This week, Sabri Blumberg joins us to discuss what it really looks like to transition out of low-reimbursing insurance plans. She has guided countless dentists through this process successfully—while increasing their production and profit—and now she shares each step in detail.
Links:
Roadmap to a Fee-for-Service Practice - https://www.mgeonline.com/roadmap
The MGE Communication & Sales Seminars - https://www.mgeonline.com/abc
Listen to full episode :
Have a question for Jeff?
Fill out the form and he will get back to you.
Why does Sabri say dropping insurance plans has become more urgent now than it used to be?
In the past, dropping PPOs was mostly a choice doctors made because they wanted to be more profitable. Now, Sabri is seeing practices come in with strong-looking production numbers but almost no real profit margin, because rising costs have collided with insurance companies lowering reimbursement instead of raising it.
Why does Sabri insist that revenue should go up, not down, while a practice is dropping insurance plans?
Dropping plans raises reimbursement per patient, so if the transition is sequenced correctly, revenue should climb throughout the process rather than dip. Sabri treats a drop in revenue as a sign the plan was rushed or poorly prepared, not an unavoidable cost of leaving a network.
How does Sabri plan to replace the patients a practice might lose by dropping PPOs?
Rather than leaning on new patient marketing, Sabri first looks at how many active charts a practice already has sitting outside its hygiene schedule. In her example, a practice with 1,200 charts but only 500 seen regularly in hygiene could lose 30 percent of its PPO patients and still end up seeing more people in hygiene than before, just by improving compliance and reactivating existing patients.
Why does Sabri recommend changing dentistry fees but leaving hygiene fees alone when a practice drops insurance?
Most patients don't leave over dentistry becoming more expensive, they leave because they're suddenly hit with an unexpected copay on hygiene visits that used to be fully covered. By keeping hygiene fees close to what insurance already paid, patients keep coming in for cleanings without disruption, and the practice still has the chance to diagnose and sell treatment at those visits.
Why does Sabri always drop Delta last, after every other PPO?
Delta doesn't accept assignment of benefits once a practice is out of network, so patients have to pay the practice directly and wait to be reimbursed themselves. Sabri says that shift causes more patient loss than any other plan, and Delta tends to respond aggressively by contacting patients directly, so practices need letters and postcards ready to explain the change before Delta does it for them.
Episode Transcript
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Jeff: Two weeks ago I did an episode on how current economic conditions have made getting out of network and going fee for service in your practice a real necessity. This may have been optional in years past, but at least in our view, it's now a pretty clear choice between long-term success, where you achieve your goals, or struggling while you're being choked out financially.
This is something we recommend you at least start working on now, since it may take time depending on your level of network participation. I got a lot of feedback on that episode, and thankfully it was positive, but for the most part the sentiment was that having a fee for service practice was desirable, of course, but the idea of dropping plans seemed daunting. Where do I even start?
So to provide some kind of solution, in that episode I made a special offer for a consult we only do with MGE Power clients. We call it the Roadmap to a Fee for Service Practice. I explained a bit about what it was, and a number of people took advantage of the offer, which was great.
Now, how this rolls out when we sit down with somebody to get them out of plans really depends on the person, since there's no one-size-fits-all solution. Maybe only 10 percent of your practice is PPO, or maybe it's 80 percent along with a bunch of HMOs and Medicaid. Some practices have a ton of patient flow, others don't. There are a ton of variables. But in any event, if I'm recommending a course of action, whatever it might be, in this case dropping plans and making a practice fee for service, I'm a big believer in explaining things. If someone understands the why and the how, they'll not only be more willing to take decisive action, but when they do, they'll be more successful.
So to that end, in this week's episode I've asked Sabri Blumberg, who if you've been listening to the podcast for some time you know, our Deputy Chief Operating Officer and senior technical executive here at MGE, to explain exactly how she helps a client get out of network and go fee for service, step by step.
To tell you a little about Sabri: she's worked with several thousand MGE clients. Pretty much any situation you might be encountering, Sabri has either encountered directly herself or helped one of our technical staff resolve it with a client. She's helped hundreds of clients get out of network.
Sabri, welcome to the show.
Sabri: Thank you, great to be back.
Jeff: It's been a little while, hasn't it?
Sabri: Yeah, it has, a few months I think.
Jeff: So I'm sitting here banging the drum on getting out of plans. What's the major difference you're seeing compared to years past? It used to be a strong suggestion. Now it feels more urgent.
Sabri: I think in the past, it was working with insurances, especially PPOs, at least in certain areas it still does. But it used to be more that the person wanted to get out of PPO, wanted to build a fee for service practice because they wanted to be more profitable. It wasn't "you have to get out of PPOs." What I'm seeing more and more now is people are in PPOs and their profit margin is essentially non-existent, even though their numbers look really good on paper.
Jeff: That was one of the things you mentioned to me a couple years back, right when this all started. It was actually one of the things that, I hate to say it, triggered my attention to the fact that you were seeing a lot of clients come in, I think this was toward the end of 2021, where their overhead was starting to get a little wonky.
Sabri: Right. We'd always had a lot of clients come in because they wanted to grow their practices. But we started seeing a lot of new clients come in who had already built practices, doing over a hundred, a hundred fifty, sometimes two hundred thousand a month, but they were coming in because they were making no money. That wasn't something we'd really encountered in the past.
Jeff: That was different. And drilling down on why these people weren't making money, it kept coming back to insurance participation.
Sabri: Right, because costs had been going up, and as those costs kept skyrocketing, the insurance companies' response was to lower their reimbursement.
Jeff: Got to love them. We made the decision that our clients aren't going to operate at risk like that, where the economy or the insurance companies control their destiny. I'm not saying anything bad is going to happen to you, but why would you want to operate that way? It's like living in a flood zone with no flood insurance. That's the thing that always hits me. I can't imagine, we have several other businesses, and I can't imagine someone telling me the market should dictate what I can charge. Someone's either going to pay for it or they're not. If you charge $1,300 for a crown and then raise it to $2,500 and nobody pays for it, then your fee is out of whack, fine, that's on you. But the idea of not being able to control your own fees is intolerable to me. I don't know what other businesses operate that way unless they have some kind of government contract. Pretty much every big business, Apple, Exxon, they all control what they charge.
Sabri: That's right, a small business needs to be able to do that too.
Jeff: So let's just jump right into this. Say I'm a dentist, a new client, and I'm in network. Let's say 80 percent of my practice is some form of PPO, ranging from low reimbursement plans up to something decent like Delta Premier. My profit margin has sunk below 20 percent, I'm not happy, and I've signed up for the MGE program. Now you want to get me out, which, by the way, is the Roadmap to a Fee for Service consult I mentioned in the intro, offered free, I'll put the link on the episode webpage if you want to take advantage of it. So what do you do with me?
Sabri: The first thing I want to know is why you want to get out.
Jeff: Okay, let's play out a scenario. Give me some options.
Sabri: There could be different reasons. It could be that you're doing fine, you just don't want to be in PPOs anymore, you want to build a fee for service practice. Or it could be that you feel like you have a noose around your neck because you're not making any money.
Jeff: Let's take the prototypical answer. I was okay with it up until about 2019, 2020, and then I started noticing my costs going up. Instead of paying $30 an hour for a hygienist, or $35, I'm now paying $52. Everything's costing more, my lab fees have gone up, everything's gone up, and I'm watching my P&L with my profit going down, down, down. I'm starting to get worried, but the idea of dropping plans terrifies me, because I'm pretty convinced all my patients are going to leave. I feel trapped.
Sabri: It's interesting you say that, because probably 50 percent of the people I talk to who want to get out of PPO could drop all of their PPOs right now, or drop all their Medicaid or all their HMOs, and be totally fine. It's the mental stress associated with dropping insurances that's far more difficult to deal with than the actual reality of what happens when you drop them. There are really two points here. One is a confidence point: am I confident I can convince my patients to stay and pay full fee? People don't give themselves enough credit. It takes a lot for a patient who really likes a practice to leave over this. There's this idea that patients are only there because you're in their plan, which is true in some cases, but for the most part it isn't, it's a very small percentage.
The second thing I've observed a lot: someone will drop the plan, a couple of patients will say they can't come back because the practice is no longer in their plan, and that becomes "everybody." "Oh, these patients are leaving, so many patients have left." I'll ask, have you actually counted how many patients have left? "Well, there's lots." Then they go count, and it's twenty.
Jeff: If you're expecting to lose 25 percent of those patients, for example, which is probably the worst that's going to happen with a PPO...
Sabri: The average I've told people is 30 percent, if they do it all wrong. Except Delta.
Jeff: Okay, let's go with your 30 percent number. Say I have a hundred people on that plan, that's 30 people requesting their records. That seems like a lot, especially if they all happen around the same time.
Sabri: It seems like everybody, but it's not everybody. I think the biggest thing is you need to be prepared in the practice for dropping the insurances. You need a step-by-step program you're executing, and the things that need to be in place before you drop them need to actually be in place. You need to be mentally prepared, and your staff needs to be trained on how to handle it, so when a patient asks why you're not accepting their plan anymore, they don't just say "I don't know." They also need to be able to answer questions like "do you still take my insurance" and "how does this change anything for me." There are ways to make that easier that we can go over.
Jeff: I think I'm pushing you ahead here. We started on why I want to get out, and you need to know the urgency. So I've told you I'm scared about the future because I'm losing all this profit.
Sabri: Right, so I want to do an assessment. How much of your practice is PPO? What's your entire patient base, and how much of that are you actually using, versus your hygiene compliance? I want to look at what kind of insurances, how much is Delta.
Jeff: Let's walk through this step by step, since for you this is easy, you do it all the time, but I want to give people some reality here. So I've told you I want to get out. First you wanted to find out why.
Sabri: Right, and now I want to find out what next. The reason I want to know why is because it tells me what kind of schedule to put you on. Do we do this over a year, three months, six months? That depends on what needs to happen in the practice in order to drop them and keep the numbers going up. It also depends on how much stress we're putting on the doctor and the staff.
Jeff: So you want to find out what timeline I want to be on, whether I need to be out in six months, a year, two years. And then you mentioned something interesting: you don't want revenue to go down while this is happening.
Sabri: No, I want revenue to go up while this is happening. It's not a situation where you're expecting to live on $10,000 or $20,000 less a month. I expect your revenue to go up, because you're dropping insurances, so your reimbursement is going to go up. That's why it needs to be sequenced correctly, and there are correct actions to take beforehand. The speed we do it at isn't always the most important thing, the most important thing is maintaining harmony in the practice, so it stays a fun environment to work in, and the doctor isn't stressed out of their mind while the staff is confused about what's happening. That's why I want to know why you want to get out, so I can establish a timeline based on actual necessity.
Jeff: Alright, let's take an average scenario. You've asked me these questions, and I say I'd like to be out by the end of next year.
Sabri: If we're talking about the end of next year, that's almost two years, that's really too long.
Jeff: Oh, okay, that's awkward, I wasn't expecting that answer. We obviously haven't rehearsed this, folks. Alright, how about I want to be out by next summer.
Sabri: If you want to be out by next summer, that's still a year or so. Compared to the timeline we usually put clients on, I think the longest I've done this with somebody is really nine months.
Jeff: Okay, so I want to get out in nine months.
Sabri: Good. The first thing I'm going to do: the biggest problem with dropping insurances, and the reason revenue goes down, is that you decrease the number of sales opportunities in the practice.
Jeff: Elaborate on that.
Sabri: If I want to produce and collect a hundred thousand dollars a month, I need to sell a hundred thousand dollars worth of dentistry, probably more, since I'm not going to close everybody. That means I need to see a certain number of patients to diagnose the necessary treatment. That's going to come from either new patients or existing patients, and while there's always second opinions and emergencies, the bulk of it comes from hygiene. So the first thing I do is count on a 30 percent reduction in the patients we're seeing from that plan, the worst case scenario.
Jeff: So you're planning for the worst case. I actually like that.
Sabri: Because then when it's only 15 or 10 percent, like with one doctor I was talking to down south, it's like a big bonus, we kept an extra 20 percent of patients we weren't expecting. But we were prepared for a 30 percent reduction. So the first thing I want to do is look at their hygiene compliance, the total number of active patients versus the people actually being seen in hygiene.
If I have four days of hygiene in the practice, and let's say five recall patients a day, that's twenty a day, times five days a week, roughly 500 charts being actively serviced in hygiene. If that doctor has 1,200 charts, which is the average in the United States, then more than double the patients currently aren't being seen in hygiene, probably because nobody has time to follow up, or there aren't enough hygiene slots available.
Jeff: And this is something I think listeners should really pay attention to. So what you're saying is the office has 1,200 "active" patients, or patients that could be reactivated, they're not ten-year-old charts, even though you should go after those too, you may get them back. I was working with a practice last year that had a lot of patients from 2013, 2014 they weren't reactivating. I said, send them a text message, you've got the software, what can it hurt? And they got a lot of those patients back. They weren't people who'd stopped seeing a dentist, nobody was just calling them because they were considered "old."
So let's say I've got 1,200 decent charts, and your hygiene calculation shows I'm actually only seeing about 500 actively in recall.
Sabri: Right, but you have 1,200. So theoretically, if you did nothing to reactivate those charts, that could be catastrophic, because you're seeing those 500 people, you lose 150 of them, or 30 percent, and all of a sudden your hygienist has a ton of openings. But if you have the 1,200 charts you're actually working with, and you lose 30 percent of those, which is 360 patients, that still leaves you 840 patients to see in hygiene, which is actually more than you're already seeing.
Jeff: So while you're dropping plans, do I go crazy trying to get these people back, or do you establish that machine first?
Sabri: The first thing I do is look at the hygiene compliance, can I replace these patients through better hygiene compliance?
Jeff: It's funny, they're replacing their patients with their own patients.
Sabri: That's the interesting thing. The other thing I examine, this is the legwork, the data gathering, is how much outstanding treatment is actually sitting in the charts. Because when you have less than 50 percent hygiene compliance, a lot of the outstanding work is sitting in the charts of the patients you're not seeing, your non-compliant patients. The patients who are easiest to handle are the ones who make sure they end up on the hygiene schedule, so it can give the impression the practice's treatment is all cleaned up when it isn't. So I'm making an assumption there's a lot of treatment we can convert to production in the charts that aren't showing up, and I want to verify that by looking at the outstanding treatment.
Then the next thing I examine is new patients. I want them to be getting a healthy number of new patients for that practice. That number changes depending on the practice, but for a practice with one doctor, healthy to me is between 30 and 40 new patients a month minimum. That builds in some waste, not every patient converts, not every patient who comes in becomes a regular patient, some are one-off emergencies. So I want to really examine their marketing, first to make sure they're actually marketing, that the marketing is effective, and that the front desk is capable of converting those calls, the actual conversion rate.
Jeff: So you're starting the whole cycle of production, not just the marketing they're sending out, but the response associated with it, the new patient sources, whether referrals need to be beefed up, and then the conversion rate at reception. You're really getting a clear picture of what's going on in this practice, because we're about to make seismic changes, dumping these plans. But what I love about this is you're not doing a lot of crazy stuff, you're using resources that already exist.
Sabri: My best case scenario is that I replace the patients we potentially lose by dropping the PPOs with the patients the practice is already wasting, patients they're not currently seeing. These are things they already have, they're just wasting them, so I'm recapturing that to replace what we're losing.
Jeff: Let me stop here for a second, because I think this is worth pointing out, not as a criticism, just as a key point. What we're looking at is the average person coming in, a new client, thinking they're going to dump PPOs and have to replace all that traffic by bringing in a ton of new patients to replace the ones they'll lose. You're taking a different approach, replacing the patients they'll "lose" with patients they already have in their patient base. The reason I bring this up is that in many cases you're writing off 30, 40, 50 percent with a PPO, so you'd need no new patients at all to maintain your revenue, because you're just charging your full fee. And the average practice I see has a tremendous amount of waste, patients they're not bringing back for hygiene because they don't have enough hygiene slots, treatment plans they're not converting, marketing that brings people in who call to ask about services and the receptionist can't schedule them properly because they're not trained.
Sabri: Right, so if I fix those things, I now have something very stable, and I'm recapturing production we should have been doing but weren't. That gives me the room to start dropping some PPOs. So I'm in a situation where I'm maintaining or exceeding my prior revenue with almost no additional new patients, but at the same time I'm still ramping up marketing to get more new patients, which puts revenue into a whole new range. And even if you don't do that, your numbers will still go up, because you're seeing the same number of patients doing the same kind of dentistry, just at a different reimbursement, you're charging $1,200 or $1,300 for a crown instead of $800.
Jeff: Interesting, that's exactly right. Alright, so you found out about my new patients, my marketing, a bit more about my hygiene and new patient conversion. What else are we looking at?
Sabri: The next thing I do is look at how your insurances break down. I'll go with the normal PPO scenario first, since it could be all over the place, could be a lot of Medicaid, could be HMO.
Jeff: Let's say an easy scenario, no HMOs, no Medicaid, just PPO. I have Delta Premier, but I also have something like MetLife, which reimburses terribly.
Sabri: Am I allowed to say the names?
Jeff: I'll call it "Pet Life." And "Beta" instead of Delta.
Sabri: So I have these horrible plans and decent plans, and in certain cases I have tiers where I have to accept the bad with the good.
Jeff: Right, and I'm about 80 percent PPO.
Sabri: Okay, so now I want to take a look at how the PPO plans break down by carrier, how many patients we have with each one, and the reimbursement rate, the average write-off.
Jeff: So this is where I bring in my office manager, since I have no idea how to pull that data together. Is that the hardest data to get, or are we doing more of a survey of a couple of CDT codes to get a general sense?
Sabri: I usually look at the crown fee. I don't even look at the prophy fee, and I'll tell you why. The biggest reason you lose patients when you drop PPOs isn't because their dentistry becomes more expensive, it's because they suddenly have a copay for hygiene. Most insurance companies, when you check in-network versus out-of-network benefits, it's the same or a minor change, but they usually still cover hygiene at 100 percent. So if my hygiene fee for prophy, bitewings, and a periodic exam comes to $293, and my in-network fee was $140, they're going to pay the same $140 they always allowed, not the full $293, so now the patient has a $150 copay out of nowhere. That's traumatic for some patients, and for some it makes it simply impossible for them to keep coming.
I'm not a lawyer and I'm not giving legal advice, but as far as I know, we can charge whatever we want for hygiene visits. So what I usually recommend when we're dropping these insurances is to change your dentistry fees and leave your hygiene fees alone. When you do that, there's zero difference for the patient, they keep coming for hygiene appointments, it's only when they need actual dentistry that we have to figure out the money, but that was already a conversation we needed to have anyway, even for in-network patients.
Jeff: So am I ever going to ramp my hygiene fees back up, or keep them as a kind of loss leader?
Sabri: Hygiene will usually at least break even, if not make you a little money. But what matters most is patient flow, I need that flow, I need the treatment plans sold in hygiene, and I need the patients to keep coming so we can monitor them and make sure they stay healthy.
Jeff: That's an interesting concept. Obviously you'd want to run the numbers and check the legalities in your area, I don't know of any law against it, but that doesn't mean there isn't one somewhere.
Sabri: Right, everyone should check that for themselves. But if I'm doing a new patient special, which a lot of practices do, a hundred and something bucks for a full-mouth exam, x-rays, and a cleaning, those run $99, $129, $139, so I'm probably getting the same or more than I would in-network, it's very similar.
Jeff: So is this specific to practices with a lot of PPOs versus just a few?
Sabri: If you only have a few PPOs, there's no real reason to touch your hygiene fee. But if we're talking about the most common scenario, 70 or 80 percent PPO in a practice, that's going to blow people out the door from day one if you're not careful. I want to keep it as stable as possible for the patients, and the first thing they're going to notice is a sudden copay on hygiene, so I do everything in my power to avoid that.
Jeff: That's actually really smart. If I had to choose where I'm going to lose money, I'd rather lose it in hygiene, even though hygiene should be a profit center, than write off 50 percent of a $1,300 crown.
Sabri: Exactly, because with lab fees and everything else, on certain crowns you're actually losing money.
Jeff: I still see practices doing a $350 union crown, and I can't figure out how they're making that work. I guess they're doing it out of the kindness of their heart.
Sabri: That's exactly how they're doing it. Alright, so once I have the breakdown of insurances, how many patients we have on each plan, and what the crown reimbursement is on each one...
Jeff: Are we going by specific procedure codes, or whichever crown code they use most?
Sabri: Whichever one they do, I don't think a lot of people use the older five-oh codes anymore. There might be some obvious ones right away, garbage reimbursement, like $500 for a crown with only 20 patients on that plan, just get rid of it. I usually divide plans into three buckets. Bucket one is the absolute garbage, where the doctor is basically being robbed and there aren't many patients on it anyway, so it makes no real difference. If they want to dig deeper, they can spot-check how many of those patients are currently being seen in hygiene. Usually there's maybe 20 over the next six months, easily replaced with existing patients, zero bearing on the practice. So that's bucket one, get rid of it right away.
Bucket two is the plans that need to be sequenced correctly. And bucket three is Delta, because Delta is its own monster. Delta has a Premier tier and a PPO tier, and not everybody's in Premier anymore, it's basically a closed club at this point. If a practice has both Delta and Delta Premier, I want a breakdown of that too, because if you're in Premier but also take the PPO, your Premier reimbursement effectively becomes PPO-level. Premier typically pays close to your private fee, on average we've seen close to a 10 percent write-off, which is basically like a marketing fee, so there's no reason to get rid of that.
Jeff: Alright, back to bucket two, the random PPOs that need to be sequenced.
Sabri: Before we drop them, in the past we'd call to see if we could renegotiate. I wouldn't use a renegotiating company to do that anymore, those take a long time, and even when they're able to negotiate certain plans up, with all the umbrella insurance policies these days, you often end up pulled into other PPOs you didn't want to be in. It doesn't actually solve anything, it just creates more of a mess.
Jeff: So with bucket two, you're sequencing what gets dropped first, second, third, and for the ones that will take a while, are you calling to renegotiate?
Sabri: You can always call to try. Your office manager can do this, it's simple. You don't want to just say you need a fee increase, because then they'll give you two extra dollars on procedures you never do. You want to print out the list of procedures you did last year from your software, see what you did the most of, where you're making your money and where you're losing the most, and pick your five most important codes, excluding hygiene, since we're keeping that the same. I'm looking at fillings, crowns, whatever you do the most of, SRPs, doesn't matter what it is. Then call those insurance companies and say you want to renegotiate those five codes closer to your private fee.
Jeff: Have clients actually done this? How does it typically play out, and what's the timeline?
Sabri: Incredibly varied.
Jeff: Give me a good case scenario.
Sabri: Let's say I was getting $500 for a quadrant of SRP against a normal fee of $900, I've seen them renegotiate up close to $900. But this is very area-specific, your fees are largely dictated by how many providers in your area take that plan. If a lot of people take the PPO, they'll basically tell you to go pound sand, because they don't need you. But they have a responsibility to their policyholders, we call them "the victims," sorry, "clients," to make sure there are enough providers in the area to actually use the insurance. So if there aren't a lot of providers and someone's threatening to drop out because the fees are garbage, they'll scramble and play ball. But if you're in Miami and there's a dentist on every corner taking Cigna or MetLife, and you call to negotiate your fee up, they'll tell you no.
Jeff: So results are incredibly varied, but it's worth doing anyway.
Sabri: Absolutely, it's a day of your life, I get that it's annoying, but how many calls is that, ten, twenty?
Jeff: Let me ask this: if I'm planning to drop a plan in the next 60 days, should I still call to renegotiate?
Sabri: No, I wouldn't. But what I have seen happen is you call to inform them you're dropping, and they come back with an accountant offering a negotiation almost to your private fee. In those cases they'll usually tell you they don't want you to drop, and ask what they can do, and now you have negotiating power, you can bring hygiene and everything else into the conversation too. At that point you know you're in control of the conversation, so take control and negotiate.
Jeff: Interesting, hadn't thought of that. What about a six-month timeline, worth calling to renegotiate then?
Sabri: Absolutely. So based on the timeline we've worked out, we take the twenty or so plans, look at the number of patients in each and the reimbursement, and toggle both. I might have a plan that reimburses poorly but has a lot of patients, so I keep that a little longer just because of the patient volume. I'll look and say, this one's six months out, so I'm calling to renegotiate. This one's next month, I'm not bothering, but I might still call to cancel it, and sometimes they'll say, "wait, Dr. Jeff, please don't leave," and that happens maybe 10 or 15 percent of the time.
Jeff: Better than zero, I guess.
Sabri: It really depends on location and the specific insurance. Alright, so that's bucket two. Bucket three is Delta, and I keep that for last.
Jeff: Meaning that's the last plan you drop.
Sabri: Right, because Delta doesn't accept assignment of benefits after you come out of network, so it completely changes things for the patient, now they have to pay you directly and get reimbursed by Delta themselves. The problem is you need to collect payment at the time of service, because if you're waiting for the patient to get their check and bring it to you, statistically that doesn't work out, you're going to lose a lot of that money. It's not that the patient necessarily wants to leave, it's that a certain number of patients simply don't have the budget to pay upfront and wait to be reimbursed. Some do, some don't, and that's why you'll lose more Delta patients than with any other plan.
Delta also tends to get aggressive when you drop them, at least in what I've seen with clients, they go after the patients hard, letters saying "your doctor no longer accepts Delta," repeatedly. There are things you can do to counteract that, letters and postcards we send to patients explaining that the issue is on Delta's end, not ours, that Delta made changes to their organization that forced us to choose between staying a participant or prioritizing quality care, and that this doesn't mean the patient loses their benefits, just that some things have changed and they should contact us to discuss it.
Jeff: Got it, so there are ways to counteract it, but you're always going to lose more Delta patients, which is why it goes last.
Sabri: Right, I handle the rest first since it's easier. So let's say you've analyzed everything, set up your three buckets, identified some reactivation work and new patient conversion work, and worked out a timeline. You have your initial throwaway plans, the ones with 20-ish patients not worth keeping, you send letters and drop those right away. Now you're getting ready to start the bulk of the work with bucket two, calling for renegotiation and so on. I want the sales side organized properly first.
Production is driven by how much treatment we sell, so I want to recapture the waste happening on the sales side, whether the doctor isn't scheduled properly and doesn't have time to present cases, the front desk isn't coordinated with the back on sales, treatment is walking out the door, there aren't enough sales opportunities on the schedule each day, or the hygiene schedule isn't built properly. There are all kinds of reasons treatment conversion can go wrong, and I want that straightened out so conversion is solid.
Jeff: I should mention we go over the organizational side of sales in depth at the MGE Communication and Sales Seminars, I'll put a link on the episode webpage. Sorry, go ahead.
Sabri: I want to make sure staff is fully trained on how to talk to patients about being in or out of network, both existing patients and new patients calling in asking if you take their insurance, so the patient feels comfortable and gets the treatment they need without any nasty surprises later, and without losing new patients you're paying to acquire. I also want to make sure the free new patients already in your practice, meaning referrals, are actually being worked. Most practices have a fairly passive approach to referrals, and there's definitely things you can do to drive them, I want that in place too.
So I start working on all the internal pieces I want in place, new patient conversion and the rest, and once those are handled, I start dropping plans, one a month.
Jeff: So we sort that all out first, then start dropping plans.
Sabri: Right, other than the low-value plans with only 20 patients, we drop those right away, it's almost symbolic. So the phases are: getting the research done, dropping bucket one, getting staff trained, and handling reactivation and all the organizational prep, that usually takes about three months, training the doctor on how to present cases properly, training the staff, all of it. After that I have about four months to drop all of bucket two. Once bucket two is fully dropped, we reassess, do we need to increase marketing, do more reactivation, fine-tune something? Then we drop bucket three, Delta, which we have to fit within the nine-month window since, as you reminded me earlier, we don't want this dragging out. You could stretch it to a year, five years even, if you wanted to, it just doesn't need to.
Jeff: This is a pretty comprehensive process.
Sabri: It really is, and I gave you the broad brush strokes version.
Jeff: I thought you explained it pretty well.
Sabri: It's very much customized to that specific practice. The plan varies depending on the doctor's circumstances, because if you have Medicaid, out-of-state plans, or HMOs in the mix, you have a completely different plan. It doesn't mean it's more difficult to get out, though you will lose most of those patients, not all, some people will pay full fee, but with something like HMOs, you'll lose a lot. So we're doing something completely different there, though it doesn't mean it's more difficult or expensive, because just like we discussed here, we're able to replace the patients we'd potentially lose with uncaptured patients already in the patient base. There are things we can do in those Medicaid or HMO scenarios too, we just have to be a bit smarter and more situational about it.
Jeff: I think the thing someone gains from talking to someone like you about this is that you've been to this rodeo before, many times, so there's actual confidence that there's a way out.
Sabri: Oh yeah. And if you're listening and this has been on your radar, wanting to get out of plans, I hope this gives you the sense that it's actually possible. I think some people have just fallen into apathy about it, like it is what it is and that's what they're stuck with. The first thing I usually do with a new client is sketch out their roadmap to getting out, so they have a sense of the amount of work involved and the timeline we're looking at. Then it's up to the client to decide whether they want to walk that road.
Jeff: I like that. And speaking of which, we're still offering that consult if you'd like to take advantage of it. As you can see from what Sabri explained, it's a very involved process, so we don't have unlimited slots for the Roadmap to a Fee for Service Practice consult, which is essentially walking through what Sabri and I just discussed here, but specific to your practice. Costs are going up, inflation continues, and insurance companies aren't raising reimbursement, so for a lot of people this is really decision time.
The other thing I want to add is that owning a dental practice, earning a doctorate, taking on all that risk and hard work to get into the position of being a business owner with your own practice, that's not easy. Especially for the people I meet who earned a doctorate in another country and had to come back and redo it here, that's an enormous amount of work and sacrifice. If you're going to do all of that, wouldn't you want to maximize what you get out of it? Not just for yourself, but for your patients, for your family, for your staff too, they don't have an unlimited window of time to practice either. You can do better for your staff, better for your patients, whose care shouldn't be limited by what the insurance companies will allow, and better for yourself. So I see no upside to staying in these plans. If that's you, I'd definitely take advantage of the Roadmap to a Fee for Service Practice consult, I'll put the link on the episode webpage. You might even end up talking to Sabri directly.
Sabri, thank you so much for being on.
Sabri: You're welcome, folks, I hope this helped.
Jeff: And if you want to find out more about MGE, you can find us online at mgeonline.com, or give us a call at (800) 640-1140. Have a great week, and we'll see you next episode.