Podcast (Dental)

How Reopening Can Affect Your Dental Hygiene Schedule

August 5, 2020

In this episode of The Art of Dental Finance and Management podcast, Art speaks to one of the top dental management consultants in the country, JoAnne Tanner of Tanner Management.

Joanne and Art discuss how hygiene schedules in the first month or two after the reopening of dental offices have been strong. However, there are many offices that will experience a significant drop in their hygiene schedules in the last quarter of 2020. This fallout could cause more problems for office profitability, and JoAnne shares tips on how to rectify this by taking decisive action for your dental office now.

JoAnne and Art also discuss:

  • Their favorite dental metrics they use when consulting with dentists
  • Why implementing key verbal skills with patients is good for business
  • Communicating case presentation to the doctor and team
  • Tips for management of a successful dental practice
  • Items to consider when buying a dental practice


Art is here to answer any question you may have on this topic or anything related to dental finance and management. He can be reached at awiederman@eidebailly.com or 657.279.3243. More information about the Eide Bailly dental team can be found at www.eidebailly.com/dentist.

What Business Areas to Focus on in your Dental Practice
How do you stay on track and help your practice live up to its potential? What is important to focus on as your practice reopens after the stay-at-home orders caused by COVID-19? Here are some of the critical business areas you can focus on to help you reach your goals.

JoAnne Tanner, MBA
Tanner Management
(916) 791-2720


Show Notes and Resources

The Transcript

Art Wiederman, CPA: And hello, everyone, and welcome to another edition of The Art of Dental Finance and Management with Art Wiederman, CPA. Welcome to my podcast. I'm Art Wiederman. I'm a dental CPA located in Southern California. Our office in the city of Tustin, about 15 minutes, probably 10 minutes from Disneyland. I always maybe if there's traffic, it's 15 minutes. I am a dental director at the CPA firm of Eide Bailly. I've shared with you that we merged our CPA firm about two weeks ago and I'm very, very excited about our merger. You will meet some of my friends from Eide Bailly in the coming weeks and months.

And today I have a special treat. Another one of my long-term friends in the dental profession. One of the best dental coaches you're ever going to meet, JoAnne Tanner. JoAnne is a dental coach out of Sacramento, California. And we're going to talk about a couple of specific things that are passionate to JoAnne. We're going to talk about the hygiene schedule after coming back from the pandemic in the fall and some of the pitfalls that you might be recognizing. We're going to talk about JoAnne also does a lot of work in helping doctors buy practices and due diligence. And she, like I, are passionate about metrics in a practice and how do they work and how do we use them to help our clients? So we'll get to JoAnne in a couple of minutes. And you'll love to hear her information. She's one of the best presenters that I've met and she's got a lot of great information. So we'll get to her in a second.

If you want to get a hold of me in my office in Tustin, which is now my home office in South Orange County, California, I'm at 657.279.3243 . Send me an email at ArtWiederman@gmail.com. If you have a question, or a concern, or a complaint, or a good joke, anything, I'll take anything at this point in life. If you are looking for our partner Decisions in Dentistry, they have a wonderful, wonderful array of articles and continuing education. So I wanted to just kind of go over a couple of their CE courses, just the type of courses they have:

  • Dental Handpiece Care and Processing
  • Demystifying Desquamitive Gingivitis: Diagnosis and Management
  • Treatment of Peri-implant Diseases
  • Diagnosis, Management and Prevention of Dental Hypersensitivity
  • Implant Treatment Planning for Hybrid Prostheses
  • Oral Healthcare with Patients with Schizophrenia.

I got most of the words right. I do numbers, folks. I don't do letters as well. But Decisions in Dentistry magazine is the premiere clinical magazine in the country as far as I'm concerned and go. You can see all of our podcasts on www.decisionsindentistry.com. Go to our website www.eidebailly.com. One of the things we're going to be talking about in the future here, sooner rather than later, is how we can help get you guys what's called a research and development tax credit. These are new provisions that have come into the law and the firm that I've merged with has a whole group that does this. We just got a client over four hundred thousand dollars in tax credits; it's really exciting. My job is, folks, as I've told you all along, to run up the federal deficit as quickly as I possibly can.

And again, if you're looking for a dental specific CPA anywhere in the country, we've got you covered. www.ADCPA.org. Is the Academy of Dental CPAs 24 CPA firms across the United States that represent over 5,000 sorry, over 9,000 approaching 10,000 dentists. So if you're not working with a dental CPA, you should be. Let me just take a minute and tell you where we are in all of the fun in Washington. I've been very closely staying in contact with Megan Mortimer, who's the congressional lobbyist with the A.D.A. The Republicans and the Democrats are just not making a whole lot of headway. Megan tells me that they are going to be probably there till either the end of next week or possibly longer. But they all want to get out of town for recess. They want to start planning for reelection and campaigning. And so they do have a small problem because the six hundred dollar stipend for unemployment runs out today July 31st, and they are nowhere near an agreement.

Some of the things that are in process are that if you have a PPP loan that's less than 150,000 dollars. We're hoping that this is going to pass into law, that you will be able to just go ahead and sign a one-page attestation and get full forgiveness and be done with it. That is a proposal.

There's a proposal for people who have between 150,000 and two million dollars in PPP loans to do a little bit less work, which would be just fine with me. There is also a proposal out there that if you have a reduction of more than 50 percent in your revenues from Q2 of 2020 to Q2 2019, which for dental offices is a very real possibility. There could be another bunch of PPP loans that would become available for you. And if that's the case, I'm going to go find an island in the Maldives and put my head in the sand because the PPP h-e-l-l will start all over again. And there's also provisions for tax credits for PPE equipment. So just stay tuned to this podcast. We will have the most updated information for you that we possibly can.

All right. I want to get to my good friend and my guest for the for the hour today is JoAnne Tanner. I've known JoAnne for over 30 years. JoAnne and I worked together on a couple of clients, one in particular, a large specialty practice that we talk about all the time. I want to read you a quote from JoAnne's website. JoAnne's quote is, quote, "My greatest joy comes in making heroes out of others. Those who have a dream are willing to do the hard work and want to give their talents and smile to their patients who need professional and personal excellence in the area of dental care." JoAnne has been a dental coach for over 30 years. She basically got her undergrad at Cal State Hayward. She has an MBA with an emphasis in strategic planning from Sacramento State, and she spent five years in active duty as a dental technician in the U.S. Navy, which means, JoAnne, since you have an MBA. You're way too smart to be on my podcast. But welcome to the Art of Dental Finance and Management.

JoAnne Tanner, MBA: Good morning and thank you, Art, for having me. And a special thank you for all that you've done for dentists during this craziness. The dental CPAs have truly been our version of the first responders. You've been there to walk us through all the way, learning all the different acronyms from EIDL, PPP, PPE and you name it. So, again, thank you for your support. And that must have been the longest tax season in history that you've experienced.

Art Wiederman, CPA: You know, you're very sweet and very kind, and you just made my day with that comment. I very much appreciate it. Folks, we did not rehearse this before we went on live. But yeah, we do feel like we've been the first financial responders. Obviously, we couldn't hold a candle to the people working in the E.R.s and the ICUs in the hospitals and the critical care units who are dealing with this horrible virus. I mean, I would never represent to hold a candle to what they do. But, yeah, the dental CPAs have really stepped up and we've had to because there's nobody else that's going to be able to help. And it's kind of part of my legacy is at the end of the day, I know ... JoAnne, I was listening to somebody talking about, you know, well have you given money to charity? And yeah, I've given some money to charity on the for the COVID-19. But what have you, you know, what have you done to help people? And I feel like this is what we've done. And you've also been out there helping your clients, too. So let's start. Tell us a little bit about your journey.

JoAnne Tanner, MBA: Oh, absolutely. When I got out of the Navy, I decided I enjoyed business and marketing. So I was living in the Bay Area after my duty station there in Oakland. And by the way, prior to Oakland, I had the pleasure of working at the Navy hospital in Naples, Italy,.

Art Wiederman, CPA: What a horrible place to work.

JoAnne Tanner, MBA: It was delightful.

Art Wiederman, CPA: Did they give you like a free glass of wine with every shift you did?

JoAnne Tanner, MBA: Exactly. Except when I came to California, I was only 20 years old and not old enough to enjoy a glass of wine in California. But we'll save that for another podcast.

Art Wiederman, CPA: That's right. Exactly.

JoAnne Tanner, MBA: So I decided, although I was trained as an on-the-job dental hygienist, I did get my RDA. But when I started studying business and marketing, I felt my passion. So when I moved up here to Sacramento, I finally finished my MBA and that's when I started coaching dental teams nationally in the early 90s. And that's when I first met you. And unlike some coaches, I truly have an understanding of the back office. I really know my way around the front. Dentistry is my love and my passion. My younger son's a dentist. So I guess you could say I produced a dentist. That's right. It's in my blood. I actually guest lecture at some of the dental schools. And Art, you'll appreciate this - my opening line is, "your professors don't want you to hear what I'm about to tell you."

Art Wiederman, CPA: This is the real world.

JoAnne Tanner, MBA: "The dentistry is going to become the easier part of your day. It's not going to be about margins. Wait, it is. It's just a different kind of margin you haven't learned about yet."

Art Wiederman, CPA” That's right. They didn't go to school to learn business. And many times, in dental school, you and I are sometimes the only people with a business background that they get to hear other than their professors talking about occlusions and margins and TMJ.

JoAnne Tanner, MBA: Right. So I appreciate that opportunity. So what we want to talk about today is being proactive within the practice. We are very fortunate that most offices have reopened and many had a record June. Many of our clients are still seeing that pent up demand and high production for July. So doctors, office administrators, scheduling coordinators, I want you to look forward in your September schedule. All of October is very light. Remember, we were shut down halfway through March, all of April, nothing. So I had a couple of clients because I am able to look on their Dental Intel dashboard in a month or so ago, I sent them a message and they were so very thankful because they're used to seeing 220 to 250 hygiene patients each and every month. Right. Art, they had 44 pre-appointed for October.

Art Wiederman, CPA: That's dangerous because you know... So that was one of the first things we were going to talk about is the we call the fall out of the hygiene schedule in the last quarter. So what do we do, JoAnne?

JoAnne Tanner, MBA: And it's not too late to do something about it. Well, starting next week, I want them to look at each dental insurance plan because it is plan specific because it could possibly be the patient's first dental visit this year. And if it is, they may be able to have two dental hygiene visits each calendar year. Some are every six months. But if it is twice a year, you bring them back in October or November, not December. And I'll tell you why December will fill up on its own, because it's December. It's the end of year rush. Right. Because our listeners may not have had this information back in June or all of July. You may want to consider going back into May and have the insurance coordinators say, had I had this information, rather than them scheduling for January, I'm going to bring them back in October and tell the patient, "Good news. You get two free hygiene visits each year. So rather than coming back in January, your hygienist Sherry, asked that I call you, to bring you back in October."

Art Wiederman, CPA: JoAnne, let me ask you a question, so, for those doctors who don't know or maybe they have a new person at the front, how can we find out which patients do have two hygiene visits and have not taken advantage of any? Is there something in the software report we can run?

JoAnne Tanner, MBA: Insurance verification. It's funny, I can transfer tens of thousands of dollars online immediately within minutes. I cannot get this insurance information easily. So it's maybe through Trojan or some sort of insurance verification, because it is plan specific to the patient.

Art Wiederman, CPA: But that's going to allow us to get more patients into the office, which allows more touches, which allows more diagnosis. And it may be that a patient hasn't been in for could be as much as nine months or a year. And maybe we find some dentistry, right?

JoAnne Tanner, MBA: Exactly. And so, next week they can be proactive about that. And if it's their first visit, let them know, it's been eight months since we've seen you, and we're concerned because now you have a few four and a few five millimeter pockets. We want to see you. And this is the clinical team talking. We want to see you back in the end of September or October so we can check this out and then we'll get you back on a six month recall.

Art Wiederman, CPA: So that's for patients who have insurance. And that's going to take a little bit of work from somebody in the front office to get on to, like you say, Trojan. And to see if they have patients who have that need. Yeah, I'm hearing that, too. So what are some of the other challenges you're seeing as these doctors open up again?

JoAnne Tanner, MBA: Well, let me give you one other suggestion before we move on.

Art Wiederman, CPA: Oh, no, go ahead, please.

JoAnne Tanner, MBA: Because what we'll be trying with the exact hygiene patients now, their patients who are 18 to 36 months past due, we consider them, lost. We've not seen them in more than a year and a half. I'd like to suggest that you send a welcome back email and give them some sort of special and other in other words, a reason to return. Now, I'm not talking the dollar dental exam. We're talking a high quality, "We've missed you, Art. It's been a while. Welcome back to our practice. On your next dental hygiene visit, after your exam, cleaning and X-rays, you'll receive a complimentary electronic toothbrush." Maybe it's take home teeth whitening, a water pic, something that might be of interest to your patients in your demographics.

Art Wiederman, CPA: I think that's a great, great idea. But again, if your hygiene schedule falls apart in the last quarter, JoAnne, they get a lot of their dentistry out of the hygiene room, right? If they're doing it right.

JoAnne Tanner, MBA: Absolutely. So patient activation is going to be the next way to fill the schedule. My third and final suggestion on how you can fill the hygiene schedule is to consider some new patient promotions. All right. If you're marketing, maybe doing a Facebook promotion, maybe there's a refer a friend. We need to get the new patients in the door in September. So then you can fill up your hygiene schedule.

Art Wiederman, CPA: Right. So some sort of a promotion like maybe 10 percent off of the new patient exam or something. Is that what you're thinking? Or do you have a particular thing you like to do?

JoAnne Tanner, MBA: Since many people have dental insurance. Sometimes the 10 percent off the hygiene visit may not pull them in. So it might be one hundred dollars off their restorative. But your listeners are welcome to call me and we can brainstorm to see what might work for you. What most of my clients have done is an either/or - the complimentary take home teeth whitening or one hundred dollars off their restorative. You know, you can give them some choices, because these are patients who already know you, trusted you in the past and somehow have gotten too busy to come back in. So those are some ways to help fill the fall schedule.

Art Wiederman, CPA: Yeah. Because if we don't fill that fall schedule, we're on a... My doctors are on a PPP high. They haven't been open for 10 weeks now. We've got all this pent up demand high. Well, that ultimately goes away and we've got to continue past the first three or four months that we've been open. So, JoAnne, you mentioned metrics and you and I both are very passionate about looking at the metrics of practices. And we look at different, we use some different metrics programs. Talk about a couple of the metrics that you look at in your work, where you can say, if I can make that metrics change, it's going to make a difference in your practice.

JoAnne Tanner, MBA: Well, we were just talking about a hygiene. And even without the fall on the schedule, the hygiene pre appointment rate is one of my favorites. Because frequently the team will say, JoAnne, I know we, eight out of 10, at least 80 percent of our patients leave with their next hygiene visit. That's their perception. When we log in and obtain the data, on average, it's around 55 percent.

Art Wiederman, CPA: Yeah, that's exactly what I quote. Fifty five percent. Yeah. And it's shocking to the doctor. The doctor goes, "but wait a minute - my front office lady, she's been with me for 400 years. She knows everything. She told me that everybody pre-appoints. Even the airline pilots." Well, the airline pilots probably now reappointed, because they're not flying very much. So. Yeah. So you see that a lot, right?

JoAnne Tanner, MBA: Absolutely. The other metric has to do with what we're talking about us marketing. Don't take your eye off the marketing, because, as you were saying, they're on this high with having the PPP, all this pent-up demand, they may have eased the pedal off the marketing. And we need to continue, because that's hard to restart. So, looking at the new patients are essential. Production per visit. And here's a good story. Years ago, Art, you referred me into one of your dear clients because their team wages, the overhead percentage that they were allocating to pay the team, was very high. So I went in and took a look at the schedule I noticed it was very linear. But yet this doctor was booked up four to six weeks. So I called you. You said, "What are you saying, you need to hire more people?" I said, "As a matter of fact, yes, because we have people that are wanting to come in and they're using this linear schedule, versus utilizing the two or three chairs that our doctor had." So when we looked at production per visit, we were able to see more patients and produce more per day. Added another team member and consequently reduced the percentage of overhead.

Art Wiederman, CPA: Because we were able to reduce the production.

So that's the thing doctors... And JoAnne, let's talk about this for a second. I have a lot of doctors, "but I've got to cut my overhead." In fact, there was even an A.D.A survey. The A.D.A. has been through, Marko Vujicic. I think I finally pronounced his name right, who is with the Health Institute over at A.D.A.

And they took a survey and they said 60 percent of our doctors, number one concerns are how can they cut their overhead? I don't think that's your concern. My concern, JoAnne, is how can I get the production to go up because then the overhead will become inline, right?

JoAnne Tanner, MBA: Right. It's an income problem, not an expense problem.

Art Wiederman, CPA: Right. We can't cut. You know, it's like if General Motors says, I'm going to manufacture 30 percent less cars, they know that they can take 5000 workers off the assembly line. But in a dental office, we can't cut our dental team by 50 percent. We don't want to cut our dental team by 50 percent. So these metrics. One of the other metrics I like, JoAnne, is the new reappointment on the new patients. And that scares me. I see a lot of offices, twenty new patients in a month and only seven of them after the first appointment, walk out with a hygiene appointment. Do you see that a lot?

JoAnne Tanner, MBA: Oh, it's so frustrating. They may come in for the toothache. And so the doctor will start the root canal, or the crown prep, and the patient comes in. But the doctor, a clinical team, forgot the treatment plan for the new patient experience, as well as following up with the hygiene appointment.

Art Wiederman, CPA: Right. And that's not good. And then, you know, we look at case acceptance. So, you've been doing this for 30 years. You've been in thousands of dental offices. Would you say most dentists need help on how to present a case to a patient, or do you think they're pretty good at it? Maybe some...a little bit. Just briefly, some tips on that.

JoAnne Tanner, MBA: That's a good question. What we need to do is be able to measure, therefore manage it. And I've tried many different ways, with Excel spreadsheet. Even back in the day before computers were keeping track and a manual form, it was very difficult. And so I like to look at case acceptance of the patients that we saw, what percentage were diagnosed with treatment, because maybe the doctor is so conservative that we're not even presenting. Yeah, we could have an associate who is overly aggressive, or again, underdiagnosing. So we need to look at what are they even presenting. So it's not necessarily in the acceptance.

Art Wiederman, CPA: Oh, and I get a call once. I probably said this before on the podcast. Everybody knows I repeat myself incessantly, but I get a call once a year from an office manager who knows me. Cause I have been the accountant in the practice for 30 years. "Art, he did it again." "What did he do?" "He let six crowns walk out of the office that my three year old could have diagnosed and sold." "Uh huh... So what do you want me to do?" So I'll call the doctor and I'll say, "So, Doctor, on a scale of one to 10, one being that you refer everything out and you just come in to socialize and 10 being that you grind every tooth down to its nub and make it a crown. Where do you stand?" "I'm about four, maybe a four and a half." "So can I get you to a five and a half or a six?" Yeah. So JoAnne, have you had those conversations with doctors as far as, you know, being too conservative?

JoAnne Tanner, MBA: Absolutely. And what helps them in that regard is if the hygienist or the assistant can pre-present to the patient. I know we're not dentists, but we can tell the patient, "Gee, if that was my tooth and you're missing more than half of the natural tooth structure, it could possibly be time that we put a crown on there. Let's see what Dr. Morley suggests." So then that way, when the doctor comes in the room and I tell them I was talking to John about the lower right first molar and it could possibly be time for a crown. You see, I took a photo for you doctor. We wanted to know your thoughts on that." So everyone's on the same page. And if by chance, it's not time, that it's not ready, doctor is then the hero. And we make a note to revisit it next time.

Art Wiederman, CPA: Exactly. I mean, see, these are these are the verbal skills. And I have preached for thirty-six years as a dental CPA. Doctors, you know how to cut a crown. You know what occlusion is. You know what TMJ is. You know how to restore an implant crown. What you need to do is spend time on how you and your team talk to your patients. So I want to take a second, JoAnne. And I would like, again, I have known JoAnne Tanner. I only bring the best onto this podcast. I probably get five requests a week for people to be guests. And I don't really answer those because I know who I want to have. And again, JoAnne is as good as it gets. So, JoAnne, I think you mentioned, I'd like you to give out your contact information. If you are looking for someone. And again, if you've ever needed to hire a dental coach, now is the time in this uncertain time when we are coming back, we were closed for 10 weeks, patients are uncertain. So, JoAnne, I know you had mentioned you might have an offer for some of our doctors that are listening and also give out your contact information. The contact information will be in the information, not only on Decisions in Dentistry's website, but also on Eide Bailly's website. So, JoAnne, how do we get a hold of you? And what do you got for our doctors?

JoAnne Tanner, MBA Well, first of all, we're talking about verbal skills. And I don't want the team to memorize my words exactly. But you're going to listen to them. And so I'd like to offer to all of your listeners. E-mail me: JoAnne@TannerMGMT.com. The website is: JoAnneTanner.com. And I will send you a complimentary audio file of our key verbal skills. Well, back in the day, when I first met Art, they used to be a cassette tape, right Art? And then we upgraded to CDs. And now, of course, we have them MP3 and I have a few YouTube videos. But remember, team, don't memorize my words, play American Idol, customize it and make it your own. And I think that's why team members truly enjoy working with me, because I don't force a particular system or style to that particular practice. We will customize it. So my first gift is the free 'Key Verbal Skills'.

Art Wiederman, CPA: OK, so again. So let's have a phone number and an email address for you that we can give out to the folks.

JoAnne Tanner, MBA: They can reach me anytime at my office number: 916.791.2720. And again, the website is JoAnneTanner.com - that's J O A N N E T as in Tom A N N E R .COM.

Art Wiederman, CPA: OK. Sounds good. Thank you for that, JoAnne. So, just a couple of other questions. Tell me about your perfect day in a dental office. What's a perfect day?

JoAnne Tanner, MBA: Oh, when everyone comes in with a smile.

Art Wiederman, CPA: That's good.

JoAnne Tanner, MBA: To start the day with that energy. Did you hear it? Art was laughing and see that positive energy, especially now with COVID and other stresses in our lives. Schools not returning, the pressures. So having the team aligned and having some few positive words to share about yesterday and having a positive thought for today. So that attitude, if you think you can make it a good day, you will. And then the perfect day after that. Well, it never flows as it should, or could, because things happen. It's dentistry. It's an art. So it's not exactly going to flow. Let's be patient everyone. Understanding of each other. And remember, guys, praise in public, catch somebody doing well. Give them a high five. If you do need to give them some feedback, coach them in private.

Art Wiederman, CPA: Oh, my God, I can't tell you how many business owners, not just dentists that I have seen lambaste a team member in front of everybody else. I mean, that is the most degrading, embarrassing, horrible thing as a leader that you can do, isn't it?

JoAnne Tanner, MBA: It certainly is. And a well-deserved thank you, a verbal thank you at the end of the day, that's heartfelt and meaningful is so powerful. Well people can find a job, but having that thanks at the end of the day goes a long way.

Art Wiederman, CPA: Oh, absolutely. So I know that one of the things that you've done, you've done it with the practice that we work with up in Northern California. How do we find, what's the best way to find a team member, when you're looking and helping a doctor find a new front office person, an assistant, a hygienist? What are you looking for? What are the characteristics of a really great team member?

JoAnne Tanner, MBA: And if you interview the Fortune 500 firms, you'll notice that 80 to 85 percent of the key words that we'll use have nothing to do with their skill. Yes, they may need to have a license to do dental hygiene. When it comes to front office, I would rather take someone with personality, with excellent communication skills, because I can teach somebody pano from PO, MO from DO. In fact, I'm doing it right now in San Francisco because he came from hospitality and cannot find work. He's a hard worker, excellent communications. And either you know how to talk to people and you are comfortable with that or you're not. I can't teach that.

Art Wiederman, CPA: That's true. You know, and I've always said, I can teach skills, I can't teach attitude. I'll hire somebody who's got a great personality and a great attitude. If they have skills, that's a plus. But if they don't have skills, but they really want to learn, unless they just don't get it. You know, that's what I think. What do you think about that? Will you hire attitude or skills?

JoAnne Tanner, MBA: Oh, 100 percent attitude every time. Now, doctors, remember, or office managers. You want to give that person feedback. Just don't wait till day 89 and tell them it's not working out, it's not a good fit. Have them write down every day what's going well, where they feel they could have improved and at least every week check in with them. Have that one on one meeting for communication, as well as communicating what's going well.

Art Wiederman, CPA: Right. Right. Give me some of your keys to growing a dental practice. I mean, obviously, I've always said that a dental coach, consultant, whatever you would like to be called, JoAnne. I've always said that there's really two functions of a dental coach. Number one is that coach needs to make the office run more efficiently, so the doctor has a better experience, enjoys his or her practice. And obviously, we want to make the bottom line higher. So what are some of your keys to growing your practice?

JoAnne Tanner, MBA: First of all, you need to make sure the foundation is in place before I try to build a house on sand. And that means you need to have the team aligned. Because everyone needs to realize, where are we today and where do we want to go? Because if we're trying to make changes or suggestions that the doctor thinks we need to do things differently and everybody else is in agreement, we're looking good. We're not going to get very well, very far. So change management is something that I've learned in the last 20 years is essential on keeping that growth in the practice going. So after the team is aligned, looking at the systems from the metrics that you mentioned earlier, so maybe the production to collection ratio isn't very good. We need to look at the financial arrangements. Which, by the way, Art, make sure your listeners have a link on their website for the patients to pay. Be convenient and easy to pay their bill online.

Art Wiederman, CPA: Yeah, convenience is huge today for everything.

JoAnne Tanner, MBA: Absolutely. So the other thing that we take a look at I mentioned earlier is scheduling, but also it's a team effort to say what can we do every day? And Doctor, if your daily goal, let's say, is 4000 for doctor only, we need to convert that to how many crowns does that mean you need to do? So if it's three crowns, that means you need to diagnose and get accepted, at least four every day. That means you need to find four to five every day. So that kind of breaks it down daily in bite sized pieces. The other thing we've been doing is looking at weekly targets. Don't wait till the end of the month and say I'm lost or I didn't hit my target. Weekly is essential.

Art Wiederman, CPA: Right. Are you one who likes the doctor... I've heard a lot of people talk about same day dentistry. In other words, doctor comes in. He says, "You know, we've we've got an opening, we've got this crown and we can do this other one, too. That's up on the screen. That looks like it's about ready to explode." Are you a fan of same day dentistry?

JoAnne Tanner, MBA: Absolutely. Especially even more so now Art. Because people are maybe concerned of coming in. It's a big deal for them to rearrange their schedule with COVID to make the arrangements. So take care of the patient's needs while they're here today if it works for the practice and then offer it to the patient. Now, doctors, make sure before you do that prep, you have your treatment coordinator come back and discuss the payment options.

Art Wiederman, CPA: OK, you know. One of the things, too, that my good friend and mentor, Dr. Phil Potter, who I know, you know, Dr. Potter, taught me, is that the patient is ready, not when you're ready for the dentistry, but the patient is ready when the patient is ready. So I know that you and I've talked about how important it is to ask patients, are you ready to start treatment? Talk about that a little bit.

JoAnne Tanner, MBA: So when I did get out of the Navy, I was a Navy recruiter and I remember this situation. They said, don't say, are you ready to? Because it could be perceived a little pushy. So in dentistry, I don't want to say, "So you're ready to do that Crown, Art? Are you ready to get that scheduled?" I would say, "Art, did you have any questions that I could answer for you before we scheduled a treatment?" So hopefully he would say no, which means yes, I'm ready to accept. And if the patient says, "Well, sure, how much is it going to cost?" Doctor, just don't shrug your shoulders and say, "I don't know. They told me, don't talk about money." Tell the patient "that my front office team is amazing on understanding insurance benefits. And we have a number of different payment options based on them finding something that's comfortable for you. Is there anything else that we need to talk about before we scheduled the appointment?" This is on my key verbal skills. It's called the 'no close'. So hopefully the patient says no. And now I hand the patient off to the front. So Mary at the front knows the patient had some questions regarding payment options. And she told doctor, if you can help her with a payment plan, then she's ready to get started.

Art Wiederman, CPA: Well, and then that comes back to the morning huddle. Which I mean, I had talked to a doctor yesterday, and I said, "Do you have a morning huddle? Well, no. But we just talked about going to start that again." How important is the morning huddle?

JoAnne Tanner, MBA: Ooh, well, when you start that football game and I know the coach is back there talking to the team members, the same thing the office manager needs, not the doctor, it needs to be a front office person, because it's not just about the schedule, it's about a lot of things. So absolutely - pull your team together for that minimum 10, maybe 15 minute huddle to get everyone on the same page looking at opportunities, potential hot spots and how we're going to make it flow better. Anticipate any other hiccups within your day. It's huge.

Art Wiederman, CPA Oh, absolutely. So, now, are you giving tips on... Are we talking to the patients differently now that we're coming out of COVID and opening up again, than we were before? Anything different that you're talking to doctors about?

JoAnne Tanner, MBA: Well, unfortunately, many patients have lost their job and we want to be mindful of that. So implementing the in-office membership plan has been very important. I've always been doing this. I started that in the late 1980s. And so the membership plan is very important. So we are talking to patients because they are delaying care or delaying their hygiene. And it's important to keep it on a preventative every six months minimum. But talking to them per se, listening to their concerns.

Art Wiederman, CPA: I mean, absolutely. I'm hearing more and more JoAnne about the in-house membership plan. Now, obviously, if you have a patient who is contracted with an insurance company, and they're using their insurance, that is not going to work very well. But I've just seen this work very well. And the other thing I've seen people do is to go to local employers. And I mean, doctors, if you have a patient who's a COO or a CEO of a company and has 50 or 75 employees, I don't know what you think about this, JoAnne, but I say, take them out to lunch and say, you know how much you're paying for dental insurance? We have this plan and this is how this works. And we would love to help the people at your company. And, you know, if you write a check for 195 or 295 dollars for 100 of your employees, that's 29,500 dollars and you know, oh, my God. Well, I'm paying like $70,000 a year for my dental insurance. Aha. So the numbers work for an in-house dental plan, especially for a smaller company that you could get a bunch of new patients, right?

JoAnne Tanner, MBA: Absolutely. In fact, let's make sure we're clear. This cannot be used in conjunction with insurance. It cannot be used as a secondary or if I'm maxed, this is only for the patient who is retired or no longer has insurance. Maybe they're self-employed. It's like my own in-office capitation plan - a gym membership for their smile.

Art Wiederman, CPA: And you control this and the patient feels like they're getting something. And then you've got them committed. And it's funny, I talked to one of the guys that runs one of these in-house membership plans, and he was saying that when you look at people who are members of Amazon Prime, people who are members of Amazon Prime buy more than people who are not. If you're a member of a club, it might be Dr. Tanner's Dental Club... I mean, we're not going to call it that, of course. But you might buy more dentistry because, oh, well I'm getting 10 percent or 15 percent courtesy on this dental plan. Well, why not do that other crown? Right?

JoAnne Tanner, MBA: Exactly. As long as it doesn't fall below the Dental Premiere. But we're not going to talk about that today. That could be a whole 'nother conversation for us. A totally 'nother podcast.

Art Wiederman, CPA: Don't don't. Don't make me. Don't. No, no. I've been having such a good day. Please stop. Let's not go there. OK. I want to I want to ask you about a couple more things. One of the things we've, you and I have talked about, too, it's important for patients to consider total health. And I've been preaching this for the last four months about how important it is that, you know, disease starts in the mouth. And if we can keep the mouth healthy, that's a better, better way to keep away, to keep our immune system healthy so that maybe we don't get this COVID virus. Talk about how important it is now to communicate that to patients.

JoAnne Tanner, MBA: Absolutely. The total health. So people are delaying coming in for their cleanings. If they do have gingivitis or advanced perio disease, we know how it affects patients with diabetes. And then if they unfortunately, do are exposed to COVID, they're going to have those underlying health issues. We don't know everything right now about COVID, but we do know the importance of total health. So anything we can do to help our patients. And I mentioned earlier about having payment options. Doctors make sure, you're understanding this correctly. I'm not saying you're playing banker. All right. I didn't say the Bank of Dr. Jones, but you may have a convenient payment options by utilizing Care Credit or some external financing, that's non-recourse.

Art Wiederman, CPA: Right. Exactly, so. And again, doctors, it's time to work on your business, not just in your business. If you're not using a metrics program and there are numerous. I won't go back to metrics JoAnne. There are numerous metrics programs out there. You and I work with the two we think are the two best. And those metrics programs sync generally. They all generally sync to either Eagle Soft, Dentrex or Open Dental. I don't think they sync to any of the other programs, to my knowledge.

JoAnne Tanner, MBA: We do not.

JoAnne Tanner, MBA: Yeah, they don't. And those are the three premiere programing. You know, Dentrex and Eagle Soft 80 to 90 percent of all of our doctors have this. But if you're not looking at metrics and you're not looking at what you know, what uncompleted treatment plans you have and you're not looking at your new patient flow and you're not looking at appointments and cancelations. I mean, these are all profit holes in your practice and it's not hard to do that. But you use metrics in all of your practices, JoAnne, that you coach.

JoAnne Tanner, MBA: Absolutely. Because, in fact, if any of your listeners would like to get a free growth report, a profit leaks report to see where there are some opportunities to improve, I'd be delighted to offer that to your listeners to help them with their practice at this time. But if you're not measuring, you're not managing. So how do I know where we're going if I don't step on the scale?

Art Wiederman, CPA: And maybe one of the last things I want to ask you about today is let's talk about leadership. How important is leadership? And again, folks, I am a broken record. Guilty as charged. Well, gee, Art, you talked about that two episodes ago. Yeah, I did. And I'm going to keep talking about it because dental employees are mostly good people, but they're dental employees because they don't want to own a business. They need. They want to be led. They want to be told, this is where we're going. And if you... How many offices JoAnne, you walk in and there's just no plan and there's no leadership, and the front office is running the show and the doctor just shows up. I mean, how important is this leadership thing?

JoAnne Tanner, MBA: Leadership is different from management. All right. They don't necessarily need to micromanage all the different tasks that are going on, but we can guide people, coach them. And we teach our doctors and office managers leadership principles. Leadership is critical because if the team is not involved with the situation, they don't understand where we're going. We kind of use the analogy about Waze. When you're driving somewhere, you put the address in the Waze, the G.P.S., a practice management starts with good leadership and guiding your team.

Art Wiederman, CPA: I use the Apple map thing that tells me where to go. Waze has too many choices. I get confused when I use Waze and stuff. So we're about coming up to the end of the time we talked about, JoAnne. Do you have any other pearls? I mean, this is a once in a lifetime time in all of our lives. I've had I've actually had three people now in my life over the last week who I've talked to, a couple of friends, couple of professional people. And they've also said the same - it feels almost like Groundhog Day every day. I get up and I do the same thing and I eat the same thing and I take the dog for a walk. So it's just a very different life that we all have because you can't go to the movies and you can't go to baseball games. You can watch them on TV. But you know, all this stuff.

JoAnne Tanner, MBA: Every day is Tuesday.

Art Wiederman, CPA Oh, yeah. Exactly. So. Oh, that's right. I did forget one thing. I'm sorry. I knew I forgot something. That's what happens when you get old. That's me, not you. I know one of the things that you do are you coach, you help buyers buying practices. And this is a very, very strange time right now for buying practices. And you've done a lot of due diligence in practices. Thank you for reminding me for this is. So give us some tips for people buying practices right now. What should they be looking at?

JoAnne Tanner, MBA: You need to physically go in the office and look at the schedule. Doctors are thinking they're going to look at x rays. Just this past Sunday, no locations, I went with one of our clients and we looked at the schedule. The hygienist has not returned yet. And for whatever reason. And so therefore, they're not fully open. And you can imagine Art, if I haven't had hygiene exams since the middle of March, the doctor's schedule is extremely light. So do the due diligence. And looking at the schedule is critical. Looking at the procedure code. The mix of procedures may maybe the seller is referring some things out. But right now with COVID, the banks may also have other contingencies or holdbacks that they're going to require until the practice is doing the same production collection, at least for a month. Pre-COVID numbers.

Art Wiederman, CPA: Right. And you also, I know we didn't want to mention that the D word. But you also do an analysis, as I remember, on what percentage of the practice is Delta. Do you get into that?

JoAnne Tanner, MBA: Oh, absolutely. It's very important because if the practice is Premiere, the doctor, as you know, will be PPO. And so we have an app that integrates magically with those three softwares, does not pull any patient data, and it tells me exactly how many active patients. Not that that changes the value, but I like to know I get it in five hundred or fifteen hundred. It also tells me of the number of active patients. How many have insurance? And of that, how many have Delta? We're seeing 60 to sometimes up to 70 percent of all the insured patients have Delta.

Art Wiederman, CPA: And now again, JoAnne, I know you represent buyers and I represent sellers as a broker. So I will say something to the... And again, you know, buyers, if you do not have a JoAnne Tanner-type person, I'm sorry to call you a JoAnne Tanner type person, but if you do not have a JoAnne Tanner type person going into your practice, you're not going to find this out. But sellers, we have to be really careful because the buyers say, well, what percentage of the practice is Delta? And that's not just a number that you just press one little button on your computer and there it is. It takes a lot of work. So sellers have to be very careful. And basically, it is up to the buyers to hire someone like JoAnne to go in there and figure that out, because, I mean, if it's 60, 70 percent Delta, JoAnne is going to be kind of rolling... I don't know you will be rolling your eyes or shaking your head or ...

JoAnne Tanner, MBA: It's not a deal breaker necessarily Art.

However, we do need to be prepared. Because maybe the sellers doing amalgam and you would be delivering composites and frequently the PPO patient will have a higher maximum when they go to a PPO provider. So again, it's not necessarily a red light. I want to keep everybody's eyes wide open. Speaking of the sellers, though, most every time at the end of the meeting, the seller will look over at me, "I wish I'd had somebody come and work with me five or ten years ago like you. And I just hope the doctors nationwide in this process. So it's not that I physically go to the practice.

Art Wiederman, CPA: Well, again, I will tell you folks, and we're about ready to wind this up is... you know, JoAnne Tanner is highly professional, very, very skilled, very competent. She's been through everything. How many dental offices do you think you've been in?

JoAnne Tanner, MBA: Oh, working, as well as doing the buyers, over a 1000, maybe even 1500. I've lost track through the years. 35 years of doing this Art. Yeah.

Art Wiederman, CPA: Yeah. I mean. Well if it's not 1500 I don't know if I want not... nah I'm just kidding. JoAnne is great and she works with the metrics programs and she works with... It's funny JoAnne. One of my...one of the people that I used to work with at Pride back in the 80s, she told me, she says, "When you and I started working together in the 80s, Art, 80 percent of what I used to do was scheduling and financial arrangements. Now, 80 percent of what I do is human interaction and emotions and dealing with people." Do you find that?

JoAnne Tanner, MBA: Absolutely, because as I mentioned, teamwork; having everyone aligned and on the same page is one of the first steps. And we even offer this virtual coaching now. I've been doing video meetings for nearly 10 years. So it's very affordable. We don't necessarily have to get on a plane anymore to help your team.

Art Wiederman, CPA: Yeah, I'm certainly not ready to get on an airplane. I don't know if you are, but I'm not. But anyway. So any last pearls, JoAnne, before we wrap up? I'm gonna let you give out your information one more time.

JoAnne Tanner, MBA: Again, if the doctors want to have a copy of the Key Verbal Skills or the Complimentary Growth Report, you can call me at 916.791.2720 or visit my website - JoAnneTanner.com. And there's a place there to enter your contact info and I'll get right in touch with you.

Art Wiederman, CPA: And if you're a buyer and JoAnne, will you work with a buyer who's buying a practice anywhere or just in Northern California?

JoAnne Tanner, MBA: Anywhere; all across the country. I've helped people in Georgia, North Carolina and even Hawaii.

Art Wiederman, CPA Sounds good to me. Well, but Hawaii, you got to quarantine for two weeks that may not work out too well. But who knows? Hopefully this will be a bad memory as we get to early 2021. Well, JoAnne, thank you so much for your expertise. You gave a lot of really great tips.

One of the things that this podcast is my mission in this podcast is to provide you resources to help you to improve your dental practice. I mean, we've got doctors that are just killing it coming out of COVID-19. They're just doing really well. They're doing all the right things. They're doing a lot of things that JoAnne said. So if you want to get a hold of me in my office in Southern California, ladies and gentlemen - 657.279.3243. Email me with a question, comment, whatever you like - ArtWiederman@gmail.com.

Go to our firm website which is www.eidebailly.com. That's spelled e-i-d-e-b-a-i-l-l-y.com. Eide Bailly's website has just unbelievable content about virtually every topic. If your spouse has a manufacturing business, they've got stuff on manufacturing, retail, wholesale, everything. We have a whole dental group that handles our now combined firm, has well over 700 dentists as clients and growing.

Go on to Decisions in Dentistry's website www.decisionsindentistry.com. I mentioned earlier in the podcast some of the great resources we've got. They brought me a couple of wonderful guests and sponsors that are going gonna be on our show in the next month or two. So that's www.decisionsindentistry.com. And if you are not working with a dental specific CPA, go to our website which is www.adcpa.org.

Go to the members tab. Look at the state that you're in and we've probably got somebody pretty close to you. JoAnne Tanner, thank you for your friendship all these years. Thanks for the great things that you've done for the dental profession and your wise counsel.

JoAnne Tanner, MBA: Thank you Art for having me. Have a wonderful day.

Art Wiederman, CPA: Great. And folks, that's it for this episode of The Art of Dental Finance and Management with Art Wiederman. I'm gonna go back to my mantra here, which is five words: failure is not an option. It is not an option. You have all worked way too hard for what you've done. Work on your practice. Do some of the things that JoAnne talked about. And let's get this thing going. So we'll see you next time. Bye-Bye.

JoAnne Tanner, MBA: Bye everyone.