Episode 101: How to Successfully Overcome Team Resistance to Dropping PPO’s

Naren:       

This is the Less Insurance Dependence podcast with my good friend Gary Takacs and myself, Naren Arulrajah.

Gary:      

We appreciate your listenership, we appreciate your time and most of all we appreciate your intention to reduce insurance dependency in your practice. Our goal is to provide information to you that will allow you to successfully reduce insurance dependency and convert your practice into a thriving and profitable dental practice that provides you with personal professional and financial satisfaction.

Naren:       

Hello everyone, welcome to another episode of the Less Insurance Dependence podcast show, this is going to be an amazing episode but before we jump in I have a quick enouncement – Garry had an unbelievable thriving dentist one day MBA, he finished it on the 11th of September, that’s just a few days ago and it was sold out and it was full of dentists and office managers and you know they have a blast. Garry what do you think about the MBA that you just finished?

Gary:      

Naren I am loving our live stream MBAs you know this one in September was great and we have done enough of these live streams now to truly run it as a workshop you know we’ve got 64 page workbook and the purposes of the workbook is so that the information lives on – it is not just something you know we’ve all taken course right Naren?

Naren:       

Yea

Gary:       

And we cater us do not remember anything in the course that we took –true confessions right?

Naren:       

Right and you give them 11 exercises Garry which is amazing and then you discuss their answers which is now you know they can not only absorb the material but they can now apply the material to their practice which is unbelievable.

Gary:       

Okay can I share insider information with our listeners? I like to think that our the Less Insurance Dependence listeners are part of our family right

Naren:       

Yes

Gary:       

So here’s the insider – here’s why we do this the reason we do the exercises is because nothing makes me happier than having our course attendees actually apply the information that we teach. You know it is one thing to have the information then it is another thing to apply it. And the 11 exercises are to engage the application of this information so the dentists can wait to apply it and that’s why we do the 11 exercises. So between the 64 page workbook the 11 exercises this information truly has legs and truly makes a difference in the doctor’s practice it is not just – oh I went to a good course

Naren:       

Right right

Gary:       

Yeah

Naren:       

And the next one is coming up on the 23rd and 24th of October it is 2 half days – Friday from 4pm to 8pm and Saturday from 1pm to 5pm eastern time, we do have a few seats left – go to thriving dentist . com / MBA – check out either the October one, the November one or either the December one and pick the one that works for you we will look forward to seeing you know , I have never heard his kind of thank you so much Garry you changed my practice you changed my thinking kind of testimonials in any other place other than the MA – I think you are going to have fun. Just 8 hours it is a long day but I think it is a day well spent.

Gary:       

Yeah and you know Naren I am really proud of the way we have been able to make this so affordable – you know it is likely the least amount of money you will spend for this amount of CE credits but I am really proud of how we made it affordable because we do not have airline expenses we do not have hotel expenses we do not have meeting room expenses – no catering expenses and we are able to really kind of cut the tuition to make it as affordable as possible, so very proud of the way we have been able to make it affordable.

Naren:       

Now let’s jump in – today’s topic is actually one of my favorites because I have heard this like a hundred times – the topic is How to Successfully Overcome Team Resistance to Dropping PPO’s and you know true confessions I have 150 plus dental clients and some of them still are heavily reliant on PPO plans and sometimes they are just afraid and lot of the fear not only comes form the owner but really it comes from the team – the team is afraid it can’t be done, it won’t work here, that kind of mindset so Garry I know you picked this topic because you kept getting the same question even the last I love Dentistry office hours you did this – this was one of the question – how do u influence my team

Gary:       

it is real it is a real

Naren:       

Yea

Gary:       

And I want to start out by saying that if you do not have your team members support it is a deal breaker.

Naren:       

Right

Gary:       

It is a deal breaker because patients do not discriminate who they ask their questions to. Thy are going to ask a question to – you know if they are asking over the phone whoever answers the phone or if they are physically in your office they are going to ask whoever is next to them – hey how come you aren’t taking my insurance anymore and if the team is not supportive in delivering a unified message then dropping PPOs will fail and so it is a deal breaker if we do not get the teams support and Naren there is many many I mean thousands if not tens of thousands of dentists that do not pull the trigger to go out of network because type do not have their team members support –

Naren:      

Right

Gary:       

Now that’s, I wanted to start with that statement that we and need our team members support. Now here is the good news, you could absolutely gain that support with the right strategies and the right clients and one of the things I would like to start with before I actually give some specific tips which I have got. Before we get to those I would like to just start by saying that when team members are resistant of this that’s okay! It is okay for them  – now imagine the doctor for the first time says – hey Linda I am really thinking of dropping – these PPOs are killing me and I am thinking of going out of network – I would think the vast majority if not you know 99% of team members go oh no and – do not do that doctor right?

Naren:       

Yeah

Gary:       

And one of the reasons for that is that it is likely that that is the only thing that they are familiar with – is being in a PPO office

Naren:       

Right

Gary:       

That’s one dynamic – that that is all that they are familiar with – if all you know is this then that is your reality and you know the second possibility is that they do not like change. Are you work with a lot of dental team member’s

Naren:      

Yes

Gary:       

There are many – you know it is not a dental team thing, it is a human condition. People do not like change.

Naren:       

Yeah and also you know I think you have used the word, institutionalized, and they are they are used to that and they are afraid of going and swimming in a new lake so to speak – they just they do not know..

Gary:       

Let me add one more dynamic to this

Naren:       

Yeah

Gary:       

If you are a PPO firm the vast majority of new patients come to you because you are listed on their networks

Naren:       

Right

Gary:      

And so it is not unusual for a practice to be heavily slanted

Naren:       

Yeah

Gary:       

Towards their PPO plans – they are slanted towards their PPO plans and that might be 80% or 85% 90% of those patients slanted towards their PPO plans and so the office thinks oh my god I can never go out of network because look how infected we are with PPO – as much as I would like to well I listen to Garry and Naren less insurance and I really want that but I have got 90% of my patients I cannot do that and what they fail and the team members are going to feel that too what they fail to recognize is  that the past does not need to be their future they can bring patients in through other ways and all of a sudden radically reduce that dependence that they had when they started this who exercise – well let me I have got 3 very specific types to successfully overcome team resistance to dropping PPOs can I dive into those Naren?

Naren:       

Yes please

Gary:       

So number 1 – and these are not in priority order they are really equally important but let me number them so we can remember to cover them all. Number 1 – begin doctor by sharing with your team members the economic impact of being a contracted provider.

Gary:       

You know when we did that with my team and there is different ways to do that, let me share with you one of the things we shared with our team, I am an open book guy when it comes to economics in the practice, with one exception so we believe in sharing financial information with our team members t hoe exception to that and you are welcome to have different opinions – but the one exception I had is that I do not believe individual team member compensation should be shared I believe that’s a private arrangement between the owner for the practice and the team member. Naren, would you agree with that as just a general construct?

Naren:       

Yes absolutely Garry

Gary:       

So I do believe in sharing all the other economics of the practice because they can help us get to where we want to go if they know where we want to go. If they do not know where there is – they can’t help us get there if they do not know where there is

Naren:       

Right

Gary:       

Oh one of the things we shared with our team was I did the cost accounting and I was able to compute very accurately that every time when we were in network with MetLife every time we did a crown on a MetLife patient it cost Paul and I a 138 dollars – 138 bucks.

Gary:       

That was an opportunity cost – that was not some fictional estimate, it cost us a 138 dollars about 70 dollars apiece between every time we did a MetLife crown – we explained that to the team and Heidi our lead assistant said, wait now I want to make sure – you guys pay its like as if you pay the patent to do their crown? So that’s exactly right – in fact I went a bit further and said, in fact Heidi you know that frond desk drawer we have up there at the front desk that has the sticky notes and the pens, we should actually take out that drawer dump it out, dump out the sticky notes and pens, and put in hundred dollar bills in there – and every time a MetLife patient walks in wanting a crown we should hand out a hundred dollar bill and say please go somewhere else and we all laughed about that because that would have been cheaper because it would have cost us 50 dollars apiece instead of 70 and Heidi when she got that information she responded in a textbook manner – she said indignant, she said that’s not right, that’s not fair for you and doctor Neilson, that is not right we need to change this.

Naren:       

Right

Gary:       

And but she didn’t know it! Before she didn’t kwon that information and maybe another way if your adjustments your discounts are 40% and that’s on the low end of the adjustments and the discounts are the difference between the UCR fee and the contracted fee – it is more likely 42 or 44% but let me use 40 just because it makes my math in my head easier – think about that for a minute that’s – when you put it in the context of your team member as a team I am just sort of – imagine that I am just speaking the team, hey imagine that on Friday you make 20 dollar and hour I am just making up numbers guys  – yours could be more or less but imagine on Friday earning 20 dollars and hour but on Monday you make 12. That’s the impact of a 40% discount

Naren:       

Right

Gary:       

How do you feel about that? Anybody signing up for the 12 bucks an hour and let me knows now. What do you think everyone in the room is going to say?

Naren:       

No way!

Gary:       

No way! And guys I am not trying to get out the violin and cry poor but that is what happens to me – every time we see a PPO patient I am getting 12 dollars and hour instead of 20.

Naren:         

Exactly but you still have to provide the work that you would provide for 20 dollars and hour – you can’t say well I am going to sleep half that time and work half the time – you still have to do the whole thing!

Gary:       

So share the economics with them!

Naren:      

Yeah

Gary:       

In ways that the can understand because I think that  team members are going to respond and immediately are on your side so that’s not right doctor that’s not right that’s not right. So number 1 – share the economics. Number 2 – benefit statements. So I am going to repeat this 3 times – benefit statements, benefit statements, benefit statements! *laughs* okay so talk to your team members about the benefits to them by you going out of network. And now Naren I will put you on the spot when it comes to benefits to the team when we successfully go out of network –

Naren:       

Absolutely Garry I can name and think of a few – one, the people there are there because they care about their oral health or they care about their smile – so the conversation is going to be more fulfilling because you can now provide the kind of dentistry that you want to provide not what insurance says is covered.

Gary:      

Yeah great play – there is also an economic benefit to team members that when the practice is more successful we are able to invest in our team! When the practice is not economically successfully it is hard to invest I our team. So there is an economic benefit to team members there is a quality of work life – we often talk about how dentist feel like they are hamsters on a treadmill

Naren:       

It is like for example the economic benefit m just thinking of an example – let us say you are a waiter and you have an option of working at a McDonalds or you can work at the most expensive restaurant right and the most pensive restaurant probably you know you will make a lot more money for the same amount of work, for the same amount of time than you would want a McDonalds and the reasons is you know even though they are treating fewer clients those clients are paying a lot more.

Gary:       

There are more resources, there is more money

Naren:       

Money there exactly

Gary:       

Yeah you are absolutely right – you know it is the same concept in dentistry – secondly quality of work life, as I just said many dentists feel like they are hamsters on a treadmill because they have to produce so much to make the economics work while team members feels the same way. You are not the only hamster on the treadmill doctor your team members are as well –so the quality for work life goes up and the third pot that I would make that is a benefit statement is that you end up with more appreciative patients so instead of just battling and butting bucing heads you know with ‘does my insurance pay, does my insurance pay, does my insurance pay’

Gary:       

Instead of that you have points that actually appreciate what you do for them and so there is 3 categories of benefits statements that you can make – economic, quality if work life and more appreciative patients and relate it to them – what is in it for them – what is in it for them. Remember to WIIFM them – What’s In It for Them – meaning your team members now the 3rd strategy meaning the third tip that I have is you want to train your team members to communicate confidently with your patients. Train your team members because once you go through those first 2 steps, team members are going to be getting on board – well I can see this, I can see how this would be a good move and for those times I would hear from team members – I just need some training I am not comfortable if a patient would – especially a clinical team members I do not have the experience if someone starts asking me abbot why we are out of network so just train me on what to say – so those three tips will lead to kind of like making a switch – kind of like flipping the switch to team members being resistant to team members been supportive – and when you accomplish that you have got full team support your success is – you are really paving our way to your success with your with your strategy of dropping PPO plans –

Naren:       

Thank you Garry

Gary:       

what do you think of those 3 strategies Naren?

Naren:      

Yeah I love it can you recap them Garry? Just real quick one two three

Gary:       

Yeah number 1 – share with your team members the economic impact of being a contracted provider, and come up with creative ways to kind of explain it. Numebr2 – talk about the benefit statement. Talk to your team members about the benefit statements – about what is in it for them when you go out of network and there is at least 3 that is have mentioned here – economically for the they will be better off – quality of the work life, getting off the hamster wheel and the third, appreciate patients that are much more joyful to work with, and then number 3 – train your team members to communicate confidentially with your patients about what to say when they get question from a patients about why you are going out of network. Put those three together and you will flip the switch from team members being resistant to team members being supportive – and if I can summarize this – doctors don not be frustrated when you start this conversation with patients – with team members – expect some resistance, expect it! It doesn’t mean they are bad people I have worked with quite literally hundreds if not thousands of team members and I have watched them evolve from being resistant to being supportive. The vast majority of team members should be supportive. Now ultimately let us address the pink elephant in the room Naren. What if a team member despite all of this work simply digs her heels and says this is not going to work, this is not going to work, this is not going to work – well then you will have to address that eventually in a different way. I have rarely seen that happen. I mean 99.9 percent of the time I have seen really good team members completely flip the switch and become very – and they become your biggest asset.

Naren:       

Right

Gary:       

Because when team members when patients ask them and the language that a patient will use – how come you are not taking my insurance anymore? Which is not true we still help them with their insurance?

Naren:      

Right

Gary:       

You can still use the insurance in your practice but the – I have seen team members just literally rise to the occasional and the proverbial  grand slam when they tell the patient why and what happens is – every time virtually every time, the patient says okay

Gary:       

I do not want to go anywhere else so of course and it sis so powerful when you see that dynamic happening, well I wanted to address this and you now have this listeners, and you have some useful construct to help overcome team resistance as you do this and you know hey I want to take a minute and thank all our listeners, we have been on a wonderful little surge of review, ITunes reviews fro I Love Dentistry and for the insurance dependence show we have had some wonderful reviews. Those of you who have joined us with I Love dentistry our private Facebook group I was thinking of head I love dentistry for those of you have joined us in I love dentistry, thanks for joining us. If you have not joined us in I love dentistry I would like to encourage you to come join us it is a wonderful group – we have almost 6000 dentists and members in the I love dentistry group, it is a wonderful way to support yourself in your passion for dentistry. On that note I simply want to say thanks, thank you for the privilege of your time and apply the information we talked today to help flip the switch and get your team members to switch from resistant to supportive when it comes to dropping PPO plans.