a huge talent they have in this person and they will elevate them up and hire somebody else in for the insurance verification. So the sky is the limit.

Yeah. You know, when I think about this strategically from this inflationary component, if you're really trying to manage your P and L well, number one, and you're like, okay, I have limited number of dollars, where am I going to make sure that those go? Well, number one, it's got to go to the associate. You don't have a dentist, you know, you don't have a dental practice. Right. Then you can kind of work out from there. Dental associates going to need an assistant Right. You probably throw in there. Also, a hygienist is another clinical piece that you need. So right there, your dollars have to go there. As you get farther out, away from the dentist, I think that's where you really need to start thinking about insourcing solutions. Right. And start thinking about where could these costs be lowered so that I have more available for the ones that are closest to the clinician. Just strategically, as I think through an org chart, that's another way to attack it. You could start at the perimeter and work your way in as well, you know.

Absolutely. I like to tell.

Yeah, Veronica. Yeah, or Victoria, please.

Yeah, I always explain it to people. It's anything that doesn't require you to be patient facing. Right. So a dental assistant, obviously difficult to outsource, hygienist, but any, any position, any task that requires, that does not require

you to be hands on. Right?

Yeah, yeah.

Can, can certainly be outsourced or insourced.

Now your new role, Victoria, is to help with this revenue cycle management piece, you know, around the billing process, et cetera. So clearly Support DDS is feeling this demand for more and more help with these dental groups. How do you see that playing out or what are you noticing and why is this, you know, kind of coming about?

Yeah, so I actually I joined support DDS about three months ago and I have spent the past 13 years on the DSO side and progressive leadership positions and operations and then heading rev cycle for both large and mid sized DSOs. And I noticed that, you know, over the past couple years, so there's just been this explosion in innovation and all of these different technologies and automated solutions that are coming out for rcm, which is fantastic. But the issue I was facing as an RCM leader was that there wasn't a true end to end solution. There's a solution out there that are that for each task of the revenue cycle. Right. But at the end of the day, that meant that I had to manage five or six different relationships and vendors. And to be honest, at the end of the day it's exhausting when you're trying to deal with the day to day and then you have five or six vendors. So I thought, you know, how can I be a part of the solution to help my fellow peers and other RCM leaders in the industry to be able to give them one true end to end solution where they're only having to manage one relationship. So when I joined Support dds, it really was to be able to say, okay, how do we leverage all of these great solutions and Add the, add in the team members to really be able to provide end to end solution, a one stop shop solution for them. So, so that's how my journey over to support DDS has come along. And we're having, there's a ton of interest and so we really noticed, you know, when I, or when I came on we said okay, you know, there's three buckets here. So there's a group, there's a. But the first solution is going to be those that already have all of their best practices in place. We have some DSOs that are like, look, we know what we're doing, we just need people inflation, right. You're going to have to cut costs and we just, we need the people to do it. So great, we can provide that.

Supplement us.

Yeah, exactly. And then the second solution is we have, we have some best practices. We don't have all of them. We're interested in learning, you know, what, what you may have or how you can help us. But also we don't have the time to train them. We're shorthanded, we're dealing with the day to day and I don't have the time to onboard 15 or 20 people and train them our systems our way. So that it was, the second solution was, okay, well we'll send one of our experts to you, we'll sit down, we'll talk through these SOPs, we'll look at yours, we'll look at ours, we'll see what fits your DSO best and then we will train your team members for you on the whatever solutions we decide. So that was the second category and then the third category are those groups that just have no idea what they're doing and they are like, look like we need all the help we can get. I bought 15 practices last year. I looked up and I realized like, oh no, everybody's doing everything their own way and we need some standardization and some centralization. How do we do that? So then we would help implement those best practices, train the team members and then kind of a plug and play solution is what I like to call it.

It's awesome. I love the categories there. Brenda, what are you noticing? Is there a difference between an individual practice and kind of what they're needing versus where maybe a group practice or even a formalized DSO might be looking for help? Because I think it's helpful for people to see those different stages.

Yeah, there definitely is a difference between a large DSO and what an individual practice needs. I'd say right now the hot topic for individual practices is More on the help with the phones. Their phones are ringing off the hook. Nobody's answering them or they're rushing. They're rushing through a phone call and they could be losing a large case. Missing phone calls is a huge issue. And so that's right now on the individual side, these smaller practices, that's really what they're trying to focus on is more of this concierge type service for all of their patients. Where on the larger DSO side they're really looking at systems and how can we cut down on our expenses? And so they are looking for all of the positions more so than just phones.

What's kind of. Go ahead, Victor.

What we're seeing too, a lot of is in those emerging groups. Right. So over the past couple of year, Well, a few years ago, there was this growth spurt where we had all of these DSOs forming and DPOs forming and it was. We're purchasing all of these practices and then Covid hits or post Covid, I guess the last year or two, we're seeing that people are really slowing down on the acquisition front, inflation economy and really starting to kind of peel back the onion and try and build on same store growth and organic growth. And so they're starting to look at their systems and processes or realize that they don't have any. So that's where we're seeing, I think a lot of people needing the help is really, really in like the, the. That emerging group part.

Yeah. The new growth is standardization. Right. That's really where all the opportunity is. If you look at the largest groups, the most successful, what they all have in common is intense standardization. Right. They are not cobbled together. They're not like total anarchy. Do whatever you want. And I think you hit on something, you know, really specific there, Victoria too, which is, you know, I write in my book about the dark tunnel. As you hit these different stages, these costs can really pile up on you and you're like, man, I was better off when I was small, you know. And so figuring out an efficient way to do that, I think that's really interesting. The other one that, you know, we were just having in our DEO WhatsApp chat about is a lot of people figuring out what their management fees with like JV partners and other things should be, how much they should charge them. And those costs get higher when you're trying to use, you know, on site individuals versus if you can get those costs down, you can charge less to your associate JV partners. That's a competitive advantage. Right. So as you're looking to scale, as you're stepping up in all these C suite individuals, etc, who those C suite individuals are brought on for their strategic capability, then they need tactical people. Right? And those tactical people, again, if you're trying to use a lot of American based individuals, you're going to end up with a lot of costs really quick. Right.

Jw, did you know Emmett? Yeah, I was going to add in there. It's interesting. Some of the roles I thought about that have just come up has been people who are looking to standardize those SOPs and put in those practices because or the standardization and we've actually had groups who are now hiring people with us who are saying, you know, I need a BI person, I need somebody who's managing my SOPs because you know, an SOP with, with, with four offices looks quite different than one with 40 offices. So are your processes evolving? Are they gaining, gaining strength and size? And I know with our company we have one person, that's all they do, they manage these SOPs, they're rewriting them on a daily basis almost, you know, so again, something else that just gets lost in the mix. As you said, they all come together. You, you put in these standardizations and two years later nobody's looked at them again. And that happens all the time as well.

Well, I think it's easy to step back, complain. It's easy to step back and feel overwhelmed. What's cool about the discussion here, what DEO brings to the table, what you all with Support DDS is like, okay, so what's the solutions like? I think one thing that I can pretty confidently say is it's unlikely that tomorrow your team all walks in and says, hey doc, I realize you've been under a lot of stress with all this inflation and we just all got together and felt like we should cut our income by 20, 30% to relieve you of this pressure that you've been feeling. What is more likely is they come in next week and they say, hey, we all got together and we think we need more money than we needed the week before. So continuing to figure out how we're going to take care of these patients, how we're going to streamline and standardize how we're going to. And frankly my, my assumption is with still the amount of turnover, still how difficult it can be to find staff, you're probably not having to do a big change of like, hey, I'm going to lay off all these people and hire support dds. It's probably exactly like Brenda Laid out, which is like, I've got team members who are overwhelmed. I've got to hire somebody. The thought of hiring someone else at the costs local is going to crush me. But if I could get two team members for the price of one, if I could get three to help with this, that or the other, well, now I'm going to retain the ones that I do need to have in the practice because they're going to actually feel like things are supported. Is that pretty accurate to what you all are seeing and why there's so much momentum around this at this point? I mean, post Covid there was always. Or pre Covid, there was always these fears I'm going to get replaced, et cetera. I don't see that with team anymore. They're like, go hire people and get me support. That's what I need.

You're exactly right. I went to an office and visited this past week and they do not have anyone on the business side in the office. So the patients walk in the door, they're greeted with a kiosk, they check in, they're already picking up the phone, speaking to one of our team members in Zimbabwe, getting text messages before they leave the chair on how to pay their bill and they're getting scheduled for their next appointment. So all of the steps are being fulfilled. It's just that they're all being done remotely. And Emma, I don't know about what it's like where you are, but in Colorado, our minimum wage is going up to $18 and 36 cents an hour. And so people directly out of high school are asking for $20 an hour to work at McDonald's.

And because, Brenda, I'm not minimum wage. Right. So if that's minimum wage and I'm in a healthcare environment, then I'm clearly not minimum wage. Right. So, yeah, that. It has a domino effect, doesn't it?

Absolutely.

Yeah.

Well, and Emmett, I think there's also, there's, there's, there's great resources. I, I don't know if you know about this one coming up the bottom line boot camp. Do you know anything about that?

Yeah, that's right. So DEO is putting on an excellent summit here where we're going to really dig into the P and L and support. DDS is a huge sponsor of that. But it's time we come to solutions, right, jw?

Yeah. And I think when we, when I saw this, I think I saw you had kind of mentioned it in one of the posts and I was like, wow, that's exactly what we want to help with, you know, we want to help people with their bottom line because to give that ultimate patient care, which is the number one priority, right, get this great patient care, you're going to have to be able to maintain profitability. And I think there's so many positions. Brenda mentioned it as well. You know, you talk about not just relieving people, but it also helps elevate your team when you've got very talented people in your office who may be doing tasks that they don't feel like they should be doing, but it's also keeping them away from doing those high ROI tasks that they should be redirected to, then I think we can definitely come in and help fill that gap and offer some solutions. And look, I always tell people whether you're, whether you're doing it with, with us, offshore, onshore, nearshore, we want to help educate you to that process and just help you to understand how you can integrate those better into your system. And at the end of the day, it's going to become the bottom line, right? It's going to be become what is my bottom line and how do I keep that margin where it is? Because I've heard that before. I said, my gosh, I was making more money when I had two practices and now I have 20 and, and I'm not doing so well. And so bigger is not better. It can be, I think if you have the proper process procedures and have your cost under control as well.

No profit, no mission, no profit, no impact. Right. So we have to be good stewards in this process. Since you mentioned it, JW, November 10th and 11th, if you want to mark your calendars for November 12th, that's my birthday, you can do a shout out. I wouldn't be disappointed. But November 10th and 11th is when we'll have the Bottom line boot camp. We're going to go through deep on the P L structure, talking a little bit about this RCM process, etc, but at the end of the day, we have to get down to nuts and bolts here and figure out solutions. I think those who do, those who don't wait for the past to come back, but they actually design the future, are the ones that are going to have the greatest impact on the industry going forward. So I appreciate everything you all are doing. Yeah, go ahead.

I'll add that to it. I think right now you can sign up for that like 150 bucks. And look, talk about a great investment to just pick up some nuggets there. And this is for anybody, right? Emmett, I mean anybody can join in this call. You don't have to be a member, I don't believe. And, and, and you can, you can learn quite a bit from this two day event. So yeah, my goodness, it'd be worth it for any, almost any business, but especially a dental practice.

One of the few things we do for everyone, even those who aren't members, but something we can give back to the industry right now at a, at a pretty low cost thanks to your all sponsorship by the way. We can do that. So. All right, awesome. Anything else that we should touch on? Like this is fabulous. If you haven't reached out to Support dds, what is the best way to get in contact and say, okay, I need to brainstorm on some positions here. Who should I reach out to?

Yeah, if it's, if it's, any of the positions we've mentioned, Brenda's the best too. Brenda support DDS.com you can contact her. You can also go to the website and schedule a discovery call that works out best. Go to supportdds.com and select that. And if it's something specifically to do. If you're really looking to scale with the revenue cycle management, we are kind of scheduling that right now into new onboards into December and January. We really filled up this pipeline early. We'd be happy to discuss that with you. Just put that in the notes and we'll make sure that we get Victoria on that call as well.

And then I'd also like to add that if you're at all considering any position with Support dds, go to the website and look at our calculator that we have. You can determine how much money you can save by utilizing our services. But also on that website, it has ideas from outside the box, things that you may not even have thought that you needed, that you do. You can't live without it. You just don't know it yet.

Yeah, that's awesome. That's awesome. Okay. And if I've never done this before, I feel a little awkward. I don't. Can you all coach me, give me best practices on what people are doing? I guess if you know there's almost a thousand people over there supporting dental practices, you've got it figured out.

So we're in over 1700 dental offices across the country. So we know all kinds of systems, we know all kinds of ways, and we also probably know best the right type of person that you need for that role. And our talent is beyond anything that we could find anywhere else. These candidates are just phenomenal.

I might add on the insourcing Brenda too, if you're looking for one or two or three people, even more than that, you actually get to interview them. You know, we're not going to just send people to you and say, hey, here's the three we selected. We're going to allow you to meet them on a zoom call just like this and for you to select the one that you feel fits your culture the best. So I think we got a really good process to do that and very good support from the from the onboard, the initial training as well as the follow up on a weekly basis, customized reporting that we can help implement as well.

All right, so thank you all so much. If you want to jump into that Bottom Line Boot camp, come over to the deo Dental Group deodental group.com and sign up for that Bottom Line Boot Camp. You'll get even more from support dds and how they work, as well as some very tactical things on how to look at your P L to increase profitability. Appreciate all three of you being on today. Your feedback, everything that you're doing for this industry during this time. If you want to have more conversations around this, you can also come over to our Facebook page at DEO GrowthSecrets. And until next time, keep smiling. Thank you for listening to deo's Growth Secrets podcast for dental organizations. Continue the conversation on our Facebook group and meet other dental leaders. Get questions answered and the strategies you need to succeed. Plus, we have some free resources for you right there on the Facebook Facebook page. Remember, you're not alone. Let's do this together. Join DEO's Growth Secrets Group on Facebook and until next time, keep smiling.