Small Changes That Lead to More Profits – Episode #353

Building a practice is not easy. You worry about billing services, insurance management, overhead, business consulting, marketing, collections, human resources, and more. One entrepreneur wants to help you solve it all. On this Dentist Money™ Show Ryan interviews Dr. Scott Leune of Breakaway Seminar whose vision has guided thousands of practices to greater profitability.

Show notes:
www.BreakawaySeminar.com/
www.DentalWhale.com

 

 

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Podcast Transcript

Ryan Isaac:
Hello everybody. Welcome back to another episode of The Dentist Money Show, brought to you by Dentist Advisors, a comprehensive fiduciary financial advisor just for dentists all over the country. Check us out at dentistadvisors.com. Today on the show, we are airing some audio from a webinar I did with Dr. Scott Leune, founder and leader at breakawayseminar.com. Scott runs through a lot of really interesting tips and tricks to run a successful profitable practice and gives us some different questions to ask and ways to think about how to move forward in the dental landscape and building the successful business of your dreams. Many thanks to Dr. Scott Leune for this. This was an awesome conversation. We look forward to doing this more with him in the future and his group. And thanks to all of you for listening. If you have any questions for us, go to dentistadvisors.com, click the “Book Free Consultation” button and let’s have a chat at your convenience. We’d love to hear from you and help point you in the right direction in your own financial plan and decision-making. Thanks for joining us. Enjoy the show.

Announcer:
Consult an advisor, or conduct your own due diligence when making financial decisions. General principles discussed during this program do not constitute personal advice. This program is furnished by Dentist Advisors, a registered investment advisor. This is Dentist Money. Now here’s your host, Ryan Isaac.

Ryan Isaac:
Welcome everybody. I’m Ryan. I’m a financial advisor, co-founder of Dentist Advisors and we’re grateful to have you here with us. And there’s a lot of places you could probably spend your Thursday evening, so we’re thankful you’re here with us tonight. These are part of our partner webinar series. We do these monthly and usually somewhere in the second week of each month, and we’re grateful to share some time with other experts in the dental industry that just know so much about helping dentists make successful and smart financial decisions. Tonight, no exception by any means, we have Dr. Scott Leune from Breakaway. I guess the official name is Breakaway Seminars. Is that the official name, Breakaway Seminars? Is that correct?

Dr. Scott Leune:
That is. Breakawayseminar.com.

Ryan Isaac:
Breakaway Seminar. I was just on the website. And really grateful to have Scott here. We have some cool things we’re gonna be talking about tonight about practice growth and just tricks of the trade, the top mistakes, the do’s and the don’ts, and Scott has so much good experience. But also for our podcasting community who will be listening to this, welcome to The Dentist Money Show. Kind of a different intro than we’ve usually had, but again, just like everything else we’re trying to do is we’re just trying to be here to help dentists make smart financial decisions. So Scott, welcome. Thanks for being here. We’re excited to have you, man, appreciate it.

Dr. Scott Leune:
Yeah, thank you for having me. This is the first time on the show, so I’m excited to talk to you guys about everything.

Ryan Isaac:
Yeah, me too. Let’s start with some intro here. I was kind of chatting with you before we hit record about some of the things you used to do previous life and I feel like we could go on… You’re an interesting guy and you have a cool background, but give us a little bit of, who is Scott, what is Breakaway, how did it evolve, where did it start? Take as much time as you want and give us a picture for what Breakaway is.

Dr. Scott Leune:
Yeah, well, I graduated as a dentist in 2005, and I’m 43 years old, I’ve got five children, I’ve been married for almost 20 years. Right out of school, I decided I wanna do a startup practice in San Antonio, and so I built this practice, and when we opened, we were seeing 350 to 400 new patients every single month, which was eight to 10 times what is normal. Imagine that with a restaurant, opening the doors and there’s 10 times as many people trying to get in.

Ryan Isaac:
350 to 400, I’m just curious, what city was this in and why did that happen?

Dr. Scott Leune:
Yeah yeah, this was San Antonio. I had studied a lot and reading business books while I was in school. I also had a little bit of business experience in managing different bands and events while I was in college. And so I kind of had a business mindset, even though no one in my family was an entrepreneur by any means. And I decided to use maybe some common sense instead of some dental sense and looked at the areas, studied some demographics. I thought of new ways of marketing that really weren’t normal yet. I thought about building a practice based around the patient’s experience, which back then was very unusual. I just did a lot of things back then, pretty good, and of course, I also knew that no matter how many leads I would get, if I couldn’t answer the phone and I couldn’t talk to the patient and convert them into an appointment, then I wasn’t doing as well as I should have.

Ryan Isaac:
Yeah, it didn’t matter. Totally.

Dr. Scott Leune:
So we did some things right in San Antonio in 2005-2006. And the problem though is when you see 350 to 400 new patients a month, it breaks everything. It breaks how you even answer the phone, how you present finances. How do you even have time to do dentistry when you’re doing 400 exams a month in this brand new [0:05:11.9] ____ practice? My wife’s a hygienist and I’m the dentist. We graduated on the same day. We were married while in school, and she was pregnant with our first child and incredibly sick the entire pregnancy. So she was seeing patients and throwing up, just switching off, patient, throw up, patient, throw up, all day long, 400 new patients a month. So right off the bat, we were forced to focus heavily on, how do we not drown? How can we innovate in a way, we didn’t know it back then, but innovate some of the systems of the dental practice so that they work very well even at a high volume? And it was a very innovative part of my career, but I was kind of pushed into it because right after we opened the practice, I suffered a severe back injury.

Ryan Isaac:
I read about this.

Dr. Scott Leune:
It broke my back in four places, my vertebra shifted, thank God nothing… I didn’t cut my spinal cord, but it crushed all the nerves that went to my legs. And for the next 11 years, I could not walk, open a drawer, take a shower, be a dentist. I was in and out of a wheelchair for 11 years after that moment.

Ryan Isaac:
What? I don’t know if you like sharing or do share comfortably, I’m just totally curious now, what on earth did you do?

Dr. Scott Leune:
Yeah, I’d like to say it was something heroic, like I took on an attacker and saved…

Ryan Isaac:
Yeah.

Dr. Scott Leune:
Two baby’s and a mother. But what happened was, I was playing soccer and I had just a freak accident with soccer.

Ryan Isaac:
Oh man.

Dr. Scott Leune:
I just landed a certain way that just happened to fracture four different vertebra and it was a disaster for me.

Ryan Isaac:
Woah.

Dr. Scott Leune:
‘Cause here I am out of school with a dream of owning my own practice, a dream of working…

Ryan Isaac:
And you’re doing it. Yeah, it’s off the ground. You’re cranking. You’re just busting at the seams. And then how long into your career did that happen?

Dr. Scott Leune:
It was the first year.

Ryan Isaac:
I feel like we could do a whole episode on when physical injuries change the dream or change the career path because you lived through what sounds like kind of a nightmare of that scenario, but, wow, that’s heavy. So early on too, into the process.

Dr. Scott Leune:
Yeah, and so… I’ve got a really long, big story. I’ve lived kind of a very unique, crazy, big life. And this was actually one of the many things I’ve experienced, and definitely not the worst, but what happened was I had to figure out how to make money now without being the dentist.

Ryan Isaac:
Yeah.

Dr. Scott Leune:
So you take this practice, I had all these debts right out of school, I can’t be a dentist. Fast-forward to year four, and I’ve got three locations, 10 doctors, 85 employees, and we’re collecting $9 million a year in these baby practices, these brand new practices. And to go from zero to $9 million in my first four years out of school without being the dentist took a tremendous amount of learning, scaling, innovating on the systems, and it was kind of my beginner course into where I am today, the business side of dentistry. That was the beginner course.

Ryan Isaac:
Yeah.

Dr. Scott Leune:
From there, I sold those offices, made millions from the sale, then I foolishly took the millions and doubled down and opened seven more practices. Every week I opened a new one.

Ryan Isaac:
Wow.

Dr. Scott Leune:
And while I did a whole lot right there, what I should have done is I should have taken the millions I made that set me for life and put that into a protective mechanism of modest returns with very low risk and gone and become passionate about something new in life, but instead, I was blinded by the success and had assumptions that I could just keep on doing it the same way.

Ryan Isaac:
Woah, yeah.

Dr. Scott Leune:
So I built seven more practices and there was a lot of things really good about them, but one thing that was really bad about them was they were losing $120,000 a month. So it didn’t take very many months for me to have to tell my wife, “I’ve gotta go move from San Antonio to Dallas, leave you and our newborn and our second child still in diapers and the third kid right out of diapers.” Two weeks after the newborn was delivered, I had to move out of my house and live near my practices to save us from going bankrupt.

Ryan Isaac:
Yikes.

Dr. Scott Leune:
And that became kind of the second innovative phase of my career where I realized in order to make those practices work, I had to change the operations around a dentist. If we said different things on the phone, will we get more new patients, no matter who the dentist was? If we change our payment options, wouldn’t more patients say yes to treatment no matter who the dentist was, was kind of the qualifying statement there. And it worked. And within three months, we were making tens of thousands of profit. And from there, I started building other companies to help our dentists. I built a call center, billing insurance, marketing, I teach a lot of things, and eventually merged those companies together. And today we now have the final phase of my career. Well, not the final, the latest phase.

Ryan Isaac:
Yeah.

Dr. Scott Leune:
We have a company that supports now 20,000 dentists every month in some capacity. And I don’t know, we got 800, 850 employees. And I spend my time now teaching people really advanced levels of practice management through either these intense two-day events, or I also travel around the country ’cause I’m asked to speak from time to time at other people’s events and conventions.

Ryan Isaac:
Yeah.

Dr. Scott Leune:
So I’ve been in the trenches. I’ve owned, I’ve sold, I’ve built, I’ve failed, I’ve had to scale. And more importantly though, in today’s world, I’ve got a tremendous amount of data. We will answer more phone calls in one month than a dentist will see in 10 years, and we know if you say these certain things on the phone, more patients schedule. If you submit claims with these narratives, more insurance companies pay. That’s where we’re at now.

Ryan Isaac:
Interesting.

Dr. Scott Leune:
It’s kind of data-backed decision-making.

Ryan Isaac:
That’s fascinating. Man, I feel like I could ask you questions for way more time than we have time tonight, and you don’t want a webinar all night, you want a date night. So thanks for the intro. That is… There’s so much there in your story and so much you’ve seen, I like… It’s really interesting where it’s landed with data and insight. When you… I can just speak from experience from our own company, when you dig into just one kind of niche and corner of your little world and go deep for years and years, you really can build a really complete picture of what people are dealing with because of the data, because of information, and seeing the same thing happen over and over and over in iterations and tweak little things along the way. So super cool.

Ryan Isaac:
But we’re gonna talk about something you were just discussing, which is growing a practice through, I guess, phone processes and procedures and re-appointment, that was one main section we wanted to talk about, growing diagnosis through new procedures and bundled diagnosis, growing case acceptance through payment options, AI, which is cool, I don’t know about that, and form design, decreasing costs and overhead in the practice. I think those are the main ones we wanted to touch on. Anywhere else where you wanna take these different points, but I think those are all really fascinating. Probably not enough time to cover them all in-depth, but begin wherever you want in any of those topics, wherever you think…

Dr. Scott Leune:
Alright. I guess you’re letting me loose here on these topics, so watch out.

Ryan Isaac:
Yeah, you just go. [laughter]

Dr. Scott Leune:
Alright, so first of all, let’s just talk about… Let’s start simple, which is sometimes the most important thing.

Ryan Isaac:
Yeah yeah.

Dr. Scott Leune:
Where does profitability come from? It comes from bringing in revenue and paying less in expense, right? As you increase your collection, increase your revenue, but if you can keep expenses down, you are generating more profit. So in this kind of noisy world of a dental practice, a lot of times we lose sight on the specific activities, the specific actions that are actually driving up our collections while maintaining our costs at a lower level. When we lose sight of this, a lot of dentists start doing things like expanding and producing more, but their costs have gone way up as well, and they don’t end up taking home more money. When we look at methods for practice management, we have an incredibly serious focus on profitability, take-home pay for that dentist, that owner.

Ryan Isaac:
Can you… I’m sorry…

Dr. Scott Leune:
So if you think in that simple way, raise collections while keeping expenses low. The collections come from the patients you see, multiplied in a way by what you diagnose, multiplied by your case acceptance. Those three things are the drivers of growth. Your patient flow times diagnosis times case acceptance equals the dentistry you have the ability to do, assuming you’ve got room in the schedule. So if we can look at each one of those things separately and dissect down to the actions that make it better, we can very effectively and quickly, actually, grow profitability. All right. So let’s talk about patient flow diagnosis and case acceptance. So patient flow. Patient flow comes from new patients and existing patients. And we start with existing patients. That’s the majority of our patient flow. And if you ask a dentist or ask a hygienist, “What percent of your patients are reappointed in six months for another appointment?” they’ll say something like 98%, 100%.

Dr. Scott Leune:
The national average is 61%. And so that’s an issue where dentists assume they are achieving a high level of success and they’re wrong. And Dental Intel did a study on all the numbers they track and they found that the re-appointment rate has the highest correlation to success. So we have to understand that re-appointment is this silent thing that we’re not tracking typically, but it is one of the major drivers of our success because it is the number that is representing the majority of our patient flow. Too many of us think patient flow secrets that we need to learn come from the new patient side, but the reality is the recall patient, that is the valuable patient for us.

Ryan Isaac:
Can I ask some questions there? That’s really fascinating. Why do you think… Maybe it’s just human behavior. Why do you think so many people overestimate what they’re actually doing in terms of recall by like 30… Yeah, I mean by really 50%, if it’s… The average 60 and they’re saying we get 90, I mean that’s a huge misunderstanding of your own numbers. What is it then?

Dr. Scott Leune:
Yeah, it’s because their software doesn’t track it. You typically have to purchase third party software to mine the data to come up with numbers like re-appointment rate and case acceptance. So they’ve never even known what it is. They’re not calculating it by hand. And they ask their hygienist, “Are you re-appointing people?” And they say, “Yes.” And they look in the schedule and they see people and so they just assume it’s always happening. But it doesn’t. Like I said, one-third of the time, people are walking out without an appointment. Statistically speaking, the biggest reason why patients leave a dental practice is because we never re-appointed them. It’s not like they wake up six months later and say themselves, “Oh my God, today’s the day I need to call the dentist, I better schedule.” No. If we don’t reappoint them, they change their behavior patterns to no longer go to a dentist. That’s the number one reason why we have attrition in a dental practice. So we have to understand how to move the needle there on reappointment rate and get that reappointment rate above 90%, which is difficult to do. Above 90% is difficult. And everyone’s assuming they’re 98%. But above 90 is difficult.

Jess Reynolds:
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Dr. Scott Leune:
There’s a list of policies that can help or hurt conversion. So when we maximize our policies to lower the barriers of entry and we change how we speak on the phone, then we can dramatically increase our conversion rate. Ours last month was 81%. And it might sound weird, I know, all these numbers, but it’s my entire life managing practices and understanding how different actions in the practice change these numbers and create more success.

Ryan Isaac:
Yeah, for sure.

Dr. Scott Leune:
So just like a dentist knows to prep a one and a half millimeters of occlusal surface, number 30 for BruxZir crown or whatever, that’s a weird number. I know our conversion rate was 81% last month on the phones. And that’s my weird number ’cause that’s my life.

Ryan Isaac:
Can you repeat again the average practice misses what percentage of the incoming calls? 30?

Dr. Scott Leune:
Yeah, the average practice misses 32% of the incoming phone call.

Ryan Isaac:
And is this due to they just don’t pick up? They’re busy? There’s not a system to handle more calls than they can pick up at a time? That’s mostly it?

Dr. Scott Leune:
Yeah, it’s not that simple. So one reason is their phone systems themselves, the technology is set up incorrectly. Another reason is that when calls come in, they don’t typically drip in evenly, calmly throughout the day. They come in waves. And so while the phone’s ringing, it could be three calls, and they are not staffed to even handle it. How do you handle five calls in two minutes with two front office people? You can’t.

Ryan Isaac:
You don’t, yeah.

Dr. Scott Leune:
Which is why utilizing the third party virtual scheduling center is one tool that can really help you.

Ryan Isaac:
Do people… It seems like an obvious thing, but are people… Are dentists unaware that that many calls are being missed?

Dr. Scott Leune:
Yes, completely unaware because they’re not tracking it themselves. They make assumptions that they see their people are busy, they’ve got good people, it’s not like anyone’s staring at the phone and flipping them the finger and say, “No, I’m not gonna answer you.” They look busy and they’re doing their best. The reality is though, it’s the way we staff practices today is the same way we staffed practices 50 years ago, and it’s not the smartest way to do it today because we can’t handle the spike in volume. We can handle the day, but we break at specific times of the day. We have six people checking it at once. We have seven phone calls over three minutes. We have four people need insurance verification now. And it’s those spikes and load where we miss, where we miss our numbers.

Ryan Isaac:
Yeah. And so, man, yeah, that’s kind of like mind-blowing, the simplicity of course, like where it begins, just answer more phone calls, but how complex it can be to make sure you’ve got a process to handle that. And then you said after missing a third of the phone calls, conversion rate of the remaining two-thirds that come in is 40-something percent conversion?

Dr. Scott Leune:
National average is 42%, 42%.

Ryan Isaac:
Yeah, so just in that first interaction of a phone call, not even talking case acceptance or diagnosis or billing, or patient experience or relationships in the office to team, and we’re just talking about the phone being answered and then saying a few key right things on the phone that literally makes the difference of double your new patient load. That’s crazy.

Dr. Scott Leune:
It changes the trajectory of that owner’s career and that… The owner’s family’s wealth.

Ryan Isaac:
Yeah, so I’m… I’m sorry. I’m just thinking I hear stories all the time. A lot of our advisors take calls from clients that are like, “Hey, I think it’s time to grow, it’s time for that second location. It’s time… ” But when I hear things like this, I’m just… I’m always taken back by how much there is you can improve in your current existing place without pursuing that next location, or another four chairs or something. There’s always something you can dig down in your existing business to improve it before you move on to make it more complex and bigger.

Dr. Scott Leune:
Yeah, and there’s a balance there because also we don’t want to get… We don’t wanna be too focused on becoming perfect before we expand either, we don’t need to be perfect. What’s very important in business is that we are consistent.

Ryan Isaac:
You’ll probably get to this, but this leads me curious too, along the way, a lot of the things you’re talking about not only sound like problems that have to be diagnosed in the business and kind of triage and fixed as a one-time occurrence, but these also seem like things that are constant, ongoing, recurring training systems process issues that don’t go away either, that require ongoing data tracking, ongoing third party accountability, ongoing training, mentoring. You’ll probably get to that, but that’s kind of just the impression I’m left with like, this is all a big deal that it’s probably not just a one-time event to fix it all.

Dr. Scott Leune:
It… Look, when you learn about all these things for the first time, it sounds daunting, it sounds like 100 moving parts, and we’re already struggling to even find employees today and let alone get them to do their job we’re trying to get them to do now, let alone learn something new. But the reality is, when we intellectually dissect everything, we can get very complicated in describing all the details, but the solutions many times are very straightforward. It’s just learning what to do and triaging that in the right order, and then committing to doing it slowly, so you just chip away at the vision. Every time you do the next thing and it sticks, you’re more successful. So it can feel overwhelming. And also, these are the types of things that you don’t need to be an amazing CEO, you don’t need to have all this time on your hands, you don’t need to be a charismatic person or… None of that is needed. You can be the most socially awkward, boring, busy dentite in the world, and trust me, these core things can be fixed in a [0:24:53.4] ____ way.

Ryan Isaac:
Cool. Very cool.

Dr. Scott Leune:
So back to the conversation, the content, so we have patient flow, which we talked a few things about, around patient flow, to raise the number of patients we’re gonna see. Then the second thing is diagnosis. Diagnosis is obviously how much dentistry the dentist is diagnosing on their typical patient. And with diagnosis, there’s a lot of opportunity there, not because… I’m not saying we need to be over-diagnosing. What I actually see is a lot of under-diagnosing. And even if a dentist is fully diagnosing everything they can do to help that patient, sometimes they don’t know how to do enough procedures. So when we talk about increasing diagnosis, it’s typically looking at what we already know how to do and ensuring we’re fully diagnosing that and looking at learning some additional procedures that will increase our profit for the rest of our career. So an example of diagnosing what we currently do, there’s… I don’t know how familiar you are, Ryan, with dentistry, but an example is, there’s something called an abfraction lesion, it’s a little notch at the gum line of the teeth because the patient has this occlusal interference, meaning their bite’s off, and they grind their teeth at night and microscopically, the tooth thins and tooth structure over time goes away and it forms a notch.

Ryan Isaac:
Woah, okay. Yeah, I didn’t know that, but now I do. Yeah, I’ll repeat that to my…

Dr. Scott Leune:
There you go. You’re almost a dentist.

[overlapping conversation]

Ryan Isaac:
Yeah, I’ll repeat it. Next time I’ll be like… Yeah.

Dr. Scott Leune:
So that lesion, a typical dentist will diagnose to fix the lesion. What they fail to do typically is to fix the problem…

Ryan Isaac:
The cause, yeah.

Dr. Scott Leune:
They’re… The cause. They’re fixing the resulting issue you see. And so maybe on patients like that, you would fix the bite that’s called occlusal equilibration. Because they grind their teeth at night, you would give them a night guard to wear, and of course, you would fix the notch, and if it’s in the smile zone, you would likely talk to the patient first about whitening their teeth before you then go pick a color and put a permanent color in their smile zone. So that is a bundling of diagnosing every time we would see something like an abfraction lesion.

Ryan Isaac:
Can I pause right there and ask you a question? Just not being clinical at all myself, to me, that seems like that would be an obvious thing for so many smart dentists to diagnose and try to fix the cause, but do most dentists… I just assume maybe they just get… Are they just busy, like really slammed and busy, and so they’re like, “Well, let’s fix the pain, let’s fix the obvious result of the problem,” that they forget to go and discuss the cause of it and the deeper rooted problems? Or what’s the reason why they skip diagnosing the cause of some of these problems?

Dr. Scott Leune:
Well, there’s a lot of reasons that impact any dentist to go deeper, farther away from what I just described. So if a dentist is incredibly busy and they’re just hoping from room to room to room and they’re just completely spread thin, they become just diagnosticians of the fires in front of them and maybe they don’t go deeper into causation, into preventative care, into cosmetic care. They’re basically just firemen of the mouth [0:28:18.8] ____.

Ryan Isaac:
Okay.

Dr. Scott Leune:
You got other dentists that maybe subconsciously have a fear of telling the patient too much, overwhelming them, they’re worried that the patient isn’t gonna believe them. There’s that whole subconscious side of, this is a conflict conversation, telling people they’re gonna owe you a bunch of money for getting a bunch of painful work done.

Ryan Isaac:
Yeah.

Dr. Scott Leune:
And a lot of dentists subconsciously wanna avoid conflict because they haven’t learned a strategy to go right at the conflict with confidence. There can be a lot of things that are causing actions like this, but it is not easy to be an incredibly thoughtful dentist and fully diagnose everything you see and fully diagnose the causation of that and offer solutions to it all on a brand new patient that doesn’t even trust you yet and you’re running behind in your schedule and you got two hydrants waiting on you.

Ryan Isaac:
Yeah, that is complex. You’re right, yeah, that’s a lot of moving pieces. Yeah.

Dr. Scott Leune:
There’s layers to it. And each layer has a very simple fix, like almost embarrassingly simple fix. Like dentists… If you just fix it correctly, dentists should never be stressed out about [0:29:29.3] ____. There’s a few things that cause dentists to then be in this terrible pressure cooker of a schedule. You can unwind that. But that is an example of fully diagnosing everything you could. And another example of bundling is if a dentist… Or excuse me, if a patient has a cavity, they have active decay, according to the ADA and according to science, they are high caries risk, and every patient that is high caries risk needs two fluoride treatments and sealants on their posterior teeth. Very simple preventative procedures, but insurance doesn’t cover those things and that has led to dentists not even diagnosing them, which is in a way, kind of malpractice, actually.

Dr. Scott Leune:
But in most dental offices, dentists don’t do sealants and fluoride on adults, even though science says some of those adults need it. So that’s part of the diagnosis thing. The other part is learning new procedures. We dentists are maybe not as good as we could be at proactively expanding the menu of procedures we offer. For example, we could take a weekend course and learn how to fix what’s called an anterior crossbite. It’s the front teeth are on the wrong side of each other. In children, we could do with a simple Hawley appliance with a spring, that’s like a retainer, that fixes it. And from the rest of our career now, we are diagnosing more dentistry. We can take a course like Myobrace and fix breathing problems in children so they won’t be misdiagnosed with ADHD and their teeth will come in straight without needing braces, we can take sleep apnea therapy, learn how to place implants or learn more ortho, or learn more endo.

Dr. Scott Leune:
So many things we can learn. And if we just take that course and implement what we learn for the rest of our career, we diagnose more, which has an immediate impact on how much we produce and collect and our profitability.

Ryan Isaac:
Man, yeah.

Dr. Scott Leune:
That is the second kind of category of things that can grow production is what we diagnose. The first category is patient flow, seeing more people, either new or existing. Second category is diagnosing more dentistry. And that leads us to the third category, which is case acceptance. And case acceptance comes from a lot of things, but there’s some big ones. The first big one is, what does the form look like that you’re using to talk to a patient about cost?

Ryan Isaac:
Oh.

Dr. Scott Leune:
Nearly every dentist prints the treatment plan form out of their practice management software. This is a form that itemizes every procedure needed. It talks about the total cost, the insurance estimation per procedure, patient cost per procedure, is not written in English, it says resin composite, RCT this, EX extraction that, post… None of it’s in English.

Ryan Isaac:
Yeah.

Dr. Scott Leune:
And it looks like a hospital bill. And I look to one the other day and it had 93 different numbers on one sheet of paper. 93.

Ryan Isaac:
Oh, my goodness, yeah.

Dr. Scott Leune:
It breaks every sales law there is, practically. And that is the go-to report that we print when we talk to a patient about money. And so, therefore, we have to give an insurance lesson every time we talk to a patient, and we are tempting patients to just pick and choose, and a lot of times they’re gonna just choose what insurance pays for and not necessarily choose what they need or what makes sense. And so when we change that form to be written in English, to only have four numbers instead of 93, and to bundle their treatment plan together for one set of numbers instead of itemizing every procedure for four set of numbers, that dramatically impacts case acceptance. Also, we have completely shun away half our patients. Patients that do not have money, that have relatively poor credit in most offices have no option, no payment option that works. Yet, there are a handful of companies and products out there that are tailored to exactly this patient, and it does not put the risk on the practice.

Dr. Scott Leune:
So if you could, overnight, put any patient on a payment plan, or overnight get financing accepted for 95% of patients, and you get paid upfront for that, then suddenly, case acceptance booms. There’s other things too. When we present finances in an operatory, in the clinical room, case acceptance is higher. Patients are surrounded by the authority, by the clinical reminders of what they need done. If you take that patient, make them get up, grab their purse, grab their kid and go to the front, near the exit to the money room, that’s a different mindset now, it’s a different set of priorities and case acceptance goes down.

Ryan Isaac:
Interesting. Yeah, I’m just thinking myself as a patient, the way I feel having a discussion sitting in a chair versus, like you said, get the kids, walk to the front, sit in the little side room. It does feel different. Yeah, you’re right. That’s funny but it’s true.

Dr. Scott Leune:
There’s a psychological principle behind it. Our brains are actually wired that when we go into a new environment, in the caveman days, we’re looking for danger, we’re looking for the saber-toothed tiger. And so we build a wall to trust, to commitments, because we are on alert, and that is how our brains are wired. And it takes a while for that to settle down. So the worst thing we could do is take them out of a room they’ve been sitting in for an hour, hour and a half, and then ask them for a commitment somewhere else. But it’s hard to present finances in the room if you print out 93 numbers and it’s not in English, it takes you 10 minutes. Right? So there’s a lot of domino effect in our decisions that we may not understand or realize.

Ryan Isaac:
Woah.

Dr. Scott Leune:
Also, we mentioned artificial intelligence.

Ryan Isaac:
Yeah. You mentioned it. You slide mentioned it. I don’t even know what that’s supposed to mean in this case, but I’m excited to hear about it. [laughter]

Dr. Scott Leune:
Yeah, this is something relatively new in dentistry, but there’s a couple… There’s two main companies right now that have software that’s kind of like sci-fi movies, your body goes through a scanner and a computer finds everything that’s wrong with you. Well, in a way, we have that for dentistry. We have software that scans x-rays and detects the tiniest changes in the grey color of those x-rays, and through machine learning is able to help diagnose, point out cavities, point out bone loss, point out infections at the edge of, at the ends of teeth, and not just find them, but measure them, measure how deep they are, measure how much bone has been lost. The two companies out there that I’ve had the pleasure of beta testing and working with are, one is called Overjet and one is called Pearl. And while I think you could make the argument that software is used as a tool or an adjunct for the dentist, so they get kind of a second set of eyes, the software eyes looking at the patient to make sure they don’t miss anything, I actually feel like the majority of the value of that software is in case acceptance.

Dr. Scott Leune:
If I tell the patient, “We’ve got artificial intelligence software, like in a sci-fi movie that’s gonna scan your x-rays and find cavities and find infection. When I click on this, look at your x-ray, and if there’s anything it finds, it’s gonna circle it.” And then the hygienist clicks on it and the patient sees it, now there’s a different level of proof and truth to that in that conversation when it happens before they even met the dentist. Now the dentist is not the first one to tell them something’s wrong. They’re the last one that verify, yes, there is a problem, and they’re there to educate.

Ryan Isaac:
It’s fascinating.

Dr. Scott Leune:
Yeah. And now, younger dentists, statistically speaking, diagnose less earlier in their careers than later in their careers.

Ryan Isaac:
Yeah.

Dr. Scott Leune:
And so you see a lot of DSOs now who are struggling in a way because they’ve got a lot of brand new dentists in their organization. They see artificial intelligence software as maybe a solution to help this young dentist see more what’s there. And what’s cool is this kind of software will scan previous x-rays, will scan the past and will tell you as a practice how much dentistry has not been diagnosed yet. It’ll compare what it sees in the x-rays to what your practice management software has treatment plan. So it will highlight all the things it found that you haven’t necessarily found yet.

Ryan Isaac:
As a patient, we don’t necessarily care about all the technology and tools all the time, but we want the right tools and technology to be in the expert’s hands so that they have as much information and context to date as they can to give us the real picture, educate, treat. And that’s just a cool parallel. That’s pretty awesome. That’s fascinating AI.

Dr. Scott Leune:
So everything I’ve talked about so far is raising collections, by raising… Through raising patient flow, diagnosis and case acceptance. But we haven’t gotten yet, and I know we need to get to it, we haven’t gotten yet to lowering costs.

Ryan Isaac:
Yeah.

Dr. Scott Leune:
And one big one that’s so easy to fix and it’s such a problem are supply cost. Right now, the average dental practice spends 9% of their revenue, their collections on supplies.

Ryan Isaac:
Nine, that’s average? Okay.

Dr. Scott Leune:
Nine, that’s average. We, in our organization, are at 3.8%. And when you look at the difference between 9% and 3.8%, for one of our $2 million practices, that’s $100,000 of profit every single year for the rest of that owner’s career. That is an immense amount of wealth-building profit that we’ve lost due to a mismanagement of our processes around supplies. So with little time we got left, maybe walk you through maybe three things you gotta do to fix that.

Ryan Isaac:
Please, yes. Yeah, I feel like this would be huge because I feel like the common thing is like, “Oh, someone in my office just orders and does the stuff. I don’t even know. We’re just busy.” That’s what I hear so often in this conversation. So yeah, totally, really interested in…

Dr. Scott Leune:
Yeah, what’s normal is there’s a dental assistant that does all the orders. A dental assistant never gets any feedback unless we’re out of something. And so they are… Through Pavlov’s principle, they need to stay ahead of it. They order more, they order in bulk, they need to order from some place to get to the next day. And you know what, because our scrubs are purple, they order the purple gloves to match.

Ryan Isaac:
Yeah totally. Yeah, right. Yeah.

Dr. Scott Leune:
There’s no budget. There’s no oversight. There’s nothing.

Ryan Isaac:
Yeah.

Dr. Scott Leune:
And it just gets out of hand. It spins out of control to the point we’re burning away $50,000 to $100,000 every year and we don’t feel it. It’s a silent little tumor in the practice. So I’m gonna try and make it very simple.

Ryan Isaac:
Yeah, okay, cool.

Dr. Scott Leune:
How do you fix it? There’s three things. The first thing is you’ve got to put in place a 4% budget. So whatever a practice typically collects a month, 4% of that is the budget. No order is approved if it’s over budget. I don’t care. It’s not approved. Order less… Order 30 boxes of gloves instead of 40, or how about don’t order the purple ones? Order less quantity if we have to. Find more affordable products. Do not waste supplies. Don’t open a whole pack of gauze. Just give me two. Whatever behavior change we need, what we will not do is spend more than 4% on an order. Okay? That’s one of the three things. What makes that easier is if we do the second one which is incredibly important. We have to join a buying group.

Ryan Isaac:
Yeah, okay.

Dr. Scott Leune:
A buying group. That gets us the access to lowest prices. Buying groups aren’t just about supply cost though. We’ll spend $39 a unit for BruxZir crown from the same lab that someone else might be spending $89 for. We’ll buy the CBCT, this cone-beam x-ray machine that is super high-end. It retails for $125,000. Super high-end. We don’t pay $125,000, we get it for $68,000. So… Because we represent a massive volume, thousands of private dentists that are buying supplies. So that’s the second thing a private dentist needs to do, is they need to join a buying group. Ours is… Dental Whale is our website. That’s where our buying group is. But we’re not the only one. There’s others as well. Just gotta join one. So the first thing is you put in a 4% budget, do not approve an order. So that means the dentist has to approve the order of the owner. Don’t let it go in if it’s over budget. The second thing is join a buying group so that everything you’re ordering is already lower cost.

Dr. Scott Leune:
And the third thing we have to do is we have to redo the list of approved supplies. That’s called a formulary. We have to redo it. We gotta make sure that over the years, we haven’t gotten away from what’s intelligent. So what cotton rolls are we gonna buy? How about the lowest cost? What gauze? What patient bibs? Lowest cost. Actually, everything should be the lowest cost unless proven otherwise. And I think you’ll see in most practices over time, we have just slowly eroded away our control over this and end up buying things that are not smart. It’ just not smart for the company. It’s just wasteful.

Dr. Scott Leune:
So to kinda put it all together, if we’re part of a buying group and we have re-done the list of things we approve, and then we have oversight to never let an order go out that’s over budget, then bam, 50 to 100 grand more profit every single year for the rest of our career. And that’s a huge issue in dentistry and it’s not hard to fix.

Ryan Isaac:
Man, yeah, 9% being the average. I’m thinking of my client P&L that I mostly see, it tends to be maybe a little less than that, but it can be that high. I’m curious, what’s the reaction you get when you’re coaching somebody and you’re saying 4% ceiling? Do they nod? Or are they just like, “No way”?

[overlapping conversation]

Dr. Scott Leune:
Yeah, they all know that it’s… We all agree to do it. And after one month I’ve been coaching, they don’t do it. Second month, I’ve been coaching them, they still don’t do it. Third month, I finally create pain, I finally have a very uncomfortable conversation and ask them to think bigger about their life and ask them why on earth they’re not wanting to build a retirement fund with this money, why they’re not investing it into their family or their children, why they’re letting their dental assistant burn it away, to just give it to some of the big companies, and at that moment, we start to get change. Like anything else that we wanna implement, whether it’s hard or easy, so many of us are so spread thin emotionally, that we don’t have the drive and strength to proactively do it. Which is why coaching is so fricking important.

Ryan Isaac:
Yeah.

Dr. Scott Leune:
I’m telling you, I speak to thousands of dentists face-to-face, I coach dentists, I’ve helped 100 practices open, I have 20,000 [0:45:21.0] ____, I’m telling you, every dentist can be wealthy. It’s not difficult. It’s just a list of simple things that need to be done, and what helps is if they’ve got someone… Well, first of all, they’ve gotta have someone teach ’em what they are, and then after that, after they know the solutions, then it really helps if someone is holding their hand. And not all of them need it right? Some of these dentists are waking up at 5:00 in the morning and running a 5K every morning and doing it right on their own.

Ryan Isaac:
Yeah.

Dr. Scott Leune:
Just most of us aren’t.

Ryan Isaac:
Yeah.

Dr. Scott Leune:
If I could, I wanna explain what this summit is.

Ryan Isaac:
Please do, yes.

Dr. Scott Leune:
Every year, once a year, my whole company puts on this huge summit that is all around the business side of the industry. We’ve got a keynote speaker that is just an amazing mind in business, and we’ve got over 45 different courses and breakout sessions, all given by top people around the business side of the industry. We call it the Business Immersion Summit. So we’re doing this September 23rd, 24th in Vegas. This year, I’ll be there, we’ll have all the other people there, the greats of practice management. And it’s a really cool event to go to. If anyone wants to get a hold of me or if I’ve said anything that is speaking to someone listening to this, you just want more information about what I do, or my world, or how I teach people this kind of stuff, I give these two-day courses that are 16 hours, it’s 400 pages of content. It’s like this times 16. You can read about it at breakawayseminar.com. I’m very proud of those courses because they’re intense. It’s like drinking from a fire hose. You walk away super energized and super exhausted at the same time. And you really see dentistry differently once you do that. But I’m giving one of those courses as well the day before the summit in Vegas.

Ryan Isaac:
Oh cool.

Dr. Scott Leune:
If anyone wanted to knock both out, kill two birds with one stone, it’d be an amazing way to spend the weekend, to immerse yourself in this kind of training.

Ryan Isaac:
That’s super awesome. I’m really looking forward to it, excited to participate. Tell us really quick, how do people find you? You’ve mentioned a few times, breakawayseminar.com. Tell us a little bit about what people would expect when they reach out and contact you guys, getting an introduction. Is this for brand new dentists, mid-career, retiring dentists? Who reaches out and what’s the experience like when they reach out and contact you guys?

Dr. Scott Leune:
Yeah, I’ll make it simple. There’s the flagship course, the varsity course called the Business Master’s Seminar, two days long, 400-page content, me the whole time talking. And we have dentists of all different phases of their careers show up to that and they walk away just a completely different person. It is not a motivational seminar where you learn three things and jump up and down, jumping jacks and hug each other. No. It is like serious, intense, 100 different systems that you learn.

Ryan Isaac:
Wow.

Dr. Scott Leune:
We also have a seminar on startups, because we build really, really successful start-ups. That’s our Advanced Startup seminar. It’s also another two-day course. We have a seminar on owning multiple locations as well.

Ryan Isaac:
Cool.

Dr. Scott Leune:
We have office manager training. All of it’s described on the website.

Ryan Isaac:
Very cool. Scott, thanks for being here and spending your time with us this evening. Really looking forward to next month in Vegas. I’m sure we’ll be doing this again. I feel like there’s so many directions and questions we could go with this, so looking forward to more education in the future. But thanks for spending your evening with us, we really appreciate it, man.

Dr. Scott Leune:
Yeah, thank you for having me and talking to your crew. I hope… I didn’t know what to expect. I hope this was valuable for everyone.

Ryan Isaac:
Awesome.

Dr. Scott Leune:Dr:
And gosh, if it was, if everyone liked it, let’s just do it again. Let’s go…

Ryan Isaac:
Yeah let’s do it again.

Dr. Scott Leune:
Round two.

Ryan Isaac:
Yeah, I’d love to, man. So many questions. Thanks everyone for attending. You’ll receive an email with follow-up information on all the websites, the links, the code to CE and everything. Scott, enjoy date night. Have a nice night out on the town. We’ll see you next month in Vegas.

Dr. Scott Leune:
Alright. Thank you. Bye-bye.

Ryan Isaac:
Yeah, thanks. See you, Scott. Bye-bye everyone. Have a good night. Bye-bye.

Practice Management