The Group Dentistry Now Show: The Voice of the DSO Industry – Episode 29

Dr. Rodney Alles, Partner and Chief of Clinical Operations for DECA Dental, Dr. Parth Patel, CEO of Smile Culture Dental and Melissa Marquez, COO of Jarvis Analytics are the panelists that discuss KPIs, dental practice analytics and secrets to the best performing clinical teams on GDN’s DSO Study Club series. Find out more from Jarvis Analytics – HERE.

Our podcast series brings you dental support and emerging dental group practice analysis, conversation, trends, news and events. Listen to leaders in the DSO and emerging dental group space talk about their challenges, successes, and the future of group dentistry.

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FULL TRANSCRIPT

I’m Bill Neumann. I’m the CEO of Group Dentistry Now. This is our fourth or fifth webinar that we’ve done in the past couple of months. And Group Dentistry Now, if you haven’t been to the website, we have about right now we’re sitting around 800, and 810 articles all focused on emerging groups and DSOs.

Bill Neumann:

So make sure you stop by and if you want to watch the recording of this webinar, you can do that. Or if you want to, of course you’re online so you won’t need to do that, but if you want to read anything featuring any DSOs including Deca I know we have a couple articles on you and Dr. Patel we’re going to have to do some work with you and a bunch on Jarvis already. Well make sure you stop by the website.

Bill Neumann:

That’s me. I’m going to let Melissa, who is the COO of Jarvis Analytics introduce herself and then let her talk a little bit about Jarvis and what Jarvis does. So welcome Melissa.

Melissa Marquez:

Thank you so much Bill. Thanks for having us today. Yeah. I started in dentistry 20 years ago as a chair side assistant in private practice. That experience really allowed me to in-depth understand the challenges and the goals of the dentist.

Melissa Marquez:

Then I started really just peeling back the business side of dentistry. I joined a DSO which at the time had around 40 locations. That was DentalOne Partners in 2004. I actually stayed there over 15 years.

Melissa Marquez:

My experience at DentalOne Partners ranged from managing one practice to moving into more of a training role for the DFW market. Then after that I moved into a regional manager role, vice president of operations, and my last almost three years were spent as Chief Operating Officer of the West region. So, over 60 locations that were non-branded.

Melissa Marquez:

I’m very proud and grateful for my time at DentalOne Partners and everything I learned there. But in that role, I worked extensively with providers and practice teams to improve results, drive results, and help them meet their goals.

Melissa Marquez:

So, my role here at Jarvis Analytics, which I joined the team here in January, and we’ve really been focused on getting this product into more hands of different DSOs, DPOs, and group practices.

Melissa Marquez:

What we do, you can think of us as an intelligent layer over your practice management system where we’re pulling and syncing all your data in real time. We also have some unique workflows.

Melissa Marquez:

Today we’re talking about KPIs. So, we have many different KPIs that are customized to that individual group and we’re going to dive a little bit further into that today.

Melissa Marquez:

But what we do is we really allow groups to make intelligent decisions based on their data and super charge their results.

Melissa Marquez:

That’s really what through that work is how I was introduced to Dr. Alles and to Dr. Parth that you’ll hear more about today. So, that’s what we do here at Jarvis.

Bill Neumann:

Thanks Melissa. Next up we have Dr. Rodney Alles, and he is the Chief of Clinical Operations and a partner at Deca Dental. Again, welcome Dr. Alles. Why don’t you give us a little bit of your background and then talk a little bit since you’ve been at Deca since their inception, a little bit about Deca.

Dr. Rodney Alles:

Sure. Thanks Bill, thanks Melissa for putting this together for us too. Yeah. I’ve been practicing for 15 years. Been with Deca since inception in November 2008. Now we’re at almost 90 offices between Texas and Florida. So, to say 12 years ago I was going to be here with almost 90 offices, I’d tell you, you could tell me I’m full of crap.

Dr. Rodney Alles:

But we knew what providers wanted and we knew what we wanted so we figured we had the same resolute as other providers. So, as we kept growing whether it was seven, 10, 12, 15, we were just going to keep growing until obviously we got uncomfortable.

Dr. Rodney Alles:

So, being at almost 90 we feel like we got a lot of things down and I think adding Jarvis over our software in the offices has really, really helped us go to the next level over the last 18 to 24 months especially with the clinicians but even meshing the clinicians and the front office together because that’s the thing that I’m doing on a daily basis, coaching, training, mentoring.

Dr. Rodney Alles:

Not just the general dentist, but the specialist too. Not necessarily making them better at extracting wisdom teeth or placing implants, but just kind of showing them things in the office that they wouldn’t normally have seen because it’s definitely data driven and that’s what Jarvis has helped us be able to show that the clinicians and then the operations team it goes hand-in-hand.

Dr. Rodney Alles:

So, 15 years into it definitely have fun with this dashboard and giving this information to our providers. But looking forward to see what we can do over the next 18 to 24 months as well because this dashboard is only 18 months into it. We’re making small iterations all the time to it.

Bill Neumann:

Thanks Dr. Alles. Last but certainly not least on the panel we have Dr. Parth Patel. He is an emerging Dental Group Entrepreneur and I’ll let him tell you what that means. But Dr. Patel welcome.

Dr. Parth Patel:

Thanks Bill, thanks Melissa so much for having us on. Rodney, it’s a pleasure to be here with you today. Really look up to Deca and you guys are doing great things down south.

Dr. Parth Patel:

My journey begins as a first year dental student at Penn. I had already been interested in the intersection between business, healthcare, and entrepreneurship.

Dr. Parth Patel:

As a first year dental student I was about 22 years old. I went out, had a fantastic partner, and a car to my first location about an hour north of Philadelphia. 25 operatory practice, and little did I know how big of a mess that was going to turn into. Anything from staff turnover, to billing practices that had gone RI and just not a good marketing approach, et cetera.

Dr. Parth Patel:

I really got in deep early on and realized how much there was to learn about being a practice owner and optimizing your value drivers in your clinic. It became a sink or swim situation. I was spending about six hours a day at dental school and 12 hours managing my business.

Dr. Parth Patel:

Luckily I’m sitting here today. So, I was able to turn around, launched Denovos, conduct successful acquisitions afterwards and really continued to follow my passion as being an entrepreneur in healthcare.

Dr. Parth Patel:

I was also fortunate enough to go on to the Wharton School, complete my MBA as a member of the Healthcare Management Program over there. Now today I’m currently focused on driving value and creating healthcare service and technology businesses for like-minded founders, doctors, and talented operators. So yeah, happy to be here and looking forward to the discussion.

Bill Neumann:

Thanks Dr. Patel and actually I think I know which practice you’re talking about with the 25 ops because it’s probably about five or 10 minutes from our offices here. So yeah.

Dr. Parth Patel:

There you go.

Bill Neumann:

You mentioned that and I never thought about that until just now. But I know exactly what you’re talking about. It’s great we have Dr. Patel who’s up here in the Philadelphia area and actually beyond that.

Bill Neumann:

Then we’ve got Dr. Alles that is down in Texas. Well Deca is all over as well, right? Dr. Alles, Deca is based in Texas but where are your other practices?

Dr. Rodney Alles:

Yes. We’re based out of DFW. So, we’ve got all four major regions and then South Florida and about to launch Orlando area as well. So, Texas and Florida.

Bill Neumann:

Now that’s great. Then Melissa was at DentalOne and at that time you were probably how many different states was DentalOne in?

Melissa Marquez:

At that time 14. As you guys know they’ve gone through some mergers with other groups and continue to grow. So, I think they’re just going to continue to thrive and get stronger and stronger.

Bill Neumann:

Yeah. It’s amazing how things are changing so rapidly in the space and certainly COVID will probably have an impact on some groups and we’ll talk about that a little bit later on in the webinar. But right now we are going to jump over here and talk a little bit about KPIs.

Bill Neumann:

What I’d like to say again, I mentioned it earlier but I don’t know if everybody had joined the webinar, is that we did have quite a few writing questions. So, we’re going to focus in on a high level on certain topics and discussions.

Bill Neumann:

But if you have any questions maybe we aren’t addressing shout them or you can’t shout them out but in the chat or in the Q&A you can ask the questions and we’ll try to answer them.

Bill Neumann:

If we can’t answer them live, again we’ll have your contact information and we’ll be able to follow up whether it’s myself, Dr. Patel, Dr. Alles or Melissa. We’ll make sure we get back to you.

Bill Neumann:

So let’s talk a little bit here. General topic is identifying your KPIs. Maybe we start off with just how did you chose what you were going to measure, how you measure performance, and then maybe we can get a little bit more granular and maybe take a look at how an emerging group like yours, Dr. Patel, what KPIs you look at and maybe if they’re a little bit different than what maybe a Deca may be measuring.

Bill Neumann:

And Melissa you can certainly add in and give us a general overview of what different DSOs are looking at that you work with. So, we’ll start off with Dr. Alles.

Dr. Rodney Alles:

Yeah. Thanks Bill. It’s a good question because where we started at or even before Jarvis where we started at and where we’re at now, I’m not saying we look at the business any different, it’s just you fine tune your KPIs because what you think was important, you may get three months into it and then you’re like, “Man, I didn’t even look at that.”

Dr. Rodney Alles:

Let’s keep the KPI for sure, don’t just completely get rid of it. But you’ve really just got to hone down and pay whether it’s three, five, eight, 10.

Dr. Rodney Alles:

The most important areas of your office, for example if you’re a PITO office obviously stainless steel crowns and  would be the most important obviously. If you’re endo, it’s going to be your endos and your referrals that you’re tracking.

Dr. Rodney Alles:

If you’re a general dentist and you refer all the molar endos out, track an endo that’s ridiculous. So, you’re probably focused more on whether that’s invisalign and crowns, whatever it is. You’ve got to figure out your three, five, eight, 10 most important KPI and then that’s just the first step.

Dr. Rodney Alles:

Then define how you want to track it. Do you want to track it by money, do you want to track it by patients. There’s a million ways to do it and I’ve worked closely with Melissa and she’ll probably laugh, but we’ve gone back and forth on some of these KPIs.

Dr. Rodney Alles:

Started with tracking it by dollar amount whether it was diagnosis or conversion or whatever it is, or then tracking it by patients. So, we’ve gone back and forth and I feel like we’re in a good spot now. But I say that and then we may change two or three next week just to fine tune a little bit.

Dr. Rodney Alles:

I think the biggest thing is just nail down what’s important to you in your office and your offices and then move forward with that, not being so stubborn that you’re going to stick with those forever and ever, but knowing full well, hey this is just a starting point and it may be totally different six months from now.

Dr. Rodney Alles:

That doesn’t mean your company is totally changed, it doesn’t mean you’re changing how you look at your company, you just realize, “Crap, this was really important. I wish I had been tracking this six months ago.” So, I think that’s the way we looked at it and it’s okay to change.

Bill Neumann:

Dr. Patel.

Dr. Parth Patel:

Yeah. I agree with everything Rodney just mentioned. Oftentimes I like to kind of zoom out and just think for a second, what’s the goal the organization. For me that’s to create value. Create financial value, create patient value.

Dr. Parth Patel:

You want to be able to link value creation to your everyday actions being KPIs. So, if you can imagine a bridge in which you have your everyday action that can hopefully link to an operating metric, which can link to a financial metric, which can then again link to if you’re creating value for your firm.

Dr. Parth Patel:

I think that’s very important to be able to have an expert understanding on how that bridge is. So, when I say creating value, what I’m saying is being able to grow with an economic spread that you can rely with the sustainability performance and economic spread meaning you have a return on your invested capital that outweighs your cost of capital or your opportunity cost, your operating margin being the number one component probably on your return.

Dr. Parth Patel:

Then those everyday metrics, those KPIs that really fill into your operating margin dictate it and effectively let you know if you are running an organization that is generating value.

Dr. Parth Patel:

Going back to what Rodney mentioned, you really want to simplify it and really have a handful of metrics that you can bank on. Being in a healthcare services business, there are an infinite number of metrics that you can look at in any given day.

Dr. Parth Patel:

So, it’s important to have an understanding on what’s the highest sensitivities for those KPIs you’re looking at and making sure that those have the highest impact on your ROIC and you can do that in quite a connotative matter and that’s kind of the framework I employ.

Dr. Parth Patel:

But yeah, the simpler the better and just making sure you can bridge those daily actions into if they’re aligning and carrying out the firm’s greater goals.

Bill Neumann:

That’s great Dr. Patel. Melissa, in general what are you seeing from the DSOs that Jarvis works with and maybe we kind of look at this and Dr. Patel and Dr. Alles you can certainly feel free to chime in because you’ve got the emerging group perspective.

Bill Neumann:

Then Dr. Alles really you were at Deca from the beginning so you have that emerging group perspective all the way up to being a large DSO. Are the KPIs a little bit different, at different numbers of a location? You’ve got five locations versus 90, you’ve got two versus 400. Do you as you mature or as you grow larger, do those change?

Melissa Marquez:

Yeah Bill. I can speak to that. We have clients using Jarvis that have one or two locations and then we have clients with over 200 locations that are much more mature in terms of the stage of life that they’re at as a DSO.

Melissa Marquez:

We do experience a pretty broad range of what each client wants to measure and that’s really where Jarvis shines. We have a library that’s been built and you can think of Jarvis as not just the tool that’s going to help you identify what your results are.

Melissa Marquez:

We have over 80 KPIs in our library right now and that does not include any of the ones that might be proprietary to a group that they’ve said we really want to have this type of KPI and have it be proprietary to our business.

Melissa Marquez:

But what our clients are able to do is really customize those. What I mean by that is you can customize the type of provider or exclude different types of providers from what you’re measuring. You can include different transaction codes and even different periods of time so that that metric really becomes yours.

Melissa Marquez:

But because we’re basically a mastermind of all these different DSOs that have been so influential to Jarvis and what we display, there’s pretty much anything you can imagine there in the library to chose from and then make it your own.

Melissa Marquez:

Some of the ones that are consistent that we see consistently measured NDSOs, of course first will tackle production. Most are dividing up their KPIs between doctor KPIs for general hygiene and then specialty.

Melissa Marquez:

Within those specialty KPIs, there’s all different ways that you might measure things. For example with ortho you might be measuring your close rate, your number of consults, your referrals out. There’s a whole host of things that you can measure for each specialty.

Melissa Marquez:

But we also have just general office KPIs. We’ll touch on that a little bit later because when we talk about the team approach, there’s so many different people that influence your office metrics.

Melissa Marquez:

Really I think Dr. Alles alluded to it earlier, the fact that when you have everyone’s eyes on these KPIs it becomes much more powerful because the whole team is really focused on a goal together and they all have influence over the outcome there.

Melissa Marquez:

But with those AB clinical KPIs and even office KPIs, with production everyone is measuring obviously total production, production per day, per visit, per procedure by provider. Whereas, when I started in dentistry 20 years ago we were kind of just looking at total net production for the month.

Melissa Marquez:

Now you can get so granular and really curve out those efficiencies in your practice, which is I think especially important as we see cost of PPE going up and all other kinds of variables.

Melissa Marquez:

Everyone is really focusing more on the individual provider and on the individual transactions that are happening with patients on a procedure level basis. Then when we step out of the production base metric obviously you have your clinical KPIs, which our clients are really focusing around their clinical initiatives, whether that’s to drive hygiene production.

Melissa Marquez:

So, we can get as granular as measuring your period of profit ratios, measuring the types of procedures that are happening when we think about adjunctive related procedures. Things like fluoride per day, enhanced oral cancer screenings per day.

Melissa Marquez:

These are all things that many DSOs want to measure because it’s easy to look at a provider’s production per day. But to really understand what’s driving that, you have to get more into the weeds of what those procedures look like and what case acceptance looks like.

Melissa Marquez:

Then I would say finally your collections metrics are really important. So, being sure that you have a way to measure the aging of your claims as well as what’s being collected over the counter in real time is very, very valuable to our clients because they’re able to see on a daily basis what those results look like so that they can adjust the behaviors that Dr. Alles and Dr. Parth was talking about earlier on the spot and you’re not waiting until the end of the month or the end of the quarter to have any unhappy surprises.

Bill Neumann:

Great information. I don’t know Dr. Alles or Dr. Patel if there’s anything more you want to add to that. I want to make sure we don’t by pass a couple of rating questions that we had there. This is something that’s kind of interesting. Are there any KPIs out there that maybe somebody wouldn’t typically think of that you’re measuring or Melissa’s DSOs that you’re working with or measuring that have been really super important?

Bill Neumann:

Just maybe something that wasn’t top of mind but has become pretty integral to the group?

Dr. Rodney Alles:

Yeah. I was going to add just before we got into that question, the one thing Melissa did say and I did feel like what the KPIs, again we’ve always had them. It’s just it was like she said, it was instead of being able to be up to the minute or up to the date or whatever, it was you review maybe mid month, but you could always get it at the end of the month, but then the end of the month rolls three, four, five, eight, 10 days into the next month.

Dr. Rodney Alles:

So, changing habits we all know this, you don’t just talk to somebody once or talk about something once, it’s got to be done two or three times. So, if on the 10th of the month you see something, when you come back on the 20th you can pull up data that’s coming from the 10th to the 20th, look at the behavior change or did whatever we were looking to move the needle with, is it being moved, right?

Dr. Rodney Alles:

So, that was really a critical thing with the … It is up to the minute or up to the 15 minute mark, I think Melissa, but we look at it more from like today is Thursday, so I would be looking at it month a day through Wednesday.

Dr. Rodney Alles:

I know that’s pretty accurate starting midnight the day before. But I think the immediate access to that information, you can really change things fairly quickly in the offices rather than waiting 10 days into the month after to talk to them about something that happened a month before. So, that’s been a big game changer.

Dr. Rodney Alles:

Then to answer your question, Bill, there’s no silver bullet here. There really isn’t. It’s if you’re talking clinical KPI, the biggest thing that the doctor controls is diagnosis and how you want to track diagnosis. There’s a million ways to skin the cat because like I said earlier it’s picking the subject matter or the KPI that you want. But then Jarvis will give you 50 different definitions, which is good, and then you’re like okay, but hold on, I think I want to track it this way.

Dr. Rodney Alles:

Again, not saying either way anybody tracks it it’s right or wrong, it’s whatever works for your organizations. For me there isn’t a silver bullet and I don’t think there’s one that I figured out over the 15 years and I’m like, “Man, we figured this out and nobody else has.”

Dr. Rodney Alles:

It’s an evolving, it is definitely evolving as we go, but it was just no silver bullet on our end. Maybe Dr. Parth has a silver bullet.

Dr. Parth Patel:

No, I wish. I was hoping for you to tell us what it is so we can take it. But yeah. No. I look at a KPI and I look at dental groups and each group is very different. You’ve got to really kind of figure out what the core competency and what the key service offerings of your group are. Then kind of back into okay, what are the key KPIs and components associated with those core offerings?

Dr. Parth Patel:

So, for instance, if you’re doing a lot of tooth replacement or implants for instance, Dr. Alles kind of mentioned diagnosis rates. Then I guess the other component of it which we’ll get to is the treatment acceptance component of that and really figuring out what the expected value and if we’re driving that.

Dr. Parth Patel:

And if our treatment acceptance is let’s say 50%, what if we tog it up to 25% to 75%, what does that look like? What type of value does that create? Okay, how can we do that? How can we diagnose that every day? Get real time feedback and be there for our teams to make sure everybody is successful and moving the organization forward.

Bill Neumann:

Excellent. Thanks Dr. Patel. Moving on, next topic, comparison versus competition. So, I really want to address here how are you measuring KPIs across all your different locations, how do you use that to mentor, motivate.

Bill Neumann:

Then there was a couple of really good writing questions that we can talk a little bit about as far as measuring maybe income challenged neighborhoods compared to higher income neighborhoods. Let’s start with Melissa, what are you seeing?

Melissa Marquez:

I think in my experience these are all really great questions. One of the amazing things about being in a DSO or a DPO or a group is that all of a sudden you have the ability to compare. So, you can compare your providers and your locations and then you start to see those differences because just like every DSO is different, we all know that practices are unique and there are cultures within a culture and the way that their providers diagnose and then the way that their teams operate.

Melissa Marquez:

So, being able in one view to all of a sudden have all of your practices or providers in a table in a way that you can kind of rack and stack them and see where your high performers are and where your low performers are and then start to develop those relationships to share best practices and even peer and mentor relationships is a really awesome thing.

Melissa Marquez:

All of a sudden you can’t go in and in my experience come out a provider with just a production number because then especially if you’re an operator like myself who’s not a dentist, the perception becomes well this organization is all about the numbers.

Melissa Marquez:

It’s truly all about patient care and I would say the majority, the vast majority of groups out there. So, talking to providers I think is really all about their goals and their organization’s goals for patient care and that’s really where that ability to compare and even have some friendly competition really drives the level of care that your patients are receiving and your result as an organization.

Melissa Marquez:

So, that’s what we are saying. Just high utilization of the features within Jarvis that allow our clients to really compare their practices and their providers together and then do something with that data that’s actionable.

Bill Neumann:

Thanks Melissa. Dr. Alles.

Dr. Rodney Alles:

Yeah, I think Melissa brought up a good point. It’s funny in just seeing how it’s changed during my 15 years. But you know there’s something wrong when you’re not just looking at production. But that’s really the last thing you’re going to talk to them about because do more production, what is that really mean, right?

Dr. Rodney Alles:

Then it comes across poorly to your clinicians for sure because whether it’s 90%, 50%, or 70%, or 30%, either way there’s going to be a lot of people that don’t take it the right way. So, you’ve got to figure out how to, okay, let’s get some clinical KPI, maybe sprinkle some operation stuff in there too, but the clinical KPI, get those nailed down that way because if you can improve these, then the production has to go up because of these whatever, three, five, eight, 10 things that you want to track.

Dr. Rodney Alles:

That’s the way you want to think about it. That was always the hardest thing. I thoroughly enjoy what I do, coaching, and training, and mentoring doctors. This is something I’ve thoroughly enjoyed. But it’s figuring out how to present the data that you know is right, but to also not get them to come across the right way to them to where it is about guess care because if somebody is way down here on whatever KPI you’re tracking, they’re probably going to be way down there as well in production.

Dr. Rodney Alles:

But you don’t really want to bring up production, but you can bring up whatever it is. Whether it’s diagnosis or conversion in the office, something like that to approach it. I would say the comparison/competition, the culture we have at Deca I think our doctors are very competitive with each other, but there’s a few that it’s not that they don’t care, it’s just like well I don’t want to be last but I don’t really care if I’m first.

Dr. Rodney Alles:

So, when you can stack 120 providers or more than 120 providers against each other, maybe they don’t care if they’re first but they sure as heck don’t want to be 90 or 100 or 120. So, I think that’s the thing and we were talking about emerging versus being in another office, that was something we just couldn’t do when we were at six, eight, 10 offices.

Dr. Rodney Alles:

You can do it but first in 10 there is a variance there obviously with dollar amounts, but first in 120 that’s a big variation and that’s the stuff that’s changed. I wouldn’t necessarily say that that much has changed as far as what KPIs we would track from emerging to where we’re at now, it’s just the leverage or the way it comes across to the providers with that many people doing a certain level in other offices similar to their size.

Bill Neumann:

Excellent. Dr. Patel.

Dr. Parth Patel:

Yeah. No. Piggybacking off of Dr. Alles, I think the fact of the matter is, is that typically in a dental office setting production and quality patient care typically align. If you’re providing your patients with the highest quality care, the best treatment options, et cetera, your production will also typically increase as a result of that and in a meaningful manner.

Dr. Parth Patel:

So, framing it the right way to providers, every provider is different. I don’t think there’s two providers that are the same. So, having an understanding of what clinically your benchmarks are, what your standards of care are, and translating that, communicating that effectively to providers in a way that they can comprehend and honestly get motivated by wanting to be the best doctor they can be and provide their patients with the best possible care.

Dr. Parth Patel:

Yeah, I think having a dashboard to be able to have an external view on not just operating in a silo but being able to benchmark yourself against other providers that you may look up to in a sense is really powerful and it definitely untaps value in your organization and for your patients alike.

Melissa Marquez:

Bill, I have to mention here and Dr. Alles I’ll pick on you for a minute. I know you really love the visuals that come along with Jarvis, being able to see your top providers in a certain color, so seeing them in green and maybe seeing that bottom 20% in red. How does that visually impact the business and your providers?

Dr. Rodney Alles:

Well yeah, it’s a running joke in the entire C-level team and execs and in our end because it’s like show me the colors, show me the colors because honestly that was what … You can do all that in Excel and you can download reports.

Dr. Rodney Alles:

I think just getting the instant like hey, red bottom 20%, green top 20%, yellow you’re somewhere in the middle. It doesn’t mean yellow is okay but I think doctors understand since, again, we’ve been utilizing you guys for almost 20 months. When they see red they know hey, something is going on here, let’s look at it.

Dr. Rodney Alles:

Now to be fair too, somebody has to do that. Sometimes we were looking at it and it’s red it’s like well yeah, I’m red but honestly that number is actually pretty good. It really was just because the other offices and providers had done it. So, it doesn’t automatically create a red flag per se, but yeah the red, yellow and green is a running joke with me and the ONs and RNs and doctors. They know I get a tick out of that.

Dr. Rodney Alles:

Again, they added the colors because before the reports we were seeing yeah you can add the colors in but it was kind of another step because you would just get kind of a data spreadsheet and it just doesn’t present as easy to clinicians because I’m a clinician at heart.

Dr. Rodney Alles:

This stuff it didn’t come second nature to me, so I know my doc said are seeing patients five days a week, they’re not looking at these reports, I don’t need them to. They’re doing what’s best for their guest. But that red, yellow and green has really made it a lot easier for them as well.

Bill Neumann:

Excellent. Thanks Dr. Alles. Let me ask this question here because it was one of the writing questions. Major differences in the types of unique, the practices that might be in neighborhoods that may be a little bit different from an income standpoint.

Bill Neumann:

Then maybe even just heavily Medicaid versus maybe more PPO or fee-for-service or insurance. Any differences on the types of KPIs that you measure or how you actually look at practice performance Dr. Patel.

Dr. Parth Patel:

Yeah. I have offices that are in straight 100% fee-for-service settings and I have clinics that are in settings where there is a heavy manage care component. There’s definitely stark differences, there’s no question about it.

Dr. Parth Patel:

Coordinating patient financials, coordinating treatment gets a hell of a lot more complicated when you’re dealing with manage care and stringent payer rules and contracts.

Dr. Parth Patel:

Dealing with the demographic that might be slightly or more low income than a fee-for-service environment. There is an increase need to have qualified financial and treatment coordination at the practice level for these patients to ensure that they get the quality care that they can, whether it’s financing mechanisms, in-house payment plans or membership discounts, et cetera.

Dr. Parth Patel:

But that, again, tying it back into KPIs, that treatment acceptance is more difficult typically in a low income setting. So, making sure you have the right resources in place at the office to optimize that is crucial.

Bill Neumann:

Excellent. Thanks Dr. Patel. Moving on to the team approach, this is kind of an interesting topic because it hits on a couple of different things. I wanted to maybe start with that third bullet point there and Dr. Alles you mentioned Deca’s culture. So maybe talk a little bit about cultural alignment in KPIs and how do they work together or do they work together?

Dr. Rodney Alles:

Yeah, thanks. They do, they do. We’ve always made culture a focus for us ever since we started in 2008 because I think it’s helped because me, Dr. Ahmed and Dr. Patel we’re all clinicians at heart.

Dr. Rodney Alles:

Right now obviously now with these many offices, these many locations, we’re running a business but we’re still clinicians at heart. So, we focus, we think as the dentist does, right, and still try to run the company.

Dr. Rodney Alles:

But as far as the KPIs go, it’s making stuff that we feel would have come across well to us and then if you can get buy-in from the doctor, I think everybody in here, if you can get buy-in from the doctor the rest of the team will follow suite.

Dr. Rodney Alles:

Obviously, if you … That will contribute to a great culture in the office. If you have a doctor that isn’t happy or doesn’t believe in the same thing that you’re trying to coach or train or mentor them on, the rest of the team is going to be checked out too because either they’re going to get upset with the doctor or they’re going to believe the same thing that the doctor does.

Dr. Rodney Alles:

So, I think that’s really key on getting buy-in from the doctor. Then a close second is the office manager, right? So, for them as far as what I’ve been, my experience over the 15 years is if you can’t just have one, a good doctor and an average or subpar ON or vice versa, a standard or subpar doctor and a great ON. The office is still going to struggle.

Dr. Rodney Alles:

So, doctor first, get buy-in, and then the close seconds beyond that. If you can nail those two parts I promise you you’re going to look at an office that has great KPI across the board, maybe not every single month but most months in that you’re going to have a good team, which in turn is going to create a great culture.

Dr. Rodney Alles:

That’s the thing we joke about too, is if office 200 doesn’t feel like office number one, then me, Dr. Ahmed and Dr. Patel will look at ourselves and be like, “Well why are we doing this?” Because that’s a big thing for us even if they’re at different states, different groups, we just want them to feel the same.

Bill Neumann:

Dr. Parth you’re shaking your head and smiling.

Dr. Parth Patel:

Yeah. I’ve always kind of considered it like a batman Robin approach with a doctor and an office coordinator and converting a patient, making sure all the patients check boxes are marked off clinically and financially.

Dr. Parth Patel:

That’s where really the magic happens, in my experience at an office. From the time a patient sits in the chair, diagnosing treatment planning, et cetera, and then that handoff to the office manager where they really understand the treatment as well and they can communicate to the patient and make it happen financially.

Dr. Parth Patel:

That whole workflow is really crucial and that’s a team approach in the purest way. If one of those components is off, the whole thing is going to be off. So, definitely I want to echo Dr. Alles there, that that makes a lot of sense to me.

Bill Neumann:

Thanks Dr. Parth. Melissa?

Melissa Marquez:

Yeah, if Batman and Robin are the doctor and the office coordinator, Jarvis is the Batmobile because I do think-

Dr. Parth Patel:

There you go.

Melissa Marquez:

… putting the metrics in a place where the entire team can see them, because they’re focused around the patient and I think most groups really do want to keep the focus on the patient and their care and the workplace environment.

Melissa Marquez:

When performance is front and center like that and everyone can see it, it creates a culture also that’s not just centered around patient care, but it’s also centered around team work and centered around accountability because the numbers are there, the team is there working towards the goal and they’re out there really in front of everybody.

Melissa Marquez:

I’ve been the regional manager that’s responsible to gather up the numbers and take them in the office and it’s you want your numbers in a place where everybody can see your KPIs before you even arrive.

Melissa Marquez:

That’s the beauty of it, is that when everyone’s looking at the store board, I’ve compared it before to like playing a football game with no scoreboard and everybody kind of has their own version of what’s going on.

Melissa Marquez:

When you have a scoreboard you suddenly have a team that’s motivated towards a goal. I think that’s very culture driving in any organization.

Bill Neumann:

Excellent. Great points Melissa. I don’t want to-

Dr. Rodney Alles:

I just need to add one thing on the team approach. One thing that really has changed, I don’t want to say changed the opinion of me and Dr. Patel we head up the doctors for Deca.

Dr. Rodney Alles:

Initially when we started this, it was basically he and I that had access and we would present it to our board of doctors which helped train the other doctors and then slowly gave them access.

Dr. Rodney Alles:

Then I think overtime the culture, the doctors, we just didn’t know what other doctors would do when they saw a long list and they saw their name at the bottom, would they respond.

Dr. Rodney Alles:

So, our doctors now are just champing at the bit. I don’t know if it’s because they’re more visible. I don’t think they would have done that 18 months ago and I think sometimes if yeah, you do a slow burn on some of this stuff and it can really change your organization because it’s just a time thing because I don’t think it would have been … I don’t know about unhealthy, but I don’t know how well it would have worked 18 months ago or 20 months ago just throwing it out on the doctors.

Dr. Rodney Alles:

Even though it’s good data and we felt confident about it, that’s something else, I think the team approach overtime. It’s like everybody is asking for them now. It’s a great feeling.

Bill Neumann:

Great feedback there Dr. Alles. I don’t want to sound like the joker here, I’m going to stay on the Batman and Robin. Thanks Dr. Patel for that. But what about … We talk about office managers and then we talk about the clinicians and with KPIs.

Bill Neumann:

So, how do you kind of keep that separation where you don’t feel like you have non-clinicians influencing clinicians. You want to talk a little bit about that? How that works because I know that there is some apprehension maybe from outside the DSO space of that happening and how you all control that. Maybe I’ll let Dr. Patel since he brought up the Batman and Robin let’s go with you.

Dr. Parth Patel:

Sure. One of the things that I really believe in is that when you’re measuring metrics or any type of measurement, you want to make sure that you’re measuring two things that have inherent tension.

Dr. Parth Patel:

So, what I mean by that is let’s say you have a practice and you’re giving your team goals to maximize the number of in-house new patient or sorry, in-house membership plans. The team is really focused and aligned on conveying these plans to patients and trying to have patients sign out and getting in on this great schedule where they can have discounted fees and a bunch of great things.

Dr. Parth Patel:

But you also want to make sure that you’re tying that with something that might have some inherent tension just like a patient experience metric because as management it’s really easy to say, “Hey, let’s maximize X, Y, or Z,” but you definitely want to lose that culture of the practice. You definitely don’t want to lose something inherent in the practice that’s really important that might misalign your team and some of the other goals in the firm.

Dr. Parth Patel:

So, I like tying a couple of things together and make sure there’s always a balance that’s striked there. I think that’s really important. But yeah, to answer your question, you want to make sure as management the rewards, the incentives, the systems you’re creating clinically they align with your admin staff and they align with the greater goals of the firm.

Bill Neumann:

Excellent. Okay, let’s move on from the team approach and talk a little bit about what everybody is probably talked out about. But unfortunately, we still have to address it as it’s COVID-19. Maybe generally we can speak about this and why don’t we start with you Melissa and maybe what you’ve seen from your perspective, the DSOs that you’ve worked with.

Bill Neumann:

From an analytics perspective, are there any things that might be looked at differently now than pre-COVID? Then going forward what would you project?

Melissa Marquez:

Well I’ll say that post-COVID and sort of as we were managing through COVID and still are, I think especially as we knew that there were going to be closures, what we saw is people really working diligently to understand what they have on the schedule so that they could project what are we losing and where can we recapture this.

Melissa Marquez:

So, taking advantage of being able to have a tool that helps you identify all the broken or lost appointments and then measure in real time as your team came back to the practice and started rescheduling those.

Melissa Marquez:

So, definitely a heightened awareness around if something like this happens again do we have a tool like Jarvis in place that allows us to identify those broken appointments so that we can manage them getting back onto the schedule before the end of the year or before insurance benefits come into play.

Melissa Marquez:

I would say the other thing is just being able to look forward at what’s on your schedule and also a heavier interest in trends. I think a lot of people re-budgeted or re-planned their goals for their practices as COVID was occurring because they knew they had to pivot for the remainder of the year and establish new goals.

Melissa Marquez:

I think fortunately the last few months we’ve seen as most people know increases in production and some of the best months of the year happened in June and July. I think everybody is anticipating potential issues on the fall as we get into that dreaded August-September timeframe that most people are worried about.

Melissa Marquez:

So, I would say a focus on being proactive instead of reactive and now more than ever you need to know what’s happening in your practice and you need to understand what you’re losing and where you can gain it back in a really efficient manner because you don’t know what’s going to happen.

Melissa Marquez:

I don’t think any of us ever planned or thought in a million years that this could have happened. So, I think having access to your data and not having to go into each individual systemic, you have multiple locations is a lifesaver because decisions were happening very quickly, changes were happening very quickly and people had to be really nimble to make those decisions.

Bill Neumann:

Great. Thanks Melissa. Dr. Alles.

Dr. Rodney Alles:

Yeah. I think everybody has COVID up. But no, man that’s the most stressful thing I’ve ever done other than when I had my identical twin boys after we opened up three offices back in 2009 right back to back and then the kids came out.

Dr. Rodney Alles:

But taking it aside, closing down wasn’t that big a deal because it was a state mandate here in Texas and Florida just like everybody is closed, elected only or emergency only. So, you just kind of pick and choose which offices are back up.

Dr. Rodney Alles:

Then you open back up and you’re looking at it and you go, well, I’m going to have a plan here but you have no clue if you’re going to get phone calls, you have no clue if everybody is scared, you have no clue if they’re coming back.

Dr. Rodney Alles:

Well, we thought they would come back we just didn’t know if they’d come back in December or if they’d come back immediately. Luckily, Texas and Florida have both just taken off. A lot of people just don’t care.

Dr. Rodney Alles:

So, some did but we made sure we put that anxiety thing bit as little as possible, right? If they’re coming out of COVID it was great. It was great seeing that we ramped up quickly. The thing that was really hard is everybody was super stressed out, right, because the clinicians we’re wearing more PPE than we’ve ever worn in our career and in Texas and Florida it wasn’t chilly outside, it was 95 to 100 degrees. So, everybody is just difficult.

Dr. Rodney Alles:

Then they were doing more with less just because a lot of people didn’t come back because of childcare or they changed careers. They were doing more with less. So, we weren’t coaching to the KPIs for a while just because there’s no way it would have come across well.

Dr. Rodney Alles:

It was basically everybody was doing as much as they possibly could and so coming out of COVID nothing has really … At this point we’re back to almost normal as far as coaching, training, and mentoring the doctors with the KPIs.

Dr. Rodney Alles:

But yeah, we all expect something to happen in the fall. Do we think we’ll be at a shutdown? No, I don’t, but again I don’t know if I thought we were going to shutdown the first time.

Dr. Rodney Alles:

So, just watching those things as we come out of COVID. But yeah, opening back up was the hardest thing I’ve ever had to do professionally, working very closely with our exec and Dr. Patel and Dr. Ahmed, what we’re doing to open these offices back up.

Bill Neumann:

Thanks Dr. Alles. I’m going to just say we’ve got about seven minutes, eight minutes left and I’ve got a couple of really good questions that just came in. But I want to first of all Dr. Patel do you have anything to add and then I’ve got a couple of questions here, one on yesterday’s WHO recommendation, which we all probably unfortunately know what that was.

Bill Neumann:

Although, the ADA did have a rebuttal to that which was great. Then another question wrapped around October re-care appointments and could that be a concern. But Dr. Patel do you have anything to add overall about kind of opening back or dealing with COVID and then got a couple of really good questions here at the end.

Dr. Parth Patel:

Sure. Just simply, it forced everybody. It was a shock to the system. I think it was an unexpected wake up. It’s like at three in the morning and someone throws a glass of cold water on you and you’re like, whoa. You’re on high alert and you have to kind of figure out what the core components of your business are and kind of rethink your business and kind of build it from the ground up in a sense with your operating models.

Dr. Parth Patel:

That is as Dr. Alles said, it’s a pretty high stress situation and then kind of figuring out how you can ramp back to some level of normalcy as well as accounting for the risk and the new normal of the PPEs and what not.

Dr. Parth Patel:

It’s an ever evolving process. But for me it made me gain an even better understanding of the operational metrics or cost structures or KPIs, et cetera, because you’re really rebuilding from the ground up when you don’t have hygiene and things like that.

Dr. Parth Patel:

You’re breaking your business down into components and just regaining an understanding of what the new dental office will look like.

Bill Neumann:

Absolutely. Just in general, I’m going to throw these questions out and you all can answer them. The WHO did come out with a recommendation yesterday, ADA came back pretty quickly and said that dentistry is essential so it should stay open. So that’s good.

Bill Neumann:

Do you anticipate any fallout from or have you seen any of that? I know it was just yesterday from the WHO’s recommendation. Unfortunately, it’s all over the news.

Bill Neumann:

Then the other question I see here is October re-care appointments could be a concern for all the overdue patients rushed in when practices re-opened. Any thoughts on that and I guess Melissa maybe I’ll let you start.

Melissa Marquez:

I’ll let our doctors speak to the WHO recommendation. Although, my husband did ask me about it this morning, so I know he’s concerned. But I love the October re-care question because we all know how cyclical dentistry is and that everybody is on this three to six month cycle.

Melissa Marquez:

I would say one good way to combat that is by looking forward knowing what’s on your schedule patient count wise and production wise and then thinking about perhaps how to restructure your hygiene staffing.

Melissa Marquez:

Also, thinking about those 49, 10 patients that are on a every three to four month cycle I would say really leverage the heck out of those patients in terms of running some reports, which is something Jarvis allows you to do, identify those unscheduled 49, 10 periodontal maintenance patients.

Melissa Marquez:

Any patients that never came back for their second maybe half of their re-planning and scaling and getting some creative ways to fill the schedule since this question is correct. It could knock off your re-care cycle because everybody essentially might be a few months off that original schedule that they had for hygiene.

Bill Neumann:

Thanks Melissa. How about all right Dr. Patel. Any feedback on the WHO, not the band.

Dr. Parth Patel:

I don’t want to get too political here or talk too much on governmental bodies. But what I will say is, is I found overwhelmingly our patients and our communities are seeking dental care, they’re looking for dental care and I believe we’re providing dental care in an incredibly safe and protective manner to all key stakeholders alike.

Dr. Parth Patel:

I also think that dentistry has gotten unfairly treated here a little bit and I think that there is a lot of organizations and bodies like WHO that are overlooking things like periodontal disease, things like cavities, things like just getting a regular checkup and cleaning that have greater health systematic impacts.

Dr. Parth Patel:

Like I said again, and I’m sure Dr. Alles agrees with this, I view a dental office as one of the safest places you can go with the measures that we took pre-COVID and certainly now after COVID.

Bill Neumann:

Thanks Dr. Patel. Dr. Alles.

Dr. Rodney Alles:

Yeah, to piggyback to that, I 100% agree with ADA. I’m glad the ADA had a quick rebuttal. I think this goes back to how I’m feeling in the offices. I haven’t heard anything different than what we were already dealing with because they’re still the people that are still trying to cancel their appointments and then you got to educate them like hey, we don’t know if this is going away. We don’t know if it’s going to get any better than it is right now, right?

Dr. Rodney Alles:

So, yeah it’s good that the ADA had a rebuttal on that and then I also think yeah, I think a dental office … Look, I think we all agree that it’s one of the safest places where you’re not going to have a guy bumping into you, grabbing an apple that doesn’t have a mask on, that’s going to happen at your grocery store even though there’s a rule or there’s guidelines saying you should wear it. They have to be wearing that in the office or at least …

Dr. Rodney Alles:

Then once we start getting, we’re wearing all the guard and we’re protected. So yeah, that part.

Dr. Rodney Alles:

Then the re-care yeah just exactly what Melissa said. You’re going to have to leverage your hygiene. Obviously you’ve got to be as firm as you can and make sure you’ve got great verbals with your front office on how you can get those 49,10s, how to get those properties in, how to maximize their insurance benefits for the year, right?

Dr. Rodney Alles:

As far as maximize what they can get as far as cleanings, x-rays, that kind of thing and make sure if you can get them in twice this year still. So, it is a tough one and hopefully our dentistry in general can weather the storm in September and October because I think there’s going to be a lot of struggles with hygiene in those couple of months.

Bill Neumann:

Okay. Thank you Dr. Alles. Melissa, I’ll give you the last word here. We have about probably a minute and a half left. Then we didn’t get to every question. We got to most of them though and certainly brought a really good conversation wrapped around the topics that we covered specifically KPIs and COVID and teams.

Bill Neumann:

But if you have any specific questions, email addresses for Dr. Alles, Dr. Patel and Melissa and myself are available, the recording will be available. This will be in podcast form. It’ll be transcribed. You’ll be able to digest it again in any way, shape or form you’d like.

Bill Neumann:

So, if I forget I’d like to just thank everybody, all the panelists for being a part of this and Melissa I’ll let you have the last minute or so.

Melissa Marquez:

Thanks Bill. I just want to echo that and thank everyone for participating and special thanks to Dr. Alles and Dr. Parth. We’ve enjoyed their partnership as they have continued to work on their versions of Jarvis and make it part of their everyday and how they’re successful with their own teams.

Melissa Marquez:

So, any questions that you have please feel free to reach out. We’re always more than happy to talk about KPIs and other topics that will help you drive your business.

Bill Neumann:

Thanks again everyone. I’m Bill Neumann from Group Dentistry Now Show. Again, thanks to our panelists. This was great information and appreciate everybody here. It looks we have quite a few attendees that hang out for the entire hour. So, we really appreciate that. Thanks again.

 

 

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