Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
How to perform dentistry faster, easier, higher in quality and lower in cost.
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1115 How to Properly Value and Purchase a Practice with Addison Killeen, DDS: Dentistry Uncensored with Howard Farran

1115 How to Properly Value and Purchase a Practice with Addison Killeen, DDS: Dentistry Uncensored with Howard Farran

12/6/2018 10:05:06 AM   |   Comments: 0   |   Views: 294
Dr. Addison Killeen is a dentist, author, entrepreneur, and coach. His passion is about bringing dentists business and life success through running their dental practices well. He began his business career doing the numbers for a business with over 20 Million in annual revenue from Defense Department equipment, 5 restaurants, a brewery. He then attended the University Of Nebraska College Of Dentistry. He proceeded to build a profitable network of 6 dental offices, with over 50 staff and 10 dentists under the core value of, Treat Everyone like Family. In 2018, he sold out of that company to become the COO of Dental Success Network, a disruptive company in the dental field. His book, By the Numbers, is proof that if you don’t have to be a PhD in statistics to be able to run your practice well with low stress. He works with the Dental Success Institute to provide coaching to their more than 140 clients across the world. Dr. Killeen is devoted to mission trips to underserved areas in developing countries, including Peru, Guatemala, and Nicaragua. His annual trip to Haiti is very successful seeing around 1,400 patients per year.

AUDIO-DUwHF #1115 Addison Killeen, DDS

VIDEO-DUwHF #1115 Addison Killeen, DDS

Howard: It's just a huge huge honor for me today to be podcast interviewing Dr. Addison Killeen who is a dentist author entrepreneur and coach. His passion is about bringing dentist business and life success through running their dental practice as well. He began his business career doing the numbers for a business with over 20 million dollars in annual revenue from Defense Department equipment, five restaurants, a brewery. He then attended the University of Nebraska College of Dentistry he proceeded to build a profitable network of six dental offices with over 50 staff and ten dentist under the core value of treat everyone like family. In 2018 he sold out of that company to become the CEO of dental success network a disrupted company in the dental field. His book by the numbers is proof that you don't have to be a PhD in statistics to be able to run your practice well with low stress. He works with the dental Success Institute to provide coaching to their more than 140 clients around the world. Dr. Killeen is devoted to mission trips to underserved areas in developing countries including Peru, Guatemala and Nicaragua. His annual trip to Haiti is very successful singing around 1,400 patients a year. I love that passion about you for me there's no better way to hit the reset button than to leave your cell phone all that go to the developing world go out in the middle of Tanzania or whatever and when you work on two or three hundred people for a week and you see them at night and they're standing in line for the morning visit and it's just tropical rainstorm all night long and they're stoical standing there with their babies in the right I mean with some some nights were out there drinking at 10 o'clock at night and they're all standing in line for 8 o'clock the next morning you feel bad that you're calling it a day. I mean it's just it makes you realize that 99% of all your problems in the in the richest 20 countries in the world are all made up in your own head. I mean it's just amazing so yesterday i pushed out on Dentaltown i put out so there's a great thread about what business books you recommend if starting a dental offices and I posted your book which i think is amazing, talk about well first of all talk about your journey and of Dental Success.

Addison: Well yeah so like okay like I guess you said in my bio early right before dental school I work for a restaurant company and you know restaurants just have such a thin profit margin and so running the numbers and the spreadsheets and basically every aspect of the restaurant books you know you really have to squeeze a lot out of it that where else you absolutely go under which 80% of restaurants go under in the first five years. So in that realm I really learned that you have to watch your P&L; like a hawk. I mean thankfully you know in the restaurant industry you have a sometimes you have problems with like theft like you know big slabs of beef would disappear and the restaurant hidden the dentists you know no one's gonna walk off with a tray of PBS that doesn't happen there's no street value for that. So you know I learned a lot of just how to be smart with numbers and then you have to watch your numbers back in that business and that business was was very interesting it got to work with some Defense Department machinery and then we have a brewery as well and so one of the original the first brewery in the state of Nebraska Imperii Nails so it's I think also to this day it's still the biggest brewery in Nebraska but a lot of good beers I learned a little bit about beer but that was mostly in the break room after work but yeah with with that I just learned that you know in a restaurant usually you make about three percent profit margin after you you know sell a few million dollars or the food and beer. Whereas in the dental industry I guess there's some guys making that little but I would hope that all of us make a lot more than that.

Howard: Well the ADA says the average dentist has 65% overhead so that would be 35% profit but the problem with the accounting on that is if you you can't call a profit if you take all the money home and you're the one doing the dentistry you have to look at the replacement the opportunity cost of you. So if you run 65% overhead and you hire an associate for twenty five percent overhead then basically that thirty five percent profit for your solar practice 25% of that is the opportunity cost of being a dentist and 10% of that is from having capital dollars employed in a dental office and the S&P 500 the average profit margins only five percent restaurants are brutal. When I still remember I'll never forget my dad I come from the restaurant too, my dad owned nine sonic drive-ins and I don't know how old I was like 10 11 or 12 nice work for him and I was making a hamburger and I put four pickles on it and it was mustard mayo pickle when I put four pickles my dad picked I was four pickles and he cremated it against the wall he said shit Howie if you're gonna put four pickles on it we might as well give it away for free and I said dad how many pickles supposed to be on he's is three it's like I'd never put more than three pickles on a hamburger the rest of my life and then you go into a dental office and like the cheapest thing in the entire dental office is a $25 PA or something. I mean it's just dentists have no idea how brutal the overheads are in restaurants I mean just crazy. So then how did you go from restaurants to dental school and by the way how far were you in dental school where you said to your mom mom why did you name me Addison that's a disease that's a gosh-darn adrenal failure did you did your were you named after the disease or someone else?

Addison: I think I was named after an English poet because my mom was a book nerd back in college but yeah you know a business world isn't too bad but you're always answering to somebody else you know even working my way up in that organization it just I knew I would never be the owner. So you know so that's when I thought well I always kind of had this hitch for medicine and maybe artwork and using my hands so that's when I thought okay dental school is the way to go. So I yeah I went into dental school and you know even coming out of dental school you're still kind of swimming and you know how to do a class to it faster than two hours. So you know after I got my feet under me for a little while that's when I joined my practice that I grew from one location up to six locations and it was, you know the second with a lot of people that go in group practices you you start off with one and you think oh one it's easy I can do two and two is definitely a huge learning curve and then you know it gets a little bit easier with three and four and five and you know it gets a little bit easier every time and you learn your mistakes but you know the biggest mistake for a lot of dentists is just they don't even know what their overhead is. Sometimes they wake up some morning and they they say hey I'm not making enough money I'm not happy you know there's there's a reason why a lot of dentists have burnout or I know I think people will argue that there might not be a statistically higher suicide rate but I think there is and so you know a lot of dentists you're just not happy because either you're not doing the dentistry you like or you're not taking home enough money or like you say sometimes your wife is spending all your money. So you know hopefully if people would just watch their numbers more and you don't even have to you don't have to go as crazy detailed as you know some of my spreadsheets but just even watching and you know don't like like with your dad don't put four pickles on a hamburger well don't use half a tube of PBS to take a single crown impression you know I'm a pretty big stickler on keeping my supply costs at four percent and so pretty much my assistant every month knows exactly what we get to order and it's four percent of the previous few months revenues averaged out and so she knows exactly okay this is all of the money that you get to spend on supplies if you go anywhere close to that you got to start asking me and we're gonna cut supplies out.

Howard: but you know it's a couple things on supplies when I go know supply is very anywhere from four to eight percent that's a hundred percent variance. What do you think the dentists are doing it at 6% or 8% supplies that they don't understand to get to four percent?

Addison: I think you need to one watch where you're ordering from I mean there's places that are definitely more expensive and there's places that are the exact same product but a lot cheaper. So where you're ordering and then how much you're ordering because...

Howard: Wait this is Dentistry Uncensored so come on get brutal, who's the most expensive who's the least expensive?

Addison: The least expensive like I've seen some warehouses out of California that are really good that have been given really great deals Net 32 is is pretty darn good some of those vendors they're you pay an extra shipping charge but the vendors sell almost the exact same products as the big names. The big names are probably the most expensive because they have the most overhead you know if you're employing big market reps and group practice reps and you have people driving around to your offices and fancy suits and ties and spiked up gelled hair you know you're paying all those people. If you're ordering from somewhere that doesn't have all those staff you're gonna save a lot of money and literally it is most of the time the exact same product. Now there's all this talk about gray market and and whatnot and I I'm pretty strict on that too in my practices. I would never order from a source where I think that the chain of custody or the chain of you know quality of assurance is broken and so you know for those things that get permanently placed in a patient's mouth I think you you got to go you maybe pay a little bit more for that but for a plastic suction tube I mean it's a straw basically do you care where your straw came from.

Howard: So who is known who is known in dentistry for gray market?

Addison: Some of like the like net 32 I think some of those vendors on there they're trying to cut them out but I think that's that their websites are known for the gray market stuff.

Howard: but when you when you had ten dentists and fifty staff and six offices with four percent supply costs where were you buying all your supplies from?

Addison: Some from Henry Schein from Darby and then some from net 32 so the predominant bulk of it was from Darby.

Howard: Mostly Darby

Addison: Yeah

Howard: Doesn't Schein own Darby?

Addison: I'm not sure I think they own a portion of it, their shareholders.

Howard: and what would you say do you think is the most expensive place to buy supplies?

Addison: Oh probably shine or Patterson would be my guess just because of their they have so many employees you know Darby doesn't have traveling sales people they have a call center so no one's gonna be visiting your office.

Howard: Well the only secret to lower prices is lower cost so when someone has a high cost structure they can at the lowest cost I mean it's just it's just as simple you have to take the cost out in order to lower the price. Like Southwest Airlines we're only flying one plane we're only doing direct flights back and forth we're not doing the hub-and-spoke we're not doing meals I mean there's and they they keep the airplanes in the sky 12 hours a day where all the other ones are averaging about eight hours a day they have the same 50 million dollar airplane but if one flies twelve hours and your competitors all fly 8 you got four hours of a free plane every day so yeah. So okay so continue on what you were saying.

Addison: So you know and then the other thing is just watching how much you use because you know in in any I still use PBS. You know in a tube of PBS some dentists will get four impressions out of it for me I said I want to know exactly how much we use and I could get it down to maybe five or six impressions for every tube or if we were doing a temporary I would actually buy the cheaper PBS the $7 a tube PBS. I call it PBS but some people call it VPS whatever but you know you could use cheap polyvinyl siloxane for you know temporary impressions or other purposes and you have the nice stuff for your final crown impressions. So you just sometimes you know dentists they give their credit card to the assistant and say hey order what we used or you know go do this order and it's just crazy because that's money sometimes hundreds of thousands of dollars walking out the door. You know I think we had a client inside the dental Success Institute recently that was run and I think he runs like a ten million dollar operation or maybe a little bit more and literally I think we saved him about four hundred thousand dollars a year because he was he was overspending supplies by that much and he was doing really great and so you think oh well I'm making lots of money but if you're walking if you're watching $25,000 a month walk out your door you can change that and he has and it's been I mean it's I think now it's just opened him up that he's has to pay more taxes.

Howard: Right right, so back to your journey on building your office

Addison: Yeah so yeah

Howard: I mean you came out of school, I Mean you're young now you're 32, I mean I'm 56 I am old enough to be your father if I had you to age 24, How old were you when you came out of dental school?

Addison: That would've been eight years ago so I was like 25, 24 I guess.

Howard: So from 25 to 32 to grow to six offices with ten dentist and 50 staff that's a beast of a success achievement. Now we're all six of those offices at Lincoln Nebraska where you went to dental school?

Addison: Five home when Lincoln and one was just 30 miles away. So yeah the one of the startups who did it was outside of town in a predominantly Hispanic town you know they they put in like a meatpacking or a food processing plant and instantly the community of this 10,000 population town kind of instantly switched to about 75% Hispanic and so we put in a clinic that was bilingual and had a Spanish bilingual dentist and pretty much did a scratch start with three operatories and it's been cash flow and ever since. All the other offices were pretty much where we did one other startup but all the others we're just buying out retiring doctors. So you know you definitely make some mistakes along the way and I've made my share of mistakes but overall it was a pretty fun ride and it's a pretty successful business now.

Howard: So in your book I would say about half the book is about how to value and purchase a practice. You want to do you want a deep dive into your book about that?

Addison: Yeah so I mean I kind of wrote this book because their's a few things that kind of annoyed me about you know coming out of school and trying to see there's a lot of kids that still come out of school and there's it's fake textbooks on you know how to run or buy a dental practice but I wanted the most simplified method and how I did it and so the first half the book is just all about okay if you're a new dentist or younger dentist and you've never owned before this is what you have to do to value a business go to the bank get a loan. You know what's what was my playbook for opening my offices and then yeah how to value it. So pretty much I value on the EBITDA method which is like you said earlier it's that if you are paying a dentist the 25 percent or 30 percent to actually do the dental work what's the profitability leftover afterwards because a lot of dentists you know older dentists who are retiring they have never really paid themselves in a real wage and you know for tax reasons we can kind of balance out that stuff but you need to when you value a business you got to take all that into account and see what's the actual profitability. I still look evaluations you know even this week that that are way high and the dentist is making you know he's trying to sell a practice for you know four hundred thousand dollars and he's barely taking home like a hundred and thirty thousand dollars. Well how was a new graduate gonna come in and buy a four hundred thousand dollar practice and make less than what Heartland could pay them. I mean and just maybe handed the keys and walk away, that just doesn't work and so I think you gotta use a standard method to value the businesses so that the business owner can make profit on their investment and they can also if they are the primary provider the dentist in there that they can also make their money as the dentist.

Howard: Okay you said that fast you said eBay da which is EBITDA interest before earnings before interest tax depreciation amortization will you just go through EBITDA. I really think that everyone listening to this that's still in dental school under 30 doesn't even know what earnings is before interest tax depreciation and amortization and I guarantee a 99% of my homies don't even know the difference in depreciation amortization will you go through that?

Addison: Yeah so earnings it's basically the cash flow because sometimes a den or a an account will throw in interest, taxes, depreciation and amortization those four things into your profit and loss statement. Well your P&L; or profit loss if you throw all those things in it can make it look like you make more money than you're actually taking home. So your accountant may say oh you did great you took home a hundred thousand dollars in earnings or in profit well where did all I'm only sitting here with you know thirty thousand dollars what happened, oh well you had to pay interest or you had to pay taxes. So EBITDA but I whatever is the earnings before you throw in all that funky stuff and the funky stuff is there kind of real numbers but some of it only pertains to Uncle Sam when they're taking their 40% cut and so the earnings is really okay, what's the cash flow at the end of the day before you start paying your taxes and everything else and so you know on a million dollar practice if your overhead is at 60% that's six hundred thousand you're paying the dentist about two hundred and fifty thousand. So you take that out your your earnings your cash flow the profit on that practice would be fifteen percent so a hundred and fifty thousand. So if you have that hundred fifty thousand that's the EBITDA number. So in my calculation though you take that EBITDA number you make sure it's normalized, so you make sure that the selling dentist hasn't thrown in their car payment or their airplane you know lease or you know all this other stuff that that you wouldn't as a new dentist that you wouldn't be doing you know it'd be really cool if you had an airplane but let's not throw that in. So you take that normalized number so maybe that jump said that maybe the dentist threw in a bunch of personal expenses in there maybe that jumps it to one hundred and eighty thousand dollars. Well you do that process for the past three years and so you know if we're coming up towards the end of 2018 so maybe you do it for two thousand eighteen seventeen and sixteen and then you weight it. I always like to weigh the most previous year heavier and so if you go to my website you can go to the documents page and download my EBITDA calculator and that has a waiting function so it waits the most previous year the highest. So if a dentist's is on a downward trend you don't want to be paying for three years ago when he took home three hundred thousand dollars if he's you know if he's in a nosedive right now and only making a hundred thousand so you got to wait it historically and then you apply in multiples. So usually the industry you see maybe three four five six for the multiple of that EBITDA. So after the waiting if you came out to about two hundred thousand and then you said okay take a three times EBITDA then that's 600,000 and in my experience I would usually do a three a multiple of three if the practice doesn't have a lot of technology needs some upkeep if it's closer to four or five then it's a pretty nice practice maybe I already has some technology digital x-rays and all that stuff.

Howard: So on earnings before interest taxes then there's depreciation amortization depreciation amortization. Depreciation is something tangible like equipment build-out you know something you can touch with your hands whereas amortization is something intangible like patents or trademarks or copyrights most notably in dentistry would be goodwill. So you're buying this practice an old man Sam has been there for 30 years and he's got this great reputation and that's built into the price of that practice that's amortization as opposed to depreciation but what do you what do you recommend to these kids coming out of school. I know what they're all gonna do they're all gonna come out they're gonna have fear so they're all gonna go be an associate somewhere and until they completely get sick and tired of working for someone else they finally want to start their own practice it's about a five year journey and when they're done with that journey and say screw it I'm so miserable I just want to work for myself would you recommend they start a denovo or require in existing practice?

Addison: Most the time I would say acquire an existing practice because their's no faster way to cash flow than buying a going concern. So that's usually the best case but there's always times when there isn't someone that's for sale in the town you want to move to you know if you're in you know northern like North Dakota or you know somewhere like that then maybe you got to go just start up a practice if there's no one else in town that's gonna sell or bring in and you know maybe you just gotta go that route.

Howard: So we're talking about your book By the Numbers, a guide to buying and running your dental practice by Addison Killeen DDS but the first half of the book is about acquiring a practice and had a value of practice the second half is really amazing also it's about a how you use 26 main indicators on a dashboard to follow your practice. I wish you would go into that I wish you a deep dive into what 26 indicators are you using to run.

Addison: Yeah so like the biggest things like any Harvard Business Review or any business book will say you need to have a dashboard for your company and so for me I thought okay what if I were to boil down to the least amount of numbers that I could look at and get a pretty healthy view of what my practice is doing what would be those those things. So I came up with 26 and so there you know half of them are leading indicators, so they tell me okay where's the ship going and the other half are half are trailing indicators or following so I called leading indicators LP eyes and then key production indicators KPIs. So you know a few of the leading indicators which sometimes US dentists we don't track well you know we don't even look at what we think oh im booked out three weeks I'm doing great or my schedules not full what am i doing. So the one of the leading indicators is number of days to the next new patient, you know I think you and I both know if you don't get a patient in within the next seven days they're calling the next office to get in somewhere else and if you're booking them out 21 days well that's great but they have a really high rate of not showing up for that appointment so.

Howard: Okay so you're so you're calling you're calling that a leading indicator and LPI and what's the and what's the LPI stand for?

Addison: Leading production indicator

Howard: Production indicator and then the other one is a KPI

Addison: Yeah and key production indicator and KPI is kind of the term for that like the Harvard Business Review would use for their business statistics.

Howard: and you're calling a key production indicator a lagging indicator?

Addison: Yep

Howard: Okay so when you're talking on when you're talking about we're gonna start with LPIs, leading production indicators your first one is days until next appointment is available

Addison: Yep for new patients which you know in my arena I guess I always put them in the hygiene schedule first for an hour and a half and so for me I would always track okay how many days until I have an hour and a half block in hygiene to get them in with a hygienist for their new patient appointment.

Howard: and what would be on a letter grade ABCDF what would do you want to see on days to get in a new patient and then what would be like an A or a B and what would be a CDF?

Addison: Under seven so if your it you know if your one or zero that's probably not great because you aren't filling the chair enough, if you're at two to four that would be pretty darn good but if you get over seven that's pretty much a D or an F because if you're scheduling more than seven days out there's a higher likelihood that their patients gonna put down the phone and call up a different office or they're gonna say oh yeah put me down and then they're gonna either forget about you or call the next office anyway

Howard: Yeah so more you said half of them were LPI, leading production indicators your first was dazed of new patients what are more?

Addison: Yeah so another one would be your no-show cancel rate. So you know for me you know when I started tracking it it was eight and a half percent or so of patients would either cancel within 24 hours or just not show up to their appointment. So you know I started tracking the number and I started to empowering my staff to come up with ideas to handle it and so you know we use open dental, so we there's a function where you can throw in right emails to all of your patients that day and just basically say hey Julie we're looking forward to seeing it 2 o'clock see you then and just another touch point earlier in the morning because we at that point we didn't use any patient communication software and so just another email drop the no-show percentage by like two points and so and then you know other ways you can get it down would be to have better scripting you know a better recall process but I think the goal should be to be under 4% you know. I think there's some people who think you can get a lower than that I think with any today's society you know you think you're old I think I'm old because I just get pissed off when people don't show up and so that's just, their's nothing more aggravating than you know they say they're coming in for a big appointment and then they just don't show up or they say oh I forgot and so part of that just scripting part of that is having more touch points but that would be another leading indicator.

Howard: What I love about dentistry and sensor I just call it is what it is I mean I like it when you give names you know names and you know so many people want to do all these softball interviews where everything's fuzzy. I want to get brutal you another brutal one is you talked about open dental and and a lot of people don't want to say anything negative about anybody or Dentirx or Eagle Soft  but let's it's dentistry uncensored why did you go with Open Dental and not the 400-pound gorilla out of Provo Utah Dentrix or the second biggest one Eagle Soft owned by Patterson at Effingham Illinois. Why did you go with Open Dental out of Oregon?

Addison: Basically it's just the functionality being able to change so much about it like when I came out of school I found it was at the practice that I actually worked in and it was just really good I used Dentrix, Dentrix is fine for one of the practices I bought used Eagle soft and I switched away pretty fast. You know the less amount of clicks that it takes to do something the better and being open sourced is just super nice I mean it's it's open source to a degree but just being open with the data and being easy to allow other modules to attach onto it. You know modularity of the software you know I think I've even in the past week I've seen someone messing around with doing voice charting for it where you can actually say you know teeth number one three and it would highlight it and then it would go in and you could say missing and it would delete it out and so just having that open ability it's really kind of following I've never met Nathan sparks but just I think the whole philosophy of the company is just pretty darn good.

Howard: Did you see I podcasts interviewed him Nathan sparks and I'll tell you what he didn't even want to come on the show because he he doesn't do any advertising and he's and has explosive growth and he says I don't want to draw any attention. I told him that you know come to the town he meeting he's like well I'm afraid if I came a bunch of people would sign up. I mean him and his Nathan works all day every day just to grow what they're growing and I'm telling you that have you have you, you talk about open source that's why everybody likes that's well the call center is like everybody likes it because it's open you can program to it have you actually hired a programmer that a program some module or some step to it for your own benefit yeah we did we did we tied all of our locations together in one database and so that was a little bit of a headache for a while. Now it's really cool I mean any patient can call any of our offices they just say which doctor they want to see and you pull up their chart and it ties it together from a phone system standpoint it makes it pretty easy but yeah I paid for some of that stuff and for a while I was testing out some other software's. I've probably thrown thirty to fifty thousand dollars away at people sitting in their pajamas in your upper or wherever just for that software but overall though I mean I wouldn't you know I mean I would I actively tell people that they need to go with Open Dental and when people and the other thing I think people sometimes think I'll be super honest that they want to go cloud based well cloud based for open dental or for any software is just a recipe for disaster cuz if the internet goes out you know your handpiece still runs but you don't know which tooth you're gonna be working on you can't take x-rays sometimes. So there's I've been on calls with private equity people that you know are owners of some cloud-based software and and I just tell them like guys I don't know how you're gonna compete no one's like from my experience having you can you can totally backup your server into the cloud but it's having a cloud-based software isn't really ever cheaper and it's probably not a good solution for 95% of dentists.

Howard: Okay so you're we're talking about LPIs leading production indicators I'm talking about days to schedule a new patient in you know show rate you like a four percent what would be more?

Addison: So that would be like the dates the next new patient that would be on the hygiene side the other big one to watch the schedule would be the number of days to next rock appointment and so when I say Rock appointment that's an hour and a half high dollar production in the doctor's column. So that kind of shows you well how full is their hygiene schedule and then rock would be on the dental side helpful is the dentist schedule so it's the dentist scheduling out and if it's less than seven days that's usually pretty good if you start getting too many more than seven days sometimes that's a problem because then you're kind of pushing production too far out so then maybe you should add more doctor time or become more efficient or add another assistance so that you can utilize the chairs that you're sitting with.

Howard: So when you say Rock is that from the term rock sand and water?

Addison: Yeah

Howard: and where did you get that from

Addison: Man I don't know it's just something I kind of...

Howard: This is giving away my age so when I got out of school the legend was Jennifer D St. George in her lecture was rock sand and water and what it meant was that you know you fill a glass with rocks and you think it's full but then you can add hold another cup of sand and then you think it's full but then you can add a whole nother water. What she was saying is that I'll never forget she laughed at me so hard or seven when I was like 25 years old sitting in the front row and my whole office and she says you wanted to do rocks in the morning when you're fresh ready to go and then sand would be like fillings and water would be like hygiene checks and and I said well I think there's no nothing more fun than at the end of the day to get an emergency Rock and do a root canal fill and crown for 2500 and she looked at me and she looked at me over her glasses as that's because you're 25 you won't want to do that when you're 45 or 55 or 65. So what would be another one number four?

Addison: Like new patient scaling root plane right you know a lot of dentists I mean I'd have to say it's kind of generational is that you know the older dentists maybe they don't treat periodontal disease as much but we know that statistically 40 percent of the population has it. So there's a high rate that if someone's coming into your office they they might have it so are you treatment planning forty percent of your new patients as pareo you know treat like treatment plan honestly but just know this is like epidemiological data. So you know if a patient's walking into your office and they haven't seen a dentist for a few years there's a high chance they have pareo disease. So that would be one another one would be number of well percentage of your new patients coming from existing patients. Now you know hopefully you're offering a high level of service to all of your existing patients and they love to tell their friends but you should look and see okay if I have a patient base of about 2,000 people what percentage is or what percentage of those 2,000 are referring there are new patients coming from so you should have a relatively high level of new patients that are being referred from your existing patient base and at a certain point if your growth trajectory isn't super high and you have a big enough patient base you might not need too much marketing because enough of your referrals will come from internal sources and especially if you're a PPO office it makes it easy for people to come to you but yeah judging how well you're getting internal referrals is one thing.

Howard: and what would be the benchmark data point though what what number are you looking at?

Addison: Oer over sixty five percent of your of your new patients should come from existing referrals.

Howard: So two out of three of your new patients should come from existing patients and there's more data on that showing that since we sell the invisible and I come in to you and you tell me Dr. Killeen tells me that I have four cavities well I have to trust you but when they're referred from a new patient they buy three times as much because then when you tell me I have four cavities I believe you but when I get a flyer in the mail that says come in for a free exam free x-rays and you think okay that's free and then you talk about need four fillings at 250 each that's a thousand dollars I'm like oh that's why you gave me the free x-rays because now it's you want a thousand dollars for four cavities and I don't even I don't even have a problem so trust base is so important and when you're selling the invisible.

Addison: Yeah yeah totally so having an already a connection even if it's through somebody else yeah that can be super powerful.

Howard: That's why the most important Facebook marketing is not buying a Facebook ad or posting it's having your patients check in on Facebook when they come to your office and tell them up front if you check in on Facebook we'll give you an extra toothbrush right here here's the oral-b toothbrush for a buck and you check in because the average person on Facebook has a 140 friends and when they see their best friend Charlene just checked into your office they're like oh wow and then that you know that that's a trust issue and I've seen it so many times in the office where they check in at the office and my gosh that the girl is sitting in a chair she goes out with my friend Julie just texted me she saw that I checked into Today's Dental and you who taught me that Mark Zuckerberg, his dad is a dentist Ed Zuckerberg he's been on the show three times and he's the first one to admit that face but you know checking in on Facebook is so powerful when you're selling invisible. So what's another one?

Addison: You know another one would be reappointment rate making sure that your hygiene patients are actually making their next appointment you should shoot for 90 to 95 percent. If you're over ninety five percent you're gonna have people make an appointment and not show up so you don't want to be too pushy and and getting people to make those appointments but 90 percent would be a good benchmark to shoot for.

Howard: and what are you seeing in the field I mean you you work for the 150 offices around the world what do you see in the field when clients calling up?

Addison: 85, 85 to 90 is is a pretty good solid area to be in if you do a really good job it's a now it's also tough because some patients some patient bases have been trained that if they don't make their appointment today they're gonna get relegated to the bad times of the day eight months later and if they want to hit six months they gotta make it today. So there's some it's clinics that do a really good job and they're probably 92 to 93 percent or maybe closer to 95 but and then but the bad ones I mean there's some that are at 50%. So you're you're potentially letting 50 % of your patient base walk out the door every six months and then you're having to try that much harder to get them back on the books whereas if you and I already make an agreement that you're gonna come in for your hygiene appointment in six months from now you have a little bit higher rate of feeling like oh I'm not gonna make that let me call in and I'll change it. So it's crazy though how many of the you know maybe previous generation of dentists that just would put their names on a little card and put it in a box and say well I'll call you in August we'll get your appointment. I mean that's just that sounds crazy to me so hopefully that sounds crazy to everybody else.

Howard: The other interesting thing about that as humans or creatures that happen so they came in today and they came in at Monday at 9 o'clock well maybe that's their day off maybe they work in a restaurant and they're off their off days or Monday and Tuesday and you know like Batman when I was little there's only three Channel ABC CBS NBC and I get out of school blessed sacrament 38 blocks away home Batman started on channel 10 ka ke four o'clock on the same bat station on the same bat-channel on the same bat-time ICS so wigged out usually the last block I would just sprint it home because I was afraid I was gonna miss the opening show. So after a while and I've been in business 31 years you have patients who always get their teeth cleaned with the same hygienists on the same day on the same hour the same bat station the same bat-time and then they remember their appointments more because they're thinking what is my cleaning why I always get my I always get my cleaning with brandy I always go on Tuesdays it's always 9 o'clock you know it's just so they're creatures of habit and that's why you don't want staff turnover because a lot of that part of that habit is I'm gonna go in and see brandy and she's my buddy she's been cleaning my teeth for 10 years and she yeah so give us some more these are awesome man you're amazing.

Addison: You know one of the others would be and some of these are broken down into whether you track them daily or weekly or monthly. Now there's not I mean really you don't have to watch anything daily but weekly were the first few that we talked about in the last year of monthly because sometimes you need a little bit bigger batch of data to come up with really actionable. So the other thing the monthly one would be total patient count, so is your patient base growing or shrinking. Now open dental will help you figure that out but also you know any statistics reports that you have out there you know there's the big players or you know Dental Intel or Divergent. For me I'm very particular with Divergent basically because I like getting an email at the end of the day yeah well it's like eight o'clock at night after I put my kids down I opened my phone I have an email from the analytics divergent it shows me you know what my production collections and then at the end of every month it actually sends you an email of all the other data which is like your production mix your total patient count your attrition rate and some of those things so.

Howard: Now is this divergent out of Raleigh Durham?

Addison: No divergent is based out of Texas somewhere.

Howard: What some there's gotta be more to their name is it divergent dental?

Addison: Yeah divergent Dental, so basically it's an analytic service where they hack into your open dental database every day and they send you emails after the end of the day with your production and all that stuff and then they send you an email for your morning huddle at like 5:45 a.m. so that you're all your staff can get all the statistics on that day's patients then - so

Howard: and who's the CEO of divergent dental?

Addison: Kevin Rossen, so super smart guy his dad's a dentist so he actually his dad is very like tech up-to-date well basically because of him so Kevin made sure he put in open dental has like 3d printers they do their own ortho trays in his dad's office but Kevin basically said well dad you need a analytic software. So Kevin built it, I think it's pretty economical compared to some of the other services out there I mean it's like a hundred and forty nine a month maybe and it gives you basically all of the data that you need and so that's the one that I like because I don't want to have to log into a web portal every day I just want it to pop in my email inbox and then I can read it.

Howard: and they do they work more with Open Dental I mean is that part of their

Addison: Yeah it's yeah so they're very he's very good with Open Dental, I think they're working on tying in to the others but I don't know if they're much past Eaglesoft and Dentrix. I mean for the most part Open Dental is the most open with their data so it's a lot easier there.

Howard: and the CEO is who again?

Addison: Kevin Rossen

Howard: and Kevin Rossen

Addison: Yeah so super super smart guy but that's so that's where I get a lot of my data for my monthly reports and then you know you have the key production indicator and these are the the ones every dentist knows you know what we're my production what were my collections what was my new patients total for the month. So some of those KPIs you know those are the three big that everyone knows but and then the other one that you know it's kind of a measurement tool that everyone talks about when you go to a dental conference is what was your overhead percentage. So you know your target overhead percentage should be under 60% at least.

Howard: So now you switched over to keep for time to lagging indicators so what was your last leading production indicator?

Addison: Total patient count

Howard: Yeah I want to stay back on that just one second a lot of that comes down to how do you count it. I mean some people count anyone who's ever been in their office one time ever some people say it's people who are only scheduled for an appointment some people say it's people who have been in your office in the last 18 months how do you define yeah total patient?

Addison: I define it by 18 months so I think if they haven't if they haven't been in in 18 months then I don't think that they're.

Howard: One of my favorite ratios and beliefs is how many people have been in the last 18 months and what would you say what would you say the average dentist in America how many patients have been in the last 18 months what would you say?

Addison: They'd probably say 2,000.

Howard: Yeah and then you would say well how many people are currently scheduled for an appointment right now for to get their teeth cleaned filled whatever and what do you think that number would be?

Addison: They probably think it's 1500 so

Howard: but what what do you what do you what do you think that you you said the average dentist yeah you say the average dentist has had 2,000 people in their office last 18 months

Addison: 1300 it would be my guess

Howard: So think about this think about this 2,000 people have come in your office in the last 18 months and 1300 are only scheduled that's 700 that means you've lost 1/3 of your practice in the last 18 months.

Addison: Yep

Howard: and what are they gonna do when I hear that their first question is Howard do you think you think I should learn to sleep apnea, dude you just lost 700 of your 2,000 patients last 18 months and then you and then you're gonna tell me and then you're gonna say that you you wanted to learn more about TMJ and I love that about you I want to go to a dentist who cares about occlusion and TMJ but gosh darn don't you want to know why 700 people came in your office and aren't scheduled to ever come back and you live in a town of 12,000 people.

Addison: Yeah well then you're talking about your marketing and I'm not getting enough new patients well you're losing all of them at the back door because your hygienists aren’t rescheduling them.

Howard: Yeah here's a typical dental office. They go buy an office and it's Hoover Dam and you have Lake Mead as far as so big you couldn't swim across it and then they get a hole in the dam that loses one third of the water and they don't even they don't even see that they don't they don't get that you that Hoover Dam is about patient retention and if 2,000 people have been in your office last 18 months why are only 1,300 not only 1,300 scheduled and why do you not know the name to those 700 people and why are you paying money to do all this big advertising campaign instead of putting a warm body on the phone dialing those exact 700 people of schedule and then putting systems in place that it doesn't happen again.

Addison: Well the easiest thing that we did to recapture patients that we didn't have on the books was doing web scheduling you know we used local med to put in a web scheduling portal the highest use of local med. I mean we had a lot of new patients use it it was actually our returning patients that were just probably too lazy to call us and so they said oh well now you have a web portal you just shot me an email yeah I'll make an appointment right now form my phone so I mean that's the easiest thing and I think a proponent of that.

Howard: Oh yeah we have a to, open dental has a scheduling app on it too and local med and and you know what I've lived through this rodeo before because I remember when me and dad were little when I was like I don't know in high school we used to laugh when they were rolling out these ATM machines we're saying what idiot would use an ATM machine when they could go in there and see Charlene and get a free sucker. I mean you know I totally did not see the ATM machine either than my dad but you know these Millennials I talked to these Millennials they would rather pay online they would rather schedule online they actually would prefer not to deal with another crazy monkey, plus I call you up to make an appointment the first thing you say to me is I'm sorry can I put you on hold and now they're sitting there for five minutes listen to elevator music and when they could have just gone online and made their an appointment so it's a millennial thing. Millennials really don't see the pluses of needing a human to do something they'd rather just do it digitally and that trend is only gonna get bigger bigger bigger bigger bigger.

Addison: Yep I totally agree so yes let's see one in the...

Howard: So are you friends with Divergent are you friends with Kevin Rossen?

Addison: Yeah I'm friends with him

Howard: Well have him email me I want to get him on the show, you're recommending him I want to get him on the show.

Addison: Yeah he's smart, he's the one that told me we were trying to dig through some data recently and I kind of had an issue I said okay is it more important to get a regular new patient in the door in the hygiene schedule or is it more important to get an emergency patient into the doctor schedule. So he ran the data through hundreds of practices like all of their databases and he figured out that an emergency patient was on average worth about eighteen eight hundred and eleven hundred dollars within the first six months in actual dollars collected across the country every dental office whatever. So highest dental offices of the emergency if you had an emergency code they collected eleven hundred dollars off you the lower ones are on eight hundred but a regular Newcomb patient on average was like six hundred dollars. So when people say oh I don't want to see emergency I know one more get free emergency dental services or anything no you really do because that's worth a lot more money.

Howard: Well some of it some of it also is irritating to me because of I know everyone's how about religion sex politics violence but the last election was a big earthquake in American elections and a lot of us because people felt they were in a flyover State no one was paying attention to them and they saw this the guy representing them and I don't want to get into whether that's right or wrong or whatever but a lot of dentists are elitist, they really value Mrs. Wimpleton because she comes in every three months she brushes every morning in flosses every night it's like dude I'm number one you never made a dime offer but number two you know what you're a dentist you're not a pastor you're not a politician everybody needs a dentist. Drug addicts need dentists alcoholics need dentists you know I don't care who you are but my god when that old guy walks in hasn't been the dentist in five years and he's holding his face he's in pain he needs a $2,500 root canal buildup and crown and you don't like him and you don't want to see him and you give him attitude and I've been obvious as I said well you don't even have an appointment. Well dude go to any emergency room in America nobody has his employment emergency it's called it emergency they didn't know their tooth was gonna explode this morning they drove straight to your office and they're getting attitude from the front everybody gives him attitude and the and the leaders the fish rots from the head down when the dentist sets of the deal and says hey everyone needs a dentist and if you're in so much pain you drive to this office like it wouldn't emergency room we're just grateful and lucky that you came here and and we'll work through lunch we'll see him at the other day. You don't see firemen packing it up at noon to go eat lunch for an hour when there's a fire going you don't see policemen in the middle of some big old chaos say oh I get off at 9:00 p.m. and it's 9:00 p.m. so I'm out of here, no you you you work and that is the one thing that the most successful people have is they have a work ethic they're ambitious they'll go through lunch you'll stay it in the day and they treat every customer respect.

Addison: Well an empathy really and that's one of the things that I try to teach our folks on the phone is that you know when someone calls in with a toothache you just say oh I'm so sorry that happened I you know I have a toothache last year and it was horrible well I'd have empathy to know what that person's situation is like and that person will already instantly feel a connection with you and then if you say something nice about the doctor they're gonna say oh this doctor must be great you know these people who are like me you know I want to go to that doctor but yeah empathy. I mean it's just sometimes I think we're losing that in the in society a little bit today but yeah having empathy towards those people in pain even if they you know don't look like they have a lot of money but yeah those patients can be very good for the practice so.

Howard: So the difference between the two commonly terms simply the difference between the most commonly used meanings of sympathy is feeling compassion sorrow or pity for the hardships at another person encounter whereas empathy is putting yourself in the shoes of another which is why actors often talk about it and you can't be Tom Hanks if you don't understand sympathy and empathy and I tell you what what's most bizarre to me is how many of these people and my whole life they only refer to cardiologists and OBGYNs based entirely on their chairside manner they listen that that empathy there they had sympathy that they were nice they're you know they never ever know what med school they went through if they got their diplomat if their board certified they never know not they don't know one technical aspect of this doctor they say oh you got to go you got to doctor this I mean he's the nicest guy in the world you know and it's like wow you're getting a bypass and you don't know any this guy he's gonna fly open your rip out your sternum and you don't know any technical thing about him just other than he's nice and that's the only thing that matters. I'll put all my money on the dentist who's got empathy and sympathy and chairside manner not technical skills I don't care if you got your magd fAGD I don't give a GD I want to know how do you communicate with your patients.

Addison: Yeah that's the biggest thing of success that I see you know yeah communication.

Howard: and what do these dentists do after they're after they do a root canal then they walk in their private office and shut the door instead of walking up front having an opportunity walk in your waiting room to press the flesh a lot of times for me I've been a bad boy I'm running 15 20 minutes late and then I'll go up front Valerie will say by the way Garrett has been he had a 10 o'clock appointment look what time it is and I walk out there Garret I'm so sorry but just acknowledging it shaking their hand touching them that you're all forgiven it's all good but so many of those missed opportunities does the dentist's I use is gonna go in this private office and shut the door because he's a natural introvert.

Addison: Yeah that's most dentists well introverts and you know (inaudible 58:03)

Howard: (Inaudible 58:04) introvert or extrovert introverts are exhausted by people and extroverts are refueled by people. So but your work so it's that's not the time to get re-energized your introvert you're still got your Hollywood hat on and you're gonna go out there and you just press the flesh. So give us more of your leading production indicators.

Addison: So let's see that was the key production yeah. So a few of them were the other big

Howard: Lagging

Addison: Yeah lagging so a few of the other ones would be well to watch your insurance write-off percentage that every month...

Howard: What was the number one lagging indicator?

Addison: Net production, so not you know you can bill out whatever you want for a crown but if insurance is only gonna pay you 800 count it for 800. So net production and then the second one was collections and then collections percentage. So of what you were supposed to collect what did you actually collect, you know so often we go into offices and we'll see you know 90 % collection rate or sometimes worse but you know that's money that's owed to you. So if you're at 90% you're letting 10% walk out the door every year that's pretty depressing when you look at that.

Howard: but look at it but look at it this way the average dental office according to ADA has 65% overhead so that's two-thirds overhead. So if you did a dollar in dentistry and you didn't collect it that means you had to take a dollar of profit so for a dollar a profit you would have had to do 20% of the dentistry you did that net income paid for the 10% dentistry that you did that didn't collect it. They say oh well I collected ninety five percent that means you did ten percent of your dentistry to generate profit to paint no two-thirds at five percent you didn't collect fifteen percent of the dentistry you did you had to take the five percent of that in order to pay the assistant lab, supplies, everything you did to generate the decision collect so would you say that number would you say what would what would be the highest cause of overhead. Do you think the collection percentage or the collection policy is the number one factor in overhead or what would you say the number one factor is?

Addison: Well labor is always the biggest cost category and sometimes it's overpaying labor but often I don't think it's I don't think we overpaid our people too much we're not leveraging them well though that's typically what I see and then bad systems just like not yet collections policy like you said, we just let patients walk out the door it's like letting I'll maybe I'll try that at Trader Joe's next week and see if they'll let me walk out the grocery store and I'll just I'll just send me the bill that never works so and there's no patient that hates you more than the patient that owes you money and so just as long as you don't let it happen and then you won't have a problem.

Howard: by the way every lawyer I've had on this show has told me that when someone owes you over $1,000 they now have a thousand reasons not to pay you doesn't feel right doesn't hurt they learn things online they turn you up you know I'm not gonna pay this or I'm gonna call the Nebraska State Board of Dental Examiners and then the doctor coughs up a blood clot and says just write it off. I mean don't incentivize so much behaviors incentivize never incentivize someone to want to sue you and leaving a big balance is incentivizing them to take you to the board, call an attorney because humans can rationalize anything.

Addison: Yep totally great so you know I think supplies and labs are another big area where they can where your overhead can just get away from you. My rule of thumb is always 4% on supplies and 6% on labs and it's not that I'm I don't send any of my stuff like overseas I keep it all local actually like a wonderful local lab techs that did all my stuff they did super great work I mean it's the kind of lab tech where you just look in a patient's mouth and you don't even remember you did a tooth but you like yep that was my crown because it just looks so nice but that I still kept my lab bill under six percent and part of that was negotiating with the lab just saying hey I'm going to use you exclusively and so part of it was that but you know the other lets see, staff payroll hygiene payroll those are the biggest cost areas. So staff payroll should really stay at 16% hygiene payroll should really stay at 9%.

Howard: Okay okay well you're okay people it always comes down to the definition so you said staff payroll 60% but then you said hygiene payroll so a lot of people peanut-butter-and-jelly out together. So when you say staff you're talking about dental assistants in front office in?

Addison: Front office yet so and ops manager yes

Howard: So all dry hands and all assistance and that's 16 percent then hygiene should be?

Addison: Another 9%

Howard: Another 9% and what percent of Hygiene would be the production for every dollar collected what percent of that would come from the hygiene department versus the dentist to get to that 9% hygiene payroll?

Addison: So pretty much a 25% of your overall office production should come from the hygienist so if you're doing a million bucks hygiene Department should do 250,000.

Howard: and 9% that should be hygienist

Addison: and then 9% of that should go back so about a third you know so if a hygiene is bringing in $120 an hour their pay should be under $40 an hour or vice versa if you're paying them $40 an hour and they should be at least producing 120 dollars an hour.

Howard: So hygiene pay should be a third their pay should be one third of production of your paying them 40 they should do 120 do you like paying hygienist hourly or do you like pay him on commission?

Addison: I did it's Commission for a few years and I it was not a big fan of it because sometimes I thought that the incentives just led them to do some things you know they'd be mad or they'd start switching patients because oh this one had bite wings this one didn't or they'd be mad because they had to do a pareo check which is a zero dollar procedure. You know so some of those incentives I just didn't like so I've gone back to straight hourly. I think that you know having an office-wide bonus system is something I'll probably look into in the future but and some of our clients and dental Success Institute use it use different bonus systems but you know for me I think hygienists are paid pretty well and a lot of hygiene tasks aren't associated with production. So keeping your instruments sharp just helping out around the office I found when I paid them on production only that it led to just some other you know they just didn't want to help out or they they would show up late because they're not getting paid to sit there every minute they're only getting paid to produce and so some of those things I just didn't work out as I thought and so that's why I've moved away from that.

Howard: Same exact you stole all the words out of my mouth the same exact system but one more thing I would add to everything you said was absolutely we paid them on production for the first ten years and we wax it why I would never go back the other problem was variance if you were my associate working for me and your whole morning fell apart but your afternoon you had this big case where it's two molar root canals and four crowns and your whole day could be when you come back from lunch and from 1:00 to 3:00 you do a $5,000 case whereas the hygienist if she loses her hour with the no show or cancellation that how she can make that backup in the afternoon it's too tight of variance there's no way she can make up. So a no-show was just just lost and and so yeah it's just just and and again it was bad on morale they wouldn't want to help out. So I'm and also on the bonus system I just gotta say one thing about bonus systems you already know if the bonus system is gonna work before you even started because people who work for $15 an hour their whole life they're not motivated by money I talked to the lady the other day as she was telling me I was at a school I'm one of the grand kids school and I said I'm she says she was celebrating her 20 years in the cafeteria of the school and I started I said why do you like and she's telling me the children in this and she when you're the cafeteria lady for 20 years you love the school you love the culture you love the kids. So going into there and doing a bonuses whereas you find someone like a dentist like an associate or an office manager so bonuses only correlate to how much money you're making like like a twenty five billion dollar bonus for a guy at goldman sachs could make could change the whole company's balance sheet but giving a bonus to all the support people you might not measure anything. So the more you make the more bonuses are effective and you're not you're not gonna take a $20 an hour dental assistant and put in some bonus system that's gonna change your whole world so you could do a little things are you know like you know little bonuses but I tell everybody you know if you're gonna do a bonus put all in the office manager just put the whole damn thing in the office manager, because she's the one thinking about dentistry on her way to work working through lunch at night running reports on weekends. I would put the whole damn bonus on the on the officer and then with the associates I guarantee you're not gonna pay them hourly and also one of the biggest mistakes I see with associates is that that office will pay for the lab it's like now they have no one said you know when the office space for the lab they're always using someone that's charging 150 bucks for a crown and then when you say oh no I'll split the lab bill with you now all of a sudden they fell in love with Glidewell. It's like well why why was Glidewell not on your screen when I paid for it and now that you pay for half of it. So you gotta have skin in the game and the associates make a lot of money the office manager makes a lot of money those people right but what did you do what did your on Associates you talked about stat payroll dry hands on deck up front assistants office manager and assistants 16% hygienist 9% what about associates?

Addison: I kind of count that outside of the overhead because I think paying the dentist is outside of what what I had. So if your overheads a 60% you know you pay the dentist probably another 25% so you pay them a little bit on their hygiene and you know 28 to 35 percent on their own dental production.

Howard: and 25 to 20 so did you pay the lab bill?

Addison: In my offices I always did yep so as long as they used approved labs.

Howard: Okay approve labs that you negotiated with?

Addison: Yeah so yeah so and I figured I paid them like when I paid all my associate is 28 and a half percent of net production and so yeah we would pay the lab bill you know that's in that's the Midwest I'm sure people in major markets like Boston or whatnot would be freaking out if they thought they could live on 20 and a half percent but in Nebraska it's pretty good.

Howard: Yeah and it's also not you net I mean I'd rather work for twenty percent take 300,000 year then worked for 30% then taken 100 but I'm the the other thing I want to I'm like I can't I'm sorry I've gone so overboard this and I you gave me an hour of your life I'm already hour and 15 one last question is on the dentists just don't they're so nice and they're so gullible and they're so shy and it's just such an uncomfortable conversation for them to call their lab and say this is the fee schedule I want to negotiate a deal with you but you just gotta be a businessman you got to be transparent and successful people are the ones most willing to have the highest number of uncomfortable conversations and another one is back to this PPO do recommend PPO's do you ever call PPO to negotiate fees?

Addison: Yeah I've used a few services to negotiate fees for me I figured that wasn't my wheelhouse so I think I've used Unitas was one of them and I can't remember the other one we used whether it was like Veritas or something like that but yeah we've used those to negotiate. I you know I'm not as much of a fan of PPOs as anybody but yeah we've negotiated them I'm in network or I was a network with virtually everybody and I think these days that's kind of the game that most people have to play.

Howard: Okay well is there anything else you want to talk about that I was too dumb to bring up

Addison: No you're good I just hope you know my book was kind of written to hopefully help other people out so hopefully people check that out and check out my website and use it, It's not a long read but you know if you're on a if you're on a flight to Arizona or something you could probably get through most of it and it's more of a tool book and a novel so...

Howard: I just tweeted you out if you follow me @Howardfarran I know you're driving in your car right now that's why we do transcripts of this so transcripts every podcast is on his book is By the Numbers a guide to buy and run your dental practice by Addison Killeen and it's on Amazon and all of the reviews for this book are five-star you don't have one non five-star review very good and so if you're driving you can find this at an @Howardfarran on Twitter all my social media is just @Howardfarran but Addison love you to death thank you so much for all that you do for dentistry thank you so much for spending an hour and a half of your life today coming on Dentistry Uncensored to talk to my homies. I thoroughly enjoyed talking to you you're amazing man.

Addison: Thanks right back at you, I love your podcast.

Howard: Oh thanks buddy you have a rockin hot day. 


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