"Taking the Plunge" - Going Out of Network (feat. Jessica Martin)

Have you ever considered taking your dental practice out of network? Are you concerned about how patients might respond? In Episode 10 of "The Dental Domination Podcast," practice owner and consultant Jessica Martin shares how she and her dentist husband transitioned to out-of-network, retained most of their patients, and dramatically grew their revenue. If you've ever considered opting out of insurance, you won't want to miss this action-packed conversation. For more information and to connect with Jessica, check out the show notes.

Transcript

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All right, welcome back to the Dental Domination podcast. This is episode eight, believe it or not, and I am Dan Bryan. I am a co-founder of Dentalscapes. We're an online marketing agency specifically for dental practices, serving general dentists, pediatric dentists, orthodontists, you name it, specialists of all kinds. But I'm really excited to bring back someone who has been on the show previously to actually discuss spa dentistry on that episode, episode six, check it out if you haven't already. But I'm here joined today by Jessica Martin. And Jessica Martin is a is the founder and CEO rather of Martin Management. She does consulting with dental practices, other health care practices as well. She's also the co-owner of Martin Dental Spa in Wisconsin, where her husband is the managing dentist there as well. So, Jessica, thank you so much for coming back. And today, you know, this is a topic that was sparked in part by our previous conversation. We're going to talk a little bit about going out of network. and how dentists can manage that transition. And it's a transition that you and your husband recently completed, or at least started the process back at the end of last year and have since completed. And so I'm really looking forward to this conversation, getting your take on what's all involved, what you would recommend, what maybe you wouldn't recommend, and just getting your tips and tricks for how to do this, because it's a process. And as you said, offline, it's an emotional one too. So I wanna talk. a little bit more about that. But welcome back to the show. And if you don't mind, just take a few moments to let folks know who you are and where you're coming from. And yeah, what's Martin management all about? Thanks, Dan. It's great to be back. It's I feel like I know you very well already. So it's an easy conversation to have. Yeah. So what I do with Martin management, none of it was by plan. It was all just organic how it happened, which I think some of the best things can happen that way. I got sucked into my husband's practice back in 2014. And I say sucked in because I know, right. I say, I mean, I kind of went kicking and screaming, but it was. It was all for the best. And it was really interesting to see how my background as a school psychologist really blended well to the dental environment and really being able to help the practice grow and differentiate in a different way. So along that journey of working in the practice with my husband for the last nine or so years, we kept moving in this direction of getting out of network. And that was always, I think, in the back of his mind is like a dream that would be ideal to not have to take all of these write-offs and adjustments. but it was one that we weren't sure we would be able to attain, to be quite honest. I think every dentist, private practice dentist really has those hopes, but it sometimes feels like a really big leap. And so when we did do that, I wanted to be able to share what worked and what didn't because we felt, I don't want to say we were nervous, but for sure we were nervous at times, but we didn't have like a blueprint for doing so. And it would have been nice to have someone that had... that had done it and lived it to have as the guide for that process. So that's what I've been doing for a lot of practices. It's kind of hitting the nation in a great way right now. And I think that's good for everyone to get more independent. yeah, and I wanted to hit rewind real quick because, you know, you mentioned that this is something that obviously a lot of dentists would like to do or have contemplated doing. But, you know, whether or not that actually happens is a whole nother matter. But what was it if you can think back, you know, you and your husband having conversations at the dinner table, like what was it that actually prompted you to say, all right, we've thought about this for a long time. We're actually going to, you know, Press play and make it happen. Like what was that like and what prompted you to actually decide to move forward with this? Was there a tipping point? You know, I think it was, we'd been talking about it for a number of years, I would say four years before we made the decision to do so. And every year, I think it was just looking at that year end and going, wow, look at all of these adjustments that we made and all this production that we're giving away essentially. And my husband has always been very steadfast in that he wants to do quality dentistry, that he wants to give people. the care that he would want for me and for our kids and for his extended family. And so it just came to a point that in order to do that any longer, we had to make this decision. And it helped that we were at a point where we had a lot of demand built up. We had long waiting lists. We had a lot of loyal patients. We have a differentiating factor that makes it harder for people to just go down the road and get the same experience. So we kind of had lined up all of these. you know, all of these things over the years. And there was really nothing left to do, you know, in that arena. We were like, gosh, you know, if there's ever a time to do it, the time felt like now. It just felt right. I'm given all the building blocks that we had made up to that point. Um, I think it was just looking at that number again and continuing to see it climb. He just came home one day and he's like, I can't do this anymore. Yeah. Well, I, that really resonates with me. And I think it does with a lot of other practice owners and dentists such as yourself and your husband. I mean, the, the passion for dentistry and wanting to provide the best possible service to one's patients. I mean, that should always be the goal. And sometimes, uh, you know, payment arrangements, uh, reimbursement makes that, it makes it difficult. And so, um, I think that's a motivation for a lot of dentists out there. And a lot of dentists are at least thinking about, you know, making a change like this. So you decided to move forward though, with going out of network, what did that look like practically for you? What were the first steps that you had to take? And what did you sort of do to prepare your practice and really prepare your patients as well? What did that kind of look like in theory or in practice rather? that's a great question. And that's part of why I do what I do now with training other teams, because he literally, he'd been talking about it for a long time, but when he finally made the decision, I wanna say it was mid-June, is in the summer, he was finally like, nope, we're doing it. And I was like, okay, so what does that look like? When are we gonna start talking to patients about it? And he's like, I want a letter to go out July 1. And I was like, wait, what? You know, so there was not a lot of... And it didn't happen that quickly because we didn't have our ducks in a row. So I think some intentional careful thought on the planning and when it's going to happen is really helpful. So it lowers the stress level for everybody. But the first steps are really deciding what that timeline is. And if an office can compare it with the timing of the drop being final around the time of an open enrollment window, that can be really, really helpful. because that gives patients the opportunity to decide not to renew their insurance. If they're an individual policy holder, they might be able to talk with their HR department if they work for a big employer and be able to switch a plan or not have a plan. If it's like if they drop February, you know, the next year, then it might not have the time to make those decisions. And now they're stuck paying a premium every month that they might not be utilizing if they stay with that office. So the timing is really the big, the first you know, really intentional thought on how to go about doing it. And then once we have a timeline, then we can, you know, backtrack and say, okay, now here's how we're going to start talking to patients about it. The really like the biggest piece of this is educating patients on what this means for them and getting the team to feel really comfortable and confident to have those conversations. And so to that point, communicating the change and also educating patients on what it means and what it means for them specifically and their families. How did you decide to do that? So it sounds like at least initially you had, intended to send a letter. Did you do that? And then what other communications channels did you leverage? Did you use email? Did you use text messaging? I mean, how did you do that? And how did you, well, I'm going to start there because I have a bad habit of packing like five questions into one. So we'll just stop there. What was the first step? yeah, that's good. No, the first step was to send out a letter. We sent it via snail mail, made our mistake there because again, he wanted it done like so promptly. And the other funny thing is he wanted it, he only wanted me because I am like a perfect human that makes no mistake. He only wanted me to touch every letter. So I literally like hold myself up in our basement and you know, I had a template, but still I had to make sure every... family's name was spelled correctly. And I went through and I didn't trust the software. I just kind of hand touched every single letter that we did, which obviously was awful for me as a person to do that. But we didn't have ink, we didn't have envelopes, like the right stuff. We weren't prepared because it happened so quickly. But yeah, that was our first step. We did not use email, we did not use texting, but we did because we started the conversation early. we were able to hit a lot of patients as they did come in for care, be able to have those conversations, you know, with them in person as well, which was helpful. That makes sense. Now, when you think about the content of the letter that you sent out, I'm just curious because this is such a complicated issue and it's sometimes hard to distill it into one easy to understand message. What was sort of the prevailing theme of that letter? I mean, how did you explain to patients this decision to go out of network and, you know, how did you frame the why, so to speak? Right, well, we definitely kept it about them. You know, we said, this is why we're doing this is because we have a standard of care that we believe you should have. And because of the reimbursement situation, we feel unable to provide that care in continuing this insurance relationship. And so we really kept it focused on that this is kind of for them to a degree that in order to continue to provide the care that we know to be. the best, this is the decision we need to make. And to second that, you know, we're here, our team is here and ready to help you figure out what this means, because that's the next, you know, they're like, okay, great, I'm glad you're gonna keep standards high, nobody wants to get chopped up dentistry, but what does that mean? What does that mean dollars and cents wise for me as a patient? And so it was really, you know, crafted to emphasize that we're an advocate for you in this process. And we want to keep you, we wanna make this a no-brainer decision for you to stay with the practice. We value you as a patient, and here's how we're gonna do that. Okay. So you, and that all sounds great. I love the patient centric, you know, focus that you, you put to work there and making it about them. And of course it is about, you know, standard of care. And it's being proud of the work that you do and being willing and able to stand behind that. And I love that messaging, but so you send these letters out. And so let's say the post office takes two, three, four days, you're sitting there twiddling your thumbs. What was the reaction? What happened? I mean, what happened next and what kind of response did you get from your patients, both patients that had been with you for years and those that were new? I mean, what was the reaction? Yeah, that's interesting. And it's been interesting also to watch clients I work with in this process, to see how their patients react. And it seems like by and large, there's a number of different ways that can go about happening. So the first thing is the people that are, really Johnny on the spot type A, they get the letter, they read it front to back. They're like, what is this? And they pick up the phone and they're like, tell me what this means for me, right? They wanna talk, they wanna ask questions. They're, you know. They're on it. There's other people that didn't either, you know, landed sit on their counter for a while and maybe glanced at it, maybe read the first couple of paragraphs and got bored and confused, and then waited till their next cleaning to ask the questions, right? And then there were people that either just don't open their mail, maybe didn't get the letter, or just never actually, you know, really digested it, that still felt like they had no clue what was going on. So it was kind of like three chunks of people. And so, Yeah. Were the phones ringing off the hook? No, but we definitely feel that a lot of questions those first few months about people wanting to know what that meant. I'm sure and how did you how did you train your front desk, your reception team, like to field those questions and answer those appropriately? What was that? Yeah. And so this is, this is what we did. And this is what I teach other teams to do. And I think it's important to actually train the whole team similarly, right. Because, because, you know, it's not going to just be the front office that fields those questions. The doctor's going to leave the room and the assistant's going to get asked, Hey, so I heard you're going on network. What does that mean? And what do you think I should do? And they're going to ask the hygienist, they're going to ask whoever's around. And if the team doesn't have a united, cohesive, confident answer to that, it doesn't feel like. so smart. Yeah. everyone on, we came up with a script that we as owners felt like embodied what we wanted to have said. And then we encouraged our team to put it in their own words, right? I don't like scripted anything really, but you need to have the foundation for your team to really memorize and understand what are the basics of this? And then how am I gonna articulate this as an individual and make it feel good for me to explain? And so we had everybody I mean, our team had scripts laying everywhere for quite a while just so that they could really like my osmosis, like get it in their brain of what we wanted them to say and how we wanted them to handle it. And we talked about it a lot. We really, you know, emphasized that it was important how we had those conversations because we needed to, we needed, when patients are feeling just like with little kids, right? When patients are feeling like out of control or they're confused. If we show that we're in control and we're calm and we're confident about it, we help them to feel better. And so that's how we approached it from that training perspective. I love that. I love the idea of taking that team-based approach. And really that's what dentistry should be anyway, is team-based. But what actually happened then? So you got all these questions, you had folks in different lanes in terms of how they handled receiving the news and following up on it. But what actually happened then, if you don't mind sharing in terms of retention among your current patients and. Did you see any kind of volatility associated with this or what did the transition look like from a business standpoint? Yeah, that's great. So, and it's been interesting also to see, to watch our practice deal with this and then watch other practices that I've worked with on this process. And I think the outcome on this really depends on a few different factors. Probably one of the largest is the demographic that the practice is in. So if the office is the first in their community to make this move, it's a different outcome than if you're the last one to make this move, right? And so when people have more options, more choices, you're going to see a larger exodus. That's just by nature. People, they're not used to hearing that Delta's out of network. Like that's just in a community where no one else has done it, that feels unheard of. And there's a lot of... We were the... practices in your community? Oh, you were the first. Oh, brave new world. Good for you. Yeah. That's pretty scary. taker. I was definitely more nervous than he was. He's the risk taker. He's like, we can't do it anymore. We're gonna do this. We're gonna power through it. We still, we just had a team meeting last week and we talked about, we're still weathering the storm in that, right? Like it's gonna take probably a few years to really not have it feel a little bit different, but we've had a lot of amazing outcomes, even though We did see a large number of patients decide to explore different care. We have actually seen our revenue increase by 3%. We've seen, obviously our adjustments are down. I mean, our collections and our adjustments are down substantially. Even our AR is down, our AR is like$30,000 less than it was. And we were stuck at that AR level for years and years. We just always had. certain chunk that we couldn't collect on. And it wasn't even insurance-based, but because of the ways we've had to modify how we do business by being out of network with all insurance, it's just helped a lot of those things, it cleaned up a lot of those things. So we're actually doing better as a business, although it does, at times it feels different because our schedule at times is lighter. Like our hygiene has more holes than it ever used to. We used to be like, just slammed with hygiene overflow, and now we have more holes. But that's okay because overall, revenue's higher and actually production's higher. So it's kind of like, it's getting used to that new normal and knowing that like in the long run, it's going to be amazing, but we're still better off than we were a year ago already. And to be clear, I mean, you went out of network, but you're still assisting patients in filing claims with their own insurance if they have it and that sort of thing. It doesn't mean that you're completely hands-off. Exactly. I think there's a huge distinction between being completely fee for service and handing a patient a claim form and asking them to do all the work on it. That's a huger jump, right? If you've been coddling patients with doing all their insurance stuff all these years and then you decide, actually, we're only going to do cash pay and you're on your own, that's going to feel a lot different from the patient perspective. I really encourage offices, if you wanna go in that direction completely over time, think there's a way to get there, but being an advocate and doing a lot of that legwork still is a way to retain more patients and make them feel more connected to you as an office than they do to their insurance company. And that's obviously what we'd want anyway. Yeah. I want to talk, uh, switch gears a little bit and talk about sort of the mental health component of this, because you said earlier, uh, when we were not yet recording, you said, I mean, this is an emotional thing for practice owners. This is a, um, in many ways a scary transition or candy. And especially, that's especially true. I think if, if you're like you and your husband were in that you are kind of leading the pack in terms of the community and and really being the first to not only do this, but the first to also explain it to patients and what it means and that sort of thing. And there's a lot of uncertainty in terms of how is this gonna affect my bottom line? How is this gonna affect patient retention? How am I going to go about generating new patient appointments, having to lead with this new message? So how did you manage that? I would imagine how did you imagine that? Or how did you manage that fear and anxiety? I mean, that's a real thing. Yeah, I think we just kept reminding ourselves and our team for that matter, why we were doing this, right? That we, in order to, to do what we needed to do to maintain our quality and our standards, we had to do this and that we knew and just like we do, we've done a lot of great things to build our business, but I can guarantee you that our practice, just like most others, there's levers to pull that we're not pulling. Right. And so we knew that if, if we really slowed down and we were hurting as a business, we could pull some marketing levers we weren't utilizing. Right. We could pull in other things that would help us to grow again. And so. Well, that's where I'm going to refer listeners back to episode six, cause you've done a lot to really differentiate your practice as well. Um, with the spa dentistry model and the amenities that you offer and that sort of thing. So folks go check it out, but I'm sorry, I didn't mean to interrupt. I don't know, you're fine. I mean, there definitely were stressful moments along the way and there were patients that we saw leave that we were surprised by. We thought, oh my gosh, we love that family. I can't believe they're gonna go somewhere else. It felt personal at times because especially we'd have, I mean, there were a couple cases and that's the thing patients don't understand is that for some people, there's going to be a big difference in what they're out of network. benefits are. And that's a hard decision. If you get like no coverage or really minimal coverage, you're going to pay $200 for your maintenance visits. Like I get it. I get that you probably want to explore another opportunity. However, we had patients that were, it was like a $15 difference in their whole maintenance visit. And we were like husband and wife physicians. And they're like, yeah, we're just like, that's too much for us. And I was like, really? You know, I'm not trying to judge anyone's situation. yeah. No, it just goes to show you never know. Yeah. by some of those moves and we were disappointed by some of those, but the other people that did stay on or that did change their policy to stay with us or said, I'm gonna do whatever it takes, that we have to, like anything, continue to focus on the positives and really hang on to those things and know we were doing the right thing. We actually also had a lot of patients come back. We crafted a... I called it the farewell card where we would handwrite every patient or family that decided to explore another dental office due to Delta because Delta was our last big one that we got rid of that just said, we understand your situation and we understand, we know that we valued having you as a patient and know that should something change, we're always here just so that it acknowledged that we noticed they left and we care and we still want to be. you know, here if something were to change, we want them to know that. And we had patients come back after getting that card. And so, you know, it's again, a matter of time before it all cycles back. We've had a number of patients that have tried another dental office and called them and like, we gotta come back, we gotta make this work because it just wasn't the same. And that goes back to that differentiating factor of we really have put a lot of things in place to care for our patients and give them a better experience. So that leap is a lot harder for them. And so again, I think the more that an office can set themselves up to be different and to do it better, if you will, the harder it's gonna be for those patients to have, to have those decisions. And then it's easier for you emotionally to know, you know what, it's okay. You go try to find another office. I dare you, I dare you to find another, you know. you know, I it's amazing. I think, you know, like you said, it can be hard, you know, saying goodbye to a long time patient, you know, who decides to, to part ways in the wake of something like this. Uh, but you know, those cards that you sent out the farewell notes, I mean, those are so important. And yet in the grand scheme of things, they take what, you know, five minutes, five minutes and no, I mean, and it pays off in dividends. I mean, it's just, it's, Yeah, it's the little things really, I think, in terms of managing a big transition like this. It's really the little things that make a difference. And I think you've really hit on a lot of those, which is awesome. You know, I'm gonna go out, venture into the unknown here, because we didn't talk about this before, but I'm just curious, because this often goes hand in hand with the transition to out of network. Did you consider offering, or are you offering currently any kind of like membership program or anything like that for your patients? Yes, and I highly encourage any office that wants to make this move to get that in place as soon as possible. Again, part of our job in this is to educate patients as what insurance is and what it isn't. And having a membership plan gives another opportunity for a patient to make a decision that might be better for them in the long run. We just did some simple math with patients regarding what are you paying in a monthly premium? Because we don't know that. We know what their maximum is. We know what their limitations are. We know what all the exclusions are, and we can educate them on that. But when we do the math and figure out what they're actually paying for that policy and then tell them what they're actually getting, they're like, wait a minute, this is not even serving me. So the more patients you can move away from their insurance before this decision needs to be made is the better, right? You have less conversations to have when you don't have people stuck in that insurance hamster wheel. So... So were you actually offering a plan like that prior to making the transition to outer network? Okay. Oh yeah. That's really nice. yep. We had our plan in place for probably two years before our official. really cool. Cool. And just for anyone who may be interested out there, just because I'm curious, do you consult with other practices as well on membership plans and that kind of thing as well? I do. I don't help them run it by any means. I have different partners that I'll guide them to say, here are some great businesses that run these plans for you, can get it set up for you. But it's absolutely part of that process of preparing the office. It's funny because I'll have some doctors call me and be like, I'm doing this right now. Like, let's do this. I'm like, okay. And there's not maybe time for that. But if we have a little bit more time and we can work together to really line things up well, that's definitely part of it. And again, it depends on the demographics of the community. If this is the last office to go out of network, then there's less that they might not need a plan as much as we did, for example. Yeah, that makes sense. That makes sense. Well, this is, and again, I think that's another topic that we could just go down the rabbit hole on too for a whole nother conversation, but this has been so great, Jessica. I can't, I can't thank you enough for sharing your insights on this. It's a, um, I think it's definitely an aspiration of a lot of dentists out there, but it's one that is fraught with a lot of uncertainty, business uncertainty, a lot of emotional, um, you know, uncertainty, I guess, and, and fear and anxiety. And so, I think it's so important that we have conversations like these and try to distill it into, you know, what it means, how it can be done, and that it's definitely possible if that's something that a dentist wants to see happen. So before we close out, though, I want to give you an opportunity, like, for anyone listening for a dentist owner listening right now, or even a practice manager for that matter, who has considered, you know, transitioning their practice to out of network. What sort of the key takeaway that you would want to leave them with here today? I mean, what's sort of the underlying message that you would want them to take away with them concerning that potential change? Yeah, I want them to know that it's absolutely possible. It might be, every practice is different and it might be a year from now, it could be six months from now, it could be three years from now, but it is possible. And I do believe that this is how we are going to survive in private practice dentistry is to be able to, you know, set our fees and get paid for what the quality work that you're doing. So I want them to know it's absolutely possible and also to have a plan, right? To... They don't have to work with me, but to have a plan for this, because the more intentional they can be about every detail of the process, the less painful it's going to be. The more patients they'll be able to retain, the more they're going to feel confident through the process. And so, yeah, it's good for everybody. We had a dentist calling us right when we got out saying, oh my gosh, I can't believe you did this. How's it going? Because we've inspired hope that if we can do it. they can do it and everyone's watching, right? Everyone's watching to see how it goes. And so I also, I guess, would say is don't be afraid to be brave. Don't be afraid to make that move and we can do it in a way that's gonna work for your practice and be smart. We'll be smart about it, so yeah. Love it. So, Jessica, thank you again so much. What can you tell listeners about Martin management and where can people connect with you if they want to continue the conversation? Yes, so I do have a website. It's martinmanagementllc.com. And you can actually book a call with me right from there if you want to talk about, I really want to do this, but I don't know what it's going to take or is my practice ready for this or how do I get started? Any of those things, I love to have those conversations. Yeah, I can do it right from my website. I also still answer all my own emails and it's just jessicaatmartinmanagementllc.com. So I would love to talk with anyone that's, you know, looking at this down the road or. or next week, ideally not next week, but ready to do this or getting ready, I think it's a great conversation to start having. Well, I'll put the link to the website and your email address in the show notes and folks can connect with you there. Thank you so much, Jessica. I really look forward to hopefully chatting again sometime in the near future. I'm sure that there are many other topics that we could dig into and it's always a pleasure having you on the show. So thank you so much for being here today and to those listening, thank you for tuning in and if you enjoyed what you heard, I would kindly ask that you go on to Apple podcasts or Spotify or wherever you get your shows and leave us a rating and review. It's super appreciated and helps us with the algorithm for sure. So thank you all so much for listening. Thank you, Jessica, and take care. Thanks, Sam.