94: From Conversation to Commitment: How Communication Drives Case Acceptance

Welcome, everybody, to another episode of the Dental Boardroom podcast, where we dive into the business and strategy side of dentistry. And I'm your host, Wes Reed. And today we're tackling one of the most important and often misunderstood topics in practice success. And that is the subject of case acceptance. Joining me today is Dr. Bob Marcus, a seasoned clinician, educator and dental practice management consultant. He's got over 25 years, both private practice and advanced dental education. He's helped countless dentists improve their communication, boost case acceptance and create more predictable treatment outcomes. He's also the mind behind a powerful software platform designed specifically to help practices convert more consultations into completed care. If you've ever felt frustrated when patients say I'll think about it, or you're looking to sharpen your team's ability to ethically present care, this episode is for you. All right, Bob, that's a little background on you. You and I have a history together in that we helped you sell your dental practice. And I remember, Bob, by the way, welcome to the show.

Thank you.

I remember when you, you came to us and I was looking at your, your P and L and I thought, wait, is this a GP practice? Wait, is this a PPO practice? How is this thing doing? About a 45% plus profit margin, close to 50% on a really healthy top line revenue. I was just extremely impressed. I thought about it a lot. I had you on a podcast probably like three or four years ago, and I'm bringing you back to focus on the subject of case acceptance, which is a huge part of dentistry. There's a lot of patients that walk out the door because they weren't fully sort of enrolled in the vision of the clinical treatment that was presented to them. And that mind barrier, that block prevents a lot of dentists from breaking through economically in their practice, even though those patients really do need the treatment that is being presented to them. And many of them will walk out the door and go buy the newest and latest iPhone, even though their current iPhone is great, because they felt that that was a better use of their money because they're not comparing the value or fully understanding the value. And somehow you did that and you did it really well. So I think you're a perfect voice on this. You have since gotten into very sort of boutique practice management consulting, and we've introduced you to a few of our clients who I have visually seen the numbers.

Produce great results. We've been very grateful to have you helping out with some of our clients. You're very limited in who you take on so you're not overwhelmed and you can give a lot of personal attention. So very, very excited to have you on the show, Bob.

Thank you very much. Good to be here. I think we last talked years ago about this. Although you and I talk all the time about this, this kind of stuff, it's kind of fun.

Yeah. Why don't we dive into the first question? So picking up on my intro there, you ran a really successful mostly PPO practice. Lot of crown. You're the only doctor I think I know at two CAD CAMs in the office running at pretty much full steam. There's a certain mindset I've noticed about you, Bob, from the day I met you, in that you are very confident in the value that you're able to provide to people, but not in a overconfident way. It's humbly you've always had a humble approach and your communication skills are very effective. And so I want to help other dentists walk away from this podcast with a few specific tools around. Both conditioning their mindset to be effective case presenters, how to talk to their team about it as well, since they're a part of the dialogue with their patients. And also I do want to talk about technology and how technology is helping in case acceptance with patients. So my first question for you is, what is that mindset like and how did you, how did you do it?

Well, you know, first of all, I think when a lot of people listen or log on to this, they're going to say, oh great, another podcast telling me about case acceptance. Every time I turn around, somebody's telling me I need better case acceptance. I need people to say yes more often. And.

There'S two problems there. The first problem is we see it so much, we kind of grow tired of it and almost we just turn it off. And the second one is when we see it so much, we don't come to the realization and maybe we're part of the problem. I meet a lot of dentists around and there's. They really fall into three groups when it comes to case acceptance. Number one, they say, yes, I am super duper busy, but. But I'm not making enough money and that's a problem. We gotta figure that one out. Number two, they say I have the greatest case acceptance in the world. Everybody does what I tell em to do. My patients love me no matter what I tell them. They say yes, I have 90% case acceptance. And three, which is where most dentists I have found around the country fall is a little bit of Ignorance, but maybe don't want to admit it. They're like, well, I really wish I knew how good my case acceptance was, but I don't, I don't really know what report I should be running. I don't know how to tell, but I'm pretty busy, so that's good enough. And we see a lot of this kind of the good is the enemy of great problems in dentistry. I see a lot of dentists, I see a lot of practices for sale where it'll say something like 20 years of goodwill, same location, great patience, beautiful facility, producing. And I look at the number and go, holy moly. How do they produce that little with all that run up time? A good friend of mine is selling his practice right now, he's retiring. And he told me he wanted to ask me and showed me his numbers and all. And I said to him, how did you not produce more than this working full time in the same location for 35 years? How did, how did that happen? And that. And, and he was clueless. And so that, that's the big group too. So I don't know if that exactly answers the question about what is the mindset. I think the mindset is this, as clinicians, if we run a report or we, and we'll talk about that in a minute, if we don't know how to run a report, what are we supposed to do? But let's say we do know what to do and we run a report and we say, hey, look at this. I see.

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A zillion dollars. The treatment that I recommend and I'm not talking about cosmetics and unnecessary, you know, stuff that is elective. I'm talking about stuff people legit need. And yet they said I've got to think about it or no. And what we commonly do as adults is we don't want to be wrong. We're doctors, we're smart people. So we say stuff like it's the economy, it's the president, it's, it's today, it's. And we make up a lot of, we define a lot of external forces that are causing our essential failure to get this case acceptance as opposed to looking inward. And so it's really important for me in my, it was really important for me in my own practice, as you know, and become important for me when I'm working with other dentists to help them kind of look in the mirror and say what, maybe it's us. Maybe there's something we could do or say differently. So patients are more apt to not think about it or do what you said and go, you know, we're not competing with each other, we're competing with the iPhone or the vacation or whatever it is. How do we put our treatment plan on that ladder of value high enough that it's above the iPhone? And that's where we as dentists fail a lot. If what I see in a lot of offices is we'll have A dentist who will. And we can talk about exam. There's two. Two steps in case acceptance. Well, there's a million steps, but two big steps are the exam itself. And then what do we do after we determine the patient needs something? Let's use a crown as an example, since it's an easy one. And we all deal with that. We go into the back in their recall and we do what I consider to be a pretty bad exam. But we come out at the end and say, hey, you need a crown. The patient says, okay, doc, yeah, you need to get this one done. It's breaking off. And I'm not talking about stuff that already broke and is painful. I'm talking about stuff that is. We know it's a problem, but they don't know yet. Clueless patient moment. What happens from that moment forward is going to determine what happens with the schedule. A lot of patients will finish up with hygiene and go to the desk or whatever it is. And then over the top of the desk or in a consult room, somebody will say to them, hey, doctor said you need a crown. The fee is $1,700. The insurance covers 800. Your portion is 900. Would you like to schedule that? And what we did is we took. We took all the air out of that balloon. We made that crown about money, and we said, you need 900. We didn't say, you need this and that procedure. We said, you need $900 worth of something that they didn't get or they sort of got. And when they say, well, no, thanks, I got to ask my wife, I got to think about it. We think that they do need to think about it, or we think they do need to go home and ask their wife, but they're not going to do that. They're going to go back to their life and go, well, it doesn't hurt. It doesn't look bad. Why would I spend $900 when I just made the deposit on that vacation and I don't want to spend it right now? So we, as an office from the. And it all starts, of course, at the new patient phone call. We could go through the entire lifespan of a patient, but we have to look at ourselves and go, what did we do wrong there? That's the hard part. Now, for doctors that fall into the clueless category, they go, I don't even know how to run a report. I have software, but I don't know what to do with it. Here's my suggestion for that. First of all, I'm not going to say Go learn software, because you've already been a dentist all these years and you decided not to. So my suggestion to you is for the next 20 treatment plans, write down. You write it down. Or who is doing, doing the case presentations, patient name, value of the plan, and write, did they accept? And by accept I don't mean they said, yes, I want to do that someday. By accept I mean they paid for it and they got their name on the schedule. Now you'll notice the order. I said that they paid for it and they got their name on the schedule. We created that contractual moment where they signed something, they whipped out their credit card, said, hey, go ahead and charge me. I see a treatment plan, big or small, like buying a plane ticket. I don't go somewhere and get off the plane and go, oh, good, look, I'm in Baltimore, let me go ahead and pay the flight attendant. That's not the way it works. I paid for it like a month ago when I booked it and then I flew. And I want to see how the patient have that mentality. In fact, other than like restaurants and maybe haircutting places, most places you pay in advance. You want to go to a concert, you buy that ticket. Now it hits your credit card. Or actually, let's talk about something day to day. You shop on Amazon, you put in your credit card, hits your card, and then the item arrives in a day or two. That's how we want to see it. So when the patient pays and schedules, that's a case acceptance. And you go to that list of 20 that we're building and you write down the amount of the total they accepted. The total was 5,000, they accepted 1,000. And then you figure out in the end what percentage of the total dollars you recommended versus what was paid for and put onto your schedule. And now you will have your case acceptance, quick and dirty. Not as good as as doing it with software, but it's a nice way to do it. It gives you a little overview of how well you're doing. Things like cleanings are going to be a very high case acceptance. Things like fillings are going to be pretty high. A crown is going to be high. And then when we get to these big cases, it's going to be lower, but it needs to be there. I also find a lot of doctors, when they're bad at case acceptance, what they do is they start to assume the negative. They don't assume the sale. What they assume is the patient's going to say no. And in making that assumption, I think the thinking Happens in our brain. I don't think we actually think about it on a cognitive level, but maybe on a subcognitive level where we think like this, oh, this guy, he's not going to want to do it. I've mentioned it before. Or he looks like he can't afford it, he's just going to say no. So therefore I'm not going to bother mentioning it. And I think that happens in our heads and therefore our treatment plans are shockingly non comprehensive. I was at a seminar just the other night, a seminar being taught by a faculty member about a particular procedure. And he was showing single tooth dental implants. And I couldn't help but notice that every slide he put up on the 10 foot screen. There were all sorts of other things wrong with that patient wear problems, orthodontic problems. And yet we're doing this dental implant. And I always wonder myself, does the patient aware of this? Did we present the whole case or did we just do the one thing where, look, this one's missing and it looks really bad. So therefore let me go ahead and just talk about that one. So the exam needs to be comprehensive. I could do, we could do a whole podcast on exams. The exam needs to be very comprehensive and the treatment plan needs to completely change. Only a small portion should be about cost. Most of it should be about value. So big answer to a small question. But the mindset is that we should think, yes, this person needs that. It's my job to get that through to them and get it into their head that they need this done. As a dental salesman, if you don't think you're a salesman, then you really may not be fit to own a private practice. You're not selling something bad, you're selling something honest and ethical, at least I hope. But you are selling it. And if you don't fall into that role of saying, I need to push this patient to do the right thing, your practice will never get to that next level. You'll become what I call a cosmodontist. You're just doing compositeontists. You're doing composites all day and crowns when things break. And you're never, I mean, look in the mirror, doc. When was the last time. Doctors listening. When, when was the last time you did a comprehensive full mouth reconstruction? A major cosmetic case. Pre restorative orthodontics. Did you mention it? That guy's 50 years old. So I'm not going to bother mentioning that the lower anterior is crowded. Why not? Did we talk about it? Are all of Your patients with wear and recession and AB fraction, are they in guards? Are we doing all these things? Are we just kind of walking into hygiene and going, yeah, you look pretty good. I think you may need a crown on that one someday. We'll put a watch on it. Bye. Bye. So to me, that's the. The hard part is getting ourselves to be comprehensive and to build value in what we give or provide for people.

So I want to summarize the three takeaways here, add my own thoughts on it, and then talk a little bit about the economics that is a. Is an outcome of increasing case acceptance. As the numbers guy, I. I do a lot of. I look at a lot of financial statements. I do a lot of financial modeling and analytics in my beloved Excel spreadsheet. To understand the economics of a dental practice. My first thought is measuring is so important to improving. And I have found this in various aspects of my life. Whether I'm trying to improve in an exercise, maybe in lifting or running. In my business, I am now every single month, I look very, very, very closely at my numbers in, in many, from many different angles. I look at it at a department level. I look at it as a whole, as a company as a whole. I look at each of my individual advisors. I look at various things. And when I do that, I set. I set aside about four hours a month on the seventh day of the month every month, because that's about when we have our, our own financial statements done. And when I do that, I can't tell you how much motivation it gives me to improve in those areas. It makes me think very practically, very detailed about how I'm using my time to make the results better. So a lot of people have heard the, the quote, when performance is measured, performance improves. When performance is measured and reported, the rate of improvement accelerates. I find that to be a very, very applicable truth. And particularly as a business owner who should be measuring various things, setting up those KPIs. Now, yours was a very simple example, but one that works. If you don't want to use technology, just write it down. That's even that alone, just writing it down. It's almost like when I tell some clients who are struggling with keeping a budget and living beneath their means, even though they're doctors. I will say for one month, I want you to keep all of your receipts when you buy stuff personally, and I want you to put it in a drawer or box. And every, every week, I want you to sit down with your spouse and I want you to look at that look, look at how much that was spent. Pull out a little calculator on your phone and add it up. Just the act of measuring and seeing the numbers creates an incredible motivational force in our psychology. So I say that's number one takeaway, is just be sure you're measuring it, even if it's simple. Now we're going to talk about your technology that, that you've created for case acceptance in a little bit, and if that has any KPIs or measuring tools built within it. The second thing I took away was communication. We are all, as humans, very naturally in tune with. When somebody is persuading us or presenting something, they want us to do, something that we can tell in their voice, in the words they use, in their tone, and how confident they are that they actually believe intrinsically that you should do that thing. And if you have any amount of doubt that they're not going to say yes or any amount of doubt in what you're actually trying to do, they will perceive it, I think they will feel it, they will know it. And so one of the first things I would say is just completely 100% believing in yourself and believing that they will say yes. So the way that I would approach it is it's I just say it matter. Just say it matter of factly. If you try to put, like sales words in there, man, it just falls dead. Just say it matter of factly. Like, of course they're going to say yes. Why would they not say yes to this? It relates to their, their smile, their attractiveness, their oral systemic health. There are so many reasons why it's an obvious answer that it should be yes. And saying it with that level of sort of matter of factness and confidence and of course, sort of scoping the value really well to them is really key. Also with the team, number three sort of takeaway is try to do a comprehensive relationship or a comprehensive presentation as well. And they may not say yes to everything, but they're probably going to say yes at least to the one thing that you felt was the most important, that you were going to present anyways. So that's another thought. All right. Now my final takeaway related to the numbers. I always try to help dentists understand that the nature of a dental practice, economically speaking, is that you have a very high set of fixed costs and you have a very low set of variable costs. Variable costs being your labs and supplies. And I'm talking about over any one month or three month or six month or even over a year. Or two year period, most of your costs don't change a whole lot. They ebb and flow a little bit. And so if 80% of your cost structure is fixed and let's say your basic fillings and cleanings and maybe some, some, some crowns sort of covers all of your fixed costs above your up to your fixed costs and your variable costs. So up to that, that amount that you pay, your overhead is 100% of your collection. So when they say, well, what's my overhead? Your overhead is 100% of collections up to a certain dollar amount per month. Now theoretically in your head you could sort of run this graph X and Y axis and your collections are going up to the right as time goes on. And for the first say three weeks, 100% of your dollar is going to pay your fixed and your variable costs. And so that last week is where all you make all your money or another way of, another angle of looking at that is, is saying that X amount of treatments covers my fixed costs. And anything above that, 80% of it goes down to my, my pocket, my, the bottom line directly to me. And that's where doctors make all their money is after they break through the fixed and variable costs of their dental practice. So that extra treatment that's done, a patient saying yes to that extra addition in the, in the case presentation, those extra amounts are what make you the most money. It's not sometimes a huge difference in collections between those doctors who are struggling and those doctors who are not struggling financially because of those extra treatments that are done. And that's where case acceptance really is the key to breakthrough economically for doctors.

Yeah. Good. And you know, here's the thing. I want to try to have anybody who's listening along with us to have an actionable item or items. And if it's okay, maybe can I give a couple here?

Yes.

So when we're presenting to patients, and like you just said, Wes, you said something about the believability, the conviction you present with. And I'm going to give doctors what I found was in my, my opinion the easiest way to do a case presentation. Most case presentations have something sounds something like this. Hey, doctors didn't need a crown. Did you have any questions about that? No. Okay, here's what it costs you want to schedule. That's the whole.

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And I think what we're not doing is doing a very good job of getting into the psychology of the patient. I'm going to offer you two different quotes here. One is the old Maya Angelou quote that we've all heard. People will forget what you said. People will forget what you did, but they'll remember how that you made them feel or something like that. They'll never forget how you made them feel. We're creating a feeling. We're creating a connection between doctor and patient, dental team and patient. We're not creating a connection between patient and dentistry, between humans. These days with AI and computers, everywhere and everywhere I look there's another flat screen. People are just longing for the human connection and they came to your office live. We are so lucky in dentistry we have something that most other fields don't have. I just read today that 75% of restaurant food at this point is takeout. Think about that. We have lost the space to face in our world a lot. So people I think are kind of longing for that human interaction a little bit. We need that. And especially if I work from home and I'm staring at a computer all day and my one foray out into the to the world is my dental appointment. Are we just going to give them a bunch of numbers or are we going to give them some of us? So the other quote, and I have no idea who said this, but I really liked it. I actually heard it on Shark Tank of all places. They said a good salesperson sells Features. A great salesperson sells outcomes. An outstanding salesperson sells feelings. So we're back to that feelings thing. So here's the actionable thing that you can do in your dental office starting tomorrow. I don't care, first of all, how small the case is, one sealant or how big the case is, it's the same feeling. Five steps. 1. We want to make sure we gauge the patient and how they are, do they care? Okay, we want to do what I call the care scale and say something like, hey, you know. And by the way, as an aside, I believe doctors should do their own treatment presentations. I want the doctor to tell me I have gotten the biggest cases from presenting an occlusal to mom about her 14 year old. And later she went home and said to her husband how amazing I was and he came in and needed a makeover. So the feeling we generate with those easy ones do those, those are the easiest ones to do. A lot of doctors only venture into the consult room when it's a big case. That's the opposite of what we should doing. We should be farming the next big case that we don't know exists by doing it on the small ones because it only takes a minute. So what I call the care scale assess. Hey, you know what? There's some stuff going on in your mouth. And yes, I use the word stuff a lot because people are freaked out by the dentist or people are scared of the dentist. So we don't want to start saying there's a horrible problem. Let me give it a scientific name instead. I'll say there's some stuff going on in the mouth. Is it important to you that we maintain your dental health? You want to keep your mouth healthy. Now your average patient's going to be like, well, duh, of course, that's why I'm here at the dentist. But we want them to give that first. Yes, you see, we're in the, we're getting them in the mode, of course I care, doc, that's why I'm here. If they say I really don't care, my mother lost her teeth when she was 40 and I don't care if I lose mine, then my answer is fair enough. I'll write, I'll make a note in your chart and if you change your mind and you want to talk about the treatment you need, you let me know. So I'm creating a little bit of a you kind of need me mindset. I'm not going to, going to sit there and beg them to do the work and you'll be surprised on me, but go. Well, I was just joking, Doc. You know, I really do want to get it done. You know, you just got to call them out. We got to call that bluff. Number two. So the care scale. Number two is what I call permission. I learned this from a dentist who is a friend of mine named James Klim. Probably one of the most talented cad Cam dentists in country, if not the world. He told me about permission. Very good tool. You can use it in your life, too. In your personal life, if you're about to tell somebody something that they don't want to hear, and nobody has ever said, please, I hope I have a dental problem. I'd like to hear about one now. We need to ask their permission. Second step. How do we do it? Hey, Wes, look, you know, you're my family. You're my brother. I love you so much, man. I'd do anything for you. But right now, I have to tell you something you really don't want to hear. Can I have your permission? Now, I wouldn't tell a patient I love them, but I might say, hey, Joe, you've been a patient of ours for 20 years, and we. I've always enjoyed working with you. I like when you come by. But right now, I have to say something that's going to hurt a little bit. Is that okay? All right. And they think that you're going to tell them, go somewhere else. You're, you know, I'm done with you, but you're just going to tell them they need a filling, but we want to get that moment of, yes, I'm ready, because I've had people say to me, well, no, I. You know, I. I don't want to hear about it right now. And my mother's in hospice care, and I really need to return to her side. And they're not ready. They're not offering permission to tell them something is wrong with their health. So I'll say, well, no problem, and back to the old narrative. I'm going to note it in your chart. You take care of what you need to do, and when you're ready, you call me and we'll talk. Call the office, and I'll hop on the phone with you myself and we'll talk. I probably won't do that, but at least the offer sounds nice. That's what we call gardening. I'm planting that seed in the garden. It might not grow for another year, but I'm still planting it. As opposed to taking this person who needs to return to her mother's side at the hospice care and filling her ear with stuff about crowns. And she cannot process it because her brain has been hijacked by something more important. So that's why we have to ask for permission. So, number one, we assess, do that. You know what I call the care scale. Are you on the scale? Do you care about this? Number two, may I have your permission to talk about something? I call it compassion with bluntness. You know, here's a hug and I'm about to sell you. Tell you something you don't want to hear. You're ugly. No, instead. But instead of saying that, we could say, your front teeth don't look that great. I don't think that this gap right here is really contributing to the overall look. So that is a toughie, but we need to say it. Now. The third one is detail. We as doctors are scientists and we're kind of nerdy educators, at least most of us. And we really want to vomit all over the patient about dental detail. Here's the thing. When that patient was about 21, that's when they decided they did not want to be a dentist and they did not want to go to dental school. And if you think now at the age 45, they've decided, I really hope that when I get there, I can get a full on education about dk. They don't want that. They don't care about it and they don't need it. What they want is you to know it, and that's enough. That's why they came to you, because you have those three letters after your name. They already showed up at your office. That shows that they have a certain amount of confidence that you know what you're doing. So I'll ask them about detail and I'll frame it in such a way of saying something along the lines of, you know, a lot of people are afraid of the dentist and a lot of people get freaked out by what we do. Did you want me to go into detail about every little thing or do you just want me to give you the theme? That's the exact question I'll ask. Because most people go, no, Doc, I trust you. Just give me the theme once in a while. They'll go, no, no, I'm an engineer and my son is an engineer and I need every teeny tiny detail, all of it. Fair enough. That's going to be your. That patient's going to go back and tell after you do, after you give him all your detail, he's going to go back to his engineering job and tell everybody else what a great engineer you are or your staff is. So you. It's a win, win situation. So if they go, I trust you, then I'll just go the theme, I'll go, hey, the theme is there's some stuff going on in the upper right. Things aren't looking healthy. I'd need to do some repairs. Did you need more detail than that? Because what we currently say is the third one from the back count, okay. One, two, three. That one has a cavity on the front and on the side where the floss goes. They didn't care. They just wanted to know that you're there for them. Now, moderate detail. If they go, well, you know, tell me a little bit about it, then what I'll do is I'll take the computer that's nearby and I'll put up the grossest intraoral photo of the problem I can find. Right. Let's say it's a decay and I show it. It's a crack and it shows it. I'll fill the screen with that intraoral photo and I'll say, check it out. What do you think of that?

Let them take a look and self diagnose. Oh, look at that. They pointed the buckle pit and say, look at that hole. And I don't need to correct them. I go, yeah, that picture clearly shows what we're talking about. Again, we don't need to take them to dental school and point at it. Don't teach them. Because when you're a teacher, student relationship that assumes that you know more, you're over them. I'm smarter than you and I'd like to tell you how smart I am now. No, no, no. We're a team. Let's co diagnose. Check out the picture. Do you see what I'm seeing there? And they might go, no, I, I don't see that, Doc. Right here. And I'll point to the screen. Right, right, right. Where's my camera? Right there is where, where that problem is. See that area that looks darker? Yeah. I got to get in there and do some repair work. Right. That, that's medium detail and high detail. You can just geek out and nerd out the way you normally do, but most people don't want that.

Yeah. Let me ask you a question on this. Step three, when I am talking to a potential client of practice, cfo, I very much changed my approach over the many years of doing this. And in the beginning, I wanted them to know about every detail that I, that I do. Everything That I do. Here's all the things that I do for you. And what I would find is that even though in my own head I'm doing a great job showing them at my, what my, what my capacities, my skill set, my talents, they sort of tune out and I end up starting to use language that to me is basic languages. Like there were even some prospects who didn't know what the term P and L meant, you know, provident loss statement. And so now I very much want to hear from them. And so I, I, I just ask questions. Honestly, those questions sometimes will go on for an hour or two. Last night I had a hour and 45 minute call with a potential client who's got a really solid practice up in Northern California. And I just wanted to gather everything about his, what's on his mind and access that. And I, I have found that every client, I'll call them client in your case, every patient has a little bit different thought process around.

Their oral health, around the treatment you're presenting, around what's going on in their life. And I always try to find out what is the thing that matters to you most because I know that I'm going to try to solve their cash flow problem, I'm going to try to solve their tax problem, I'm going to maybe try to solve their personal spending problem. If there's an issue there, I'm going to help them set up, set up a proper, well designed 401k plan as an example. I might set up 529 education accounts in my head. I can do all these things, but they may not care about all those things. It may just be that their college education for their kids is the most important thing for them because maybe they're an immigrant, they didn't have good education opportunities as much and they had to work for that and they want to give that to their kids. But finding that thing and letting them, I always say, unload the chamber. So, so it's empty now. Now I know. So my question for you is, as a dentist, you're busy. Especially if you're in a PPO practice, you don't have a lot of time around case acceptance. You can't sit there for an hour, how much do you let them talk and encourage them to talk? If you had to place a portion, a percent of the time that they're talking and the percent of the time that you're talking, if you can even do this, what do you think that apportionment looks like?

Okay, that's a fantastic Question. And I'm going to come back to steps four and five in a minute. But let me answer your question.

I don't have a fixed amount, but I will tell you what happens in most practices when, when you get a dentist. When I have a dentist says, I'm really busy, I'm so busy, but my numbers are not the way I want them to be. I just got done with my, my practice, CFO folk or whatever, and they told me that I can't retire yet, right? I can't. I really want to because I want to retire, but I can't.

I find that what's going on in a lot of those practices we have one of two things going wrong. The first thing going wrong is the doctor's mindset that I'm so busy. In fact, I hear it all over the place. Hey, how you doing? I'm so busy, I haven't seen somebody in years. Oh, it's great to see you. How's things? So busy. So we, a lot of times we fall into this I'm so busy type mentality. And when I, if somebody says that to me, my first thought is, well, I guess they don't want to talk to me. They really need to get back to whatever they were doing before they were talking to me because they're so crazy busy. So if we portray that to the patient, oh, I gotta run. I only have a minute or I'm going to hand it off to whoever. If we portray that, if we let them see that, the value proposition goes down.

Your question was, how much time in my day, the second part of the answer is going to get to that. When I go into dental offices and I look at a schedule and doctors go ahead and look at next week's schedule and count how many appointments you're doing on the day. I'm not talking about exams, but how many appointments. And you'll find that most doctors schedules are pretty choppy. 8, 10, 12, 14 appointments, a filling, a crown, a filling, two fillings, a crown, two crowns, you know, this or that, an implant placement. And by the time we're done, we're seeing 12, 14 people. That means your assisting staff is running around. That means you're spending a fortune on cleaning up and setting up rooms, which I believe Gordon Christensen determined well before all these, in all this inflation we had that it was somewhere in the neighborhood of 30 to $40 per patient just to clean up and set up when it comes to time and stuff. So if you take two appointments to do two things versus one appointment to do two things. You just wasted 40 bucks. That creates this busyness. Doc, I need you in Room 1. Doc, I need you in Room 2. Doc, I need you in room 3. That creates busyness. So my goal is to avoid what I call debundling. So getting away from my top five, I don't want to come back to that in a minute. But bundling care is very important. If you went to Target right now and you went to the toaster section, I'm making this up. And you said, oh, good, look, a toaster. This is exactly what I need. It toasts bread. And you brought it to the front and said, I'd like to buy this toaster, but I would like to know how much is the cord, how much is the button, how much is the heating element, how much is that plastic? And I got a whole list from the Target about that. That would be ridiculous. The person at the target checkout stand would look at me and say, what are you nuts? It's a toaster. It's 20 bucks. But we do that in dentistry every single day. We debundle. We take Dental health and we debundle it and we change it into a list of things all predetermined by codes that the ADA and their wisdom created. We go, oh, you're a 2150 and a 4170. And we literally take the treatment as a veto level list. We present this list to the patient with numbers everywhere on these written treatment plans, which I did away with entirely in every office I've worked with, including my own. Get rid of that crap that comes out of your PMS software, because patients will look at the line, I'll take that one. That's covered. I don't want that one. I'll cross that one out. And we start to debundle care. We make it into a bunch of little procedures in my office. And it didn't always work right. Some people have to take it apart, and sometimes you have to take it apart. For example, you can't restore the implant on the same day you place it. We're going to have to make that into two appointments. I get that, but why? We take apart the mouth into upper and lower or left versus right or quads. I don't get that. If a patient needs eight fillings and two crowns, that's one appointment. That appointment might take all morning. But think about the luxury, doctor. You know that when you see your schedule and let's say your goal is to do $6,000 of the dentistry a day on the Doctor side and you see that you're achieving that goal by lunch on one patient. Isn't that a lot easier than trying to achieve it on 15? But we take all of these cases apart and we do, we inch along. We'll do this, this, and we'll do this. We'll wait till next year because of insurance. Oh, my gosh. The fact that we even suggest that or even condone that makes no sense. I always say that every case is a full mouth rehabilitation. Now, I have a different definition of that than many. Most people think that that means a crown in every tooth and perionortho. No, no, no. In my definition, a full mouth rehabilitation is everything that patient needs to get to health. It might just be a simple cleaning and they're done. That happens a lot. It might be they need that those sealants done. It might mean they need a single tooth fix, but it might mean they need five teeth or 10 teeth or a lot. Regardless of how many, that's one appointment.

Is it safe to say. Is it safe to say that the doctor, when presenting a case, should present a case that has no relationship or. Or I should say the PPO contract that this patient is in, whatever their providers, it has no bearing on the case presentation for the doctor. The doctor is simply presenting what they need for good oral health and to fix the. The stuff, as you call it, in the mouth. And then when it comes to actually addressing PE, PPO or payment plans, that's somebody else.

What do you think about that? I'm going to disagree with that one. I want, first of all, okay, because of time constraints, because I got to get back to the back and do my work, then I might delegate that. That's fine. But a lot of doctors delegate it because they're completely clueless as to how it works or they're uncomfortable talking about money in their own business. That does not make sense. I just had a plumber here the other day at my house to do some work. He came over and he took a look at the problem and he said to me, okay, what we need to do is put a new regulator in. I'll turn off the water to the house. That'll take about an hour or two. It's going to run $750. He didn't say, I need to put a regulator in and I'm going to have you talk to somebody else about what it's going to cost. He's the expert. Just tell me now. Within network PPO we have an amazing.

Narrative that we can use that we Fail to use all the time in dental offices when a patient. If you've decided, doctor, to take in network PPO insurance, you've made that decision, then celebrate your decision to do this. Cast doubt and complaining and moaning and groaning about how the PPO screw me over. That's you screwing you over because you're taking that voluntarily. If you don't want to deal with the ppo, then get out of network. But while you're in the network, and I was, and I don't have a problem with it at all. I know I'm making less per procedure, but we were so effective at bundling, as I was talking about before, and we're so effective at not chopping our day up into a million pieces that we achieved every, every goal. And we, our practice was, I don't know, you know, in today's terms because I stopped clinical practice a few years back. But I don't know anybody that was producing what we were producing. And we were 80% in network PPO, especially Delta, who has terrible, you know, huge write offs. But you're passing up this huge opportunity to tell the patient how great their insurance is. Hey, Wes, I'm so thrilled for you. You see, your total treatment is $6,500. But you have this PPO and I'm so glad that you have Delta because with Delta, your total fee just went from that down to 4,000. That's fantastic. In fact, that's $2,500 savings is probably more than you paid for the insurance premium for the whole year. And you're going to save it in one day. Now they're going to also, and that's guaranteed. Wes, you're going to, no matter what, you're going to have that cost reduction guaranteed. I'm going to take that remaining amount and I'm going to have my office manager over here. She's going to send what's called a claim. A claim is a piece of paper where we write down or electronically these days, put down all the things we did and we request even additional more insurance. Now, your maximum insurance is about thousand dollars or so. You've used up a little bit. I anticipate about 800 bucks coming in addition for. You can't guarantee that, but that's what we're thinking is going to happen approximately. So with your savings of 2500 plus that, you're saving $3300 on this plan. And here's your bottom line. That is a much healthier presentation than your insurance sucks or we start with the Delta Fee. As if that's the fee. No, no, no. We start at ucr. Now in my, in my app, which we haven't talked about yet, I have a thing that replaces the PPO or the practice management software printout from Dentrix or Ecosoft or whatever you're using because that's a mess. Next time you have a treatment plan with 5, 10 items on it, count up how many dollar signs are on that treatment plan. All of them. There's columns of them. Discount, write off, patient portion by the time you're done. I've seen treatment plans with a hundred dollar signs and numbers. That is not understandable. We only need three numbers. Where do we start? What is your amazing savings and what is your portion? That's what people want to know. I want to know the same thing. When I go to the store, I just got a new car two weeks ago. I knew where we started. It was on the sticker, right? Then I know my savings because we have a military discount. We had a couple of discounts. I knew my savings and I knew what the bottom line was. And then I made a decision. Is that acceptable to me? Right. Same thing needs to happen in the dental office. Everybody loves a sale. Let's tell them, congratulations, your everything is on sale. We're having a clearance sale. I've seen people just don't understand how to make a PPO a positive thing. I'll give you one other concrete example, very concrete example, Doctor who. If you're listening or watching this on, and this is not a trick question, okay, On a typical Delta, day to day insurance, normal PPO in network insurance, how many cleanings are covered each calendar year? What's the answer going to be? Now, most of you are going to say. Say it. Most of you are going to say two. That's absolutely false. The first cleaning was $120, but Delta dictated we had to charge only 80, right? That sound about right? And then they covered it 100%. They paid for it. The second cleaning, same deal. What about the third one? Well, they only have. They only pay for two, right? Wrong, because they still started at 120 and they still knocked the fee down to 80. Now in that example, that's a 33% sale.

So if I have four cleanings in a year, the patient will pay 160 bucks. The total was four hundred and eighty. That's a good deal. So the presentation sounds like this. Hey, you know your hygienist Lori determined that you need four cleanings each year because you have so much Staining from coffee or tartar buildup or whatever it is. She's going to see you quarterly from this point forward. Great news. Your insurance kills it on this. The total for all of Those will be $480. I'm making up the numbers here, but it's about right. The total will be $480. Your total will only be 160. That's amazing insurance. It pays for a lot, almost all of it. And that's 160 for the whole year. Now you can add in the X rays and exams and stuff, and it makes it even more exaggerated as to the great deal they're getting. And then what I'll have the patient do is prepay that 160 bucks and schedule all four of them. That's case acceptance, right? So to me, the narrative of the way we explain insurance is the difference. We didn't. We're not lying to them. We're telling the truth. We're framing it differently as a, as a benefit to them. It's insurance benefits as opposed to how much we hate it and how much it sucks for us. Also, when people hear the word write off, Wes, they think that's a good thing. Oh, you got a write off. Congratulations. You don't have to pay taxes. You got that computer. I love when people go, oh, you bought a computer, your office. That's a write off. Like, well, no, we still have to pay for it. People think a write off is a positive thing. So never say that word to a patient that we get that the insurance write off, terrible word. Instead, say, because you're a member of this ppo, you get an excellent discount. Does that make sense? So basically we're changing the, your own mindset to change their mindset as to how much they're getting as to how, as opposed to how much they're giving up.

So two main themes here, one is that I'm taking away. One is how you present the plan and the value and the benefits. Your language matters a lot in how they psychologically interpret or receive what you're presenting to them. That's number one. And number number two is. And I think this one is indispensable if you really want to have a healthy profit margin on a ppo. Practice is you do have to bundle. You have to get more work done per hour, per visit from your patients. Because if you think about not just. It's not just your extra time that goes into it, your front office extra time and the booking of the meetings, your, your assistant who's with you now in both treatments, essentially doubling their time in a way, or adding significant amounts of their time in the way the, the rent costs. You're now using up more, more rent for, for those two treatments that could have been done at one time. I think that has to be highlighted or elevated as one of the most important takeaways from, from this podcast episode is the importance of bundling when you're doing case acceptance. Those are the two, Let me tell.

You, two ways to get to bundling. Two ways that we can get there. Number one, remember that patients if their appointments an hour, for example, that's not. That's an hour out of our schedule. Correct. An hour out of our day. That's not how their day looks. They have to take off probably the whole morning. They might arrange for a babysitter or somebody to watch the dog or somebody to take care of what, Pick up the kids from school. They need to drive to the office. That's a half an hour. Need to have the appointment, drive back, and now they're numb. That's like half their day. So bundling is to your patient's advantage. Secondly, patients will do what you as a doctor suggest. So if the patient has, for example, two fillings here, two fillings here, two fillings here, and two fillings here. If anybody listening to this podcast, and I just pointed at my face, but if you're, if you're listening, I pointed at each quadrant. Two in the upper right, two in the upper left, and so on. If you think that by default that's four appointments, then you're not making that patient's life easier in any way. For make them come four times. You're making their life harder, and you're making your life harder. You're making your life harder. Which is faster, doing eight fillings on one patient or doing eight fillings two at a time? Separate days. If I am one patient, I could be about three quarters of the way done with the upper right, and I numb the upper left, finish the upper right, begin the upper left, numb the lower left, and I could just walk right around the mouth. And this old mindset of, oh, we're not supposed to numb all four quadrants. Tell that to the oral surgeons that are pulling out four wisdom teeth. That's baloney. That's dental school. And it's got to go out the window. Patients, I would rather be, as a patient, have my whole mouth numb. Except in a child. Okay. As an adult, have my whole mouth numb and deal with that for a couple hours, then come four times and have one section numb at a time.

And I would expect, on the financial side of that, I really, really want doctors to understand how costs work in their practice and in their business. And if you do that in four different visits, if you're an, if you're in, if you're an MPPO practice, your margins are significantly less than a fee for service practice. And we're talking a lot about case acceptance here, at least with you, because you were a PPO practice, how to do this well within a PPO practice. Of course, all of this applies any practice as well, on all of them, but particularly on the fee for service. It's just my point that I'm going to try to make is accentuated with the PPO practice, but it applies to a PPO or fee for service or anything in between, which is, let's say your profit margin on doing a.

A crown. Let's say your Profit margin is 20% of whatever the income is. So let's say you're paid $100, you have $800 in costs, you, you net $200 when all is said and done. And that's what sort of you keep as the doctor. If you do it all in one visit, your profit margin may be 40%. So your profit margin is $400. Where if you do it in four different visits, to use your example, if you do it in four different visits, those extra little costs which are adding 10 to 20% because of all of the incidentals around getting them back and in that chair, could cut your profits in half. So that these indirect costs, doctors, you just gotta understand the effect of indirect costs is significant. And that's why the bundling dramatically reduces those indirect costs and could probably, I would just ballpark and say probably increase by 50 to 100%. What is your net profit by getting them to do more of that treatment in one visit rather than, rather than two.

Right. And it's not just the cost in the back, it's the you. If I divide something out to four appointments, one in each quadrant, that's four chances for the patient not to show up or to come late and screw up my day. That's four chances that, you know, depending where you live at bad weather, that's four chances that you, your assistant might not be there that day. There's so or, and that's four times that the front desk has to deal with confirming the patient versus once. So to me, it balloons out as soon as we debundle, as soon as we take that toaster apart. We have to learn to bundle and bundling starts. A treatment plan. Because if we present a line item treatment plan, here's 10 things you need, all written out on separate lines. The feeling is why I, I want one of those right now. I want two of those. But if we as doctors say you need a bunch of stuff to get the mouth back to health, there's a couple things here and there's a couple things there and that needs to be done simultaneously. And there's. There's scientific reasons, too. Example, if I do scaling or if I do scaling in one area and I let the rest of the mouth go and I just blow it off, what's going to happen? Are the bacteria going to go? Well, they had scaling in the upper right, so I'm not going to go back there. As soon as we make the mouth healthier, we make the whole mouth healthier. If I fix one quadrant and leave the other three, guess what's going to happen to that one quadrant? Well, it's going to take more forces. Now the patient has gained in confidence. I'll begin using the new tooth and we'll see if I can break that one. So for me, I don't like ever taking stuff apart ever, unless I scientifically have to, because I have to wait for healing or there's a reason to. I have to wait for that denture wax up to come back from the lab or whatever my reason is. And I'm always looking to get things bundled up with a little bow.

And I would say that there's. Yeah, there's a little bit of communication around that. If they're. Instead of coming in for, let's say, an hour, they're going to need to come in for four hours for this. And. But again, how you phrase that and say, look, this is going to be a little. This can be a longer visit, but you're only going to have to make it once.

Yeah. And I just stay away from any negatives like that even longer. I don't love that one. What I'll say to the patient is, hey, Wes, there's a bunch of stuff going on. We need to get this fixed. We can go over the particulars of this in just a sec. But here's the bottom line. This stuff needs to be fixed. I'm going to go ahead and set aside. Do you prefer morning or afternoon? Morning. Okay, I'm gonna set aside a morning for you. It's just gonna be the two of us. And I'll have my assistant, Three of us will work together, shoulder to shoulder. And by the time you leave here at the end of the morning, you're gonna be all fixed, ready to go back to normal, right? I'm not gonna say it's one hour versus four. See, we think a four hour visit, we're like, oh my God, a four hour visit, that's. People see it like an operation. Oh my gosh, a four hour operation, I can't possibly sustain that. When I had my mcl ACL surgery, I didn't care how long the operation was. I just wanted it done. They didn't say, let's do one ligament today and the other ligament next month. They bundled it and it wasn't an option. Doctor, as soon as you give a patient a path of least resistance, they're going to take it. So say, hey, here's all the treatment. This treatment is to be done all at once. That way I'll be able to match everything up, make it look real good, get your mouth as healthy as I can. That's the proper way to do dentistry, in and out. I'm going to need to set aside a half a day for you, so you need to make whatever arrangements in your life so you can be done. Eat a good breakfast because you're not going to really be eating much for lunch or I've had patients. I'm going to have you set aside the whole day. And do me a favor, bring a couple protein drinks or whatever. We'll have you have something during the middle of the procedure, take a little break. But you're going to come in the morning and leave in the afternoon.

And you know what I think when I hear you talk like that? This is a true doctor. He knows what needs to be done. He's stating it matter of fact. And then what you're doing is of course you're focusing on the benefits coming out of that. And so there's no concept of negativity there. You're just laying it out as a clinician, as a trained, specialized clinician in this area. And then it's, it's almost like the, the automatic answer is expected to be yes. Okay. That's the way, you know, that's the agree. That's what we're going to do.

And can I, can I? If you don't mind, I just want to complete the thought on the five step because this goes right back to it.

Yeah, I wanted to hear four and because I think we got through three.

Review. One is framing the case. You know, do you care, you know, what matters to you? Do you want the teeth healthy. Number two is permission. We talked about that. Number three is detail level. We asked them, what kind of detail do you need? And I usually frame that by saying most patients freak out when they think about dentistry. They think it's gross or scary. Do you want me to give you all the gory details or you want me to just tell you the theme? That. That's the. I want to lead them. It's like the old lawyer doesn't ask a question when they don't already know the answer kind of thing. And sometimes I'll lose on that one. But generally I want to lead them to the answer I want. Now, number three. Number three is going to be. Number three is detail. I'm sorry. Number four is going to be the three most important questions. Now, let me ask you. You're going to know this one because. Because you've been doing this for so long. But what are the three things that are on a patient's mind when they have it? When they're told they need a dental procedure? What. What is on their mind? What three things?

Well, as a consumer of dental services, I will say, number one is, what is the specific treatment I need? That's number one. What. What's wrong? Number two is what's my cost? And I may not be right on these, by the way, Bob, but this is. We're going to find out what. What's the cost going to be? And I would say number three is what is this going to require in my schedule?

Right, absolutely. Those are the three. So boil them down to time cost, and I call the third one pain. Because in wanting to know the procedures, you don't really want to go to dental school. You just want to know, is this going to sideline me? Is it going to hurt? Should I have fear? So what I'll usually do to a patient? Not usually. And by the way, this is not a usually thing. If you're going to change something in your office, it's 100% of the time. You change it for a month, and if it doesn't work, you change it back. Implementation is always the hardest part with dentists because we live in this tiny box where we do the same thing over and over all day. So I'll literally put out three fingers on a go. You know, when I sit here with patients, there's three things that usually on their mind. Number one, how long is this all going to take? Number two, what's this going to run me? I didn't use the word money or cost. I'm Using a euphemism. What's this going to run me? And number three, is this going to hurt? And then I'll ask the patient, is any of these on your mind? Now, you might think, well, duh, they're going to say all three of them. But that is not usually true. It's very funny. It's very interesting. I had a case where I was doing consulting work with an office in Baton Rouge, Louisiana. Big, huge, beautiful office. And I was working with the new office manager on how to do these treatment plans. And we got to this step, and we were talking about it, and she was uncomfortable with the whole thing, and it was new for her. That's fine. And a patient came in, and the doctor came over while we were working on this and said, hey, this patient needs three crowns. 18, 19, 20. And they were a CAD CAM doctors. They do it all in one visit.

So I said to her, name, Paula. And Paula, if you're listening, good talking, is she? I said, hey, why don't you do this one? She said, I'm not ready. I'm not ready for this yet. You do it. I figured, fair enough, I'll do it. Patient doesn't know. I don't work there. Patient came into the office, and I went through step one, two, three, as we discussed. And I got to this step, and I don't remember his name, but I said to him, you know, at this point, most patients are wondering, what's this all? How long is this all going to take? What's this going to run me? And is this going to hurt any of these on your mind? Right? And he says, exactly this. I don't care how much it costs. I don't care if it hurts. I'm a roofer. I'm in town from the hurricanes, and I just need to get it done as soon as possible.

So I called the doctor back in. His name is jt And I said, jt, come on in here. I know we're closed tomorrow. Which was. This was a Thursday. I know we're closed tomorrow. Any way you can come open up the office tomorrow morning early and get these done? He said, absolutely. Why don't I come in at 6? We'll have you done by about 10. You don't have to worry about it anymore. Guy said, that is great. And he literally pulled out his credit card and handed to me.

He.

He had no idea what it was going to cost. So I said to him, well, let me look here. I'm going to charge your card right now for this. It's going to be, I think it was like 5,000 and something dollars. And he just shrugged. He didn't care because he had the money. And then he got in his brand new F350 and drove away. He did. The money was fine. He was making plenty of money being there. What cost him more was not working on a roof. And he wasn't worried about pain because he was kind of a big, burly, tough guy. So he didn't care about that either. He just cared about time. So we ask if patients say time is my concern, we address that. No problem. Time wise, you're going to be here for one morning, you'll be out of here by lunch, or you'll be here for one hour, cost wise. Let me go over that with you now. And that's that, That's a separate thing. And pain wise, oh, you're going to love Dr. Whoever. Dr. Is so gentle. I don't want you to worry about that. If you're completely freaked out, we can put you to sleep. Did you want to talk about that? Right. So to me, when we ask that question, that's step four. And part of step four is cost. And that's a side road that I'm not going to address right now. We may in a minute. And then step five is a, is a call to action. We have to have a call to action. Doctors are so bad about calls to action. They go, okay, we'll see you next time. What they should say is, hey, Wes, this needs to be done within a week. No more. Or let's say it's elective. This can be done whenever you want. We don't want to lie. We want to say this needs to be done in my. I, I always put it into three categories. I said, this needs to be done yesterday instead of saying as soon as possible. Because ASAP is. We hear that all the time. I go, this needs to be done yesterday. But since we can't go back in time, it needs to be done right away. Those are my, those are my words. ASAP is overused. Or this needs to be done within the next couple of weeks. That'll be a tooth that's cracking, maybe some decay, maybe scaling, replaning. Or this can be done whenever you're ready. That's the cosmetic work. Space closure or whatever, orthodontics, whatever. I'm only gonna put in three categories. People don't do well with six categories. So we need to do this asap. We need to do it yesterday. So let's get you on the Schedule right now. And I'll even say to patients, I've sat there in treatment plan or I've come back and do what we call the drive by separate thing. I've sat there or come back to the treatment plan and said, hey, did we get you scheduled yet? No, we're still working on it. Okay. I want to let you know you are not allowed to leave this office without an appointment on the books to get this fixed. I cannot let this go. That's being a doctor. Now, you might think that's being a presumptuous jerk, but if you say it in a very nice, sweet way, like I care about you, which we established earlier in the conversation, they'll understand that you're saying that because you care. I've said that to my own kids. My kids. You cannot leave this house until you X, Y and Z, or you cannot go outside until your homework's done. I didn't say that because I don't like them. I said that because I love them. So I'm teaching the patient, I'm the doctor, and I say, hey, I cannot let you leave the office without getting a schedule. Now they might say, well, too bad. I'm leaving and I don't care. And I don't care if it breaks. Fine. I've learned that's fine. See you later. But I want to at least make the suggestion of how important it is to me that they're healthy. So those are my five steps. Framing, permission, details, concerns, and call to action. If you miss a step, you're going to lose the treatment plan.

And I'm going to put in the show notes those five steps. I'm going to put in the show notes those five steps as well.

I have a PDF on that I'm happy to send. If anybody wants it, they can let you know and I can send it to you. It's kind of a presentation I've done that just details this and outlines it. I'm happy, happy to. All this stuff, I'm. I'm an open book on this stuff. I don't have any proprietary stuff. Ask me whatever you want. Happy to send it to you.

Okay, great. I think, I think one of the things that you just, you just did. Well, I don't know if it's more natural to you or if you deliberately put a lot of emphasis on it, but was. Was communication. Like, none, none, none of this will, Will land well if it's not communicated well. And so, so much of this relates to the communication. Now, technology can help, but I Want to pivot a little bit into technology. You've got a. You, you. You've got an app. I don't know if it's a desktop software or if it's a mobile app. Only tell us about the app, what it does, and how it's sort of tried to make this method that you approach it almost more systematic.

Okay, let me tell you what it doesn't do first. What it doesn't do is replace the human touch. It doesn't replace the moment where we show caring and we are there for the patient. When I say we, I mean myself, my office manager, I can give her a doctor by proxy. For example, her name was Marianne when I worked. And I would say, hey, Wes, listen, I told Marianne everything you need to know. I've got to go see a patient right now. But she's going to talk to you. If you have any questions, she'll come get me. That's a way we can kind of proxy away, like a proxy vote. We got a proxy away our expertise. I wouldn't just have them do it. I'd always go to the treatment plan room and say, she's going to go over it with you. But anyway, the app is something I developed that fits exactly into the way I case I case present I treatment plan. Here's how it fits. The number one thing that takes a lot of time is showing people what's wrong with them. We as dentists constantly trying to tell patients what's wrong with them and have them understand it. And here's a news flash, they don't get it. And as soon as we can help them understand what's wrong and they can see, oh, I get it now. I see what's wrong and I see the consequence if I don't solve this problem. I get it now. Now the value is built. I need to go and get it fixed. Example, doctors showing patients an X ray. This has got to be the number one worst thing you could possibly do with a patient at a treatment plan. They don't get it. If you took that same X ray and printed it out and showed it to a random person on the street. Don't identify. Identify yourself as a dentist and say, here's an X ray, or here's a an item. What is it? They'd look at it and go, I have no idea what this picture is. It looks like toes or mountains or whatever. They don't get it. So what happens is we as dentists start saying things like this, here's an X ray. This white part is the enamel, this gray part is the dentin. And you see this dark triangle? That's your decay. It's coming in. It almost touched the dentin. It's past the dentin enamel junction, so then expands and it goes to this. This other part here, this is the pulp. They don't get it. Now we're in dental school. They decided years ago they didn't want to go and we're wasting our time and breath. So, doctor, next time you put an X ray up, think of this moment when I told you, bad idea, okay? You're wasting your time. Intra photo, maybe, maybe one. If they're not grossed or freaked out as we talked about earlier, I'll put one up and go check it out. I hate when doctors take 18 intra photos ago. Look at this one. Now look at this one. Now look at that one. See, this one is broken. Now check out that one needs a crown. And check out this one. The patient's like, oh, my gosh, I've never seen one of these before. I have no idea if that's the upper, the lower, the left, the right. I don't know. All I feel now is stupid. So I'm going to nod my head so you don't think I'm stupid. And then I'm going to go home and think about it. Because what you did is you gave me 50 things to think about as opposed to a solution. When I had my knee surgery, and this was years ago, but I still remember my doctor, Dr. Cohen, said to me, I need to fix this. You need to get this knee fix. And I'm the man for the job. Let's get it scheduled. You know what I said? Okay, I did say, hold on. I need to know everything about the surgery you're going to do. He didn't even. He would have been glad to show me an X ray. I understand X rays better than your average person. I didn't want it. All I wanted him to do was confidently tell me that he would fix me. And he did do that. So, doctors, you got to stop with these visual tools and then drawing on the bracket table. If you're doing that, if you're drawing pictures of things, forget it. And showing patients a video, another number, another sit in the dental office. If you say, let's watch this video on dental implants, what you've done is you've taken yourself as the doctor expert and you've created a different expert. The person on the video now, the woman or man presenting the video, the voiceover artist or whatever. That's the expert. And you know what? Patients are sick and tired of watching video. It used to be cool back in the days when Casey came out in the 90s. Now I can't go to the gas station without video in my face. It's everywhere. Go to a bar. There's screens everywhere around me and patients have tuned them out. So I created this app in. In 2010 when the iPad.

What's the app called?

It's called DDS GP, so it stands for dental demo suite for the General practitioner. But it's, you know, it's dds, so. And I'm a dmd, so I already have a problem with that. But it's DDS gp. It's an app in the App store. It only runs on iPads and iPhones or you can run on a Mac computer, I guess a newer Mac computer. But I don't recommend that. The app. The app is designed to help patients understand what's wrong with them by showing simple illustrations of problems that you can draw on so we can make it our own. I could say, check out this drawing right here. Here's your problem. And I can circle it. And then I can move a little slidery thing to show the progression of the problem. For example, it shows interproximal decay. It's getting deeper. It's getting deeper. It's getting. Now it's really deep. And I could say, you're about here on this progression. If we wait and go over to here, we don't want to do that because you're going to need major treatment. Let's go ahead and fix it here so it shows diagnoses and treatments of them all. The whole idea is to be. Remember you said about the time issue, how much time are you going to spend? And I kind of dodged the question because doctors spend too much time. I only want to spend 30 seconds or a minute. How do I get it compressed? By having easy visual tools. The patient will understand. Now, the reason it's on an iPad and not on my 60 inch TV is because I want to be shoulder to shoulder. Me and the patient versus the problem. It's us versus the decay. It's us versus the bacteria, us versus the trauma. It's not me. I'm the doctor. Let me teach you. It's. I'm going to work with you. Let me show you what we're going to do. And when I pull out an iPad and I start showing them, we can literally touch shoulder to shoulder because we have that focus. That's why I don't like presenting across a table. I want to sit next to the patient with the iPad and show them it can be done, but it's not the best way. So that it's. It makes it more intimate. It makes it. I care about you. Together, we're going to help solve this. This is what we're going to do. We, we, we. And what that does is allows me to have a consolidated battle against the problem. We're going to go to battle against this problem together. We're on the same side because a lot of patients see it as me versus the dentist. The dentist is the monster. He's going to hurt me, stick noodles in me and take my money. That's a. That's. That's a monster. We want to take that off. And we'd just be like, no, no, no. I'm your ally here. So I can't possibly explain the app without a visual, and I don't have a visual on a podcast. So I just encourage people. If you want to learn more, you can reach out to me or go to our DDSGP website, which is ddsgp.com and learn about the app. The app is available in the App Store now. It's actually undergoing, as we speak, a huge rewrite and increase in functions and features that will be released within the next week or two. It's been in beta now for about four months. Getting. Because it's so much new stuff, including my treatment plan worksheet, which is a replacement for that junk that comes out of the practice management software, where we can literally type in the total, the PPO discounted amount and the PPO anticipated payment on claim, and then it'll literally output. You're saving $2,500. That's 34 off. Like, it literally leads the conversation for you, and the patients can sign it and you can send it to them. That is a financial plan, not a treatment plan. We always say a treatment plan is about money. It's not. A treatment plan is about treatment. And then there's a financial plan that goes with it. So the app creates them both. So it's hard for me to explain it. It's really a fantastic tool that I started using for myself, and I realized how good it was. So we improved it and improved it and started selling it. And then it kind of sold big. We have about 14,000 dentists, believe it or not, around the world using it. It's now in 13 languages. It's in. We've sold in 80 countries. So it's getting to be a big Deal. And it all started with just wanting to say stuff better to my patient. It's simplistic, it's easy to see drawings. It's not, there's no X rays, stuff like that. So long winded. Answer to your question. I encourage people to research it. I'm literally working on it today. I own the company. This is not a one of those that you know, is owned by one of these major companies.

Private equity. Yeah, yeah.

Owned by one of these major distribution companies. I know that those are out there too. It's not AI. What AI does in dentistry right now is it adds color to X rays so patients can be convinced. I don't see. I think that's cool. But just because the decay is now depicted in red, all I did was say, well, as a doctor, I have no idea what I'm doing, so let me press a button so it can do it for me. I, I don't know. I guess there's, there's a lot of advertising about that stuff out there. And it's also very expensive. The app I have is very inexpensive. I believe it's going to change to a subscription model upcoming very soon. But I think it'll be, If I remember, it's 349 a year.

Wow, that's remarkably cheap.

And the name of it again is ddsgp.

Ddsgp.

It's a little more expensive right now, but it's a lifetime right now. So people that get in under the wire, I don't know when this podcast goes out, it might be after the update because Apple is going to subscription models and everybody, they don't want these, you know, buy one models anymore. So it's cheap. I always say that if you do, if you use it for one treatment plan a year, it pays for itself. But I always encourage it's implementation. Right. It's the old, you know, implementation is thing. It's the old £10 trick. We've talked about this before everybody. How many people do you think want to lose 10 pounds?

Most people, a lot.

How many of those know how to lose ten pounds?

I mean, don't eat right.

Well, you know, burn more than you put in or calories or, you know, if you don't have some sort of endocrine problem. I need to exercise or stop eating so much. You know, brownies, whatever it is, they know how. But how many people do it? They don't, they lose it. Behavioral.

Yeah, it's a behavioral issue.

So getting the app, I always are best users and we have metrics on users we have a great group of users that gives us metrics on how they're doing and it's shocking how well they do with this app. The key is using it every time. So in my office it was required. If a hygienist had a treatment plan to talk about with a patient, it was required that she pull out the app. If the office manager was talking about anything with the patient, it was required that she pull out the app. And I required it of myself and doctors. That's the hardest one to require. Look in the mirror and say I'm going to do it. I'm going to do it for a month or two and see if it helps me. So once I implemented and it became natural to always pull it out and it became a normal thing we did, it saved us huge time and it increased our case acceptance. That's where the numbers came from. My office. I was very proud to say that when we sold the office, Wes's group at practice CFO was legitimately shocked at our production on a, on a PPO based practice right here in San Diego. So it was and I was very, very proud of that. And it didn't come from anything other than narratives and you know, showing patients and supplementing our narratives, let's say with that app or other other visuals.

Well, one thing we didn't talk about is really how to align the team communication with patients as they come in. So it's almost one common method or communication approach.

Right.

That's where your technology could come in handy is if the team knows how to use that. It keeps everybody aligned on how they're messaging the value proposition to the patients.

And we have a lot of instructions on how to use it and even some built in narratives in the instructions of that people can learn. The instructions are currently being rewritten, they have to be translated into numerous languages. That's being done right now. They will be up and ready to go within a couple of weeks or probably, I don't know when this podcast airs, but probably concurrent with that. So go ahead and read the instructions. That's available to everybody and I and we have zoom meetings where we have users will call up and go look, I want to learn how to use this better or the contact support. And when we have a group large enough we'll do a little group zoom and help people learn how to use it. But it's pretty self explanatory, it's pretty easy to use. It's designed to be simplistic and easy to use, but it is a very Powerful under the hood. It'll make treatment plans, it'll, it'll do a lot of stuff. That is pretty fancy schmancy. We're in version 10 right now, so we've gone through a bunch of updates and we have version 11, believe it or not, while we're still in beta on 10, we have version 11 already planned. So all this stuff keeps getting added in and the subscribers get those as updates just like they would to any app on your iPhone. People always say to me, well, can I use my, my, my Google or my Android tablet? No, it's on an iPad. Well, I hate Apple. I never quite understood that. But. So, okay, well it's not about you. It's about your patients and your case presentation. So just suck it up and go buy an iPad and install it and use it.

Yep, go drop a grand. Have an iPad. The iPad looks great and professional.

We test all the various iPads to make sure that it tests well on various screen sizes. So we own a group of iPads for our testing purposes. You can get a pretty fancy schmancy iPad these days for like, for less than $500.

Yeah, you, most people tend to have like an old iPad sitting around the house anyways, just grab that, you know, polish it up and go use it. All right, let's take the landing here, Bob. Let's take the landing. Give. Just give our listeners a quick status report with where you are as a practice management consultant. Are you open for business and if so, how do people get in touch with you?

We are by, by, I mean sure people can, can contact me. We're, we work with only a small book of clients at any one time and I used to be national and travel all around the country as you know. And I'm getting old and I have two grandkids and so I've stopped that. So currently it's local clients only. We are in the office local being in San Diego area, anywhere within 100 miles of San Diego. So we get up to Orange county and get down to the border. Anybody who wants to is ready to take their practice at next level and wants an in office practice consultant who is also a dentist. So gets it. I'm your guy. It is a, it's a neat thing I'm doing. We have a very small book. We do not have any openings right now for clients. We're full. But if anybody would like to get on the list clients, usually it's a year program and then we always have somebody finishing and then, and, and the list moves. So I I love doing it, but I love being with my grandkids even more than I love doing consulting. So I'm keeping it small on purpose. And it's done all by me personally. We don't, you know, we don't have. I. I mean, I love Frank Spear and his group, but Frank isn't coming to your office, so it's all done. It's all done by me. And our average increase last. Well, our average increase of practice came to us. It can be expressed on a percent or a number basis. I'll express it on a number basis because some practices are big and some are smaller. Our average Production increase was $430,000 year over year. So that pays my fee several times over. And as you said, once they get above their fixed, fixed margin, they're into their marginal overheads, which runs maybe 20, 25% based depending on labor and credit card fees and materials and stuff. They can probably put. Most of these guys are putting 1 to 10 to $20,000 a month extra in their pocket.

And what's the name of the website? Do you have a website?

So that's just my name. So It's Bob Marcus, DMD dot com.

Got it. Bob Marcus, B O B Marcus. M-A R C U S dot com.

C U S D M D dot com.

Oh, Bob Marcus, DMD. And I'll have that in the show notes as well. Bob, it's been a pleasure. I've always admired what you did as a dental practice owner. And I've admired you also after, you.

Know, what's cool about it. Wes? I got to retire early. That's my favorite thing. My grandkids are little one in three. I'm loving life right now. It's Tuesday afternoon.

Well, let's, yeah, let's help other dentists get there as well through good case. Case presentation. I always say, like the two main areas here, to make money and have good economics. I mean, after all the years of sacrifice and debt and risk that you've taken on, you definitely deserve to have a return on your time and sweat and stress that you've taken on. So, yeah, you should, you should be able to say, I deserve to make some money. And the first challenge is marketing, getting people in the chair. Second challenge is case acceptance. Once they're in the chair, how do you get them to say yes? And if you get people saying yes to bigger bundled treatment, not unbundling, you don't necessarily have to have as many people in the chair to make some really good profit margin in the practice.

Agreed. And your best internal marketing, Wes, are those consults because you're showing a patient you gave a crap about them and then they will go out maybe and tell their friends I never spent a dime on Internet or other other marketing. I marketed by being the doctor. They wanted me to be strong, confident, non egotistical and there for them. That's what they want and they're going to tell their friends if they have a positive experience if you make it. If the parting shot is about money, call me when you're ready. That wasn't a positive endpoint to the to the office, to the visit.

Bob, thanks for being on the Dental Boardroom podcast. We will have you again on for other subjects. Case acceptance is one area that you're sort of specialized in, but there are others I would love to talk with you about, particularly the PPO side and how to, you know, how to really succeed in that. We did talk about some of that today, but we will have you on for more podcasts. So thanks again for joining the show.

Thanks for having me.