Dental Unscripted | Getting into Ownership and Practice Management Insights

Welcome to Dental Unscripted.

Where Mike Dinsio and Paula Quinn break

down the practice ownership journey,

one episode at a time.

Starting up, buying,

and running a successful dental practice.

What up, what up, guys?

Another episode of Dental Unscripted.

My name is Michael D'Incio.

We also have Paula Quinn on the show.

What's up, Paula?

Hey, what's up?

are rolling today i think this is episode

three so it is podcast day and Steven

knows all about that well you mean episode

three for the day for the day we're

on episode three for the day steven knows

all about that we'll introduce steven here

in a second but we're super excited to

have this episode as we're interviewing

and talking to dental intelligence

One of the OGs of DI,

Vice President of Business Development,

happens to be the podcast star of the

Growth in Dentistry podcast.

So if you're trying to check them out,

Paula and I were just on the show.

Check out episode what, Stephen?

Like,

four hundred and seventy two with Michael

and Paula.

Uh, no, but, uh, uh,

we always like interviewing dental and

tell us they have so many great numbers,

trends and things they're looking at.

And, uh, we use it, uh,

pretty much every single day.

So, uh, thanks for being on the show,

Steven.

Um, welcome to the program.

Yeah.

Thank you guys.

Excited to be on.

Yeah.

Well, without further ado,

I like to get right into it as

we usually lose people after seven

minutes.

So let's get hopping.

So what is Dental Intel?

Let's just start with that because I feel

like not everybody,

even though it's on ten thousand dental

offices right now,

a lot of people don't know what Dental

Intel is and what you guys do.

So just give us the high level.

Yeah, cool.

I like to frame it this way.

It wasn't that long ago when dentists were

taking film x-rays.

My wife's a hygienist,

so she went to school and was forced

to learn how to do film,

even though digital x-rays were on the

rise.

And

You know,

so what's interesting is with getting a

diagnostic picture of teeth,

there has been so much progress.

So if you're a dentist listening and

you've been in the market for twenty,

thirty, forty years, like you know that,

you know that the technology has gotten

better and better.

And even today we've got AI that's looking

at the tooth to help us out.

And even though there's been all of this

progress in getting a really clear picture

of the tooth, where is it strong?

Where is there decay where we need to

do some restorations?

Man, if you go ask a dentist, hey,

where in your business is there decay?

Like if we wanted to take an x-ray

of the business and really understand

where is it strong and where is there

decay where we probably need to spend some

time as a business leader doing some

restorations.

A lot of owners,

I would say the majority,

are still in a position where, man,

they might not know.

They're looking maybe at new patients.

They're maybe looking at collections and

production.

But they don't have the ability to get

a real x-ray of the business.

So what is dental intelligence?

Dental intelligence is just that.

We're looking at Dentrix.

We're basically taking an X-ray of

Dentrix, EagleSoft, Open Dental,

and we're showing you graphs, charts,

reports to help you understand the health

of your business.

Where is it strong?

And then where might we wanna go spend

some time doing some restorations so that

you can take the best care of your

patients and your team and your business

profits as well?

So that's where we started.

Since then, we realized, hey,

all of this data exposes action that

people need to take.

So since inception,

when we started with the x-rays,

we've now added a bunch of additional

actionable tools.

So we do the patient reminders and

confirmations.

We do digital forms.

We do digital treatment plans,

payment plans,

all that kind of stuff on the patient

engagement side.

But man,

our original product is that analytics

product that I think people really know us

for.

Yeah.

I do get sometimes like, well,

can I get that in the dental software?

Yeah, I mean, that's where I'd be like,

yeah,

can't you look at a tooth and see

a brown spot and know that there's some

decay?

That doesn't mean you know how it's all

connected together, right?

Yeah.

Or maybe even another comparison would be

that older x-rays to the newer ability to

have AI go highlight things for you and

look at all the shades of gray,

where we're taking all the different

reports and comparing them against each

other for you.

I was just going to link it back.

We interviewed one of those companies,

two of both of them, actually,

just more recently about AI and how X-rays

are being kind of.

And I'll never forget the story of of

us finding out that someone was using AI

to read an X-ray.

And I didn't understand it, of course.

So one of our clients was interviewing one

of those companies.

And I said, Paul,

I don't even know how to answer this.

So I hand the phone to Paula.

And I'm like, Paul, talk to this guy.

He needs a software to read an x-ray.

He's about to spend all this money.

And so I handed it to Paula,

thinking that she was going to have a

way better response than I did.

And this was years ago, right?

And I hear her say, well, Doc...

don't you know how to read an x-ray

and i literally spit water out my mouth

but but full circle here we are on

the phone with these guys yesterday and

our minds are blown and how it could

really take a practice to the next level

so

Um,

that's how dental Intel is with practice

management software.

Yep.

Full circle.

Well, where,

where do we want to take this Paul?

I mean,

we could ask this guy a hundred questions

about all kinds of things.

How do we use dental Intel to incorporate

and where do we want to take today's

episode?

Because this thing's a powerhouse of

information.

It is.

I know I could go on a hundred

tangents,

so I have to watch my episode on

their episode.

I think probably one of the biggest things

is obviously being a coach,

I do see pitfalls,

but you all get the luxury of ten

thousand practices or more.

and seeing those pitfalls.

So, you know, I mean,

I've got my thoughts behind it and what

I see in the trends,

and they're probably not too far off,

but I'd love to hear your perspective of,

you know,

what are some of those pitfalls that you

really see in practices with collecting

this data?

Yeah.

I think that's a,

that's a common question people have.

And Hey,

you guys are sitting on the data on

ten thousand practices.

Can you like open up the hood a

little bit and just tell us like what's

going on in dentistry?

I think a lot of dentists are curious,

like, Hey,

is what I'm experiencing the same as

everyone else?

Or do I just,

or do I just suck?

You know, hopefully it's not the,

you just suck thing.

Hopefully it's the same thing as everyone

else.

But some cases

Let's start.

There are several trends that I think

people are feeling right now.

The first one I'll share is this.

So one of the things I look at

is how successful are we in the average

dental practice at growing our patient

base year over year?

In the last several years,

we have flattened out,

meaning the average practice last year,

I think,

grew by like two point one percent.

This last year was one point eight

percent.

So for every, you know,

a thousand patients you have,

active patients,

you're only adding ten or twenty.

which you just don't feel.

You don't feel that in the schedule at

all across a whole year.

And so then the question becomes, well,

why?

Why is practice growth flat?

I'll tell you,

it's not because they're not getting any

new patients.

That's happening.

So new patients isn't necessarily flat?

No, no new patients is, is pretty normal.

That's like happening standard.

In fact, there's a lot of,

there's an increased demand for things

like Invisalign now more than ever.

And so like those,

some of those marketing campaigns are

working exceptionally well, um,

in comparison to the past,

but we're still, we're still, you know,

sitting there flat now.

Coming out of COVID,

there was a ton of growth and I

think everyone knows why.

Is that where you got to the two

point one and now we're back down to

one point eight?

It's even flatter than it was.

Exactly.

But like after COVID,

there's a ton of patients that fell off

everyone's calendar.

So there was for sure like a land

grab of like, hey,

we can go grab a bunch of patients.

It just doesn't exist today.

So it's a more competitive market.

people are more stable in their job.

There's not as much movement, but,

but really what I want to highlight are

some of the actual trends that are causing

this like flat flatness in our patient

growth.

So one of those is cancellations and no

shows.

I mean, Michael and Paul,

I don't know if you guys want to

speak to what you're seeing with your

clients, but I'm seeing, you know,

before COVID,

it was the most boring thing to track

every year.

It was like, okay,

anywhere between like eight and eleven

percent combined cancellations and no

shows.

So if we

for every ten patients we were scheduling

every day, we would have, you know,

one of those ten would cancel or no

show.

And if we had twenty, it was two.

You get the idea.

But now that has almost doubled.

between fifteen and eighteen percent

combined cancellations and no shows which

is just decimating the schedule it's

making it feel more chaotic more difficult

to people people coming in and then what

that also does is that puts more and

more people in our unscheduled patients

bucket which means we have to start

calling them we have to start emailing

them to like track them down and they

just get into unscheduled la la land once

they fall on the schedule right exactly

I was thinking when you said that, like,

okay,

so eight percent before and now it's

sixteen, twenty percent.

And you feather that with hygiene wages of

almost probably thirty,

forty percent higher.

Well, you live in the Pacific Northwest.

But just it's true.

That's true.

Arizona hasn't moved very much.

So before COVID,

it was it was about the same.

It leveled out.

Five dollars an hour more.

So so but we are paying our hygienist

more.

So if we're losing if we're losing

patients or falling off in cancellation,

it hurts even more on the pocketbook.

Yeah.

Yeah.

I think, you know,

the fact that insurance reimbursement

stays the same year after year,

I think that if you, you know,

aren't coached to increase your UCRs,

although we know that there's not a

trillion fee-for-service patients out

there, coupled with, yes,

the increase in wages in general.

I mean,

hygiene for sure in the Pacific Northwest

and other regions, but I think in general,

dental assistants, front office,

all the way around, even...

Even associates, you know,

you know what I got my associate for

back in the day.

It doesn't exist any longer.

So one hundred percent.

And I agree with you.

It's it runs amok of your schedule and

what you're you're supposed we our last

episode or last two episodes were on front

office and it goes hand in hand with

this because you.

you have poor front offices up there

trying to just get through the day and

all of a sudden five people fall off

or what you know and guess what happened

well if they're great you know they're

gonna go straight to i've gotta fill this

um so absolutely it's it's a it's a

it's train wreck so

Yeah.

So one of the one of the things

I like to go with this, because,

you know,

I don't want to just give people like,

oh,

dental intelligence is going to like sound

all these alarm bells,

but then not help me actually fix the

problem.

So, you know,

one of the things that I like to

do with people, I'll tell you,

there's a dentist.

Her name's Dr. Sidney.

She's out in Nebraska and she bought a

practice.

It's been almost two years ago now.

She bought it when I since I met

her and she bought the practice thinking

Kate is going to be great.

It's a retiring doc.

He works three days a week.

He says there's like four thousand active

patients and and he just, you know,

stays busy.

And this is going to be a great

situation for.

And so she buys the business and she

is struggling to keep the schedule full.

And one of her friends from dental school

who also owns a practice,

she took a while.

She worked as an associate for a number

of years,

but decided she wanted to own her own

practice.

Said, hey,

you should get connected with dental

intelligence.

So we went and installed the tool.

She got going with us.

And then I got connected with her because

one of our reps was like,

this lady needs some help.

And I'm going to have Steve go just

take a look and see what's going on.

So one of my favorite graphs.

I like to pull up and it really

tells the story of like,

if we're not growing with patients,

what's really going on?

The graph for those that have never seen

it will show on the top side of

the graph will show a count of all

your new patients.

If you're getting fifty new patients a

month,

there'll be a big blue bar that says

fifty.

But what we do that no one else

shows you and you can't

is on the bottom of that graph,

we have a red bar that says,

how many patients did we lose this month?

And to lose a patient is one of

two things.

Either we marked them inactive,

so we know we lost those ones.

You can go pull a report in the

practice management to find those.

one that has gone eighteen months since

their last appointment with you guys,

we're going to say we lost them.

We have stats to show that they are

highly,

highly unlikely to come back without any

activity, you know,

or effort from the practice.

We don't have the right number.

We don't have the right email.

They've got URLs there.

We're going to consider them lost.

And when I say the industry on average

is flat with their growth rate,

what that means is when I pull up

this graph,

almost every time what I see is as

many new patients as we're gaining,

we are also losing out the back door.

And in Dr. Sidney's case,

She was actually losing more than she was

gaining.

So the doctor was right.

She was getting fifteen to twenty five new

patients a month on a three day schedule.

That was real.

But what the doctor didn't know and he

wasn't trying to like pull up,

pull a quick one on her like really

what he thought.

We had a tool telling him what was

going on.

But what we found was that, you know,

for those first six months of her working

in that practice, some behaviors change.

There was a turnover in the front office

and their rescheduling habits went out the

window and they were just bleeding

patients.

And they were before she ever bought the

practice.

We saw this in a pediatric office that

we coached through an acquisition.

He had a ton of cleanup.

One of the things that we track on

an acquisition is that retention

post-close.

As soon as the close happens and we

start seeing a lot of the red pop

in that amazing chart,

we know that a couple of things happen.

They're either cleaning up

which is what we're hoping is happening or

the new office or the new doctor is

not doing a great job with patient

experience and patients are like asking

for their files.

So we love that chart, but, um,

this particular doctor did a huge cleanup,

his patient growth,

like just way down and then more recent,

but he's been getting like, uh,

you know, eighty patients a month,

a pediatric doctor.

And so it's like, gosh,

he was breaking even.

But just more recently saw these that that

red line shrink up and he he maintained

his new patients and his patient growth

has just exploded.

And it's just it's incredible to see that

when you focus on who's going out the

back door,

how fast your active patient count pops

immediately if you can just tighten up

some of these systems.

Yeah.

And that's exactly what happened with with

Dr. Sidney.

It was like, hey, OK, well,

where are we losing all of these patients?

And it's pretty simple, guys.

Like I think intuitively,

if we were to start having a conversation

with the office manager or dentist,

they'd be like, yeah, these places.

And that is on our new patient exams.

We're not always great at rescheduling

them.

The industry average is only fifty six

percent on the same day.

They're scheduling that next appointment.

So like the industry average is half of

our new patients are getting rescheduled.

So we're losing some new patients.

We're losing those cancellations and

no-shows.

Those are big buckets.

That's why I brought that up early.

A lot of no-shows and cancellations aren't

making it back on the schedule.

And we make that really obvious in DI.

There's like a whole chart for both of

them that shows you of all your

cancellations,

how many have you gotten scheduled back

and how many are still unscheduled.

Mm-hmm.

and then hygiene reappointment this is one

where we were sometimes we're losing and

with dr sydney we did have to improve

that but just so everyone hears

industry-wide that's been going up for

like ten plus years we keep getting better

and better and better across the whole

industry with hygiene which is like yeah

it's like that's actually very encouraging

to see now granted

I am only looking at DI customers.

I was just going to say that Dental

Intel gives you that resource.

Little skewed there.

I think it is probably skewed.

probably lower,

but that has been improving,

which I think is a good sign.

And I hear other people evangelizing that

idea outside of us.

So I think that's, that's working.

And then the last place is people will

come in for a limited to see the

doc and they'll get tooth pain fixed.

And it's pretty,

it's doctor and assistant teams just are

not in a habit of double checking for

that, that next future visit.

So it's another place where people,

you know,

pretty easily fall into la la land.

So yeah,

The tactical idea is how could we use

dashboards to make it so the team has

one place to look to know if we're

going to win or not, right?

So that was the question I had for

Dr. Sidney.

It was literally her.

She had no hygiene team.

It was just her.

She's doing her own hygiene and

restorative work.

And she had one person in the front

office, just two people.

Oh, yeah.

And it turns out she did not have

four thousand patients.

She had like six hundred and thirty.

So she could not afford to lose any

more patients.

We had to like plug.

There's no way two people can handle four

thousand people anyway.

No,

but we at least want to start working

three days productively,

work towards getting an assistant.

So her an assistant and one front office

work towards getting.

a hygienist in there so she can start

doing more restorative.

But we needed to solve the patient

problem.

So the task was simple.

It was two things.

One,

there is a bucket in DI that says

unscheduled patients.

And that number was really big.

And I said, every single day,

we want that number to get smaller.

If it gets smaller,

then we're solving the problem.

If it's getting bigger,

then we're not solving the problem.

makes sense.

Here's liter All we have to do on

a da Sidney assistant in front we end

the day with more

let's see if we can end the day

with ten people scheduled in the future

now all of a sudden our unscheduled bucket

has gone down by five and that you

take that and you start to do five

patients extra a day times by a hundred

and eighty working days and all of a

sudden she doesn't even she can't even

schedule that many like the whole problem

solved in like four months almost you know

of scheduling

so so wait can can we back that

up because i i think i think all

of us are on the same page and

sometimes i think the the folks that are

driving to work uh whenever they're

listening to this what are we talking

about so so essentially what you're saying

first of all you need the intelligence no

pun intended to know if you're where

you're at right and how many is on

the schedule so that's number one figure

that out number two is you're saying

Say that a little slower.

So so you're saying if X amount of

people are on the schedule today.

Yeah.

Five hundred and eighteen.

Whatever.

Like active patient.

Active patients are on the schedule.

Yeah.

Just say five hundred.

And then at the end of the day,

there were three cancellations,

one no show.

And we didn't reappoint a hygiene

appointment three times also.

So whatever.

So now that number is going down.

But what you're saying is,

is we're we have to fight that.

to be more to try to get five

oh one for the day essentially correct

every single day every single day

interesting that's that's really cool

that's really cool i mean i i don't

know about you guys but that that's not

discussed in the morning huddle how many

patients are scheduled today or forever

and where do we need to lay it

right yeah that's that is that is one

of the things that i i wish was

more obvious now what we do in the

morning huddle is we do highlight where

are my opportunities to schedule these

extra patients like where are my easiest

opportunities for example in the morning

huddle we're showing and that's why we're

showing them

is, hey,

you've got twenty patients coming in

today.

Did you know that there's an additional

twelve family members that are associated

with the same guarantors that aren't

scheduled?

So let's just see if there's any not

all of those are going to be slam

dunks,

but let's see if there's some opportunity

there to get some additional family

members scheduled while we're seeing one

of them.

Right.

I'm going to put you I'm going to

put you in a hard spot here.

Maybe, maybe not,

because I can promise you you've heard

this.

What about HIPAA?

How can we ask Paula's husband,

what about him?

What if they're getting a divorce?

What if they're not doing well?

Am I allowed to mention your husband

doesn't have his dental appointment

scheduled?

Yeah,

I think probably the most practical one is

more like a parent-children relationship,

you know, where you're asking about them.

My answer is like,

don't you know your patients?

Does she just not talk about her husband

when she's sitting there in the chair?

Yeah.

yeah and then that that stuff will come

up as well you know where where a

lot of times you know they're cut they're

yeah they're they're i don't know i don't

think i think that you stumped him oh

i stumped you my response to that is

of course use use common sense obviously

don't say hey you know it looks like

your husband's unscheduled for his root

canal that we diagnosed six months ago

that stuff you know where it's like you're

talking through a treatment plan you know

probably not i feel like most people

especially as a hygienist when they get in

your chair something's gonna come up about

their kids about their spouse about you

know um if nothing comes up you don't

know them very well maybe don't say

anything but i feel like if

And if you don't know, you know,

if you want to be extra safe there,

then in that situation,

you could also just take that list of

family members that aren't scheduled.

And you can shoot a message and be

like, hey, you know,

we love seeing your family here in the

practice.

Notice you were unscheduled.

You don't have to bring up the reason

why you noticed they were unscheduled.

You know, you know,

you don't want to make sure we get

you scheduled to come back and you can

just reach out to them.

You know what I mean?

Yeah, I mean,

I always come to you because I get

that pushback a bit.

You've not heard that?

Yeah, no, a hundred percent.

I've heard that.

Yeah, that's a common thing that comes up.

I mean,

common is in like maybe one in...

every couple hundred practices.

Yeah, yeah, yeah.

Not every day, but definitely comes up.

For sure.

Use, which is good.

I'm glad that comes up.

It means people are doing their HIPAA

training, making sure that they're like...

Right, right.

Well,

let's put an explanation point to this

topic of...

of of attrition right because I think just

like every dentist that every business

owner that I always talk to they always

want to talk to me about marketing because

I'm supposed to be the marketing

specialist I am I'm discrediting myself on

a podcast but I am the marketing

specialist okay so the first thing that

they want to say is well I don't

got enough new patients

Yeah, every single time.

And then I'm like, Well, dude,

you kind of hired us.

You don't have a lot of money.

This was a big decision to take on

consulting.

And so that's an extra expense.

And so now, you know,

you don't have a lot of money to

throw around a marketing.

So

And then let's just say you do have

a lot of money in marketing.

Then it's like, well,

what do I spend the money in?

Is it pay-per-click?

Is it SEO?

Is it mailers?

Is it ZocDoc?

I mean,

there's a hundred things to do there,

right?

And then there's all the organic ways.

Let's set up a booth at a trade

show or some kind of school event.

There's so much effort and money,

both effort and money,

that goes into getting new patients.

And ironically,

they're fighting to get all these new

patients ultimately to only see two

percent growth to your statistic.

And so it's a lot of money and

a lot of time.

When really they're just not taking care

of not taking care.

They're not they're not tightening down on

this topic.

So I always say, Paul,

and I always say, well,

before we throw a ton of money in

a marketing,

shouldn't we like fix who's going out the

back door?

A and B, by the way,

new patient reappointment rates you

mentioned was fifty percent.

So you're going to spend a shit ton

of money on all these new patients and

then fifty percent are going to walk right

out the door anyways.

The one thing I will give people credit

on,

because I do have people all the time

push back on the new patient

reappointment.

We were like, no way,

we're getting more scheduled back,

which I will give people credit.

When I jump into the source data,

practices do follow up with those new

patients.

So if I were to take like,

because the reappointment number is same

day,

how many do we get scheduled for the

next one?

And the reason why that's important to

people here,

this is we don't ideally we want to

schedule that new patient the same day for

the next visit, because if we don't,

then I'm spending dollars as a business

owner to have my team members call them,

text them to try to get connected.

People answer their phones these days.

So it's like a lot of time to

connect with them to finally get them

scheduled.

So I will say, you know,

if I had to do like a finger

in the wind,

like what percentage of new patients

ultimately get scheduled back?

Yeah, it's probably more like sixty five,

seventy percent probably with, you know,

thirty,

thirty five percent falling through the

cracks.

And that's just me.

Like I said, finger in the wind.

I've looked at hundreds and hundreds of

these, you know,

dashboards and clicked on the source data.

So people do get some of them back.

I'll give them that.

I will still say there are still a

good number of new patients that come in

for one visit that never come back.

So it's an area of growth still for

the community.

That's interesting.

That's interesting.

I also think about how many patients don't

get their calls,

the new patient calls get picked up.

So between the no patient call...

Between the patients that don't even get

phone calls,

like they call in and no one even

picks up.

And then the other seventy percent,

the statistic that we heard from a mailing

company that we use is thirty percent of

new patients don't.

calls don't get don't get picked up so

of the thirty okay so now we got

seventy that actually got picked up what's

the conversion there and then once you

funnel that way down to the people that

showed up how many of those patients don't

get reappointed it's like oh my god what

is happening all right so i think you

wanted to share a little bit more about

another little trend uh and i think it's

an it's a good one

yeah let's hit this one so the other

there's really like two two big things

that i've seen happening in dentistry over

the last little while that that i think

we need to put focus on as an

industry that are worth our attention the

second one is an interesting one oh it's

been almost the last five years straight

there's been a decline in two things that

doctors care a ton about the first is

patient case acceptance so i it doesn't

matter the case size there i could present

ten thousand dollars i could present five

hundred dollars

are patients saying yes to something and

that number has been coming down that's

that's the doc the number a lot of

doctors like it's typically you know

somewhere in that like i think doctor

excuse me think you know eighty eighty

five percent of patients are saying yes to

something and that's coming down into the

mid to low seventies you know where a

patient's saying yes to something and then

the second number is a similar number it's

one i i prefer i think it's a

better number

and it's treatment dollar case acceptance

so that one's saying hey if i'm a

dentist and i diagnose four million

dollars in a year how much of that

dentistry that i'm diagnosing that i've

identified is actually getting scheduled

and completed so let's say if you know

for sake of numbers if your case

acceptance there is twenty five percent

that means you're getting a million

dollars of treatment done and that number

has been coming down year over year as

well so that one

you know, average, you know, yeah,

average three years ago,

five,

forty six percent of the treatment that

was getting diagnosed was getting

completed.

And now we're down into that twenty nine

to thirty three percent range.

Wow.

That's pretty significant.

So for every million dollars of dentistry

getting diagnosed,

there is a hundred thousand dollars plus

that's not getting done that used to get

done.

Just the question I always get the

question I always get on this one is,

well, I I put multiple treatment plans in.

And no one deletes them.

Right.

You know, stuff like that.

And I'm like, well,

that's why it's never a hundred percent to

begin with.

Like, you know,

top treatment acceptance is, you know,

maybe sixty percent.

So you're they're already accounting for

not everybody's going to schedule all same

day.

You're not getting all acceptance.

So I think in this is configured like,

you know,

that that's that's why top isn't a hundred

percent.

correct with that or am i am i

i totally agree another thing i always

like to tell people because that's a

common thing that comes up is like oh

there might immediately go yeah that

number sucks because i do duplicate

treatment plans and and that might be true

what really matters to me with this case

acceptance on the dollars number is what

direction are we trending as an individual

dentist and

as a practice and as an industry.

And so I keep behavior the same.

Let's say my behavior is I do duplicate

treatment plans and I don't ever clean it

up.

You should at least see it the same.

Correct.

The trend will still show up the same

way.

Exactly.

Or worse.

Which is why Paula throws KPIs at our

clients every week.

Every week.

And whatever that is for their practice,

the goal is to get it up.

Correct.

Yes.

So that's the thing that matters the most

here.

And so for all ten thousand plus dental

intelligence clients,

there is there is the law of large

numbers.

There's a bunch in there that do duplicate

treatment plans.

There's a bunch in there that don't like

we have roughly the same cohort of types

within this metric.

And so that's that's coming down.

So.

The question that becomes,

why is that coming down as an industry?

And I think there's a couple of things

that I should highlight that are not

concerning,

that don't have to do with the patient

or the doctor as much.

So here's one that I think is good

for people to hear.

The diagnostic rate.

So on every exam we complete,

how often are we diagnosing?

That has been going up.

year over year for the last five years.

The amount diagnostic per visit.

I'm going to do both.

Both have gone up.

So one, for every exam I complete,

how often am I having a treatment

conversation?

That's been going up.

That one has a lot to do with

general dentists expanding what treatments

they offer in their practice.

So

We're seeing more Invisalign happening in

general dentist.

We're seeing more implants happening in

general dentist office.

We're seeing more all on four cases

happening in general dentistry offices.

So that trend of expanding treatment means

I'm going to have more clinical

conversations than I did in the past

because we offer more clinical services.

So that has been going up.

And then that, though,

doesn't necessarily mean case acceptance

is going to come down.

The number you're getting to, Michael,

is the one.

where there is traditionally an inverse

relationship.

Meaning if I present more dollars in

general,

my case acceptance on those dollars goes

down.

So let me share like the common pitfall

that doctors make when they're looking at

case acceptance metrics.

They'll look at the DI benchmarks and

they'll be like, oh, sick.

I am one of the top diagnosers in

the industry.

I'm doing comprehensive dentistry.

I'm diagnosing like, two thousand dollars,

like nineteen hundred dollars per exam.

But then they look at their case

acceptance and they're like, oh,

what the F?

I'm like one of the worst, quote,

worst in the industry.

And they'll fail to realize that in

general, the best case acceptance,

and I'm putting quotes for those that

aren't seeing this video,

the best dollars case acceptance

oftentimes are the ones that are very

conservative in diagnosis.

So they're only diagnosing six,

seven hundred bucks per visit.

And then once we go up to the

heavy diagnosers and they're presenting

really big cases consistently,

you'll see an inverse relationship where

their case acceptance on the dollars is

lower.

So logically,

it seems to follow if the industry as

a whole is diagnosing more dollars per

exam,

then we would see some softening in the

case acceptance metric.

Does that make sense?

It does.

I mean, yeah.

It's complicated,

but I want people to hear it.

I get it,

but I think there's solutions to all of

that.

Correct.

Yeah.

It's hard for me to say yes,

but I do understand.

You're doing the same thing I'm doing is

asking the question.

No,

I know people that that doesn't happen

where we do expand ourselves clinically

and we're able to maintain or even improve

diagnosis, right?

Well,

I don't want to take this too far

here and maybe make some general

statements,

but the question that I have is like,

Are doctors, if that's the case,

are doctors...

today graduating with less acumen less

training on how to connect with people

interesting i think it's just a different

generation in my opinion well that's what

i was going to say but i didn't

want to throw out any dramatic statements

but i'm wondering if the connection isn't

there like it used to be or if

it's a communication thing or if it's a

training thing

I don't know.

I don't know.

There could be some of that on the,

we're putting it on the clinical team,

but there could be some of that.

Thank you.

I was about to say that.

It takes a team.

It takes a village.

Millennials and Gen Z,

like those patients are starting to be the

ones that are, they're on their own.

And they have money.

They have the money.

And they're a different breed than,

you know,

our boomers and Gen Xs that we've been

working with for the last couple of

decades.

And don't you think, I mean,

some of it's got to be the industry

in general.

There's a,

we were talking about this earlier,

you know, in my hometown,

there were two dentists.

Now there's, I mean,

I came from a very small town.

Now there's.

You know, it's, it's.

there's so many choices.

Now this one used to,

we went to convenience and because this

was Dr. Smith, the town dentist.

Now it's like, Oh, there's this,

there's this, who takes my insurance?

Who's convenient?

How, you know, how can I schedule?

I can't get same, same day treatment.

Yeah.

Yeah.

It's so much.

I think that goes into it now that,

you know,

what what i love about dental intel is

exactly that the trends that only tells

you what's happening doesn't tell you how

to fix it so i think the next

step is you know michael and i you

know say it all the time and probably

every coach out there says it is you

know even the best athletes in the world

have a coach there's nothing wrong with it

it doesn't it you're your head's in the

game you can't be thinking outside the box

watching your every move thinking ahead

you know um

And then when you're done playing the

game, you just want to go chill.

So it's like this extra pair of eyes

and dental Intel is as well is between

the two.

It's like, okay,

now we've diagnosed the trend or what's

going on or are we below or above

our average on industry standards?

And now it's like, okay,

what system is broken?

Because we just said it takes a whole

team.

Is it the doctor's delivery or is it

no one following up?

Where they already have a bad taste in

their mouth when they came in because

things didn't go smooth.

Now this added to it.

Now I just don't trust what you're saying.

Now no one follows up with me.

You lost me forever.

You know,

so it's to me when someone says my

case's acceptance is down, what do I do?

I'm like,

We've got to look at the whole system.

I don't know what part is broke,

but something's broke.

It's always the what's wrong and then the

why and how, right?

And I think on this panel,

we can figure out the what with dental

intel.

We can do it.

And then Paula can figure out the why

and how.

And the how.

and the how i was thinking about i

know we transitioned away from the last

topic of attrition but like you know like

cancellations for example well no we were

on we were on case acceptance i know

i i know i'm going back to the

last topic i'm thinking like there's like

seven or seven or seven or six or

seven steps that paula walks our clients

through to prevent a cancellation right

and so it's like okay cancellations are

double but are you doing

this touch and this touch and text and

email and how often and when and are

you charging and is it written here and

is there's a whole bunch of things that

you need to do to fix that to

see that number change it's the same with

case acceptance it's like gosh are you are

you slurring are you not using uh are

you not using ai to read your x-rays

do you not even have a screen does

nancy joe not have financial arrangements

i mean

There's a hundred reasons why that might

be,

but it's interesting that it's going down.

Yeah,

what I'm hearing too is for every problem

we identify, like there, yes,

there can be changes in patient behavior,

which might mean the system we used ten

years ago doesn't work.

So we need like a Paula to come

in and say, hey,

here's a new system that I've proven

works.

Fixes, you gave the example, Michael,

of cancellations and no-shows.

It will reduce cancellations and no-shows

with your demographic of patients if

you'll implement this strategy.

And if that's true,

then that's probably also true in case

acceptance.

Hey,

maybe there's some changes in patient

behavior or finances, etc.,

And there are probably new systems to be

discovered,

new ways of doing things where if we

implement them,

we can kind of buck this trend.

So one of the things that I think

always speaks to you.

Oh,

and one other thing I want to say

so that this is very clear,

because I don't want people to just like

think, oh, well,

just because we're diagnosing more,

that's why it's going down.

But the thing I forgot to say was.

We are only diagnosing on average two

hundred dollars more with a dentist.

So like that slope is really like slow

going up where the treatment dollar

acceptance is like steep.

You heard me mention it's like twelve

percent less over the course of two years.

So there's like a much faster downfall

than you would expect with this slow

little creep up in dollars presented.

So wait, wait.

I love I love where it went because

it doesn't even matter if it's going down.

It's how how what do we need to

change?

to meet that, you know what I mean?

So, okay,

what we did isn't working anymore.

It's doing something else now.

Sorry, Michael.

The place I like to go jump with

that is, you know, I don't know, Michael,

do you want to chime in?

No, no,

I just wanted to make sure I was

with you and where you're going.

So the amount...

Because the idea was we're diagnosing more

so case acceptance is going down.

Yeah, that is normal.

But what you're saying is the amount

that's gone up is minimal.

The amount that's gone down is dramatic.

Correct.

The amount that's gone up is less than

inflation.

So it's small in comparison.

Perfect.

So where were you going to go with

that?

Because that is a problem.

That's a problem.

So then the question becomes like,

where and why is that happening?

You know,

the questions you guys started to ask.

And what comes to mind is that it's

probably been a month and a half,

two months ago,

I was doing a training with a bunch

of doctors that work for a sixty five

location DSO.

And one of them specifically, Dr. Joseph,

you know,

I just had to raise your hand and

said, OK, who who?

Can we go and go through your case

acceptance workflow?

I like to dive into three numbers that

really help me understand,

at least within this clinical flow,

can I start to identify where there might

be gaps?

Uh-oh, here we go.

Okay, hold on.

Are we listening, folks?

Because Steven's about to drop three

things you need to pay attention to right

now.

Go.

This is good.

The first one I like to see is

our diagnostic percentage.

And that's super simple.

It's every time we complete an exam,

how often are we having a clinical

conversation?

So that one,

I like to look by what I call

a treatment team.

So dentists by themselves,

those are typically going to be like

limited exams.

And then I like to look with dentists

with each of their hygienists.

Typically there's,

for the average dentist,

two hygienists associated with them.

What that allows me to see is,

are there relationship things?

Are there timing things across by

themselves and with those hygienists that

are changing their diagnostic behavior?

Does that make sense?

So every time you talk to me,

a patient,

how many times on percent are you talking

to me about restorations or whatever?

So that's it.

Just ten patients come in.

I talk to four of them about fixing

teeth.

And I think every dentist would agree if

I'm across my hygienist,

assuming there's a relatively similar mix

of new patients over time, right?

Where if I'm isolating new patients,

I typically will have a higher diagnostic

rate.

But as long as it's a pretty consistent

mix across hygienists,

I would hope to see a pretty homogenous

or similar diagnostic rate across my

hygiene teams that I'm presenting with.

Like that's reasonable.

And with Dr. Joseph,

we jump in and his was like on

point.

Now, sometimes it's not.

Sometimes I have conversations where I'm

like, whoa, what's up with like your,

tell me what's different with Sally than

it is with Joe.

Paula.

Or Paula.

You know,

like why is the diagnostic rate so

different?

And it's interesting to hear doctors talk

through, you know, their experience.

That is interesting.

What's the average, by the way, on that?

The average?

Ooh, for diagnostic rate.

Well,

you're the one that threw the stat out,

so I figured you had it on point.

Wait,

you guys have a diagnostic rate for

hygiene with dentists?

I don't know that.

Or just overall restorative.

Every time we do an exam,

limited or what's the other just normal

exam you do with a- So the treatment

case acceptance percentage?

Is that- No,

just every time they're talking- Just

diagnostic percentage,

are we diagnosing when we bill an exam?

And that- Is that on provider polls?

That's about fifty percent.

Yeah, that's in provider polls.

Oh, I've never really paid attention.

I paid attention to the little,

when you spread the team out,

but I've never liked it.

Okay.

Okay.

So the average, the average is about what?

What is that number?

Fifty percent.

Fifty percent of the time you should be

talking about restorative average.

Okay.

What's the next one?

Okay,

so that one we want to be about

the same.

The second number I like to look at

is, okay,

now we isolate just the people we had

the restorative conversation with.

And I want to know on average,

how many dollars are we presenting, right?

So how big,

what's our average treatment plan size

basically?

And then I do the same thing.

I break it down by doctor by themselves

and then with both hygienists or that like

clinical team.

And that can also tell me a story

potentially.

Now, ideally, once again,

this is one where I hope if I

have a really strong clinical plan or like

clinical strategy,

then it should be pretty much the same

with hygienists.

And I would hope as a dentist alone,

I hope it might be higher because I'm

doing limited,

which I'm like talking about fixing stuff

now.

And then if I'm a more comprehensive

dentist,

I'm doing some consults and I'm talking

maybe about some bigger cases there too.

So doctor by themselves, clinical team.

once again i hope to see some consistency

pretty close there now the place where it

often breaks is the number that i said

has been going down where there's i find

opportunity left and right and that is i

look at the same thing but it's treatment

dollar acceptance rates it's the one that

paula said she only looks at it she

doesn't look at the patient case she

really wants to know the dollars i'm

presenting what percentage of those

dollars are getting accepted meaning

they're scheduled or completed

That's the one where I almost never,

when I break it down to doctor by

themselves and with the team,

I would hope I would see a high

number for everyone,

whether it's me by myself or it's with

the hygienists or me as a doctor with

a treatment coordinator,

I would hope to see a system that's

delivering consistent results.

And I'm telling you, dental practices,

it's pretty obvious most of the time,

do not have a system that's

really making sure that we're getting good

outcomes there.

So Dr. Joseph, here's the example.

Dr. Joseph was like bread and butter,

same diagnostic rate,

very consistent with how much he's

diagnosing.

Then we got to the hygienists and it

was a fourteen percent difference in

treatment dollar case acceptance with one

hygienist versus another.

And we went and plugged in the actual

math.

And if he could improve with a lower

performing hygienist like that clinical

team,

if they got their case acceptance up to

match the other hygienist,

it was going to be a twenty four

thousand dollar difference in doctor pay.

OK, in doctor pay.

Wow.

Dr. Joseph was like, man, dude,

that's a Peloton treadmill and sauna.

Yeah.

my eyes on for a while or just

or just covers my loan payment and i

can look like we we track acceptance

dollar acceptance percentage but i could

think of some of our bigger offices right

now doing that study we could weed out

quickly paul because you have that

fantastic hygiene program you could add

another element to it per hygienist that's

customized to the doctor

Yeah,

the hygienists and which ones suck with

the doctor and which ones are great.

That's great.

He's already on it.

So I think that's really,

I showed the hygienist.

I haven't showed the doctor.

Of course he did.

What's interesting about your Joseph.

He's he very immediate.

Actually,

here's what's really interesting.

It wasn't even Dr. Joseph.

The first one to speak was not him.

It was a dentist.

He's really good friends with at another

practice set.

I can tell you he and the,

and the high performing hygienist,

those two are like best friends.

Like they are in lockstep.

And with the other hygienists,

they don't have a bad relationship.

She's just kind of like, like Matt.

And they just kind of like, it's like,

it's just a job for them when they're

presenting together.

And they aren't,

they aren't in that same kind of lockstep.

And Dr.

Joseph kind of started to talk through

that.

He's like, dude,

I had no idea that like kind of

that professional relationship that like,

Hey,

People sense our like,

like how we're committed to this.

They sense our energy.

They sense, you know,

how excited are we to be talking about

this dream and plan?

How excited am I?

Am I to be in this room with

this other coworker of mine?

Like there are so many things that can

really fuel the patient's sentiment as

they're sitting in that chair and we're

having that conversation.

I've got a question because we focus so

much on the hygiene team.

I know some pediatric dentists that would

love to know that statistic with dental

assistants.

They don't track their assistants.

I know.

Hey,

I'm wondering if that's something that we

can- It is possible.

I've tried.

I've tried so many times.

How do you do this, Steven?

I'm like,

put your assistants in as providers.

Yeah, so this is-

In order to get it,

just so everyone hears,

there's no magical solution to data.

You have to create data to get this

insight.

So what you have to do is you

have to put the assistant in or treatment

coordinator.

If you're like, hey,

I want treatment coordinator as well.

As a producer.

As a provider.

And then you add a zero dollar,

zero dollar.

And it can be whatever code you want

it to be.

You just add a zero dollar code to

those appointments so that dental

intelligence or

or any report can figure out,

was that person associated with that

appointment?

Then if we do that,

we can pull that and get it for

you.

There are- I love this.

I love this.

This is some sophisticated shit here.

No, it is.

It's so sophisticated.

If we can just get them-

doing that morning huddle and those

reactivations.

I mean,

I would feel like the most accomplished

consultant in the entire world.

You're right.

You're so right, Paul.

I mean, acceptance per hygienist,

adding pediatric dental assistants.

You're right.

That's futuristic right now.

This is what three dental professional

nerds would talk about on a podcast.

Yeah.

Because the reality is we just next

leveled the shit out of all you guys

right now.

If I can just get those...

Gen Z dental assistants to stay long

enough to track them in a practice.

That's so true.

That is so true.

We took this thing to like,

let's keep this super simple to like,

we just literally threw it.

But here's the cool thing.

And tying this episode up is with data,

you have an opportunity to just get

better, right?

Whether you're the struggling doctor that

can't pay his bills, her bills,

And you're trying to get to profit or

trying to get off of that associateship

that you're trying to get your practice to

be the primary in your world.

Or you're the four million dollar client

that we just signed that's doing

production,

and they're trying to level up to get

to a DSO sale.

the more you grind on some of these

little things and own that.

We have clients that own a lot of

this stuff,

but they don't own some of the stuff

we talked about today.

You can always own something and level up.

I was going to say,

let's take that even one step further.

Whether your, you know,

your perio acceptance is at fourteen

percent, sixteen percent, thirty percent.

You know,

you don't if you're a fourteen percent,

like I don't ever come in thinking,

you know, you guys are garbage.

You need to be at thirty percent.

I mean,

I would love for everyone to be there,

but like, let's just get you to sixteen,

seventeen percent.

Like,

it's really just about and all of these

numbers, I think,

tightening that system as much as your

team is capable of doing.

Yeah.

Yeah.

Because really at the end of the day,

the doctor's the leader.

And if he or she is okay because

they've got loyal people that are

getting the job done retaining patients

and then you know you got to go

with it you can't just fire a whole

team because we're not at fifty eight

percent case acceptance or thirty percent

perio acceptance but what we can do is

what could you know to me what can

we do better and that's that's what i

use dental intel for is that that huge

overview of everything listen when i own

my practice i'm going to say this and

i'll be done i as a clinician

owning a dental practice.

So a dentist, too.

I don't have the front office brain with

every report in Dentrix or Open Dental or

Eaglesoft.

This thing right here was my reporting.

I didn't have to pull thirty reports.

I didn't have to.

Oh, my gosh.

It was just I could open this up

and literally run my practice.

So when we started consulting,

we're like every practice that we do this

with has to have this.

It is so hard.

as a coach to help when you're asking

now mary jo to oh can you run

a new patient report can you do this

so if we have someone that we can't

use dental intel on like a cloud-based or

something we just remote in i mean it's

the only thing we can do you know

we can't we can't ask the poor team

to here can you run a weekly report

eight of them for me ten of them

you know whatever we can

We've got Ascend in process right now and

Denicon on the way.

So you already did...

Didn't you already do the engagement part

of Ascend or not yet?

Yeah, that's rolling.

So you're on the analytics...

I have one client on Ascend.

I need it so bad.

I need it.

Let's go.

Steven, I need you to program that today.

Yes.

Immediately.

I want it two years ago.

Do we have a buy-win even?

Is it?

We'll have analytics going in Q one of

this next year.

And then Denicon might be fast on its

heels because it's really similar.

The API is very similar to the Dendrix

Ascend one.

So we think that's going to really

accelerate.

So I think we'll be, we'll be quick.

All right.

All right, guys,

let's just not get crazy here.

Guys, thank you so much.

I mean,

this might be a dental unscripted record.

We're at fifty five minutes.

We just did four drives to work today.

But that's awesome because we just got

into so much amazingness.

Stephen,

it's always super fun with your energy and

your company.

And we really appreciate your partnership

at Next Level.

It allows us to be.

incredible coaches um it's the what and

then the why and without what you know

without one or the other it's really hard

to do our job so thanks so much

for for providing this and and being one

of the leaders or if not the leader

in this uh in this space so without

further ado i guess uh we'll put a

end cap on this um thank you both

for your big brains and your energy today

we'll talk soon okay guys all right see

you bye

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