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753: Maximize Your Margins: Slash PPO Write-Offs and Skyrocket Your Dental Profits – Dr. Barrett Straub & Miranda Beeson

Do you want to own a practice just for someone else to control it? If not, don't miss this episode! Kirk Behrendt brings in Dr. Barrett Straub, ACT’s CEO, and Miranda Beeson, ACT’s director of education, with a treatment plan to get you out of the thumbs of insurance so you can achieve financial freedom and personal fulfillment. With careful, strategic planning you can start removing some — or all — PPOs and reshape your future! To learn the steps to a better practice and a better life, listen to Episode 753 of The Best Practices Show!

Learn More About Dr. Straub & Miranda:

Learn More About ACT Dental:

More Helpful Links for a Better Practice & a Better Life:

Episode Resources:

Main Takeaways:

  • Whether you're looking to drop PPOs or not, try out ACT’s PPO Roadmap.
  • Insurance isn't what's killing your practice — but they will if you let them.
  • You don't need to become anti-insurance to achieve financial freedom.
  • Don't start indiscriminately dropping PPOs. Plan and be strategic.
  • Clearly define what growth means for you and your practice.
  • There isn't a singular path to reach financial independence.
  • Know which data points to track to start slashing write-offs.
  • Follow the 12 steps to align and strategize with your team.

Quotes:

“If you're writing off 33%, generally speaking, that means you're working one out of every three days for free. Let me better frame that. That means you're going to work all of 2024, and you're not going to collect a penny until May 1st.” (11:40—11:58) -Kirk

“Insurance independence means that you have enough patients willing to pay you 100% of your fees. If you dropped all of your insurance plans tomorrow, hypothetically, you'd still have enough patients choosing your dentistry to pay your bills. Insurances are not killing your practice. They will if you let it. Ultimately, as a business owner, you’ve got to have people that are willing to pay your full fee. Now, you may start at 0%. But let's get to 10%, then 15%, then 30%. Once you get to 70% or 80% of your patient base paying your full fee, now you're on your way. And now, when things change, you're like, ‘Meh, I know insurance has changed in my state. It doesn't affect us or my patients.’ For some dentists, this will mean that you're going to have to fully transition to fee-for-service or out-of-network. That's not what we're suggesting — it's just for some. For others, it will mean ending some agreements.” (14:11—15:10) -Kirk

“You are in full control of your own destiny. I know there are changes out there. I know you bought a practice, and that's the way they've always done it. But nobody writes your story — you write your story. The coolest thing about this profession is you get to write the whole story, and stories change. They get better every month. They have new chapters. They have cool things along the way. So, don't feel like you're stuck.” (15:56—16:19) -Kirk

“If 90% of your patients are in-network that you're contracted with, you have very little control over the future of your own fee schedule and your own profitability. You are beholden to the decisions of the insurance company. So, we're not even making a judgment statement on the quality of the insurance. We're just making a statement of, ‘I own this dental practice so that I can control my freedom.’ And yet, if 90%, 100% of my patients are in-network, I have zero control of the profitability because the profitability is controlled by the insurance. I have control over my operations. I have control over some of the expenditures I make. I have control over how I do dentistry. But I have very little control over profitability. So, when we think about insurance independence as a business owner, I like the idea of insurance independence as, I have enough patients paying 100% that despite what decisions the insurance company makes, I still have some control over my profit margin.” (16:29—17:37) -Dr. Straub

“We're not pushing you to go all out-of-network, or, ‘You’ve got to do this,’ or, ‘Everyone's doing it. You’ve got to do it.’ There's no peer pressure here. We're going to help you think a little differently so that you can say, ‘I own this practice. I want to control my financial future for the next 10, 20, 30, 40 years.’ In order to do that, I've got to manage my profit margin, and a large part of that is my exposure to insurance. So, I at least need to track it, monitor it, and mitigate it so that I never find myself where it's like, ‘Boy, what happened? I didn't know.’” (18:36—19:11) -Dr. Straub

“I believe dentistry is the greatest profession in the world. Period, exclamation point. It's just so cool. You can choose everything. You can practice dentistry any way you want, where you want, with who you want. You can choose your patients. Nobody chooses your patients. You choose your patients. It's the greatest profession because of the freedom it [gives] us. PPO participation threatens that freedom. It's like working for somebody else. You own a business, but you don't really own it. The insurance company owns it. You have somebody that works at the front, but they actually work for the insurance company, but you pay their salary. And I want you to hear this. We are not anti-insurance. We are pro-dentists.” (21:34—22:21) -Kirk

“We have to believe that money spent on dentistry is one of the best investments a human being can make. That's another thing I want you to think about as a team. Now, I believe that. I wonder if your team believes that. And that's a big part of education. We've got to keep working with our team to make sure we think that. We can't think like, ‘Dentistry is expensive. Nobody wants to be here.’” (22:44— 23:03) -Kirk

“The why of joining us in the BPA as a member for $99 a month is this PPO Roadmap is going to save you hundreds of thousands of dollars over the course of the next few years — and maybe more — in your career. And it's all right there. Now, the why of the Roadmap is because the idea of going off of a PPO or more than one PPO is scary. The fear comes from the unknown, and the unknown comes from the complexity. And actually, it's pretty simple. It's not easy though.” (33:22—34:12) -Dr. Straub

“You, as a business owner, need to see your business clearly, and you need to see the reality clearly so that your decision to or not to go off of PPOs is an educated one. And so, we know when we reduce our insurance independence, less of our patients have a financial incentive to be our patient. Therefore, our business has to be better. So, our operational systems need to be strong. We need to know what our overhead is. We need to understand where our new patients are coming from. We need to understand how we get to our gross production. Do we do a lot of dentistry on a small amount of patients, or a little bit of dentistry on a lot? We need to know these things before we just call up X, Y, Z insurance and say, ‘I'm done.’” (34:20—35:12) -Dr. Straub

“Everybody thinks they get 100% of their patients [for hygiene reappointment]. Nobody gets 100% of their patients. You're rushed, you forgot. My favorite story around this is I challenged a hygienist in Colorado. She's like, ‘I get 100%.’ I'm like, ‘No, you don't.’ I actually looked at it, and she missed two patients the previous day. She said, ‘Oh, that's Mrs. so-and-so. She's friends with the doctor.’ I'm like, ‘Okay. Why wasn't she scheduled?’ ‘Well, she's good. Who's the next one?’ And then, I went to the next one. She's like, ‘Oh my gosh, that's one of our best patients.’ Well, she was describing what happens in every office, in every operatory, with every provider, every day. Those two people go off into the universe. By knowing this number and tracking this number, it gets better. That's the important piece of it. It's a great health indicator to show you if we're ready to make the next move.” (37:32—38:22) -Kirk

“Identify your target insurance plans to remove from your practice. You're going to do that from your Segment Scorecards. Again, here's my challenge to anybody watching this. If you do the scorecards and you don't know which one to do, call me or call one of my team. We'll instantly start asking you questions, and in 10 minutes we'll both know which one you need to target first. Then, we're going to set a target date. Now, here's what's cool. We're planning. We're planning way in the future. You're not just doing this on a whim, starting it on Monday, or next month. We're going to set a target date to drop the plan. Then, we're going to proactively communicate with people instead of just mailing a letter to all these people. Our best advice is six to 12 months. Now, it gives you ample time to inform your patients on the why. It's also to recare schedules. You can actually sit down with somebody and say to a patient, ‘Mrs. Jones, some changes are coming ahead, and I wanted to be knee-to-knee with you to describe this,’ and you can follow up with something written.” (42:25—43:30) -Kirk

“Every insurance plan will have a window in which it takes to be out-of-network. So, you might decide, ‘I want to drop Delta.’ Well, that doesn't mean as soon as you send a letter, starting the first day of the next month after they get it, you're out-of-network. For every plan, it's a different window of time — 30 days, 60 days, 90 days, whatever that may be. So, it's also very important to make sure you do it so that your team can be prepared and have those conversations, for sure, but also that little caveat of knowing the contract details to know what window of time you'll have before you can officially be out of that contract based on what the agreement was when you signed up with them to begin with.” (43:36—44:14) -Miranda

“One of the steps in the Roadmap is read your contract. People always say, ‘What contract?’ I'm like, ‘Well, you signed something.’ It was so funny. I actually saw one, and it had plastic on it. The dentist had never opened it up. Didn't even know he signed it. I'm like, ‘Okay.’ So, somebody's got to go back and read the contract because of what Miranda said. There are particular details that have to be followed in that whole process.” (44:22—44:48) -Kirk

“Get everybody together. Get them on the same page and strategize with your team to develop a successful transition. You have to overcommunicate because if you just do this because you saw a webinar and some bald guy told you to do it, all of your team members are going to be like, ‘Well, he or she just wants to make more money,’ type of a thing. They’ve got to know the why and the steps. Get everybody involved because they're going to be your best ally.” (45:03—45:27) -Kirk

“What do we believe about this change? Now, this is a big one because I'm going to tell you right now, you've got two team members on your team, and you've been slamming one of the PPOs you participate in, and you're like, ‘We're going to get rid of this one,’ and one of the team members is thinking, ‘My mom is on that. She's not going to be able to come here.’ And it's not about that. So, we've got to get together and get aligned on the beliefs around this. Why are we doing this? Is it good for the practice? Is it good for the patient? What's the real motivation behind them? If they watch this webinar and look at some of the segments and understand this whole process, we'll start to believe the same thing.” (45:30—46:10) -Kirk

“We've also got to get on the same page about how we're going to explain it to the patients. Team members are terrified that you're just telling them, ‘We're going to drop [this insurance]. Let [patients] know.’ No — it's got to be done carefully, empathetically, and then followed up with written communication.” (46:11—46:26) -Kirk

“We've all got to be using the same words. We're big fans of verbal skills. What verbiage do we need to use? We have a great resource in the BPA. It's Say This, Not That. It's our highest download of all time. It's things that are said in a dental office and some ways to say it differently. And, as you can see, there's a column for your office to say, ‘No, we're going to say it this way,’ because we always want to give you a little bit of freedom — or a lot of freedom — to do it your way. This is great for existing team members, new team members coming into your team. How do we say things? Verbal skills matter. They create a lot of value, and I want to be extremely aligned on a dental team in how we communicate. So, make sure you put something like that together.” (46:32—47:20) -Kirk

“Align with your team. Go slow. How are we going to deliver this? Are we going to talk to them first, then give them the letter? Is there an email included? I'm a little biased on this. I always like a little face-to-face before the written communication because people don't read written communication — they skim it. So, you've got to be very careful in how that's communicated. And once you do it once, you're going to do it a second time, and a third time. You're going to go, ‘Well, we've already done this. We know how to do it.’” (47:23—47:51) -Kirk

“Ensure all communication clarifies that you can still be their dentist. Just because you don't participate or you're moving away from participation doesn't mean you can't be their dentist. You have to say it over, and over, and over, ‘You can still come here,’ because they're going to be bombarded with information from the insurance company saying you can't go there, and you've got to be the myth buster here saying, ‘We still want to see you. It's going to work a little bit differently, but we still want you to come back.’” (47:53—48:25) -Kirk

“Continue to drop your worst-performing PPO plans over time. The cool thing about the Roadmap is once you go through it, then you go through it again. Rinse and repeat. Then, you go through it again. Then, you go through it again. If you go through it four times in four years, you'll say, ‘Wow, we don't have those problems anymore.’ Your practice will get better. We're big fans of not making everything perfect right away, just incremental improvements. Every quarter, our write-offs are becoming less. Our margins increase. We just feel better.” (48:26—48:59) -Kirk

“Many practices may decide to keep one or two [PPOs]. The beauty of practice ownership is that you get to decide. There are some people we still coach that are like, ‘No, I can't get rid of that.’ But the cool thing is they can make it less of their practice. It doesn't have to dominate their schedule day in and day out.” (49:01—49:17) -Kirk

“When we do this step-by-step, in the right order, at the right time, in the right sequence, things go well. And what makes or break success is not when you communicate with your patients — all that is important. It is truly your team, the mindset, the confidence, and knowing what to say when you get those hard questions.” (49:43—50:19) -Dr. Straub

“Really getting your team on board with why you're doing it, the value of your dentistry, and some training on the front end of, ‘When proposed with this question, you might say this,’ that's when people are successful with this. Not, success looks like, ‘Hey, I dropped X, Y, Z insurance. We're starting in three months. Let's go, team.’ That's always a recipe for disaster. So, there is a very proven way to do this, and that's what we're presenting to you.” (51:22—51:53) -Dr. Straub

“People are more unhappy than ever, I think, in some respects. And again, it's not dentistry, it's how they're doing it. I wouldn't be happy doing that, racing from operatory to operatory. You can get the passion back and reduce the burnout rather than being controlled by PPOs and write-offs and working for free. Working for free is not fun. This is too hard of work to work for free.” (52:36—53:00) -Kirk

“Insurance independence isn't about being anti-insurance. I can't say that enough. It's about prioritizing quality care and patient satisfaction. That's what this is all about. You're going to start to pick patients that believe the same things that you do and that value what you do, and you're giving them priority seating in your practice week over week, month over month. And after a couple of years, you're like, ‘Wow, this is great. I have people that appreciate what we're doing here, and they're happy to pay for that.’” (53:02—53:29) -Kirk

“When you talk to your patients and you say that they've just become an HMO, a lot of rational patients will understand. Like, ‘I no longer can afford to give the quality of care that I personally demand in this insurance because of the restrictions they place. If I continue, the quality of my care has to diminish for my business to stay open, and I'm not okay with that.’ A lot of people get that. Some may still leave. But at some point, you as a human being have to look in the mirror and say, ‘I can't keep going on this.’ And the more authentic in explaining that to a patient, a lot of patients will stay and will understand that, or at least appreciate why you're doing it and it's not just a money-grab, it's actually a stay-in-business, stay-psychologically-sane grab.” (55:08—56:14) -Dr. Straub

“You have to differentiate yourself in a way where you're doing something different, better, more, and you believe in it in a way that, ‘Okay, they don't provide out-of-network benefits.’ ‘We interact and engage with any insurance that will play with us. We'll play with anyone that will play with us. And what they're saying is they won't. So, we're happy to, but that DPPO that you have is saying that they won't. We're still going to provide you with the same level of care. We're still going to be taking exceptional care of you. We're going to have the same relationship we've always had. Just, sadly, your insurance is saying that they won't contribute if you stay with us. Now, that doesn't mean that you can't stay here. Let's talk about ways that other patients with plans just like the one that you have have had success here,’ so that they know like, ‘Oh, I can still stay. Other people have done it. It's possible. It's not unheard of to be somewhere that doesn't have benefits from my insurance plan.’ And maybe that's someone who decides to transition to a membership plan that you have in your practice because they're not receiving benefit, but they don't want to leave you. So, I look at that as, it's not a no. It’s not, they're going to be gone forever. It's really about how you handle it. And in the end, it's about the team being aligned on how we communicate with those patients over the phone, in person, or whatever it may be.” (56:46—58:01) -Miranda

“It costs $4 million to be a dentist, most experts will say. The investment in dental school, undergraduate, postgraduate, you lost wages to buy a practice — by the time it's all said and done, you kept all your receipts, it's a lot of money. Game on. Get a coach. Get a coach and go, ‘I want to do it this way,’ and navigate to the place that you want to go. It's not that expensive, comparatively speaking. Or you can just keep plugging along.” (59:09—59:36) -Kirk

“If you're going to play in that game, or if you're going to stay in the insurance game for the rest of your career, yeah, go for it. Negotiate some fees. If you're not, take that money, time, and energy and put it towards this Roadmap and move to get out. Drop a few of your worst PPOs. Your profit margin will benefit more from doing that than negotiating fees.” (1:00:08—1:00:30) -Dr. Straub

“There is a man in the mirror, woman in the mirror moment. We've got to look and say, ‘Am I good enough that a patient would come to me versus the three other dentists down the street?’ If the answer is no, that stinks. And dentistry is wonderful because we can change that answer very quickly. There's so much CE, clinically, to skill up. There's so much CE we offer on — you just heard, Miranda is like the verbiage queen. There's so much CE we can offer on how to be better at customer service, how to use the right words, how to operationally set up your practice so at a new patient experience, you're set aside, and you're differentiated. And so, if you can't look in the mirror and say like, ‘Yeah, I'm pretty darn good,’ then we've got some work to do before we drop all the big [PPOs].” (1:02:09—1:03:08) -Dr. Straub

“More so than you doing really great crowns with beautiful crown margins — which is very important — how someone feels when they leave your office is really going to be what helps them to decide if they're going to stay with you through a change like this. If someone feels like, ‘This is where I belong. This is my dental home. These people get me. I'm comfortable here. They listen to me. I have ease of use. They know me by name. I don't have issues with my dentistry. My hygienist is excellent. She gives me the most thorough, comprehensive care of anywhere I've ever been, and she knows my kids' names,’ when someone feels like they're a part of something and you create an experience for them like that . . . Sometimes, people do leave because they don't know any better. Then, they go down the road, and they come back because you made them feel differently because you're purposefully creating an experience every single time someone walks through the door because you know you have to set yourself apart and you want to be something more and something different.” (1:03:45—1:04:51) -Miranda

“There's going to be a 22-operatory practice built not too far from your office, and they're going to take every insurance under the sun. They're going to be open Saturdays and Sundays. They're going to have pediatric dentistry, and all that stuff. They're going to find it cheaper over there. When that happens, you’ve got to go, ‘Knock yourself out. That's awesome. You guys work Saturdays and Sundays and evenings. I've got my patients. I'm good at what I do.’” (1:04:59—1:05:24) -Kirk

“It feels really fulfilling and rewarding to work somewhere where you feel like you're making people feel something special, that you're not just checking a box, you're not just showing up, you're not just — I was a hygienist — picking teeth. Like, you're doing something different. You're creating change and experience for people. It feels really good to be somebody who works on a team like that, for sure. Not only are you going to keep your patients, you're going to keep your team.” (1:05:37—1:06:01) -Miranda

“Most of my patients have a financial incentive to be with me if I'm in-network, and I have this smaller segment that has no financial incentive. Those are the people that pay me 100%. If I'm really busy and I'm booked out, and Barrett has no financial incentive and he calls me, and, ‘I want to come to you to be my dentist,’ and I tell him it's going to be nine weeks before I can see you for a new patient exam, if I'm the patient, I'm going elsewhere because I'm impatient. I was motivated and I called. Nine weeks? If you tell me that and I'm going to pay out-of-pocket, I'm going to go elsewhere. So, if you want to increase that percentage of people that pay you 100% without even going out of network, make it easy. You said it really nicely before. Make it easy to do business with these people that are going to pay you. Set up blocks for those people and get them in within seven days, and you will keep them.” (1:06:38—1:07:39) -Dr. Straub

“Yes, you are required by law to treat everybody with the same dignity and respect. But they also don't all have to go in the same line. That's why when you go to the airport, you get into one line that's different than the other line. In my pocket — actually, I don't have it. Laura has it — I have an American Express Platinum card. I'm not allowed to have it anymore because I like things. But what's really cool is if you call the American Express Platinum line, your ring is in one ring. One ring, they pick it up. Here's my point. They know how to seat people in their businesses.” (1:07:47—1:08:23) -Kirk

“I actually learned this from the amazing Miranda, and you can see all this back in BPA. Miranda teaches all of the admin teams that we coach across the country, name number, knowledge. Now, I think that's brilliant. You want to get people's names, you want to gather their number, not because you're going to get disconnected but because you want to start accumulating information. And then, you want to gather some knowledge about why they're calling. Somebody who's just looking for a quick-fix PPO, ‘I just need somebody on my plan,’ it's going to tell you everything right away and you can seat them accordingly. Some people are going to go, ‘My periodontist that I just met says you're the only person in town that can do this, and I want to get it done right.’ That's really good knowledge. Now, as a team member, I know where to seat them. If your team is not equipped with name, number, knowledge, they're just putting patients in the schedule because they know your head's going to spin around and fly off if you don't keep pummeling patients into the schedule. You have to be strategic about where these people go.” (1:08:28—1:09:24) -Kirk

“Being in private practice for 20-plus years and coaching teams, I hear teams go right to the, ‘When was your last visit? When did you have your last X-rays? What is your insurance plan?’ right off the jump. ‘Hi, I'm Miranda. How can I help you? When was your last dental cleaning?’ There is so much more important information that we want and need to know from patients before we get to that step.” (1:09:39—1:10:02) -Miranda

“First of all, you’ve got to decide what growth really means. Growth, for me, means my life is getting better, care is getting better, my schedule is getting better, and profits are getting better. My life is getting better. Growth, for me, does not mean production went from $4.6 million to $6.4 million. That is not growth for me. So, what does growth mean? That's the first step, and having a good coach or somebody go, ‘Listen, that's not growth.’ Growth, for me, is going from 220 days a year to 182 days a year and making more money. Growth, for me, is working five days a week, then going to four days a week and making more money and having more time. Growth, for me, is we used to work 8:00 to 5:00. Now, we work 7:00 to 3:00, and I get to watch my kids, and I get to coach their soccer. So, that's growth. I think that's the big thing. And growth is sexy to talk about. It's on every webinar. It's everywhere. I like growing. I want to grow as a business. But we've got to grow the right way, in a way that I go, ‘I like this,’ and it's not taking more of my life. Better practice, better life.” (1:12:23—1:13:27) -Kirk

“If you're super unsure if you ever want to drop PPOs, or you're sure you do, and everywhere in between, the PPO Roadmap will help lots of people. Even if you never drop a PPO, it's going to help you do a lot of these things. And if nothing else, it'll allow you to understand your business at a much higher level.” (1:14:37—1:14:57) -Dr. Straub

Snippets:

0:00 Introduction.

6:53 About ACT’s TTT, BPA, and Pro Coaching.

10:26 Why this is an important topic.

12:15 Objectives.

13:52 Insurance independence, explained.

21:22 Improve your thinking and mindset about dentistry.

23:04 Figure out your overhead percentage.

25:26 Figure out your capacity.

26:59 Figure out your new patient referral sources.

28:22 Figure your new patient hygiene re-appointment percentage.

29:53 Figure out your annual patient value.

31:53 Figure out your unscheduled active patients.

33:14 Why you need to join the BPA.

36:50 Figure out your hygiene reappointment percentage.

38:23 Figure out which segment your patients belong to.

40:53 Rank and identify the PPOs you want to remove.

43:30 Read your contracts!

44:48 The 12 important steps to align and strategize with your team.

52:17 Final thoughts.

54:07 Q&A: Navigating plans not allowing out-of-network benefits.

58:02 Q&A: Advice for negotiating fees.

1:02:00 Q&A: Differentiate yourself before dropping bigger PPOs.

1:06:02 Q&A: Advice for limiting PPOs in your schedule.

1:08:25 Name, number, knowledge.

1:11:55 Q&A: How do you juggle growth during this process?

1:14:22 Try the PPO Roadmap today!

Dr. Barrett Straub Bio:

Dr. Barrett Straub practices general and sedation dentistry in Port Washington, Wisconsin. He has worked hard to develop his practice into a top-performing, fee-for-service practice that focuses on improving the lives of patients through dentistry.

A graduate of Marquette Dental School, Dr. Straub’s advanced training and CE includes work at the Spear Institute, LVI, DOCS, and as a member of the Milwaukee Study Club. He is a past member of the Wisconsin Dental Association Board of Trustees and was awarded the Marquette Dental School 2017 Young Alumnus of the Year. As a former ACT coaching client that experienced first-hand the transformation that coaching can provide, he is passionate about helping other dentists create the practice they’ve always wanted.

Dr. Straub loves to hunt, golf, and spend winter on the ice, curling. He is married to Katie, with two daughters, Abby and Elizabeth.

Miranda Beeson, MS, BSDH Bio:

Miranda Beeson, MS, BSDH, has over 25 years of clinical dental hygiene, front office, practice administration, and speaking experience. She is enthusiastic about communication and loves helping others find the power that words can bring to their patient interactions and practice dynamics. As a Lead Practice Coach, she is driven to create opportunities to find value in experiences and cultivate new approaches.

Miranda graduated from Old Dominion University, and enjoys spending time with her husband, Chuck, and her children, Trent, Mallory, and Cassidy. Family time is the best time, and is often spent on a golf course, a volleyball court, or spending the day boating at the beach.
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