Key Performance Indicators to Help Dentists Grow Their Practice

Art Wiederman, CPA: And hello, everyone, and welcome to another episode of The Art of Dental Finance and Management with Art Wiederman, CPA. My name is Art Wiederman. For those of you who have not met me over the Internet or on your iPhone or wherever you listen to podcasts, I am a dental. I got this right the last time. I'm a dental division director at the CPA firm of Eide Bailly. Dental Division Director. I'll work on that, folks. I promise. I'll get it right next time.

I've been a dental specific CPA for thirty six years. I'm very proud of the work that we do at Eide Bailly with our three hundred dentists in the city of Tustin, California. And I'm very proud of our podcast, which we are in our third year of doing, and I am very excited about my guest today. Again, made lots and lots of friends over the years and one of my new friends is named Eric Vickery. Eric is a dental coach. He works with All-Star Dental Academy. And you might have heard Alex and Heather Nottingham on a prior podcast that we've done.

And Eric and I are going to talk about Eric's seven favorite KPIs. And KPI is key performance indicators and how if you change them, it means more profit. And folks, I brought you many of the best consultants in the country of which Eric is one of them over the last two and a half years that we've done this. And it's just, you know, I get lots of comments of, boy, this is great information and I hear different things from different people and what have you.

So Eric and I are going to talk about new patients and comprehensive exams and write offs and hourly production and all the stuff that you really, really need to be looking at in your practice in order for it to be successful. And he's going to give you a lots of gems of, you know, what can we do to drop more money to the bottom line. I mean, on the one hand, we work with the, we try and get our doctors more ERTC Employee Retention Tax Credit, money to take money away from the federal deficit. But we also want to decrease the federal deficit by you guys making more money and paying more taxes. Does that make any sense? I have no idea. But it is what it is, folks.

So, anyway, a little bit of information before we get started with Eric, do go to our partner's website, Decisions in Dentistry magazine. Their website is wonderful. www.DecisionsinDentistry.com. If you don't know about Decisions in Dentistry, it is the premier clinical dental magazine in the country. They have been on top of everything that has been happening with covid-19 and changes in practice methodologies and clinical issues over the last year. Over the last many years. They have a great website. Go to the website www.DecisionsinDentistry.com. You can find our podcasts there. And if you want a complimentary consultation with one of us from either my firm or the Academy of Dental CPAs, go ahead and go on there and click on that button right at the front page and you'll be able to get that consultation.

You can get up to one hundred forty continuing education classes at a very, very reasonable price. And some of the courses are absolutely fantastic. Get your CE online and do it that way. If you're looking for a dental specific CPA anywhere in the country, we've got you covered. The Academy of Dental CPAs. Twenty four CPA firms across the United States that represent over ten thousand dentists. We had Eide Bailly represent about 800 dentists. We have a really nice practice. We take really good care of our clients. You're more than welcome to email me if there's something we can do to help you. And that's awiederman@EideBailly.com. Or call me at 657.279.3243. Do remember that I am in California. And so if you call me at eight o'clock in the morning in North Carolina, I'm probably not picking the phone up.

But anyway, with that said, just a couple more updates, folks. Remember that the government has extended the time to file for your PPP 2 loan. We are recording actually on March 31st. So today was the deadline to file that has been extended to May 31st and there's about seventy five billion or so last I saw left in the kitty. So if you have not applied for your PPP 2 loan and you had a greater than 25 percent reduction in your gross receipts for any quarter in 2020. Most likely the second quarter and you meet the rules and you feel that this is something you want to do. I would do it sooner rather than later.

We are also talking about on every podcast right now through probably August, the government now allows you to interact and get both full PPP forgiveness for your round one loan, as well as getting an Employee Retention Tax Credit of up to five thousand dollars per employee if you had a greater than 50 percent reduction in your gross receipts. Again, more than likely in the second quarter of 2020, you will qualify. And we are starting at Eide Bailly. We're probably going to about a hundred of these, maybe more.

We just did a doctor's office that we're going to get them at one hundred and fifty five thousand dollar Employee Retention Tax Credit and full forgiveness of their almost four hundred thousand dollars PPP loan folks. The numbers are as my oldest son used to say, whenever he thought something that I said was dumb, says, Dad, that's stupid. Well, these are stupid numbers. If you are a multiple practice owner and you have 80 employees, that could be four hundred thousand dollars for you. It's a lot of money.

And if you had a 20 percent reduction in the first quarter of 2021, it goes from five thousand a year to seven thousand a quarter. And that's good for the whole year 2021. So if you want any help with that, or you think you might qualify and your CPA isn't talking to you about that, give me a holler.

So and again, one more reminder, and we're kind of doing this as we go along. As I had mentioned the last couple of podcasts, we are going to be recording and publishing twice a month every other week. We started doing that on April 1st with all this PPP and ERTC stuff. I was literally folks on the phone with clients all morning and every single conversation turns into forty five minutes to an hour to go through all the rules and something had to give. So we're going to publish for a while, twice a month, every other week. Really good information. You're going to love Eric Vickery today. He's fantastic. So I just want to know if you're looking for it every week, we're going to be skipping every other week for the foreseeable future.

Last thing I'll tell you is that if you want to participate in our monthly webinar series, The Business of Dentistry, which we're doing for six local dental societies in Southern California, our next one is April 14th, which is Wednesday, April the 14th. That will be on cybersecurity and preventing fraud and embezzlement in the dental office. If you want to register, go to www.EideBailly.com/dentalseries. All right that's enough announcements for today. Let's get to my guest.

Eric Vickery is a really smart guy. He holds a degree in business administration. He is the president of Vickery Coaching, which brings a strong business and systems approach to his clients. He's managed dental practices for over ten years. He utilizes dental practice management training with his clients. He helps lead teams to improve their practices with coaching. He's done that since 2001.

Eric is an expert in verbal skills system training, engaging and humorous delivery. So Eric needs to be humorous today, hopefully he will be, to all of his seminars that he leads. He's been a key contributor to the All-Star Dental Academy's coaching services program through the development of his KPI practice monitoring systems, coaching dental offices all over the country who benefit from his experience in coaching over two hundred and fifty dental offices since 2001.

Eric is also an expert on case acceptance, verbal skills and the DISC personality profile. Eric and his wife Abby are the proud parents of four children, and he's still smiling, believe it or not. And they live in Northern California. Eric, four children and you're smiling. How's that working out for you? Welcome to the Dental Finance and Management.

Eric Vickery: Yeah, Art, thanks for having me. I really appreciate it. That's because one of them is get ready to move out. So it's getting ready to go on three. So they've hit that age where they're starting to leave the nest, so.

Art Wiederman, CPA: Ah. No, I had that happen. Mine are all grown and they're both, both doing really, really well. And but you know, they do let us know when the birthdays come around and they let us know when the holidays come around. And I'm waiting for one of us to say, by the way, this is your wedding anniversary, where's my gift? So what can I tell you? So I gave a little bit of background, Eric, tell me a little more about your journey and what you've done in your career, and then we'll get to helping doctors with some KPI issues.

Eric Vickery: Sure. Yeah. I, like you said, graduated with a business degree, and my father in law is a dentist. So there was some job security in it. And I was from California. He's from Maine. And he said, you and my daughter move out here and I'll give you a job and I'll teach you the ropes of dentistry. So we moved out there and that was in 1998. Managed his practice for about six years and halfway through it I started working for a company called Dental Boot Kamp with Walter Hailey.

Art Wiederman, CPA: Yeah, I'm very familiar with that.

Eric Vickery: And so I did, I learned a lot of case acceptance verbal skills there, took my own expertise from my father in law and his training on numbers created a KPI tracker at that time in 2001 for myself. And then it turns out that would be something that I would develop fully over the years, the last 20 years for clients. And so in 2004, we moved back to California and been helping coach clients and offices full time since that time. And it's been it's been a huge blessing for my family. And I really enjoy doing this kind of stuff and getting to know people and helping them become successful.

Art Wiederman, CPA: Well, that's what we're here for. That's our legacy is to is at the end of the day, is for people to hopefully say that we were able to make their lives a little bit better. I mean, it's been a tough 12 months for everybody. So, yeah, let's see if we can give them some gems. So let's start the first thing I want to talk to you about is tracking new patients, OK? I mean, what's a new patient? How do you track it? What does that mean? Does it mean I met somebody on the street and they said, oh, I'm going to come into your dental office. Does that make them a new patient? No, I don't think so. But, you know, how does it qualify? How do you track it? Talk about that a little bit.

Eric Vickery: You know, over the years, I've changed my perception on this. And Alex, Heather and I, All-Star Dental Academy. We talk a lot about what new patients are and how to get them in and what's too many. It's a loss leader and all these things. And we'll hear, you know, maybe dental office outside of our realm talk about sixty, seventy for one doctor, new patients a month. And we're looking at that going, how is that possible and how is that healthy?

And so I think it's really important to understand, first of all, how to define a new patient. And in dental terms, that's simple. A comprehensive exam and a D0150 has been completed. I don't believe that a new patient is an emergency visit because we're not treatment planning. We're not presenting comprehensive dentistry. Now, if you want to see them as an emergency first, that's totally fine. Get them out of pain. But reappoint for the comprehensive exam. Right. That's when we can do full comprehensive evaluation and presentation.

And now when I look at a number and you tell me, yeah, I saw fifteen to twenty comprehensive exam new patients last month, I say I gotcha. Now I can in one of our trackers, I can look at case presentation to existing to new patients and see that treatment plan size dollar amount at a certain level and to make sure our percentages are acceptable when it comes to case presentation and side note, this isn't one of my top seven, but I love this number. People always say, well, what should my case acceptance be? And or I'll ask them and they'll say, oh, eighty five percent. I want about eighty five percent case acceptance. Well what does that mean. Eighty five percent of what is that.

Yeah. And so I'll tell them there's actually two numbers that you have to track, you got to track the number of people who schedule something. You got to track the dollars that they schedule. And we're going to look at eighty percent of the people scheduling something. And out of all the dollars we present, we want sixty percent of the dollars being scheduled. So we'll track that. And if you're not hitting those numbers, then we'll work on the verbiage to get case acceptance. We'll work on it as a team and do some training and help you with that.

So, yeah, but the new patient thing is really what I want to talk about Art. And that was it's comprehensive exams. And by the way, it's adults, it's not kids. The other thing I see all the time is, oh, we saw 40 patients yesterday and it was a mom and three kids. Those three kids are not equal to an adult comprehensive exam because typically they're not going to have the treatment plan presentation that the whole class size that we would for an adult or if they do, we're probably referring them to the pedodontist. And so forget about it. It's not going to affect your numbers in a positive way anyhow. So and I love seeing kids in a GP practice because it absolutely is a great way to care for our community and it also is a great way to care for your hygiene department. So it's not that I don't want to track those things, it's don't just tell me that you've seen 40 new patients last month. And if you run your dental software report, it'll tell you, oh, yeah, you saw two new patients yesterday or, you know, some of them work on registering the patient in your software. They may never even come in your practice. You register them and all of a sudden they're a new patient because you activated someone. If you don't do it just right, you're going get the wrong data.

Art Wiederman, CPA: So Eric, talk to me about a comprehensive exam. I have talked to doctors for all these years, and some of them tell me that, you know, we include X rays in that. Some of them tell me that it includes probing. And I mean, what do you like when you coach a doctor? What should be part of a comprehensive exam? How long should it take? How much time should the doctor be spending? What do they do? I mean, this may be a whole podcast on its own.

Eric Vickery: We could probably do something on that.

Art Wiederman, CPA: We probably could. But give us an idea. I mean, because I'm sure there's lots of different ways this is done right.

Eric Vickery: So I'll say first, exam typing was taught to me at an early point of my career. And I think that's one thing that's super important. But you're also starting to get into selling and anybody in dentistry who says they don't sell or they don't like to sell is lying to themselves. We sell health. The trick is, how do you do it so that it's not selling. It's not pressure. Right. So that you're not feeling like your car salesman and so that your patient doesn't feel pressure from you. That's the difference. You can call it case presentation, case acceptance, treatment presentation, all you want. Those are just fancy terms for selling. And so to do that comprehensive exam, you need to set up systems so it's done properly and absolutely perio evaluation, imaging, both X-rays and intra oral extra oral, you know, regular photography, charting.

How you do that, and I mentioned exam typing is going to be really important so that you're not wasting time. Your inefficiencies can create a real cramp in the ideal scheduling. So if you have a goal to hit every day, right, that number, how are you going to hit that if you got eight new patients that day, it's not going to work. So how you schedule new patients both on doctor side and hygiene side and how do you do that with or without a cleaning?

And all those things go into it. And so we create a system where we actually get the patient in the door within seven days, because motivation only lasts seven days. And if you're scheduled to beyond seven days and you hang up the phone, they're probably going somewhere else to get in sooner, then they don't call you back and they just don't show up.

So we want to make sure we create a system that eliminates friction. I'm sure you've heard Art, that business term friction. So most dentists don't they don't understand what that means. In a business world. Friction is like how difficult it is for me to do business with you. I got to wait three to four weeks to come in. Maybe I have insurance, maybe I don't. I'm afraid of the dentist. You only have these hours when I work already to come in. And if you can't eliminate those frictions, then you at least need to eliminate the perception that they exist, right?

Art Wiederman, CPA: Yeah, the people are busy. People are very, very busy. They have they have kids, they have jobs, they have hobbies, they have vacations. They have all the stuff and they don't have the time. If you make it too difficult to engage with your business, whether you are a dentist or an auto dealer or a supermarket or whatever, they're going to go somewhere where it's easier because people want easy. Right?

Eric Vickery: Well, at least understand that from the patient's perspective, they think a dentist is a dentist, is a dentist, is a dentist. They're all equal. And we know that's not true. And the experience is different. Competencies are different. And you have to be an expert in your field. You've got to have credibility for them to want to do business with you. So if they've been referred to you and you're excited to see them and yes, I want we want to see you want to take great care of you and we'll see you in two months or we'll see you in a month. That just doesn't make sense. So you've got to figure out ways to drop them in your practice and typically, well, Art. Maybe you know the answer to this question. Where do most cancelations occur in the dental office? Do you know?

Art Wiederman, CPA: When you say where? What do you mean?

Eric Vickery: Yeah, like either doctor schedule or hygiene schedule. What do you think has the most cancelations?

Art Wiederman, CPA: Well, I better get this right, or else. I'm going to guess the hygiene schedule has more cancelations. I got one right. Yes.

Eric Vickery: Sense of urgency, right. I waited six months for something versus two weeks or something. It's doctor appointment or hygiene. And it's a sense of urgency. Now we work on verbal skills to improve that sense of urgency. But if you're getting hygiene openings tomorrow or the next day and your doctor doesn't have anything for two or three weeks to get a new patient in, or I don't want to flood his or her schedule with a bunch of new patients to not hit that daily goal. Wow. I've got an hour opening in hygiene tomorrow and I can figure. Again, it's another podcast probably, but I can show you how to do that over a couple visits instead of one visit.

Like you said, people are busy. They don't want to come sit in your chair for two hours and they don't even know if they like you. Get them in the door. We'll show you how to break down the systems that you can actually customize to be completely efficient and effective with that time to get a new patient in.

Art Wiederman, CPA: So, Eric, let's go back to the new patients. Let's have a doctor. Doctors got working four days a week, you know, eight to five, eight thirty, five thirty. Maybe they're doing a million a year. Eight hundred thousand, something like that. How many new patients do you think is healthy? I mean, like you say, you know, 60 new patients, no dentist can handle 60 new patients. I mean, what should you, do you have a sweet spot? Do you have a number you like?

Eric Vickery: Yeah. So typically a practice is going to lose between six and eight patients a month and those are going to be from they either just stop going to the dentist. They moved away. And moved away, typically, you get notice that they moved away or they switched dentists. Those are the two they tell you, but when they just stop going or they pass away, right. Those are the four ways we can lose a patient. Typically. Two of those ways you're never going to hear from them. You're going to reach out to find out. Someone will notify you eventually. But if you're going to lose six to eight patients a month, depending how good your systems are, it could be less than that. If you're really improving your communication and how you get a hold of people to get them in, then just to stay even, you've got to be at eight new patients a month just to stay even.

I did an analysis with a practice 2019 and 2020. They were closed for two months, which would be the equivalent for that practice of about four hundred and fifty hygiene visits lost because they were closed. So they lost nine hundred visits in year two. In 2020 they had nine hundred fewer visits. That's four hundred and fifty fewer people coming in the doors twice a year. Right. So that's not just for the two months. That's way more than that. And the reason is people are afraid to go back to the dentist. And we didn't communicate safety in all these things that we got to market to them. And so when you have these openings, you've got to understand, well, if I need eight just to maintain, I need 15 to grow.

So depends on where you practice. Like, I've got a client in New Hampshire they've done two scratch starts and they did really good marketing. We have a KPI for just new patients and where they come from and how much we spend on marketing. And so we know, hey, if we're spending another client spending eight thousand dollars a month on radio and we're getting one or two patients a month from that marketing source, it's not a good marketing source. Right. So we not only look at how many new patients we get, but where they come from and how much we're spending to get that new patient to show value on different marketing sources. So we're paying attention to that.

Art Wiederman, CPA: You know what amazes me and I've said this over and over again on this podcast and on the lecture stage. It amazes me how many dentists just don't ask their patients for referrals. It's the first question I ask in a new patient consult, new dentist consult when working with the client. Do you ask for referrals? Well sometimes or they also say not as often as I should. I said, and then my immediate comeback is, so that means you don't. Oh, not really. And I get the I'm afraid to sell. I mean, that's the low hanging fruit, right?

Eric Vickery: Well, that's approval addiction. That's fear of rejection. That's all the things that I work on. Before you can do verbal skills, you got to be good with yourself and you got to be confident in a healthy way. And then you got to have a system where at that morning huddle you're talking about who you're going to identify to ask for referral. And then you've got to have the verbiage to know how to do it. And then you got to follow up. You know, you've got to take notes on, hey, I asked this person this was their response and oh, they sent someone we sent them a thank you gift. You can't just do pieces of this. You have to do all of it. And then you got to get a look at the results at the end to say how many came from referrals.

So this practice, the scratch practice was seeing, you know, forty comprehensive exam, new patients a month. And the reason they could do that was because it was scratch practice. The doc had the open time. So but once we got to a certain point forty doesn't make sense anymore. The number that makes sense is about fifteen to twenty is about right. And here's another thing that practice that saw nine hundred fewer visits, they're having hygiene openings the next day or two. We're putting new patients in there because we need to get them in because if we just put them on the doctor schedule, the patients waiting too long, new patients waiting too long to come in, therefore they don't come in as often, etc.. And so we and there's tricks to get them to come in. If you're scheduled to be on seven days, verbiage that we put in place, systems that we do. But the goal would be to get them in within seven days with doctor or hygiene. It doesn't matter. It's how you do it once you get them in.

It's how you do it once you get them in. It's how you focus on comprehensive care once they're in. And you will not sacrifice comprehensive care because they're being seen on the hygiene side if your team is trained really well, and if you follow an exam typing system to get them in for a full comprehensive exam customized to meet their needs and fit your schedule.

Art Wiederman, CPA: So, I mean, at the end of the day, what we want that patient to walk out and go home and tell their spouse or their son or daughter or friend to say, I just went to Doctor Vickery's office and I've been going to the dentist for thirty years. And I've never had a great an experience like that because people tend to tell other people about really good experiences and they also tend to tell them about really bad experiences, too. So that's important. Let me go back. Comprehensive exams. So are you saying 15 to 20 comprehensive exam, new patients? What about to grow practice?

Eric Vickery: So what I think to grow up practice and the keyword to grow is how much do you need to grow. Again if your hygiene department isn't at eight days a week, by the way, the key KPI for how many active patients do I have, right, just take two hundred times the number of days of hygiene you have and that's how many active patients you actually have, forget about what your software says. It takes about two hundred patients to fill one day a week of hygiene for a whole year. Pretty simple math. So if you've got eight days a week hygiene, you have six hundred active patients. And that's about the ceiling for one dentist. You're pretty maxed out at that point.

Art Wiederman, CPA: So that's I mean, I have clients that have 11, 12, 13 hundred. They're doing a million. A million, two. Yeah. I mean, one doctor. Yes. Sixteen hundred active patients. That's going to keep you plenty busy. And, you know, and a lot of it is just what kind of a practice do you want to have.

Eric Vickery: That's right. That's right. And most of the clients I work with either are or want to be out of network. And so I help them get out of network, out of insurance and the right verbiage and done correctly so that they can charge everybody the same rate, do comprehensive care on every patient, have peace of mind and sleep well at night knowing that, hey, I'm getting treated fairly by the insurance companies. My patients are getting the best care possible and I'm doing as much dentistry every time they come in.

You know, talk about growing. There's only two ways to grow a dental practice that I believe. One, everybody knows more patients. Right. But at some point like that, 40 new patients a month system. Right. You don't want more patients. Right. So you want to keep your patients right. So it could be overdue hygiene. It could be new patients. That's everybody knows that's a way to grow the practice.

Not everybody knows the second way to grow a practice. And that second way is once the patient's in the chair, we do as much dentistry as possible while they sit down. It's much more efficient to do three or four teeth while they're sitting there in one visit than it is to see three or four patients over a longer period of time. Yeah, and so that's how you how these practices I work with take it to the next level. So we take customer service, we take case presentation, case acceptance, verbal skills so that the patient is doing more dentistry than just one tooth. You're not helping them enough. And the practice isn't getting as healthy as possible at the same time. So you can grow with new patients at fifteen. But more importantly, doing more dentistry per visit is how you can really grow your practice.

Art Wiederman, CPA: So I'm guessing you're a fan of same day dentistry. I put it kind of. Sort of, maybe.

Eric Vickery: Yeah. I mean, look, as long as it doesn't negatively affect your schedule where you've got a happy paying patient and chair one waiting because you decide to put this emergency in and treat them for a root canal while your patient who's sitting in the other chair waits as long as it's makes sense for your schedule to do so. And you have the availability then. Sure. What I really love is the patient to say yes to everything. What bothers me is where dentists go. Well, I presented phase one. OK, well, they spent all this time with your administrative team to figure out how to financially afford phase one at, I don't know, three thousand dollars. Their total treatment plan is twelve thousand and they've decided they're going to pay that three thousand dollars for twelve months no interest on the outside financing company. Guess when they start phase two? Well, they're going to start phase two in thirteen months. That's when they're going to start phase three? By the time they get to phase 3 and phase 4, I mean we'll be lucky if the teeth are still serviceable, you know.

So you have to assume that this patient is going to pay things out. Start with the whole thing and we'll back up from there. Don't start with little things in the you know, the patient are going to you know what? Let's super size me. Give me more. Right. They're not going to ask for the upgrade. We got to talk to him. But that's where people get afraid of selling. They think, oh, I'm going to overwhelm them. I'm going to scare them away, you know, and that's just not how it works. If you have the right verbal skills, you're not talking about treatment. You're talking about conditions and the consequences of those conditions. And so that's how we can make a big difference in growth.

Art Wiederman, CPA: I want to get to my other KPIs, but I also want the folks to obviously, again, I'm very careful who I bring on to this podcast. I only bring people that really know what they're talking about. And it's obvious, Eric, that you do. Would you please, if you wanted, if a doctor listening to this and we have thousands of people all over the country that listen to this podcast, if they wanted to call and just kind of, you know, bend your ear for 30 minutes and talk about some issues, what would be the best way for them to get a hold of you?

Eric Vickery: Well, because I'm on the phone all day long or Zoom or meetings like this, the best is just to reach out by email or text. And so, yeah, you could text me. How about that? We'll just do a text. That could be easy. It's 630.356.4011. And I'm on the West Coast. Don't text me at three a.m. I won't answer, but you're welcome to text me and say I heard the podcast wondering about this. I'll text you back and forth and if it makes sense for us to schedule call, we'll do that and get to know each other. You can check out www.AllStarAcademy.com and look at some great verbal skills training for getting new patients in and to prevent cancelations.

And so we track how much does a cancelation cost? Just one hour of hygiene a day, one hygienist working four days a week is equivalent to about thirty five thousand dollars a year loss. Open time, one hour a day, doctor, one hour a day, four days a week is about ninety five thousand dollars a year. So up that adds up quick. So if you have two hygienists you're talking about a hundred fifty thousand dollars a year, we'll cut that in half if that's happening to you.

The national average is about thirty three percent of open time. So yeah, numbers are a great indicator that something's either really right or really wrong. And so when I see numbers that are wrong, we can talk about the system and the verbal skills to fix that wrong number.

Art Wiederman, CPA: Let's move on because I like everybody else we could do this is for days. Write offs, OK? And I believe in this too. Why do you think it's important if we are charging the actual fee as opposed to a PPO fee. I mean, you know, you've got a you know, get an 1110. That's URC fee is one hundred and thirty bucks. But my contracted fee is 80 and I'm going to put 80 into the computer and oh my collections are ninety eight percent and I'm know. What do you think about that.

Eric Vickery: So there's obviously two schools of thought that you're looking at. I believe that early on, you know, if you're in network and you're doing write offs for insurance, you should probably track those so you get a feel for the pain that's involved with that. So that's one. But once you got an understanding that, hey, I'm losing anywhere from 20 to 42 percent, depending on premier PPO in network inside your practice, it ranges. But if you look at a PPO insurance, it's about forty two percent write off rate. We know that number.

Art Wiederman, CPA: That's about right.

Eric Vickery: We know that number. So once you know the number, now it's time to put the actual fee in for that insurance in your system. And here's why. You give me a goal. You say, Eric, I want to produce and I say Doctor. Doctor says I want to produce five thousand dollars a day. I say, great. Well, let's go ahead and put a treatment plan. This is the case sizes you need, new patients equal this dollar. You see this many patients and we start getting all these things together and you start presenting it and they start saying yes, and we start scheduling five thousand dollars a day. Awesome. Why are we only collecting three thousand dollars a day then? Something's off.

So we don't need to produce 5,000. We now need to produce eight thousand. Nine thousand. And so I don't, I want to play with real money. So I recommend once you know the write off rate, you put in the fee schedule for the PPO that you're involved with. OK, this is part two of three. So know your write off. Part two is now put the actual insurance fee in so that when you treatment plan it, you're actually scheduling to a goal that's real dollars. So we can actually collect that.

So now I know what numbers, not when money's not missing. Right. When money's missing and you have a bunch of write offs, so I go, should it have been written off or should we have collected it? I don't know. But when you produce eighty dollars, that's your PPO fee then I know you need to collect eighty dollars. Now when you tell me, hey, we're up ninety eight percent collection rate, I go that's ok, that's real money.

Now you might say and it sucks I'm only hitting phase three, I'm only producing three thousand dollars a day working really hard. I'm doing everything you're saying. Eric is only three thousand. I can see that if I was not in network that would be five thousand dollars a day. And then I helped clients get out of insurance plans on a regular basis year after year.

Art Wiederman, CPA: Again, this is another podcast. But the fact of the matter is, is that being successful in getting, in reducing your dependency on insurance and getting out of PPOs is very simply verbal skills between the doctor, the front office and the patient. Isn't that right, Eric? I mean, yeah, it's that simple.

Eric Vickery: Has to be. And any doctor who says, oh, my team does all the verbal skills, they're fooling themselves. Any doctor says, oh, I just need to do the verbal skills. They're fooling themselves. A team, it has to be everything from the phone call, which is the second impression because they heard about you somewhere. That was the first impression, from the second impression on case acceptance is beginning. If credibility is one of the number one factors in people wanting to do business with you credibility, then that credibility comes from the patient's confidence in your competence. So credibility equals confidence in your competence. I trademarked that you can.

Art Wiederman, CPA: Well at least you are able to pronounce words I at beginning the podcast was unable to pronounce words.

Eric Vickery: I feel you. Those introductions always get me. So here's the thing. So when I answer the phone, listen, I'm answering the phone for Dr. Smith. That patient calling only has a little bit of an idea of how good of a dentist he or she is. But how I answer the phone will start to give that patient a frame of reference and confidence in that doctor's competence. And so if I do a really good job on the phone call, they're going, wow, Dr. Smith must be an amazing dentist. And then they come in and the hygienist does everything right, says everything right. The assistant. And I still haven't had any dentistry done as a patient. And then I'm still building that credibility, that confidence and competence.

And if your systems and verbal skills are breaking down in those regards, i.e., patient sits down in the chair and the hygienist or dental assistant says, what brings you in today? Or the doctor even worse, walks in and says, what brings you today? After I just told the person on the phone, I told the assistant, and now you come in and ask me that for the third time. Confidence starts to go down.

Art Wiederman, CPA: It's about team communication and all that stuff.

Eric Vickery: Simple example. Simple example. I know we were talking about write offs, but it always comes back to verbal skills. So my three phases are know your write offs, once you know them, adjust to using the actual fee schedule so that you can schedule the goal. We can collect that actual money in real dollars. And then when you feel the pain point and you go, wow, I'm working really hard to produce this number because a lot of doctors know their production. They're not paying attention to the right part of that. They go, wow, it's time to get off insurance. And I help them do that part, too.

Art Wiederman, CPA: Now, this is great. This is great stuff. Let's move on to some of these others. OK, doctors talk about, you know, what's my monthly hygiene production? What's my monthly doctor production? I mean, I've heard this for years. I used to be part of the Pride Institute. I don't know if you knew that Eric, but I was part of the project for years. And I worked with some great dental consultants, coaches, Jim Pride. And Phil, Dr. Phil Whitener, for those of you who are gray hairs like myself who know who they are, if you're in your 30s, you may not know who they are. But I mean, is it more important that we know about production per month? Is it per hour or is it per patient? What do you like to look at?

Eric Vickery: Yeah, so we take we work backwards. What do you want to earn, Doctor? What do you want to earn. Well, we know that number based upon where they are in their career. Right. If they have a lot of school debt, practice debt, whatever it is. Right. We can figure out the percentage and we can work backward and say, well, then you've got to collect this amount. Let's say we say you got to collect a million dollars. So you end up with what you want. Now we take that million dollars and that's eighty three thousand three hundred a month.

OK, then we break that down by provider who's going to produce what, fifty three doctor. Thirty hygiene. OK, what does that per day. Fifty three. That's thirty three hundred per doctor. That's a thousand twelve fifty per hygienist and we can break that down. That's fine to do that. But once you get beyond that, once you get beyond those numbers and you start telling me what we're collecting one hundred sixty thousand dollars a month or we did two point three last year. Well how many providers and how do I know if you're efficient or not?

The only way to know if you're producing what you ought to be producing is if we look at production per patient by this is by provider, production per patient and production per hour. So in a doctor's schedule, production per patient and per hour should be the same, at least five hundred dollars per patient per hour. And what we see a lot of times if that per hour is low. It's because they have open time. If that per patient is low, it's because they're not doing enough dentistry per visit and the ideal scheduling is flipped. It's not right. They're not following the right system. And then we look at case acceptance. Are you just doing, you know, presenting phase one? You're not presenting all of it, all those things. On hygiene then we look at it, say production per patient and production per hour should be the same because they see one patient per hour. And that should be you know, it depends on the area geographically, how much insurance involvement. All these things play a role, but typically somewhere between one fifty and one seventy five per patient per hour should be the same. Again. If you're per hour.

Art Wiederman, CPA: And that comes in to Eric, does the practice have a good non periodontal nonsurgical periodontal program?

Eric Vickery: That's right. Yes.

Art Wiederman, CPA: Because a lot of practices don't.

Eric Vickery: We'll track. We're going to we're going to chat about that. And I think that's in here. Yeah. It goes right into that.

Art Wiederman, CPA: We're definitely going to chat about that.

Eric Vickery: How do you get to that number? Right. And so production per hour will go down for a lot of reasons, but especially if there's openings. You don't have anybody your production per hour zero, if you're production per patient is high, but the production per hour is low. That's typically the issue. But if your production per patient is low too, then there's some other factors that come into play. One of those being perio procedures and the other being, you know, we're not doing fluoride at a 40 to 45 percent usage rate. We're not doing six x rays annually. We're only doing four x rays annually.

We're writing off every pano we do because it conflicts with FMX. We can fix all that. All that is fixable so that your hygienist can produce what they need to produce so that you can pay them. You want to pay your hygienist. I'm assuming the hygienist you have on your team are phenomenal and you want to pay them at a phenomenal rate. So they provide phenomenal care. You know, I don't know if you've ever been to Disney World. Art, you ever been to Disney World?

Art Wiederman, CPA: I have been to Disney World once. I've been to Disneyland a lot. Haven't been. I always promised myself the next time, if I ever have grandchildren, that will be probably the next time I go to Disneyland. But I yeah, I'm familiar with them.

Eric Vickery: So you've seen what the real Mickey Mouse looks like, OK? Yes. All right. Now, if you go to New York, you go to Times Square, there's another Mickey Mouse there. You get pictures taken with. Do you notice that Mickey Mouse looks a little bit different, doesn't quite look the same. I don't think I would pay the same amount of money to see that Mickey Mouse that I would at one of the Disney's. You get what I'm saying?

And so if I'm going to have a great team, I see them at the best rate possible so that they provide the best experience possible for my patients, so that they say yes, so they refer more people, it takes all of us involved to make this work beautifully. And I can't do that if I'm being limited by either my fees, my efficiencies, my case acceptance, how I schedule. All of those things play a role. And so we can use the KPIs to figure out, well, where are they low and why. Here's the system that fixes it and here's the verbal skill that you accompany that system with.

Art Wiederman, CPA: Well, I want to go back to something very important. I grew up in New York for the first sixteen years of my life. What does Mickey look like on Times Square that I missed?

Eric Vickery: That Mickey Mouse is so phony, you can tell he's fake. You can tell us that's not the real Mickey Mouse.

Art Wiederman, CPA: Well, you know, I just must have missed that.

Eric Vickery: And you could use any example, any of the movie characters there. Like I was there in Times Square. My wife was doing some shopping and there was a storm trooper. Anyone could tell it wasn't the real storm trooper. There's just characters there that you can get your picture taken with that just are mimics of the real thing.

Art Wiederman, CPA: I'm a Wile E. Coyote and Road Runner fan. Those are my favorites. We'll do another podcast on favorite Warner Brothers characters. I love that. Or favorite Disney characters. OK, so let's talk about hygiene and percentage of perio. I mean, I beat on people about how important it is. The hygiene department, Eric, in my opinion and we learned this at Pride is three things. It's a revenue source number one, it's a place for asking patients for referrals and developing relationships and it's a place to develop work. And I can't tell you how many hygienists dentists tell me, well, does your dentistry does your hygienist help in delivering the converts of dentistry? And we're selling well. Oh, she doesn't. She just likes to clean teeth and that's it. And it's like I just want to like, take the dentist and shake them upside down. Say why are you not?

Eric Vickery: Again, that goes back to foundation - approval addiction, fear of rejection, lack of confidence. All those things actually play a role in this. And so usually when I coach, I start there. I do life coaching as well. But the life coaching side of it comes into the executive coaching. Before you can sell, you have to first believe that you're worth it. Right. And so that could be the doctor. That could also be the hygienist, could be anybody who answers the phone. And so if you don't have confidence, it's going to come across. Your patients are not going to want to do business with somebody who's unsure of themselves. It just doesn't exist. Right?

Art Wiederman, CPA: Can you teach that? Because I have doctors that listen to this podcast that have called me that have e-mailed me and said, you know, Art, I am the way I am and I just don't know if I can change. Can through coaching. I mean, whether it's life coaching or Eric, dental coaching, have you been able to get the dentist to have a change in how they do things? I mean, is this possible? This is this is fixable, right?

Eric Vickery: Absolutely. I'll save names to protect the innocent. But I'm thinking of one example right away that I met in the early 2000s. I still work with him. He's getting ready to sell his practice. He's in the Missouri area, I'll say that. And he went from wavering and stammering, you know, to confidence. And it takes time. It takes repetition. It takes you've got to train yourself to master it.

Art Wiederman, CPA: It takes work, folks. You have to put the time in.

Eric Vickery: And yeah, you can't just show up and oh I'm different. You know, you actually have to work on the insides before the outsides can show up. So, you know, that's something that I learned way back when I worked with dental boot camp and Walter Hailey. That was something that was amazing for me. And he was a great mentor for me. So, yeah.

Art Wiederman, CPA: OK, so periodontal percentage in hygiene, what do you like?

Eric Vickery: Yeah. So again, can't be just a super prophy. It can't be that, you have to do what is right. And if it were your mouth, it was your family's mouth. So the number one thing that I express to hygiene departments is this. We know all know this statistic. Eighty percent of the population has some form of gum disease, OK, that includes gingivitis. So I don't know, let's take 20 percent off the top. So 60 percent of the population, OK, half of them don't go to the dentist, which half? Probably the unhealthy half. So let's say thirty percent of your practice ought to be dedicated to perio.

Now, I've got a practice in San Jose. I work with them. I worked with them years, years and years and years. And they do everything when it comes to periodontal evaluation and treating what's there and they consistently run about eleven percent perio. It just has to do with their demographics. They're in Silicon Valley. Their patients grew up on fluoride. They grew up going to the dentist every six months. They have a high value for prevention. And so the perio isn't there as the patients age. It just isn't. They're healthier people.

However, most practices, I will say this, I have another practice on the other side of San Jose and they're at 54 percent perio. So you can look at the demographics, say who are we attracting? And they're both using the same system, the same verbal skills. So I will say this, if you're well below 20 percent perio in your practice and most of them I see around nine percent.

Art Wiederman, CPA: And the national average, that's what I quote is nine percent.

Eric Vickery: About nine percent. And I look at practice purchases. I'm helping about three different young doctors right now do practice evals and look at those numbers I look at it and go, how can they do? And this one was just one hygienist she was doing like three hundred sixty prophies in this time period. In that time she did two perio maintenance in the same time. I'm like, that's not even on, that's not even a screen. There's no way that she is not treating gum disease and billing it as a prophy.

Art Wiederman, CPA: And that, part of that doctor's is you setting the tone in your office for what is important. If you don't let the hygienist know that perio is a number one priority in your practice, why would the hygienist make it a number one priority in your practice? Right, Eric?

Eric Vickery: That's right. And I have seen offices transition to really get on the perio bandwagon and then all of a sudden they stop talking about dentistry and the dental chair goes down, the doctor side goes down, and we've got to maintain both. And so actually the same practice in New Hampshire, we used the case acceptance tracker and their hygienist only tracked perio presentations they did. And so we took, remember, there were 40 new patients a month or more. Grow and grow.

And they saw all their new patients in hygiene so kept their perio percentage really low like it's time to decrease the new patient, time to increase the effectiveness of our hygiene department because it wasn't profitable and we went from because we tracked it. What you measure, you improve because we tracked the presentations of perio, that practice is now about twenty five percent perio. So they're almost there, but they still see a lot of new patients in their hygiene department. So it's been.

Art Wiederman, CPA: One thing doctors I want to share is if your practice is at five percent perio or seven percent perio and you're hearing Eric and I talk about that, you should be at twenty five to thirty three percent is probably a good place. Don't flip out and go into your office tomorrow morning and say, OK, so we're going to change everything and I want perio to be one third of it. No no. If you can increase. Eric, I think that if we were working on a plan and we have a doctor that's at nine percent and we could get them to in a year, maybe to eighteen, nineteen percent, that's pretty good, right.

Eric Vickery: That comes from planting the perio seed. You never pull the carpet out from your existing patients because they're going to say, I've been coming to all this time. Why are you telling me this now? Right. And it comes with selling the condition. It comes with over here psychology. Have them hear what the condition is of their gum tissue and having them understand that and say, hey, you know what? If you come, you come back next time, it's not better, let's talk about things. And so the verbal skill and the system associated with it is really important.

Art Wiederman, CPA: OK, couple more things that I want to hit on, so let's talk about lost time in the hygiene in the doctor's schedule that must drive you as a coach absolutely bat crazy.

Eric Vickery: So I mentioned one earlier on the value which we always track open time we try to get due to cancelations are never filled, whatever it is. And I always track a net result of that. And that one hour of hygiene and what equals to. And we take that value of one fifty to one seventy five, we multiply that, that's where we get that thirty five thousand annually. And our goal is to get new patient I'm sorry, hygiene time. Hygiene open time under 10 percent, ideally five percent, so a hygienist typically works about 110 to 120 hours a month so they can be at five, six, seven open hours a month. That would be amazing. So about one to one and a half hours a week for a hygienist. That's what we're talking about. And it's doable. But you got to have the right proactive system to do it.

Art Wiederman, CPA: I mean, that's like if you know, I mean, I'm sure doctors, none of you have come into the office getting ready for your 9:00 a.m. prophy, hygienist got a 9:00 a.m. prophy and at 8:45 the patient calls. Oh, I forgot I had an appointment today and I have to change it. Right. And that's having a system that where you can have a whole bunch of people who are waiting, they can get a mass text message or something like that hey, we got a cancelation first one who calls gets it, you know, the little things like that. Right?

Eric Vickery: So there's prevention, which I believe 80, 20 principal. Right. So I believe 80 percent of our efforts in preventing making that. So that patient never calls at 8:45 or when I call them, they say, oh, just getting ready to call you, you know, tooth's not even bothering me. I'm going to go ahead and wait. Like we prevent all that from happening a vast majority of time. Again ninety five percent of time. So and then on the doctor side, because that's one hundred thousand dollars a year just to lose one hour a day, four days a week. And we say we want to be at three percent or less of open time. So that's about two to three hours a month open time, about a half hour a week of doctor time.

Now I'm talking about it never got canceled. Not like it canceled, fell off, we put something in there, because that is first aid. The 20 percent of effort that we spend is on first aid. What do we say when that call comes in and how we handle cancelations once they're on the phone instead of you know, I do interviewing preliminary interviewing for clients. And I ask them, how do you handle a cancelation call? Oh, I always say OK, let's get you rescheduled. They think, you know, administrative measures take as long as I get that person rescheduled, it's OK.

Sure, that's OK. But it's good. But what's great is to save the appointment, if you can. Now, as administrator, if your clinical team isn't saying the right things when they schedule the appointment, the patient doesn't have urgency and value to keep the appointment and therefore you're fighting an uphill battle. And that's why I start with clinical and then on prevention and then work on first aid secondary.

And then you mentioned something about a mass text and I'll just give this out. This is free. No charge advice, right? Don't tell your patients that you're trying to get in sooner, that you had a cancelation, that you had an opening, that you had a change in the schedule or that you even had previously reserved time that has recently become available. OK, never let them see you sweat, OK? Don't live in a world where you get cancelations that someday you can live in a world where you don't get cancelations.

So if I were to call you, Art, and say Art, Betty, your hygienist asked me to give you a call. She said she'd be willing to see you tomorrow at 11:00 a.m. because she was concerned about how far out you were scheduled and wanted to see you sooner rather than later. Would you be able to come in tomorrow at eleven? So nothing was mentioned about a cancelation and now that patient doesn't hear, hey, we had a cancelation, we had an opening on the schedule and they think, you know what Eric does? He's my automatic cancelation answering machine. And any time I need to cancel, I'll just call Eric and he'll put someone else in my spot. I have to retrain my patients. I got to change that. So but that's the type of verbal skills.

Art Wiederman, CPA: But if I get that cancelation thirty minutes before the appointment, that's a little more difficult.

Eric Vickery: Now you text them.

Art Wiederman, CPA: That's what I meant. Yes. If I have a day or two of an appointment, that's the difference with the cancelation and a no show.

Eric Vickery: That's right. So if I or a last minute cancelation. Now, if I'm going to send a text message, I'm going to use the same verbiage and I can send it out to a few people. I can send out that same verbiage knowing that I have about a 30 percent open rate and send out hey, Betty was concerned. She wants to see you sooner rather than later. She said she'd be willing to see you tomorrow. Give us a call if you're able to come in tomorrow, maybe you put the time, maybe don't. And if they get last to say, hey, we had two patients we contacted and we just got concerned about both you and they took it before you, they'll understand, you know.

Art Wiederman, CPA: So it's all about systems. I think the last KPI you and I were going to talk about today was comparing your collection rate of production and write offs and what's healthy. Talk about that a little bit.

Eric Vickery: So, again, we talked about this earlier, but a ninety eight percent collection rate versus production is ideal or more. Obviously, you want to collect as much as you can of what becomes the question. Are you talking about UCR cash fee or are you talking about insurance rates and that sort of thing and at forty two percent. So how can you collect ninety eight percent of your writing off twenty percent if half your practices insurance based or thirty percent of seventy five percent of it is.

So my when I use my KPI tracker and when we track numbers, I look at adjustments every month and I look at insurance and I look at everything else and I separate those two and I say of the production, one hundred thousand dollars produced. How much did you write off for each of those columns, and I want those write offs to be less than five percent a month. How can I collect 98 percent if I'm writing off 10 percent, 20 percent, 30 percent? So I want to severely low write off rate.

And if something is high, then I investigate. I say, well, why is the insurance high? Why is the, oh doctor's a good guy. He gets friends in here every day. They're all new patients. I've known him for like five minutes and he's given them half off their treatment plan. It's like, OK, then I got to work on doctor approval addiction. I got to work on something there or, you know, family and friends discount or the senior discount is 10 percent or more or their in office membership plan is 20 percent. And I'm going, what are we doing?

So you got to know what your profit margin is to know what you can afford to write off. And so that leads us into the KPI side of, say, your profit and loss report or your realm Art. But I look at a profit and loss and I say show me percent of income column and I compare that to lab, I compare that to payroll and I know what all the healthy guidelines should be.

And once those are out of whack, I say, look, you're not going to take money away from your team. You can only increase collections. How you can increase collections, stop giving it away, stop being insurance, start scheduling better case acceptance, et cetera, et cetera. So there's lots of ways you can do it. And not everybody needs all the ways. We just need to figure out how to take that practice and improve it five to 20 percent.

Art Wiederman, CPA: And at the end of the day, doctors, we want you working on your practice, not just in your practice. And that's what someone like Eric Vickery can do to help you. Again, I don't advertise for my guests. They're all great. They don't need my help. They're all in great demand. But Eric just gets it. I mean, it's funny. You work with a specialist and you're working at your general dentist, work with a periodontist, work with an endodontist. And you just go, yeah, this person gets it. And this is people like Eric who get it.

So since you get it, Eric, and you can pronounce words much better than I can, apparently, would you please let one more time as we wrap this thing up? And again, please stay with us. Stay with me after I sign off, would you please let our listeners know phone number to get a hold of you and maybe an email and website or something so they can call you and it will be in the show notes.

Eric Vickery: Yeah, absolutely. www.AllStarDentalAcademy.com. You can go there. You can text me 530.356.4011 and we can start the conversation from there. I think that's the easiest way, quickest way to get a response from me. And yeah, you can email me. That's totally fine too. But I'm here for you.

Look, I'm passionate about dentistry. I love helping clinical people understand business things and people things and self-improvement. That's the thing I'm passionate about. I know nothing about clinical. I mean, I know about clinical dentistry, but I know not I don't know how to do it. You know, I can drop into a practice and run it. But it's so much more fun for me to help multiple people. I've probably coached somewhere between 200 and 300 offices in the last twenty years. And I love when I help them reach their goals and they love doing what they do. They love tricks that make their job easier and more effective. So, yeah.

Art Wiederman, CPA: And doctors, this podcast every single week is a call to action. That's right. OK, if you call Eric Vickery, I get nothing other than the satisfaction of knowing that you're going to be in really, really good hands and that your business is going to improve, your life is going to improve. So this is a call to action. If you are listening to this podcast and you're hearing some things that Eric or any of my guests say on this podcast, and you say, oh, yeah, you know, I've been really thinking about I going to make some changes, make the changes, make the phone call, get started. Please, please, please get started in working.

Eric Vickery, thank you so much. I really appreciate your time and your expertise. Very excited about what we talked about today. And folks just want to, again, remind you, go to our partner, Decisions in Dentistry magazine, www.DecisionsinDentistry.com for great clinical content.

Also, if you're looking for a dental CPA, this year is like no other. It's be kind to your CPA here folks. www.ADCPA.org. I'm at awiederman@EideBailly.com would be happy to help you with anything. 657.279.3243. If you had a fifty percent reduction in your revenues in the second quarter of 2020 and you have not or even if you have filed for forgiveness for your first PPP loan, you need to look in the Employee Retention Credit. The ERTC we'll be happy to help you with that.

With that said, folks, again, another wonderful episode. Wonderful in my opinion. And I'm the host, so I get to say it's wonderful, wonderful episode. I will never say this was really like the worst episode of this podcast that I've ever recorded. That will not happen. It just doesn't happen, especially if we're talking to nice people or even about sports or golf. What can I tell you?

That is it for this episode of the Art of Dental Finance and Management with Art Wiederman, CPA. Thank you so much for listening. God bless every one of you. And remember my five words of encouragement that we've said since March 16th of last year, which is failure is not an option. So folks, work on your practice, work in your practice. Make it better. Make your life better. God bless every one of you and we'll see you next time.