Episode 850: Consider This When Buying/Maximizing a Practice

 Kiera lists out exactly what doctors should be looking for when either buying a new practice or hoping to systematize their current one. Considerations such as:  What’s the AR? What procedures are being offered and is there room to add more? How is the team communication? How are supplies purchased?

Then she suggests how to boil down the most critical items to implement and ways to go about doing so that won’t overwhelm the team.

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Transcript:

Kiera Dent (00:00.91)

Hello, Dental A Team Listeners, this is Kiera and I am so excited to be podcasting with you today. So I just wanted to get on and do a quick tip, tactical one with you of tips of buying a practice. But if you already own a practice, some things you can do to just maximize and optimize. There was a really interesting post where we found that someone bought a practice. They wanted to own their practice.

They thought the practice was going to be a great practice. They were super excited that the schedule was full. So when vetting the practice, they saw full schedule. They also saw like perfect. The patients are coming in. They had a lot of amalgams, a lot of opportunity for them because they weren't doing amalgams. So like we could do that. When they were visiting the office before the sale, they couldn't figure out like why the AR was so high. And good news that they didn't buy the AR. So some tips on that.

And then they were just kind of looking at like, why would like the business aspect of the practice and CE and things like that. And like, they were trying to figure out fraud and ordering supplies. And so they made this list of changes that they wanted to do. And I read this post in this article. So this person's listening. Hello, nice to have you. Thanks for sharing your story. But they thought of just some different things. And so I thought about when you're looking at a practice to buy and or in your own practice,

A few things to look at is number one, with their AR being high, are they collecting patient portions? My husband told me, I kid you not, he just went to the dentist. We actually go to two different dentists here in Reno. And he said that, yeah, he left the office and they're like, oh yeah, you can just pay next time. That is a great way to have high AR. And so really making sure that your practice, even if you've been doing that for a long time, that you work on making sure that you are collecting at time of service.

I know that sounds so silly, but people ask here, how are you able to add 20 grand to a schedule? And I'm like, I literally had them stop at the front and make sure that they actually collected their balances before they left. You can go a step further and actually pre -collect before they even go to the back. So if they've got balances, think about when you go to the doctor's office, they always have you collect the copay before you go back and see them. They're very proactive on collecting. And I just think why in dentistry do we not do that? So that's one thing when you're looking at of that high AR, what can be also looking to see, are they billing out?

Kiera Dent (02:22.222)

claims? Are we sending them out? Are we running our procedures not billed to insurance report constantly and consistently going all the way back to the beginning of the year? Because if we're not running that, we're actually not able to see like what procedures we actually did that just they got stuck in the funny zone and they did not send out. And so looking at that, and so for this office, I just thought let me give you some tips. Where

A few things when you're buying this practice, good things to look for are what's the AR? Do I want to buy that? Do I not? If it's a high AR, are they collecting at time of service? Can we get that there? Another thing to do is looking about billing out same day. Are we doing that with hygiene? How's their hygiene department and are they doing perio? What's their perio percentage? How many new patients are coming in? Where are those new patients coming from? There's another practice that I talked to and he's looking to buy the practice and he's like, here, we're only getting like two new patients a year, a month.

And I was like, whoa, I would not be buying that practice until I found out why and am I confident I could increase that new patient flow? Other things to look at when we're buying this are what are all the procedures that they're offering in the practice? Are we able to add in additional services? And even within your own practice, if you own it right now, can we add in additional services like ortho, Botox, implants, all on fours, smile makeovers, any of those things sleep? Are those things currently in the practice? And if not,

What one's going to be, excuse me, the least amount of effort with the most amount of ROI and could we add that in? What else about like, what is that doctor doing? And are they delegating the tasks of the business? And could you set up your schedule to work on the business for even two hours a week where we look at the financials, we're going through the billing, we're looking at the reports, we're running those reports. We're also looking to see what other things we're cross checking. We're going and grabbing an EOB and just checking to see was it posted.

Also, we're looking at the AR. We actually have a spreadsheet. Dental A Team has this for a lot of our clients where we have an AR spreadsheet where you download all the AR. Your biller is expected to go through every single account. And then every single month, you actually have a meeting with your biller. And we go through every single account. Is it first, second, third statement? Are they set up to go to collections or are we writing the accounts off? The doctor is gonna review all those information before we do that. These are the accounts we need to do. Insurance follow -up, how long are claims taking to get paid?

Kiera Dent (04:45.294)

Doctors, you don't have to do this, but you could simply just have an insurance AR spreadsheet and patient portion where you look at it and your biller knows that they need to get this done. So I think that really can also help and make it easier for you too. That's a good way to prevent fraud. You're checking all the payments. We're also closing off the audit trail of who can actually take things in and out of the ledger, making sure nobody can delete the audit trail, putting up passwords on your computers, making sure that's there.

making sure that payroll, you have a good company for payroll and QuickBooks and making sure you're actually looking at your P &L every single month, looking to make sure all the charges are there, putting your P &L into an overhead calculator to make sure are we in a line with industry standards to make sure we're not overpaying or underpaying or where we could maybe chip down one or two zones to get that a little bit stronger, making sure that we have goals for our whole team.

looking for production and collection goals and what our overhead is and new patients. With new patients, are we having referrals? Are we making sure that we're getting our Google reviews? Are we using a company like Swell to make sure our Google reviews are high and to be drawing in new patients even when we're sleeping? Are we looking for other zones that we could be attracting more new patients? Can we do monthly giveaways that are for our ideal patient avatar? And then looking at...

when you guys are diagnosing treatment, are we reactive? Are we proactive? What are we doing with that? And, you know, some dentists are like, we'll just watch it and see, could we move it into even where we do one more item of treatment than we would normally do, not over diagnosing, but maybe something that we would watch. So we're going to watch five teeth, let's watch four teeth and actually treatment plan one of those. And so I think that there's also so many other zones that can help. And also the question is like,

when we go and buy a practice or when we're trying to make changes, people ask us all the time with consulting, like, how do you actually do this? And how do you get a team bought in? And what I found is make a running list of all the items that you want to change. Teams enjoy change. I don't say that they don't like change. Teams don't like unnecessary changes and teams don't like to have a ton of changes put on them all at once that are just going to fall off the bandwagon. Teams like to have less stress, more fun. And so what I found is if we

Kiera Dent (07:05.07)

I like when I consult a practice, I literally make a running list of all these items. I'm looking at the AR, I'm looking at how we're scheduling patients, I'm looking at handoffs, I'm looking at how the exams go. I'm looking at all these different pieces. I'm watching their morning huddle. I'm looking to see are they tracking goals? I'm looking to see how do we answer the phones? I'm looking to see how is the front office working? Do they have it separated out? Are we sending our claims? Looking at their AR, pulling an EOB and checking that, listening to how the hygienists are teeing up perio and fluoride. I'm looking to see our...

Assistance looking for additional treatment they can add on I'm looking for handoffs between doctors and and team members I'm looking at their financials. I'm looking at their overhead. I'm looking at their costs of things I'm looking at their supplies in the practice. Are we putting them in all the operatories? Do we have one set space? I'm looking at their sterile Are they cross contaminating and not realizing it? All those things I look at and you better believe that if I go tell a team all the things that they're not doing or things that they could improve

I'm probably gonna lose a team. Just like if you buy a practice and go try to change everything all at once, you're probably going to lose a team. So again, I have a whole list. I'm putting it in a notebook. You can have a document for it. And then what I do is I consolidate, I combine, and I also look to see what if I could implement only three items will move this practice forward the most, the quickest, and I get the team bought in for a six week time period.

The reason why I do six weeks is it's just easy, perio, a six week retreat, come and check it out. But I've also found that that way the team feels like there's not too much. And what I also do is before I go implement anything, I already know usually what I want to implement and what I think would help this practice the most. But I go to the team and say, hey, where are our struggles? Where are the hot fires? And what do we need to do to change? Like the hot fires are our communication. Our hot fires are this. And I already know I want to implement X, Y, Z. I want to implement.

handoffs between doctors because they know it's going to increase case acceptance. I want to implement an AR spreadsheet to make sure we're tracking that because our collections might be low and let's see if we can get that. And I'm going to collect like perfect handoffs where we collect money. Those might be my three things that I'm going to implement. And then what I do is I get the team to tell me what their problems are and then I bring the solutions to their problems to the table. And that's what we work on for six weeks. And so I think when you're buying a practice, do the same thing.

Kiera Dent (09:23.15)

When you're looking at your practice, go around, be a consultant, listen in, spend an hour just walking around and you'll be shocked at how much you see and then look to see of all your great ideas, what's going to move your practice forward the most and then stick to that for six weeks. Don't let anybody off the hook. That's what I think people really love when we consult them because we don't let you off the hook. You are with us. You are, uh, you're accountable to us. We're going to check in because what I found is people have shiny object syndrome. So we start this when we want to change all of these things.

So we try to do 500 things and we actually don't end up doing any of the things. And so if I can just get three items put into place, maybe it's three items as a team and then an additional one or two for people to just get things rolling, but it's very manageable and it makes their life easier and more efficient because it's solving their perceived and true problems with actual solutions that will make a difference. And then I make sure it's sticky. And that's how you're able to truly make change in a practice. That's how you're able to, when you buy a practice or things to look for,

or when you're having your team and you wanna make changes because buying a practice and having an existing practice oftentimes have some of the same problems. Just when we're buying it, we're very, very nitty gritty because we wanna make sure we're taking care of our investment. When we own it, we forget that we should be constantly protecting our investment because we want to refine and make it better. But that's not just better for us, it's better for our team and for our patients. And when we come from it with that approach, your team's bought into it. So I might suggest buying a practice, here you go, here's some tips of what to do.

owning a practice, these are also some tips, but I might suggest no matter where you are, make your whole laundry list of items to improve, consolidate and combine any of them that are likes with likes, and then figure out what are the top three items that if implemented for the next six weeks would exponentially move your business forward and then stick to those consistently. And I think that that is just a really, really lovely way to do it. Another way to do it is what we do in some of our consulting where we have all 12 systems.

and we run it on kind of a monthly cadence for you. So yes, you've got your hot fires, but you're also starting to implement every single system. And so we're chipping away and we're not necessarily looking at like, what are the big issues right now, but we're chipping away at systems. So over the course of the next 12 months, you literally will become systematized. And I think that that's another great way to do it. It's a little more streamlined. It's a little more structured. We're not shaking the tree as much. We're not coming in and implementing as many things, but you know, over the course of 12 months, you'll really get your practice very systematized.

Kiera Dent (11:48.558)

We'll be able to still address your issues, but this is a good way for you to also do it. So either it's let's go pick the top three things or let's just follow a map of the 12 items. Like with my finances, I usually don't go look for the big three items to move. I don't really even know what I should be looking for. But in Dennis advisors, they have 12 elements of things like my trust and my finances and my PNL and tax strategy and my burn rate, my save rate, and it's set up on months. And so I just know I need to work on that one little area.

And at the end of 12 months, I will have my financial portfolio much, much better. Same thing with your practice portfolio. Following those 12 months can really, really help you just get it into a better spot. And what I love though, is I know that just because I'm following this path doesn't mean that hard problems and hot topics won't hit you. And so that's where you also have access to the consultants every single week to ask those hot items. And you also have a community of people and the consultants to answer all those questions for you. But those would be some of my tips of how to buy the practice.

how to get a practice systematized, how to get a practice organized without dumping everything, but also not losing the momentum as well. Cause both are beautiful and both are necessary. It's just the time, the effort and the energy and making sure that we're consistent. Consistency is key and making sure that we're focusing on the things that will truly drive us forward and make an impact. So our team doesn't just think we're painting the house just cause we feel like painting. We're literally doing it with a purpose and an intentionality behind it. So if we can help you guys, I'd love to have you come join us.

Reach out [email protected]. Click on our link, schedule a free call. If you want to do the 12 systems or the spot checking, both are available. I'd love to help you, but hopefully this year it gave you guys a bird's eye view of how to really truly make your practices more systematized with ease to give this person of like looking at it from all the ownership piece, but not implementing it to where we overwhelm our team, but we're still able to execute.

So I love stories like these. I love giving you guys tips and solutions, things that we see on a day -to -day basis and the success stories on the other side are less stress, more profit, happier teens and a happier life. So reach out, I'd love to help you. hello@thedentalateam .com. Go do this on your own if you can, otherwise reach out. And as always, thanks for listening. I'll catch you next time on The Dental A Team Podcast.