Money Matters

Collecting money in a practice tends to be one of the more difficult tasks. At times, odd emotions get in the way. Sometimes we feel guilt over charging a patient for something they need, a service they receive. We attempt to lighten the guilt feeling by making unsanctioned collections agreements or even avoiding to collect altogether. Balances can loom over our heads at times and can cause patients to resist returning to the practice. Dr. Kuba and Bethany tackle this topic today. It is a MUST listen as collections are pivotal to the success of every practice. Stay tuned in the June Subscription for even more collections tips and training! 

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Transcript

00:00
 Are you looking for a podcast where you can hear from real people regarding their real dental drama? If so, then

00:09
 you've come to the right place. Join hosts Bethany Penny and Dr. Reena Kuba as we dive into the solutions we've

00:17
 created and the mistakes we've made while managing dental drama. Let's get started.

00:24
 What up? What up, friend?

00:26
 Hey, lady. We better warn our listeners that we are slugging it out again in thunderstorms.

00:34
 We smartly parked under a tree just, you know, to make sure the rain wasn't clouding the microphone.

00:42
 I think the tree may give us more rain from all the like runoff off the leaves.

00:46
 But, you know, in theory, but just we thought we were getting some sort of protection.

00:52
 We tried. We attempted. So, but if they hear rain, that's that's what's going on.

00:57
 That's what's going on. Yeah. Supposed to have flowers. April showers, May flowers. Where they at?

01:02
 It's like April showers, May showers, like no flowers right now. I think you're right. Yes. No flowers.

01:10
 Oh my gosh. And before we get going, I should have told you that I wanted to say this. We've got lots of stuff coming up that we need to remind our listeners

01:18
 about because leadership summit in September. Um, so if y'all haven't signed up for that yet, you need to. And

01:24
 then any subscribers of mine are getting to stay a day and do a Bethany brunch.

01:29
 So, quick reminder to all you guys to go register. Um, when does set invitation go out?

01:36
 Said invitation has gone out to I have not gotten one is where I was going with this. What?

01:44
 Maybe maybe we knew that you were bound to be there.

01:50
 I guess I will have to crash yet another party that I wasn't invited to and just make myself welcome.

01:57
 You're the star of the show. I mean, come on.

02:00
 Please, please. But that's why I was like, I didn't know it's gone out yet. Like, because I haven't gotten one.

02:06
 It's out. It's out. So, if y'all haven't gotten it, guess what? It'll be in the show notes. So, yeah. I guess that's where I'll look to

02:13
 see about said event and make sure I find a way to infiltrate in.

02:18
 She'll be there. Don't worry people, she'll be there. So rude.

02:24
 Anywh who, um Okay. Was that it? That was it. The reminders. Yes. Okay.

02:30
 Yes. Um well, if I I'm going to switch over to then what I was hoping we could talk about when I was asking you again,

02:37
 what's your week been like and kind of things that are coming up. And I think we could call this one like money matters.

02:44
 Oh yeah. Um, and the the focus I want to take is um because I think my docs, y'all are all

02:52
 going to be like, "Heck yeah." Um but so this one's kind of more for um team

02:58
 members and um maybe even for doctors of how you if you've never paid attention to this

03:06
 like one more thing that if you were trying to bury your head I'm going to ask you to unberry because good chance this is going on in your practice because it goes on in every

03:15
 practice and a lot of times we're unaware until we do start paying attention. Um, but do you have a sabotur

03:23
 in your office basically is where we're going with this. And and I'm not talking about like um purposefully maybe I I

03:31
 think all of your examples too. It's not on purpose.

03:33
 No. But um people who and oftentimes it's your RDAs, sometimes your hygiene

03:41
 team, oftentimes your business team that tends to seem to want to fight for the

03:48
 patient. And it makes it hard for us because we we do want you advocating for the patient. That's why we're all there.

03:56
 But when it comes down to the fees or balances or things like that or insurance didn't cover this, can we

04:04
 write this off? Or I have been writing this off or whatever it may be. Yeah.

04:10
 Um inadvertently encouraging patients to go somewhere else. Oh, well, down the street takes your insurance. We don't,

04:17
 but there you go. Right. Like, so are we inadvertently having people sabotaging or undermining what we're trying to do?

04:25
 It's very difficult for us as the dentist to um not look heartless, not look money-minded.

04:34
 And for me, this is a moment of I guess for the dentists, make sure and and we'll come back with some tips on how to

04:41
 what kinds of things to look for, questions to ask or what to listen for.

04:45
 But then for team members, are you a sabotur? And keeping in mind, if you are sabotaging, you're cutting your own leg off. Mhm.

04:54
 Like do you realize like that the the business the blood flow of the business one of the things that gets blood is you?

05:03
 Yeah.

05:03
 You know if the business does well there's monies to go towards paying your salary.

05:08
 If there's no money coming in somebody's getting cut off. And so are you inadvertently not advocating for your

05:16
 practice? Practice goes down you can't help anybody right? So, es yourself or anybody else.

05:24
 So, um I'm gonna have you, if you don't mind, diving in with the the examples you gave um and then dogs

05:32
 be listening to go, what am I listening for? Are my team members doing this?

05:36
 Yeah, I know. I talked about it with one of our team members. We talked about it in an episode not too long ago and we had been training and training and training and thinking she was doing a great job

05:45
 only to come finally find out that she was like, "Well, I wouldn't spend this money on getting my kids to eat fixed." Mhm.

05:52
 What then? Why are you Why are you in this practice? How are you helping the kid with the decay? First of all, like, let's focus on the patient. Yeah.

06:00
 Yes. The parent's going to have to spend a lot of money on getting this fixed, but the parent typically is the one who created the situation.

06:07
 Yeah. And so now this kid's got a mouth full of cavities, but by telling the parent, "I wouldn't pay for this, their baby teeth," you've not advocated for the health of that child, right?

06:16
 Um, so now when the kid's face blows up or they're in pain or whatever, you you've really not helped. That's number issue number one. Issue number two is why wouldn't you pay for it?

06:27
 Because you're putting yourself in somebody else's pocketbook and maybe your kid hasn't had all this decay, so you you can't I don't know. I'm getting

06:34
 off topic here. I mean, I'm in topic, but I'm kind of getting off the rails. Let's go back to your examples.

06:41
 Yeah. No, I'm I think this is a category that, as we briefly talked about it, it's incredibly common for a team member

06:50
 to feel bad honestly about having to collect from a patient or a parent or

06:57
 even um if they have a balance, they're feeling bad about having to pursue that balance. So, a few issues that popped up this week, just to kind of paint a

07:06
 picture of what I'm talking about. Um, there was one client of mine that he found out that his team members

07:14
 were upset because for a very small percentage of the of his patient population, if they've been a member of

07:22
 the practice for a very long time, and if they ask to extend payments out over two or three months, they will grant that to a very small percentage of the

07:31
 population. Well, his business team team member somehow got confused that that was for very long-term patients and they

07:38
 had a brand new patient that was standing in front of them trying to schedule a crown, I think, and she didn't want to pay anything, but wanted

07:48
 to just spread that out over two or three, I think it was 3 months. Um, and they wanted to grant that option to her.

07:58
 And when management came in and said, "No, no, that's not an option for her," they got upset and felt like, "Well, that's not very fair cuz we do extend it

08:06
 to some." And I remember listening to this example and I was like, "Wait, this doesn't even make any sense." Like, I

08:13
 could understand if it's like 90% of our patients are on a 2 or 3 month payment program and then we just don't grant it

08:20
 to this one patient. I could see how that feels unfair, but it's a very small percentage of the patients that actually get the luxury 5% 3% like it's not very many.

08:31
 No. No. So why they even thought that that would be a good option when they do that so few times and then for a new

08:38
 patient who's has no loyalty to them, I can't tell you how many times I've watched a patient get that crown and run. They disappear when there's not

08:47
 that long-term relationship there. And so that was one example that came up.

08:53
 Another example was um somebody who had come in for their child's cleaning

09:00
 appointment and insurance was already maxed out. The parent knew that they were going to have to pay for that

09:07
 cleaning. Um but he failed to bring money with him. He's like, "Oh my gosh, I totally forgot." And so then this

09:14
 weird situation that the business team member is in like, "Well, what do we do?

09:18
 do we still see that and just let dad call us back to pay? And this is a newer practice, by the way, so no real

09:24
 long-timers in this practice. And so again, the team member having to go back, ask the doctor, what do you want me to do in this scenario? And then have

09:33
 to go back and u you know, communicate to the parent that, oh, let's just rebook the appointment until next week.

09:39
 Um so that you can bring that that money in. Um a third example, then we can kind of stop and pause and talk through these. Another one where a client of

09:48
 mine, the patients are the our system that we set up is that when a patient schedules treatment, we go ahead and

09:57
 tell them, "Okay, great. I can go ahead and take your portion for that." 

10:00
 So on the day of scheduling, we attempt to get 100% of the patient portion. And then if

10:05
 the patient is unable to do that or doesn't really want to do that, then our alternative is you could always pay half of your portion today and then half at

10:13
 the time of treatment. been that way for years in this practice. And honestly, most of the patients are very well trained and and a good portion of them paying full at the time of scheduling.

10:24
 And so this one was questioning it and the team members was response was, "Oh, this is Dr. Jones's policy that we have

10:33
 to collect this." So again, trying to deflect off of just being confident in the system and put it back on, oh, this, you know, Dr. Jones, he's the bad guy

10:42
 and um this is his policy. And so all of these happened this last week. And I

10:49
 realize how often this category of a business team member or any team member just feeling uncomfortable and almost

10:57
 bad about having to collect from the patient. And so they find themselves waffling like, "What do I do? I need to

11:06
 go get special permission from my doctor on this to extend this credit or to not take this payment or or feeling so

11:15
 uncomfortable in the conversation that they're deflecting on to things that are not them like oh this is not my fault this is somebody else or oh my manager

11:23
 is going to get mad at me if I don't collect this which is all the wrong way to communicate about collecting money.

11:30
 So anyway these are examples that came up just this week. So, I think for me, like the one you were saying where it's

11:37
 uh the guy who owes the practice money and or even if he didn't owe the practice money, did he owe the practice money?

11:45
 Yeah, he he already had a balance and then he the visit that he was coming in for that day wasn't covered at all.

11:52
 So, his kids cleaning was not covered and he had a balance. So, for me, but even if he didn't have a balance and you were maxed out and you knew you had to pay for this appointment,

12:00
 um, or even if they didn't know ahead of time, like maybe they thought they were coming in and the office didn't communicate that it wasn't

12:08
 going to be covered and you're telling them right then, oh, okay, well, you're maxed out. You owe this.

12:12
 I get from the team member standpoint that what you're afraid of is this man's going to lose it on you. Why'd you waste my time? I took time off work. I took my

12:21
 kid out of school and here I am and No, no, no, no. I get that. But at the same time, I guess I kind of go back and say,

12:29
 "Okay, if this man is not going to pay today." Mhm.

12:34
 Then you're back to going, "This is not like why would I go back to Dr. Kuba to ask her if that's okay?" Yeah. Because now you've made me the bad guy.

12:41
 Cuz if I say no, well, no, Dr. Kuba is not willing to do your kids cleaning unless you pay today. Like, how does that make me look, right? And so if you're like, "Well, it

12:49
 is you. It's your choice. It's your practice." Okay. But now we look like we can make arrangements and I'm just choosing not to.

12:58
 It looks like there's an option to do that and you're being the bad guy and going, "Yeah, no.

13:02
 Not in this man's case. No." Right. So like it it's like it's got to be uniform and even. And that's what you're trying to say. You've got to say with

13:09
 confidence, these are our rules and policies. And not even to say that's our policy. It's just this is how it is.

13:18
 Period.

13:18
 This is just what we do. and we're so confident in it that we don't waffle when a parent or a patient pushes back

13:25
 on that. And to me, I think the waffling makes the business team member or the

13:32
 the clinical team member member feel better, but it actually makes the parent or the patient feel worse

13:40
 because of exactly what you said when there's a waffling and then we come back and and clamp down and go, "Oh, yeah, no, that's not an option." there was

13:47
 this little glimmer of like, but it's an option for some people and it's just not an option for me. And so I found that

13:55
 when people waffle that they they have this tendency to kind of get the monkey off their back and make it look like

14:02
 somebody else is the bad guy when nobody is the bad guy. I mean, that's what's mind-blowing to me about this is that it

14:11
 takes money to run a business. If we want to stay open and continue to advocate for patients health, we have to have it takes money to do that.

14:21
 Unfortunately, we can't do that for free. And I think there's this little slippery slope that team members get into where it's like, oh, it's just this

14:30
 one patient. But then we've created this this gap, this rule that we can break,

14:37
 and now we have a harder time deciding, but when do we break it and when do we not break it? And it's it's this slippery slope that now we're breaking

14:44
 it so much more because it's easier to break it. And we honestly feel better about it when we break it. We feel like

14:51
 we actually did that patient a service by not collecting from them or by extending a payment arrangement when we wouldn't do that for anybody else

14:59
 or by writing off something. Oh, you know what? It was just $16 for their fluoride. It was just $35 that insurance downgraded to an amalgam.

15:09
 But but you know, we we want to help them. All of those justs add up. Yeah.

15:14
 And my comment always has been back to the team.

15:17
 Okay. Can I delay your pay? You didn't need to get paid this Friday, did you?

15:22
 I'm going to I'm going to break your I'm going to extend that out. I owed you 500 bucks, but I'm going to pay that out to you over the next 3 weeks. Is that okay?

15:30
 Yeah.

15:30
 So, if you're not okay with it, why should I be okay with it? Why should the practice be okay with it? Yeah.

15:35
 Because I can guarantee you the electric electric company's not going to let me pay it out.

15:39
 No. the um composite that I've got to buy. Yeah.

15:44
 The lab is not going to let me pay it out. No. So, I've got to pay those monies, right?

15:49
 Then yeah, rent has to be paid. Utilities have to have to pay. Supplies have to be paid. Payroll has to be paid. And I do

15:56
 want to address that cuz I think this is where, again, this is going to be directly to team members who are listening. I think this is where we have

16:03
 a false impression of what it takes to run a successful business. And and to be fair, most team

16:12
 members don't know the nuts and the bolts of what payroll percentage should be to have a viable business. They don't

16:20
 know the percentage that's allocated to supplies.

16:24
 They don't know how it works when rent all of a sudden is shot up. How does the practice close the gap on that? So to be

16:32
 fair, a lot of people don't understand the inner workings of the finances behind the scene. I do. And what I can

16:40
 tell you is first and foremost, every little nickel and dime matters and it adds up. I tell people this all the time

16:48
 when I went back to help my dad's practice that was struggling.

16:53
 The first thing I did was go through and I looked at months of expenses and tried to figure out where there were nickels

17:01
 and dimes that we could add up to make into a dollar. It was painstaking work to figure out how we could eliminate

17:08
 certain expenses because part of running a successful business is controlling your expenses. The reason that we have

17:16
 to control expenses is because there's only a certain amount of income. And if that income goes down, and yeah, maybe it's only $16, you know, here and there.

17:26
 Those $16 add up because it's our slippery slope. Now, we've made this exception that it just compounds. So,

17:33
 now we've reduced our income, our collectible income, which means now our expenses versus income is out of whack.

17:42
 And now we have to solve it. Well, how do we solve it? If we're if we can't get more income, the only thing to do is to cut expenses. But funny enough, most

17:52
 people want to grow their income. They want to actually make more, which is fair. People in life want to earn more and and get themselves into a better

17:59
 place. But if you're cutting the income, guess what? Your pay cannot go up. And as a matter of fact, now we're having to reevaluate the lab that we're using.

18:09
 We're having to reevaluate the supply guy that we really like to buy from cuz he can get us our gloves overnight when we need them. We have to reevaluate that

18:17
 cuz those things cost more. And a lot of team members don't realize that. They just think, "Oh, I wrote off that $16

18:24
 for this patient, but Doc can afford that. It's not about Doc's pay. It's about making sure that this business can

18:32
 stay viable not only today, but 2 3 4 years from now." And I think there's a misconception there that leads people to

18:41
 then be hesitant to collect from patients, which and I think if I was, you know, in that same boat, if you're sitting there watching monies come in and you're like,

18:49
 "Well, we just did this implant case and we got paid $4,000 for that. So what's the $16 compared to the $4,000 we just

18:56
 got in?" And that it doesn't work that way because there's still all of these expenses that you don't see going out. I think the other thing that can cause

19:04
 some misconceptions are, well, Doc just bought a brand new Tesla, so Doc must be doing fine. The 16 bucks isn't going to help Doc.

19:14
 Yeah. But it's going to help the patient.

19:16
 So, it's like it it ends up being this like, well, the doc is okay, but what you're not considering is the doc's

19:23
 salary is only a portion of it, but in order to have a healthy business to where you can keep your job

19:30
 Yeah. and keep earning and raising because at the end of the day if you are not increasing income and as it is we

19:38
 all see how insurance has cut a lot of reimbursements and things like that but our expenses have gone up and continue to

19:45
 and continue to and and at what point do I have to look at it and say okay what's an expensive part of my practice and is

19:52
 it you Susie maybe we could just do with just Mary at the front and and it is all those little $16 that

20:00
 could add up to be where somebody on the team is on the chopping block cuz that's the cheapest way to cut costs cuz one of 

20:08
 the most expensive things is you Susie and Mary and Sally like your staff is your number one biggest cost.

20:16
 So can we function with fewer people? Mhm.

20:21
 And that way then maybe I don't have to switch the lab that I'm I like because we did have crappy lab before that was cheaper. And then we had far more

20:30
 patients upset, far more fits that didn't go. You know what? If it comes down to paying for the lab that I want that I know I'm going to get a

20:38
 predictable result or Suzy and Mary, man, I do like both you ladies, but you know what? And is this where AI comes

20:46
 in? or is this where we're going to have other team members pull and try to So, I think that's the the scary part of if you are

20:55
 completely clueless as to what all the expenses are and you're making assumptions. You're making assumptions that Doc just bought a new car or Doc

21:03
 just went on this vacation or you're making assumptions that you know where that money Yeah.

21:08
 is being allocated and you're putting yourself at risk.

21:11
 Yeah. A even besides all of that, I think to me the other thing that I kind of look at is for any business, take yourself out of dental for any business.

21:22
 If you are the one that is Starbucks, can Starbucks just say, "Oh, here I just I'm going to give you an extra croissant." Yeah.

21:30
 I know you can't afford it, but you've got two kids and that kid's upset. Here, take an extra croissant. Does Starbucks do that?

21:36
 No. Does does any So to me that's like are you okay if you're asking me to give Mr. Jones uh an extended time to pay his money?

21:46
 Yeah.

21:47
 But you are you willing to take can I pay out your pay if you're not willing to? Why are you asking me? Mhm.

21:55
 Can we go to the gas station and say well you know but I really need to get to Oklahoma today but I only have money for 10 gallons of gas. Can I go ahead

22:03
 and just, you know, can I get 20 gallons and come back and pay you the 10? Will any business let you do that? No. So

22:10
 then why are we making that an option in a dental office? And you know what's frustrating about it too is I I've sat

22:19
 with so many clients of mine that have had to turn off their payroll for a period of time, their personal

22:28
 income. And it's not due to anything catastrophic.

22:33
 It's due to a series of little mistakes that have occurred and now the bank account got too low. And in order to

22:40
 protect the employees payroll and to ensure that they get paid, I have had clients of mine that have turned off

22:49
 their payroll in order to make sure that cash stays in the practice. And you know what? The teams never know about that.

22:57
 They never see the two or three months that there was no income for that doctor because of X, Y, and Z that happened.

23:04
 And now they're they're having to scrape by for a few months. And yes, maybe they're still driving their nice car and

23:12
 maybe still they're still living in their same house, but can you imagine your paycheck being turned off for 2 or 3 months and you're just hoping that the savings that you have in the bank is

23:21
 enough to get you through? That's very, very scary. And team members never have to worry about that. They would never

23:29
 stay at a place that stopped paying them for 2 or 3 months, but doctors do it all the time. And because that isn't well

23:36
 publicized to teams, I think team members don't think that that ever happens. And that is just not true. I've

23:44
 got amazing clients that work with amazing financial planners are an ex incredibly smart business people. And the reason that they can turn their

23:52
 payroll off and not for two or three months in a row is because when they have gotten paid, they've set a good they've set a good portion of it aside for something like this.

24:03
 I think people assume that doctors are just always fine because of what they drive or what

24:10
 vacation they took or what house they live in. And I think that's very unfair to assume that. And it all it takes is a

24:18
 few of these little freedoms that we take to write this off or to not collect from this person or oh I really hate

24:26
 calling people about balances so I'm just not going to and all of a sudden cash flow dips below a certain point and

24:33
 then that doctor isn't getting paid and may be forced to make more substantial decisions like having to release somebody and why would we want to risk putting our doctor in that position? it.

24:44
 It's mind-blowing to me.

24:46
 And yet, I think it's that combination of we feel bad. We're all feeling the pinch of gas is more expensive, meat is more expensive, everything has gone up.

24:56
 Oh, I feel bad. This patient probably is in the same boat. Mhm.

25:01
 Maybe me extending them this, but it it's not yours to extend, first of all, but second of all, it's where name me a

25:08
 place that you can go that is like, yeah, sure, fly your flight and then pay us afterwards. Yeah, I have yet to find that. So sometimes, I

25:16
 mean, I'll be honest, I'm the softy sucker a lot of the times in my practice. I'm like, uh, let's just write this off or let's just do this. And then

25:24
 I'm like, but who does it for me? What industry am I an outlier? I'm like, no, I'm making myself the outlier and letting somebody take advantage of us,

25:33
 but I can promise you no medical office is saying, "Come on in. Let me treat you for free." Or no. So I I guess that's what I remind

25:41
 myself is I I'm not you know I always try to go okay outside of dental is this the norm? No, this is not the norm at all.

25:48
 Not the norm anywhere, right? Like you you pay for what you that that is the cost. If you want it,

25:57
 then bring your money. If you don't want it, then don't come. Right?

26:00
 And so, um, I think for team members that are allowing this to happen and that are feeling bad about it, I think that would be my advice to you is to go

26:09
 where I appreciate your empathy. Please don't put yourself in that situation where I guess maybe you're hoping and thinking somebody's going to give you a payment plan somewhere but who would

26:18
 where would you go that that's going to be norm nowhere. So then why are you expecting that or trying to offer that to your patient?

26:26
 Um so for look be be selfish look out for yourself because by not collecting what you need to collect you are putting

26:33
 your your practice your job your livelihood at risk. Mhm.

26:38
 Um and then please don't throw your doctor under the bus and make them seem like the bad guy. Yeah. Please don't do that.

26:45
 Yeah. Yeah. These are normal policies.

26:47
 They are not the bad guy. That's the bottom line. Just like Starbucks isn't the bad guy for collecting every every dollar for every cup of coffee that they

26:56
 make. They aren't bad. We don't look in them at them and go, "Oh, Starbucks, you're so selfish." No, we go they're

27:03
 getting what they're they're getting paid for what they've created. I It is not selfish to provide a service and

27:11
 expect to be paid for it. Just like if we were to break it down to the simplest. If if my son goes and mows the lawn for the neighbor because they made

27:20
 an arrangement that if my son came and mowed the lawn for them that he that he would get paid 10 bucks, he should get paid the 10 bucks that they agreed upon

27:29
 because he did the work for. So in the even in the simplest if we take it away from the corporate Starbucks or the flights that we book or anything like

27:37
 that if we take it away from that and just go when a service is rendered it is normal and natural for somebody to be paid for that and it should not matter

27:45
 that we believe the person that's providing the service is perfectly fine financially. That's

27:52
 what have to do with anything that has no no that is not fair at all. And again, just to reiterate a point here,

28:01
 doctors make a decent wage because of the amount of debt they are in for the schooling that they went through to be

28:09
 able to become a doctor. And yes, do they make a decent wage beyond paying for their debt? Absolutely. But they took on a lot of risk to become

28:18
 financial risk to become a doctor. and team members on a team did not take that

28:24
 same level of risk. Therefore, there is a pay there. It It's sad that I'm even have to say this, but I think I need to

28:33
 say it here. There absolutely should be a pay discrepancy between a hygienist and a doctor. There

28:41
 should absolutely be a pay discrepancy between an RDA and a doctor, between a business team member and a doctor. The

28:48
 doctor should make the most money in that practice. Well, or an RDA and a hygienist. Yes.

28:54
 Like the hygienist took on the extra risk, the time to go to school, all of that debt.

29:00
 Yes. There's there's discrepancies for a reason. And we should not feel um like we're we're treated unfairly in the

29:08
 process because we aren't able to live the life that the doctor lives or the life that the hygienist lives.

29:16
 You're getting the am out of your job.

29:18
 You're getting the pay based on the amount of time that you put in to get that job. And that doesn't mean that you can't earn a good living. I know plenty

29:27
 of business team members and RDAs and hygienists for that matter that do exceedingly well financially. But do they do as well as the doctor? No. That

29:36
 is the way that it's designed to. And we should not take that as fuel to be like, now I'm going to take that quote unquote

29:43
 extra money that the doctor has and I'm going to extend it to patients that I deem to be worthy of that ride off or of

29:51
 not having to pay that bill or that I don't want myself in the hot seat looking like the bad guy. I don't want this patient to yell at me. I don't want

29:59
 so I'm going to kick the can down so that it's not me. 

30:03
 That's that's not okay. If that's your job, then you need to do your job. Yeah.

30:08
 And that is your job is to protect and serve your patients. And you can't serve them if the doctor can't pay the rent, right?

30:16
 So, it it all does. It's all interconnected. And all those dollars matter.

30:21
 Mhm. Yep. It does. and you actually aren't helping the patient by extending those type of courtesies or or special

30:29
 favors because what it creates is now you've backed yourself and that patient into an awkward corner because eventually you're not going to be able

30:38
 to do that write off when those write-offs are caught and you're going to need to change your order with that patient. They're going to be frustrated

30:46
 now over money that they all they owed every time. But you took these little luxuries and they got confused into thinking that you were going to always

30:54
 do these special favors for them. So you're Yes, it may feel good in the moment to give them something free or to let them off the hook, so to speak.

31:03
 You're like, "Oh, now I'm the hero." I promise you, you will not be the hero for long because next time you will have to collect or you won't be able to ride

31:10
 off and they're going to be frustrated and confused by that as they should because you showed them a reality that now cannot exist. So you've put yourself

31:19
 in a tight spot by doing that. So I know it may feel good in the moment, but it is not a spar a smart strategy and it makes you less confident as you're

31:28
 attempting to collect that payment from the patient. You waffle and therefore it creates a weird interaction. So don't

31:36
 deceive yourself in thinking that that's the path of least resistance. It's absolutely not. So then the question then for the doctor would be even for some of these patients that have been

31:45
 patients for a long time and you have agreed to let them pay it out. Should we just not do that for anybody?

31:50
 So my general rule of thumb is I do not like payment arrangements internally.

31:56
 I've always said that. But over the last couple years I have seen because of economic uncertainty and finances being

32:04
 a true true barrier. I've seen more offices extending some form of internal

32:11
 what I call credit, means you're you're providing a service that hasn't fully been paid for yet. Um, and I think I've

32:20
 come to a point where I have to be okay with that. It's still not my preference cuz I I feel like it poses a risk to the practice, but I understand the other

32:27
 side of it, which is but if I can't get any patient to move forward because they genu genuinely cannot pay for it, that is also a risk to the practice. And I

32:35
 get that. So then would that be like sit down and make a clear set of rules? You have to have been in the patient a patient in the practice for this amount

32:44
 of time. You have to have not had a history of y not paying and things like that. Like that way it makes it very black and

32:52
 white as to who you could or couldn't offer this to.

32:54
 That's correct. Um, and you you've kind of made it clear for the team members that are supposed to collect and also protected yourself that the team member

33:03
 is not going to come back and be like, "Hey, can I do this?" And now if you say no, you're discriminating against the patient or you don't like that patient or whatever it is. It's

33:11
 Yeah, it's very it's got to be crystal clear. And even if we were to put a crystal clear plan in place of who we

33:18
 could extend that to, that doesn't mean that we should for everybody. So I think that's the other thing that's tricky about it is just because we might have a

33:26
 two or three month payment option doesn't mean that 100% of our patients should know about that. Because I say this all the time when I'm working with

33:35
 practices if I or orthodontic treatment for example

33:41
 the but when I had we've got two in ortho at the same time and when it was presented to me hey you can pay this out monthly I said absolutely sign me up.

33:51
 Yes, let's do monthly. Could I have paid for both of those at the same time? Yes.

33:57
 Do I want to? No. And they very easily gave me the monthly payment option. So, why would I not do that? So, we have to

34:04
 be really careful of when we decide if we decide that we're going to extend this certain type of patient credit, so

34:11
 to speak. We have to make sure that we're not leaning on that too much cuz now it feels better that I have this option. Well, every patient's going to

34:20
 take you up on that option. I can promise you that. And now we've thrown it from a nice little luxury that we can offer to some people to now it's a risk

34:28
 to the practice that we then have to manage. The other thing about this is

34:34
 we lose patients more quickly when they owe the practice. It is so much easier for them to walk away, cancel that

34:43
 appointment, not come in because they have a bill. Uh a lot of times I'll look into uh retention in a practice and I'll see oh why did this patient cancel their

34:51
 appointment and then I click over to their account I'm like ah balance why did this person cancel ah look at that balance I would say it's probably

35:00
 75% of the patients that are past due for their prevention appointment have some type of balance. So if we can

35:07
 prevent, we're a patient advocate first and foremost. And if we know that advocating for that patient means keeping them in their prevention, it

35:16
 also means keeping them from having a balance because then we have the best chance of them actually following through with our prevention recommendations. So again, we have to

35:25
 kind of change our thinking to go, yeah, I feel bad kind of having to collect from this patient, but I'm going to feel

35:33
 more terrible about myself if I don't collect and then they just leave dentistry altogether.

35:39
 Because that's the thing, like if we assume that they are leaving our practice and then they're going to go to the other one, well, no, they're going to owe there too because they've maxed

35:48
 out. So they're not going to pay over there either, but they don't want to pay us what they owe us. So, we're just going to defer and slink away. Yep.

35:55
 And then now you're not getting care. Y.

35:58
 So, I think that's the other thing to kind of keep in mind with we we really have not done anybody a favor. No.

36:04
 By extending I I think um even down to and this is not exactly the same, but it's the patients that don't want X-rays ever.

36:12
 And whether that's truly because they're scared of radiation or they don't want to pay for it, they don't believe in it, whatever it is. and how sometimes we'll agree to go okay we'll go another 6

36:20
 months and then we're not going to and you're very upfront with them we are not going to like please don't come to your appointment please find another

36:28
 dental office if you um and I think that's a lot of times we get scared and go oh they're going to go somewhere else

36:35
 but you tell me what dental office is going to accept a new patient and be okay with not taking x-rays exactly so I push back and I'm like no this is

36:44
 standard of care and I follow guidelines of standard of care If you don't want x-rays, I totally

36:50
 you deserve your autonomy, but I deserve mine, too. I am not going to put myself and my practice at risk and miss some uh

37:00
 diagnostic a major diagnostic tool where I miss something on your child. Yeah.

37:04
 If you feel like you're that strong, again, you know, please find another office cuz I know you're going to get another office and you're going to agree to take their x-rays. Mhm.

37:13
 Um, so same thing like they're going to have to go somewhere else and pay money. Yeah.

37:18
 Cuz if they had the money and wanted to pay it, they would have paid you unless they don't like you, unless they didn't, right? But if they're a patient and they you fully intend that they

37:26
 want, you think they want to come back, but now they're not because of finances, they can't go anywhere. Yeah.

37:31
 Because of finances, which means that they're they're not getting they're not keeping up with their oral care. And again, that was one of our main reasons

37:39
 for that was our main reason for opening our doors was to be able to help patients maintain their oral healthcare, right?

37:45
 So, I can see again where a team member might go, but they're not going to get this crown because we can't extend out the payment. Yeah, they will. Yeah, they will.

37:54
 Mhm.

37:54
 And so, give them a minute to come up with it, but that shouldn't become your problem in trying to help figure out how they're going to pay for it. Yeah.

38:02
 Um people figure out when they when push comes to shove, you figure out how you're going to pay your rent. you figure out how you're going to and and

38:10
 yeah, and that's not our burden to bear ultimately. Our our burden is to tell to diagnose properly, to do a good job of

38:18
 diagnosing, to give them the option/ options that they deserve to know about and to make it as easy as possible for the patient to move forward with that.

38:29
 But their financial situation is ultimately not our problem. That doesn't mean that we're not empathetic to the expense of it all. We certainly can

38:38
 understand that. But we can't solve it in most cases unless we have this little pocket of people that we're willing to

38:45
 make these policies for. But in most cases, it just is what it is. Um, you know, I think about this all the time.

38:52
 time I was in a practice recently where um again just lots of dental decay and this lady and one of the things the team

39:00
 member said they were talking through how she was going to synchronize this treatment to make it affordable for her and they said but it happens every time

39:10
 you see a you know mouthful of problems and their lashes are all done their fingernails are expertly done they're

39:17
 carrying a fancy purse well why they value those things enough to pay for them. And if they value their teeth, they will find a way to pay for them.

39:27
 That doesn't mean, "Oh gosh, I know dentistry is expensive now. I've got to make it not expensive for you." No. Let

39:35
 the patient figure that out and don't assume that they need your help in figuring it out. Just present the facts and let them figure it out. And either

39:43
 they will or they won't, but that's not our problem to solve ultimately.

39:47
 Right. Um, before we wrap this up, I think at the top of the the conversation, I said docs, things for you

39:54
 to be. So, if if you're a doctor, you're like, "Nope, I don't have this pro problem in my practice. My my staff is great." You're probably a unicorn then. 

40:03
 I'm not going to say it's not happening, but you're probably a unicorn. There's probably somebody, whether it's an assistant, a hygienist, a front desk,

40:10
 who kind of tends to soften the blow, if you will, and be like, "Well, maybe we could do this or uh I don't want to be

40:17
 the bad one to tell the patient that they've got, you know, they need four quads of SRP. I don't want to be the one to how how is a doctor to know if

40:25
 there's a sabotur in their office." How how should we should we listen for when should we be listening or what what are your recommendations? I definitely

40:34
 first and foremost I think the recommendation is listen because a lot of times the dentist isn't hearing the financial conversations that are

40:42
 happening at the front. It usually occurs in a different part of the office and they can't overhear it. So I would say step one is attempt is as long as

40:49
 you can find a way to be a fly on the wall. Even if that means you just happen to casually walk up to the extra computer at the front and you're doing

40:58
 something on that extra computer while somebody's checking out behind you. uh do something to overhear these conversations because I don't think

41:05
 you're going to know that somebody's uncomfortable with collecting from a patient until you can overhear. Um so listen, I think would be number one.

41:14
 Find a way to listen. Um I don't love the idea of recording conversations that occur between a team member and a patient without the team member knowing.

41:24
 Um so it could be that you're setting a recorder up there, but you're letting the team member know, hey, I'm really trying to figure out treatment acceptance. I want to hear the patients reactions to the financial components.

41:34
 I'm going to leave this recorder up here today. U so make sure your team member knows if you do that, but if not, just just listen. Um the other thing that I

41:42
 would say is in addition to listening, I think it's worth having a conversation with your team to say, "Hey, I know

41:50
 patient finances is always a concern for all of us. So, let's just have an open dialogue. What do we think are fair policies to have? um what are ways that

41:59
 we could support patients in making dentistry more affordable and just hear how they talk about it. It never fails.

42:06
 You'll have the people like me that are like, I don't care. Like, we do the service and we're going to collect money and why are we even talking about this?

42:15
 You know, so there's the black and white people that are like, I don't even understand why this is a conversation.

42:19
 And they're the people that likely should carry the weight of a lot of these financial conversations. And then you'll find the person that you can tell

42:26
 it makes them physically uncomfortable to even talk about it. They're like, "But I just feel so bad when this happens or when that happens." And it

42:34
 doesn't mean that that person cannot collect money. It means they need some training to ensure that they collect in the right way. So to me, I tie in with

42:43
 literal collections, but also getting people on to schedule like the one I was talking about before that like we we couldn't even collect money because she

42:51
 was basically like, "Yeah, I wouldn't schedule my kid for this work either." Um that that's a problem. So we discovered that actually it was a

42:59
 conversation because we had done a lot of trainings. We had been listening to her. you and I finally just point blank asked her

43:07
 in a conversation because we were getting the sense that she was uncomfortable and she did fess up to that.

43:14
 So I think just kind of listening for how whoever's reviewing the treatment needs, how are they reviewing the treatment needs? Do they sound knowledgeable? Do they sound confident?

43:23
 Are they wishy-washy and going, "Well, I don't know. I mean, maybe dog could do a filling if that's what you prefer." No. Cuz now again, you've made the

43:31
 doctor the bad guy. Yeah. I I'm not doing a crown because I feel like it.

43:35
 I'm doing a crown because that's what's best going to meet your needs so you can chew and retain your tooth. Yes.

43:41
 Um so if it was an option, I would have said that. Yeah.

43:44
 So why are you making me try to second guess myself or make me backpedal? Why are you backpedaling and fiddle fattling around? Right. Like we should all be

43:52
 confident in this. And so really listening. I think the other way you could listen to some of these is uh if you have like um for in our office we

44:01
 have weave and it records calls. So maybe trying to intentionally go okay well you know on Mondays at 3 is usually

44:09
 when Mary calls patients that are due for their treatment or Jenny calls to collect balances. Yeah.

44:17
 And so maybe going back and listening to some of those calls to hear how your team does try to get patients to pay to

44:24
 schedule uh unscheduled treatment or um recare things like that. So physically trying to get in a spot where you can

44:32
 listen to some of these conversations and or um going back and if you have a phone system that can record calls and

44:41
 listening back to those calls. Those calls tell us so much.

44:44
 They really do. They're eye opening. a really great and a lot of people don't even realize that they have a call recording option.

44:51
 So, I would say if you're like, I don't know, do we record phone calls? Check with your company because a lot of times they have that option that you can

44:59
 either turn on or it's already available.

45:02
 So, I know we have weave. What other ones that might people have that are recording?

45:06
 Um, well, there other phone places like that are like Ring Central. Um, Mango is another popular one that automatically

45:14
 has that call record feature. But even just some of your simple VOIPE, voiceover IP phone systems that aren't connected with a company like a Mango or

45:23
 a Weave, uh, they have call recording options, but because the dentist has never asked about it, it's not turned

45:31
 on. So it often times it's just a capability that has to be turned on.

45:36
 Yeah. So yeah, I would say those would be the takeaways. listen to figure out if there is a problem. Assume there is a problem is what I would say because most

45:44
 people, especially with hard economic times, our hearts bleed for patients in a situation where now they've got this dental problem that they're having to

45:52
 pay for. So, I would say assume that there's potentially a problem or an uncertainty and then listen into those

46:00
 phone calls or those conversations and then put a system together for are we offering payment arrangements? If so,

46:07
 what are they and who qualifies for those?

46:09
 And if you're a team member and you're going, "Man, I didn't realize that's what I was doing. How can I stop my bleeding heart?" I think that's one that you need clarification on where you can

46:18
 have a little wiggle room. And then what else would you suggest? Just keeping in mind that.

46:24
 Yeah, I would say if you're a team member that knows that you struggle with this, you need to pursue your practice owner for support. Um, and again, that

46:33
 could be teaming up with other business team members in town that work at other offices. And maybe you know somebody on

46:40
 their team that's just really a solid collector. Maybe you don't know and you're like, "Can I just come and observe? Maybe that's not somebody in town. Maybe that's somebody in another

46:48
 state and it's worth going and observing in their practice to see how do they do it?" And then asking that person for feedback on how you change your mindset.

46:58
 Um, so I would say if you're uncomfortable with it, get get support. And I would say take take some classes.

47:05
 There's plenty of webinars. Adom, the blah blah blah of office dental managers, academy of dental office managers, something like that.

47:13
 They have a ton of courses and speakers that will help you build confidence. Yeah.

47:18
 Um, in that arena, I mean, you, you know, come to a crash course.

47:24
 We talk about it and train y'all live on how to do Yes. um improve in those areas. Yeah.

47:31
 But bottom line is if your practice is spending as much or more than what it's bringing in Mhm.

47:40
 that you're not going to have a business for very long. Exactly.

47:42
 The expenses need to be as low as possible. Yeah.

47:46
 So that you can bear the fruits of of what you are bringing in. Yeah.

47:51
 And if you are one of the roadblocks, you're not helping the business.

47:55
 Exactly. Yeah, couldn't have said it better. Love it.

48:00
 Thanks for joining the conversation today. We hope that you are comforted in knowing that you are not alone, but we also hope that you're walking away with

48:08
 some really great tips and tricks to try in your practice.

48:13
 We value your feedback, so please take a few moments to rate and review the podcast. Finally, we want to make sure

48:21
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48:28
 let us know what topics you want us to cover. As always, please know that we are rooting for you today as you manage your dental drama.