“Pick and Profit!”
With special guest – Bill Rossi
EDITED TRANSCRIPT
Richard Madow:
Hello again. This is Dr. Richard Madow. Thanks, everyone, for being a fantastic member
of the Madow Brothers audio series. We’ve had some really great interviews lately, and
speaking of great interviews, we have a frequent Madow Brothers audio series on for you
today, and that is, of course, Bill Rossi, the founder of Advanced Practice Management.
How are you doing today, Bill?
Bill Rossi:
Doing good.
Richard Madow:
As always. You know, you work some really difficult schedules, you’re always busy,
always on the road working with practices, but you always seem to be in a good mood.
Do you have, like, a secret to that?
Bill Rossi:
Are you sure you think I’m in a good mood? I tell you what, I’m not in a good mood if
there’s anyone in front of me the left lane; I tell you that.
Richard Madow:
Are you one of those fast drivers?
Bill Rossi:
No, I mean, I’m a … if you have a van, and anyone out there listening has a van, please
stay out of the left lane. I travel so much, the bane of my existence is Caravans in the left
lane.
Richard Madow:
Don’t you just love it when a van’s in the left lane going slowly and they have the right
blinker on and they don’t know it?
Bill Rossi:
Yeah, I love all versions of vans in the left lane. Sorry, I sound cranky but I just want to
prove I’m not always in a good mood.
Richard Madow:
Ok, so if you take anything home from today’s interview, if you have a van, get the heck
out of the left lane…
Bill Rossi:
Get to the right.
Richard Madow:
Especially if…..
Bill Rossi:
But generally I’m in a good mood. Yeah, I’m in a pretty good mood.
Richard Madow:
You seem to be. Bill, I know you’ve been one of the most frequent guests on the Madow
Brothers audio series, and, geez, we’ve been doing this for 15 or 16 years. I guess it’s
kinda like when Alec Baldwin hosts Saturday Night Live.
Bill Rossi:
Yeah, I went to that, you know, I get to be the strange dude, and I always forget his name,
who is the guy that did the horror show where you touch people and you can see the
future, and he’s on Saturday Night Live all the time? Come on, you must know who I’m
talking about.
Richard Madow:
Wow, I don’t know. I’m sure some of our listeners do.
Bill Rossi:
Forget it, but god darn it, who is that guy?
Richard Madow:
We’ll figure it out later.
Bill Rossi:
Ok, sorry, let’s skip that part.
Richard Madow:
Ok, let’s introduce you a little bit maybe for some of our new members who aren’t
familiar with you. You are the founder, president, and chief cook and bottle washer at the
Advanced Practice Management in Minnesota. You do a fantastic job going into practices
and just really helping them realize their potential, and you’ve done a fantastic job
helping our listeners as well. Sometimes you’re known as the insurance exorcist and
sometimes you’re known as the practice calibrator, but what are you gonna be known as
today?
Bill Rossi:
Today, well, I’m Mr. Buffet, I’m Mr. Buffet today. When you and I were talking about
this, instead of trying to dwell on one subject, why don’t we do a little smorgasbord, a
buffet, kind of a collection of things that are easy to do, bite-size, and you can just hit it
and do it. So the idea is you and I just walk down the buffet and explain what’s on it and
people can pick what they want.
Richard Madow:
That sounds fantastic. As a matter of fact, I know that you titled this interview “Pick and
Profit.” I’m just wondering cause I looked through the list, and they are all fantastic
ideas, why you think that people should only pick a few or pick whatever they choose? It
seems to me they should…
Bill Rossi:
Here’s the thing. Change is so hard. In my experiences, when I go out in offices, they are
at a set point. You see statistics from year after year that are amazingly stagnant or stable.
I’ve been in offices where they’ll do within one crown in a whole year what they did the
year before, or they’ll average 12.5 new patients one year per month, and the next year
12.3. So you see these things where the statistics are stable. When I see that, if I know the
statistics aren’t moving, I know the people aren’t moving. And so I find if you come in
and go, “blah, blah, blah,” and give them a million things to do, nothing happens; they
just freeze. But my strategy, and the strategy of our company, it works, is we pick two or
three things at a time, lean on them until they are set in, and then get them to the other
things, and that really works; you kinda lean on it. So if the people listening pick 2, 3, 4
things, assign someone in the practice responsible for each of those things, and line up
sort of a game with it, and they stick with it, they’re gonna get an actual change. And it
doesn’t take much, it really doesn’t, and then the organization starts to move. It’s just like
unplugging something and then the numbers move, so that’s the idea; just a few things
that you really actually really do.
Richard Madow:
Well, that sounds fantastic cause we’re gonna fly through this list with, we’ll tell you
about twenty or so great new things you can do in your practice. Pick the ones that suit
you, the ones that you think you can accomplish, and let it rip, so, I think that’s great
advice. I think if we told any office to do twenty new things or make twenty changes, it
would be a bit overwhelming, so I agree; that’s a great strategy.
Bill Rossi:
Well, and then another thing is, my big theory is that dental offices are different so I
don’t believe in canned advice, but not knowing about each of your listener’s office, the
ideas we’re talking about today are very adaptable; any office can pick and use them. It
doesn’t matter if you’re country or city, and that’s another aspect here. If I was sitting in
an airport and had to talk to dentist who said, “Ok, here’s 50 bucks. Give me an idea or
something or I’ll buy you a drink; give me an idea.” This is the kind of things I would do
without a heavy analysis. Again, just do it.
Richard Rossi:
Right, makes a lot a lot of sense. Fantastic. Now let’s get started with the topic everybody
wants to know about, and that is getting more new patients. I mean, we work across the
practices all across the country with our new patient mail program because I think the
need for new patients never goes away, so you’ve got a great new list of ways to get new
patients. Let it rip!
Bill Rossi:
I’m focusing just on a couple things on this. First of all, Google reviews on the place
page. If you don’t know what they are, then you should. So if you do a local search on
“dentist, Rochester, Minnesota” or something, it comes up with a seven pack of doctors,
and you’re looking for stars. If you have five or more Google reviews, you have stars.
And there’s no question that having those Google reviews, there’s not a direct
correspondence, like if you have a hundred Google reviews, you’re ahead of the person
who has 98, but there is no question if you look at competitive areas, that people that
have stars and reviews tend to surface, so it helps with the SEO, getting it forward in the
search order. But it also helps with conversion, because any of us who have used reviews
to pick out a vacation spot or something, the reviews not only get people to look but they
make people confident in buying, so it’s a conversion factor as well. So to hit, but Google
reviews are a pain to get, especially since Google said you can’t just have a Gmail
account to do a review; you have to have Google+, which is like a mini Facebook, and
it’s a pain truthfully, and so it’s harder to get those reviews. And you can’t buy them; I
suppose you can hire someone in India to do fake reviews, but if Google finds out, they’ll
crush you, cause that’s black hat. So the good news about these things are that they’re
hard to get, so how do you do it? First of all, everyone in your practice has to set up a
Gmail account and a Google+ page; it takes under five minutes. I was in Newhall,
Minnesota, early this week. I had an assistant sit down, and in five minutes she had done
it, and I said, “You have to do it if you want to have your patients do it”; otherwise you
say, “Do a Google review,” and there’s no concreteness, so everyone on staff does it.
Everyone on staff should do a review on something in town like a beautician or
veterinarian, or something; I mean, a real review, so they’ve been through the process.
You can’t lead the patients somewhere you haven’t gone. Once you’ve done that, you
appoint someone to be in charge of keeping track of the Google reviews, and reporting
once a week or month that they are going up. And if you’re under five, you’ve got to
really try hard to get over five cause then you get stars, but they seem to help. In the early
days of Demandforce, that was one of the first digital communication companies, they
had the influence of Google, and if you know somebody did a review on Demandforce, it
was put on the place page, and so the clients I had that had Demandforce early on had a
lot of Google reviews, and I saw their numbers go up in new patients, even if their
websites were primitive. Well, Demandforce got kicked to the curb, in terms of reviews.
They are still there but they are kind of sequestered. They’re not on the face page, but we
still think it’s an important factor. So you get everyone to do it, you put someone in
charge, and you should have a way to make it easy for patients to do a review, so there’s
a bunch of handouts that tell them where to go. Better, you have a button on your website
that they push that says, “See what other patients are saying,” and also makes it easy to
do a review or send them a link to your place page. Now many of listeners have multiple
place pages, which is a problem because they can fractionalize your search, so you have
to claim the place page you want and populate it with photos. It just kills me to see a
blank place page because it’s the front porch of your website; why not put furniture and
lights in it? Ok? So you want to make sure that place page is there, that your staff has
done a Gmail account, has Google+, which isn’t hard to do, done a review so they can
show patients to do it, and then last but not least, you incentivize. Now its black hat to
pay patients for reviews or do phony reviews, it’s just bad karma, but if you say to the
staff, “If you get Mrs. Murgatroyd or anyone to do a sincere review on us, I’ll pay you
$20 until we get to 20 reviews.” And what happens in a practice, one or two people just
go ape over this and you get the reviews real fast; so I started throwing money in cause I
get tired of talking about it. I said, “I’ll be back in three months; I’m gonna pay $20 per
review to whoever can claim to get the Google reviews up,” and things start moving. So
that’s simple, doesn’t cost anything. Well, it cost 20 bucks.
Richard Madow:
So worth it. I love that.
Bill Rossi:
And it works. And then I’m just gonna keep moving. Once they get to your website, they
have to have conversion factors. Now, if you do direct mail, and many of your listeners
have, I’m sure, if you did direct mail without an offer, it would be like dragging line in
the water without a hook; people look at it and go, that’s interesting, and it goes in the
trash. You have to have an offer, and there’s lots of kinds of offers: the free Sonicare,
whitening with a checkup, or price point checkup. Likewise, when you land on a website,
the area that shows above the screen better almost look like a direct mail piece; if it’s just
got clip art of the generic family, which is starting to irritate everyone, two kids (one
male, one female), two good-looking couple; no one’s like that anymore. And if you just
have generic photos instead of photos about you, you don’t have any reviews, and you
don’t have any offers, the person is gonna go to another website. So if you’re paying for
this sort of thing, great, to have a website, but if you have a website that’s pretty, that
doesn’t have a hook on it, I think that you’re wasting, I think, a lot of your potential.
Richard Madow:
Hey, Bill, what’s your favorite offer? I know we see free whitening, free exam and
cleaning, $49 exam, cleaning, X-rays; do you have a favorite?
Bill Rossi:
I try not to have a favorite. I try to see what’s working, and that’s what you’re asking, but
it is kinda like fishing and can kinda vary by area. To my surprise, free professional
strength whitening along with your checkup visit still pulls; I would have thought
whitening would have been tired out years ago because there are so many alternatives to
it. A price point checkup for a kid, like a $59 complete back-to-school checkup or a $5,
$19, $29 complete exam including any necessary films. Those sorts of offers tend to pull
pretty well, but it’s exactly like fishing; you kind of have to tip your hook with different
things, and you want to have multiple offers even on your website. Or you put offers one
month, take them down, put them up, that’s the beauty of the website, direct mails out
there; you can change things on a website and see what works, so you tell your web
person, “Try this offer.” If it didn’t work, next week try another one.
Richard Madow:
That’s the beauty of electronics, for sure.
Bill Rossi:
Yeah, so that’s really important. Moving on…
Richard Madow:
This one’s really intriguing because you’re saying there is one question that the business
team can ask to increase new patient conversion by 50%. I love those kinds of things.
What’s the one question?
Bill Rossi:
This one is actually, this one I have to give credit to Aaron Boone at dentalmarketing.net.
It used to be 123 Postcards. They’re an outfit out of Utah. I have a lot of clients using
them for direct mail; there’s other good outfits out there, Howard Horrocks. I like these
guys cause they make the phone monitoring so easy, and you know how important that is.
So I go to my office every Monday morning and I can listen in to 15-20 of my new
clients/new patients’ phone calls from direct mail. And I have to be careful about doing
that, cause if I do tit on a Monday morning and I hear the usual crappy phone stuff, my
secretary says, “Bill, stop doing that; it’s putting you in an ugly mood,” because of the
insanities you will hear, like a new patient calling up and saying, “I’d like to schedule this
free checkup deal,” and the front desk person’s saying, “Well, what’s the expiration date
on the card?” and I’m trying to claw my way out of the window of my office here. The
secretary is holding onto my shirttails so I don’t jump, because there is no intrinsic value
on the card; it’s not like it’s a gold flow that went away at the end of January or
something. Anyway, Aaron listened in on 50,000 calls, he and his staff, listened in on
50,000 calls, and he says, when the people call, the front desk person, every time, every
time, remember to say, “Is there anyone in your family that you would like to have take
advantage of these offers or like to schedule or like us to take care of or anyone else in
the household who wants to see a dentist or anyone else on this policy you’d like to get
taken care of?” Some version like that. If you do it consistently, he says that you’ll get
50% more bounce, so even if you’re getting one of your new patient mailers, you know,
the new resident mailers, Rich, if you personally remember to ask every time, you get a
lot more bounce. Now, you might get those family members eventually anyway, but you
might not. If you’re paying for direct mail now or paying for SEO or paying for pay per
click or whatever, when someone calls, get more.
Richard Madow:
No question about it. We talk about that in our seminars too, the context is you can
double, triple or quadruple the amount of patients just by saying this, so good stuff.
Bill Rossi:
I’ve been talking about this for years and so have you, but it was interesting because he
really measured it, and so it just really underlined it three times. Now again, I’m listening
on those calls every Monday and even having said that with my great persuasiveness, I
listen and no one is doing it; it just drives me up the wall.
Richard Madow:
I agree, you got to do it.
Bill Rossi:
You got to do it; it works. Now here’s another thing that I would have not thought would
work, if you have caller ID and the front desk person misses a call and it’s not like a
stock broker from New York or something, it looks like a local number, just call the
person back and say, “Hi, this is Betsy at Rossi Dental, and we were with another patient
and noticed you called. What can I do for you?” Now I would have thought, nah, that’s
weird, it’s stalking, and I have had clients track this and it’s highly worthwhile, so you
have missed calls and you call them back, hardly anyone does that. But if you do that, if
you have caller ID already, Doctor, say, “Let’s just try it for a month and see what
happens,” and ask your staff, give them some kind of reward so they actually do it, so if
you schedule a new patient from a callback, this way you get free Starbucks for a week or
whatever, you know, make a game, I don’t want to make it a bribe so much, it’s just
something to make sure they are tracking it. Why not try it? It costs you zero, what if you
pick up two more new patients a month just because of that?
Richard Madow:
Agree. Good stuff.
Bill Rossi:
Now I had this one lady do this for two weeks and I said, just keep track of it; this is
pretty representative. So for two weeks she had nine times where she did callbacks like I
just described, and for half the people nothing happened, but for the other half, four or so,
she ended up scheduling eight people, and you go, wow, you know. So why not try that?
So next item on new patients is something that I know you’re aware of, it’s new patient
readiness. It’s shocking how often a new patient calls and wants to get in; they have to
wait a month or two. I worked with a practice where two doctors were getting less than
10 new patients a month and you call to get in and you can’t get in for two months. I
mean, that’s just crazy; so you have to make it easy for new patients to come in. Now,
most practices have new patients come in through hygiene for an hour, but some do two
hours, you know, an hour with a doctor, oral hygiene, an hour and a half, all kinds of
these variations. If you are one those doctors that takes longer appointments with new
patients that are not emergency new patients, you had better block out times or they are
not going to be able to get in. So you have your perfect new patient intake. My theory is
just get them in, maybe the first visit isn’t perfect, but your hygienist doesn’t have to
make up for three years of six missed checkups in one hour, but you got the patient in the
door and they see how great you guys are.
Richard Madow:
I agree. It used to be status symbol to say, “Oh, I’m booked three months out.” Now the
way to go is to get people in same day, next day, day after, you’ve got to or they’ll go
somewhere else.
Bill Rossi:
Well, our friend Howard, our friend, he says doctors are hung up on how far they’re
booked out. He goes, “How far is McDonald’s booked out? They do ok.”
Richard Madow:
So true.
Bill Rossi:
That’s Howard, isn’t it? So it’s really critical, and I saw that twice this week. I’m in
practices that like most who want new patients, and you call, well, the prime times are
taken by hygiene. Well, block out hygiene. So what you do is you appoint a person in
your practice and you say, “Your job is to make sure new patients can get in within a
week, two weeks in the outside.” You know, you guys got through dental school, staff
around you, use your brains and solve this problem. So if you make it easier for people to
get in, you have offers on your website, you have Google reviews, ask about family
members, and you do callbacks, I think it’s very likely that you’ll get new patients, not
thousands more, but what if you get five new patients a month. For many doctors, that’s
like three more months’ worth of new patients a year, or two more months, and so none
of the things I mentioned cost anything.
Richard Madow:
Agree. Let’s keep going, one more thing about new patients
Bill Rossi:
By the way, I do like taking to Madow listeners. I get calls after these interviews and they
are always very nice and interesting people. I have a favor to ask you folks. If you try this
stuff and it works or doesn’t work, I’d appreciate the courtesy to call and say, “Hey, Bill,
I tried it. This worked, or we tried this and it worked better.” My whole career has been
spent by keeping my eyes and ears open to looking for what’s working and what’s not
working and making course adjustments, so one of the things I can get out of this
interview is feedback, and I’d appreciate it, and I’m serious about that. If anyone does
this stuff, let me know, ok?
Richard Madow:
Excellent, and we’ll give your phone number and email at the end, and copy me on the
mail too. I’d love to see cause I know Bill is giving this great stuff, so I’d love to hear
about it too. Ok, one more thing about new patients.
Bill Rossi:
Good, good, good. Email to both of us, and I think we’ll both find it interesting. Ok, let’s
move on.
Richard Madow:
One more thing in the new patient category.
Bill Rossi:
Oh yeah, this one is interesting. I heard about this sort of indirectly through Howard
Horrocks, the New Patients, Inc. guy. I think I met him at one of your seminars. I think
he had a booth there or something. Anyway, he was talking about how he read a book by
this guy called Predictably Irrational and was talking about, let’s say you’re having
turkey dinner at your mother-in-law’s place and it’s a good turkey dinner, and at the end
you go, “Man, that was great. Here’s a hundred bucks.” You know, you can’t convert
social things into dollar things; they are two different worlds, and once you make
something that’s social marketplace, you taint it; you take it to a different direction.
Another example uses, they were trying to recruit lawyers to do work for senior citizens,
and they said, “Well, we’ll pay you $30 an hour for semivolunteer work.” They got no
takers. When they said, “We’d like you to help with seniors” for no dollar amount, they
got takers, because with lawyers, when they go to a social marketplace, they go, “It’s not
worth my time for 30 bucks. When it appeals to the social norms, it’s worth my time to
help people.”
Richard Madow:
Interesting.
Bill Rossi:
And so he says you got to keep it that way. Now, I actually had a conversation with Dave
about this. I don’t know if he passed it along to you. Whenever you talk about referral
gifts, when a patient gets a gift, there’s someone to bring up, “Oh geez, our board is
gonna kill us because that’s fee splitting.”
Richard Madow:
Oh, I can’t stand that BS.
Bill Rossi:
I know, and I mean, it is BS, but I tell you what, the reason I like to key off of that is you
want to keep it in the social world. So if I say to you, “Rich, come here, send me a pic
now,” I was talking earlier about bribing your staff but you’re already in the marketplace
with your staff and you make a game out of when it comes to encouraging patients to do
reviews, but you’re not bribing the patients, ok. When you have a patient and you go,
“Psst, Rich, could you send us smart victims? I’ll give you 20 bucks,” it just seems needy
and it takes things the wrong way, the people that refer others to you generally are people
that like you, they are in the social part they want you to like them, they like your staff,
they like feeling at home in the place, they like to know that people know who they are
and then you go, “I’ll give you 50 bucks to…” it’s just yuck. There is a danger. The way I
would like to see this really done is: “We’ll give you a $50 credit on the account” cause
that really brings it right to money. Now a gift is different versus a bribe, so a gift is …
we’re on a mission; our whole job is to help people, so when our patients go out there and
get others and they hear that we can help people seeing a dentist or are unhappy with
their smile, that’s why we’re here. And when you do that, we really want to let you know
we’re happy with that. We’d love to have you do that and send you a thank you gift, and
so you can get your choice of gift. So wait for someone to refer is one way to do it and
instead of just sending them something you call and say, “Hey, thanks for sending us Joe,
Rich. We really appreciate it. We love Joe and he asked me to get you a little thank you.
What do you prefer? Would you like a gift certificate for Starbucks or would you like a
Barnes and Noble” or something like that, so it’s truly a gift, and even better is if you
know what the patient’s into and you give them a gift. If they’re into gardening, you can
send them a bunch of seeds or something.
Richard Madow:
Send them a hoe if they are into gardening.
Bill Rossi:
A gift certificate to a nursery or something. So what you’re doing there is you’re trying to
keep it in the social world. And the emphasis of asking for referrals is not asking for help;
it’s offering help. That’s why most doctors aren’t comfortable doing it because they feel
they are at the 8th grade mixer again trying to ask for dates or something. It’s just really
awkward to ask patients to send patients like you need them but it’s not awkward to offer
help. That’s why we’re here. “Any friend of yours we’re happy to help” is different from
“Could you help us by sending us your friend? And we have a $25 credit for you.” So it’s
sort of a subtle thing but I think you guys are hearing what I’m saying.
Richard Madow:
No question.
Bill Rossi:
Now there is another reason for that. If you’re paranoid about the board getting mad
about fee splitting, if you’re giving out a gift even though it’s a gift card, it’s sort of like
money; if it’s a gift, there’s gonna be a lot of specialists thrown in jail for … I mean ,do
you get chocolate cake and popcorn and special gifts from your specialist? No one
accuses them of, you know, no endodontist has been thrown in jail for sending out
chocolate that I know of.
Richard Madow:
Yeah, tell me of one person that is in jail for fee splitting because they sent someone a
gift. That’s just BS.
Bill Rossi:
Yeah, to me it keeps it one step removed and it’s better anyway if it’s truly a gift and not
a bribe, and so that whole idea of helping people versus asking people for help just puts
everything in a much better tone.
Richard Madow:
No question. Hey, let’s move on to something that you are really known for. I know you
have lots of areas of expertise but this is maybe something you’re known for very highly
and that is the insurance PPO game. Let’s talk about how to get more from our insurance
companies and PPOs and maybe even less, whatever the case.
Bill Rossi:
Yeah, you know, don’t get me started on this, but in the spirit of the buffet, I’ll move on.
First if all, if there’s any plans you have, make sure you’re aware of the plans you’re in,
and at least once a year pick up the phone and call them or have your office manager pick
up the phone and call them or your spouse, they have good ___ on that kind of thing. Pick
up the phone and call them and say, “Hey, can you do any better?” Now, when you make
the call, you don’t want to talk to the normal insurance bureaucrat; you want to talk to
whoever is the network manager, so you want to find out who is in charge of provider
relations, so the network manager. These people are paid or recognized for maintaining a
provider network. Let’s say, Rich, you had 2,000 active patients, you have plenty of
patients, and so any one patient you could go, I don’t care. But if a patient comes to you,
I know how my clients think, and I know how my dentists think, you have 2,000 patients,
plenty of patients, patient comes to you, “I’m not happy about that filling. Can we do this
or that?” You would do it, you would go, “Well, the patient’s kind of a complainer but I
like him. I’m gonna take care of him.” You could just say, “Hit the road,” but most
dentists don’t. Dentists don’t think they have power with the insurance companies, but
every dentist signed up with a network represents a stream of income to that network and
the network manager gets recognized or compensated for it, so even if you’re a little bit
pushy, they want you. So once a year pick up the phone and you call provider relations,
“Can you guys do any better? I’m kinda ticked, I’m looking at this, I’m busy, I’ve got
these write-offs, even other insurance companies are paying better.” We don’t think this
way but if you quote to United Concordia that the people at Preferred are paying better, it
kinda gets their hackles up. Are there different laws of math? What’s the deal? And so
just pick up the phone and call. I was in a practice yesterday where they were with dozens
of plans they didn’t know they were with, so in their case I had to say, you got to figure
out who you’re contracted with and call them at least once a year. That’s a hint, those are
two things right there. Second, look for money in the glitches. What happens is most
people that process insurance just accept it. You want to have the people that look at your
EOBs look for glitches. Example, client of mine, I think we may have talked about this
before; I can’t remember if it happened before or after our latest insurance interview; but
a client of mine was getting from an insurance company $24 for every periodic exam but
the charge was $42 or something like that. I go to the front desk person and go, “With
this insurance company, you mostly experience a 15 to 20% discount, but on this it’s like
a 50%. What the heck is going on?” “Well, that’s just how it is.” I go, “Well, I don’t
know, that seems out of line.” And we called them and checked into it; they had
transposed the 42 to a 24.
Richard Madow:
Oh, you got to be kidding.
Bill Rossi:
Yeah, it was ten thousand bucks.
Richard Madow:
Wow.
Bill Rossi:
Ten thousand bucks, and they go, oops, that’s your mistake, and we can prove that they
sent in 42 in this office; they screwed it up. There’s another place where buildups, similar
type thing, the doctor was getting a hundred dollars for buildups; the charges were two
hundred. They didn’t do tons of them but they did about 10 a month and you go, “Man,
that buildup fee, that doesn’t look right compared to the others fees. It’s a completely
different level of pain.” And ask the manager, “That’s how it is. It’s always been that
way,” and I go, “Pick up the phone and call.” “Well, they said we only get 1 or 2% this
year.” “No, no, this is different. You’re doing an appeal, not just a routine raise. You’re
calling and saying is this right?” And they made the phone call; a hundred dollars per
buildup. Now imagine, is that phone call that’s a $1,000 pure profit a month, all year
long, and next year and so on, good phone call? And so you ask your people processing
insurance to look for inconsistencies or weirdness in the coverage, and have an active
mind. They got to be looking for money cause it’s out there; when you start looking, you
start going, “These people at the insurance companies have importers. They transpose
numbers; they put in the wrong fee schedule, etc.”
Richard Madow:
I agree, and I’m not a conspiracy theorist but I know some people think those insurance
companies, some do that stuff on purpose to see if they can get away with it, which could
be true; who knows.
Bill Rossi:
I don’t think so. I just think they are incompetent, like the whole world is.
Richard Madow:
I like the incompetence theory better than the conspiracy theory, but you never convince
some people on either one. Ok, good stuff. So let’s talk about maybe what to look for
before you join the PPO or the lousy PPO.
Bill Rossi:
Yeah, before you join again, huge subject. Again, we’re in an airport somewhere, and I
can’t do an in-depth analysis, I’ll just say this: Before you join a plan, count to 10. Here’s
what happens. New plan comes to town; fee schedule sort of looks ok, and you have one
family says, “Well, I work at that factory. Are you going to be a MetLife provider?” or
something like that. “Oh God, I better. I don’t want to lose the Rossi family,” and they
sign up. If you sign up on a plan that you lose eight patients on; you’ll sign up for
anything. So I always say before you sign up, wait to see if you’re really having
problems. If you’re not really losing patients, don’t run for the discounts. You can always
join later. And if you are gonna join, for crying out loud, before you sign up, ask them if
they can do any better.
Richard Madow:
Good point. That’s a great point. And that’s probably the best time to ask, “I’m thinking
about joining. Can you do better?” That’s the time they really want to hook you.
Bill Rossi:
Yes, and how much does it cost to ask that? Nothing, and it just, you know, you have to
do it. I’ll see two clients across town here, again, in my area, I got a pretty good feel for
stuff. I can do stuff elsewhere, but I really know the jungle here, and I’ll see two doctors
signed up and one will get a completely, well, 5, 10, 15% more than the other because
they ask for more money. So there is a lot of play out there, and as I told you before when
we talked about the subject, the insurance and the PPO companies, they are like the
casinos; they have all the information, the odds in their favor, they have big money, and
we’re walking into the casino jungle. But we don’t have to play stupid and sometimes we
don’t have to play at all. We can walk, and that’s my theory on that.
Richard Madow:
Good point.
Bill Rossi:
Dropping.
Richard Madow:
Yeah, you’re fed up, you’re ready to drop a PPO. What do you need to think about?
Bill Rossi:
Again, huge subject. When we’re doing exorcisms, bring me an old priest, a young priest.
We go through all kinds of stuff. Basically, what you want to do before you drop is two
things: 1. Check on what the other network benefits for this plan will be. So, for example,
in Minnesota, if you go from Delta PPO and leave that network but stay with Delta
Premier, most patients will have pretty good benefits with Delta Premier, the same
benefits at 100, 80, 50, ok. But, at the U of M in Duluth, at least the year or two past, I
don’t know about now, the people with the PPO have zero out-of-network benefits, so if
you have a lot of college professors or staff at the U of M Duluth and you leave Delta
PPO, those patients are going to be gone, and you need to know that. But if you’re like,
let’s say, in Long Prairie or some other place, and you leave Delta PPO, most of the
patients are going to have good benefits. So if you drop a PPO, you have to do a little
homework to the out-of-network benefits. Usually they are just fine. The other thing you
have to do is train your staff so they know what to say to patients and they keep calm. It’s
like you want to keep the staff calm so the patients keep calm. So here’s what happens.
Sometimes I’ll go to a PPO transition with someone and the staff person doesn’t say
exactly the right thing at the front desk. The patient blows up for something, and then the
doctor comes out and beats the staff up too; pretty soon the staff is like a gun-shy dog. I
mean, they’re just shaking in their boots, and you don’t want them shaking in their boots
because that doesn’t make it comfortable for them or the patients. So you have to train
the staff about this and you have to back them up; you have to know even if Mrs.
Murgatroyd blows up, we made this decision to leave the network because the discounts
weren’t fair to us or other patients without that deep a discount, and you have our full
support.
Richard Madow:
Sounds good.
Bill Rossi:
So those PPO plays, to recap on that, just ask for more money every year, look for the
glitches, don’t join too quickly, and when you drop, do your homework, and those are
probably worthwhile thoughts.
Richard Madow:
Ok. Bill, I know you’ve got a ton more information but all these things you’re talking
about and the things you’re about to talk about, you got to execute. That’s one of the big
problems in dental practices. You go to a seminar, you listen to a great audio interview
like this, you have Bill Rossi come into your practice and recommend all these things, but
then you get busy, you get complacent, things never get done. How do you make sure
things get done?
Bill Rossi:
Ok, thanks, that’s great. The systems checklist is our big deal so, because I can’t live at
every office and I have a lot of people to take care of, my clients are busy and we want to
get things going; you don’t have a lot of time for management. So I really believe in
checklists, and we talked about that before, but checklists are just the way to do it, so let’s
start with an example, continuing care. Continuing care is the most important
administrative system, and every office we work with at least once a year we have to do a
continuing care tune up because it fades, you have hygienist leaves and the commitment
percentage appointing people ahead drops or the postcards stop going out or something
happens. So what you do is say, first of all, “Who in this office is responsible for the
continuing care system? Everyone helps but I want someone on point; I want someone
whose job it is to do this checklist each month, to make sure all the bases are covered.”
And on that checklist would be things like this, what’s our appoint ahead percentage; at
the end of the month, how many people at the end of June have appointed for December?
And you can do that by looking at December, see who is due with or without
appointments in your software, and go, ok, that’s our commitment percentage. Your goal
is 75% or better; that’s your recall system. 2. How many postcards went out to people and
what sort of pattern? Now most of my clients, we send out postcards to people 3, 6, 9,
and 12 months past due, so we don’t overbug them; we give them some time to cool off,
but once a season we send a postcard. Nowadays, with digital communication, we do
email, text, wait three days if they haven’t scheduled, do the postcard, wait a week, if
they haven’t scheduled, call, one more call, then you leave the patient alone for three
months. But you need someone to keep track of this, and if they say, “Well, we send out
200 postcards,” then go, “Well, how many calls did you make on past due recalls?” “Uh,
fifty.” “Well, then, I know there’s more people to schedule than you’re getting to,” and I
see this all the time. “I know, but I’ve been real busy.” But if you schedule four people an
hour, which is about par when you’re calling in delinquent recall; on average your
listeners probably do about $500 per examination between the hygiene and the doc, what
they discover. So you’re paying someone 20 bucks an hour, and they get on the phone
and they schedule four people, how is that return?
Richard Madow:
That’s a hundred times return, right?
Bill Rossi:
Yeah, and so it is, but why, and I say it over and over again, and I’ll say, “Why don’t you
tell the doctor?” “Well, I don’t want him to think I’m not doing my job,” and I go, “No,
no, no, your job is to do the checklist and if you don’t have enough time to call and the
postcards aren’t going out or the digital communication isn’t in sync with the postcard or
that it’s not appointing people ahead, we need to know that cause if we fix it, we’re
gonna see more people more often and the practice will grow.” So, doctors, this is
critical. You have a checklist. Now, you may not have the same thing on the checklist.
The last thing on the checklist I have is: Do we need more hygiene time or do we need
more calling time or both, because that percent means with the doctor per month go
through the checklist and go, you know what, August is coming up. Maybe we should
add some hygiene time, or Betty Lu is on vacation; we gotta replace her, or gosh, I need
some help on the phone, so that’s the use of a checklist. A collections checklist would be
like: What are your front desk collections? How many accounts haven’t paid you for 60
days or more? How many outside financing did you do? What’s your pending insurance
amount? You know, you can come up with your own. How many collection calls got
made? How many people got turned over to collections, although you hope not many. So
the idea is you have a list of duties so that the person who does them knows at the end of
the month, the doctor cares enough to ask, “Did you do your job?” and if they did, you
say, “Thank you, as obviously you’re on the phones getting the notices out, you’re doing
a good job of calling these people and collecting money and being nice to them, thank
you.” But if you don’t check, I have my favorite ongoing question is this: “Doctor, do
you know how many collection calls your front desk person made last month?” and they
usually go, “No,” and I say, “Well, they didn’t make enough, did they?”
Richard Madow:
Or maybe all your patients are paid up cause you’re collecting up front.
Bill Rossi:
No on gives a crap cause they are not fun to do.
Richard Madow:
That’s for sure.
Bill Rossi:
Ok, so checklists for everything, new patients. How many Google reviews do we have?
How many new patients did we get last month? Where did they come from? Have we
sent the thank you notices out? When is our next promotion coming up? What offers are
working on the website? What is our competition doing? How many Google reviews do
they have? It’s pretty simple but you put a person in your office in charge of new patient
tracking or development to make sure that the tracking is happening to the computer
software. Here is what I hate. You spend the whole year on a computer program and at
the end of the year the doctor says to me, “Well, you think I should do it?” I go, “Let’s
look at the computer software,” and the response is, “We don’t really enter the new
patients in the software,” and then we go, “Why don’t we just read tea leaves. We could
do tarots. Should we keep doing this?” One of the things with paying with promotions is
to find out what doesn’t work, and if you don’t track things, you can’t see what’s
happening. And so the new patient marketing checklist. Once a month you ask them
those things, you get every person responsible on a key statistic too, like, what’s a key
statistic for continuing care, do you suppose?
Richard Madow:
I would say the amount of recall (I hate to use the term recall) but recall exams.
Bill Rossi:
Yeah, periodic exams. If periodic exams are going up, things are getting better. If they
aren’t, I can almost certainly. Here’s my theme of all this stuff is: If you’re moving, the
statistics will move. The key statistics of new patients is new patient comprehensive
exam, new patients going up, that’s the key statistic. Key statistic in collections are your
accounts receivable ratio going down and your collection percentage going up.
Richard Madow:
I just want to bring up a point that you said quickly but I think it’s really important and
that is when you’re having your team… and we’ve been through this in our office as well
and we’ve resolved it…when you’re having your team meeting, talking about the Rossi
interview and which things you’re gonna pick to do, and everybody says that’s a good
idea, you have to say, ok, who’s going to be responsible for seeing this through. You
have to do it. If everybody agrees it’s a good idea, it’s never going to get done unless
somebody is assigned to it, and hopefully someone will volunteer, but if not, they need to
be assigned.
Bill Rossi:
Thanks, right, Rich, and it’s so important, and that way you can give the person
recognition and say, “Hey, Suzie, you established a whole new practice tradition here.
Our referral management is up and running and that deserves recognition.” If you have
good people around you, they want to have tasks where they can shine. So cut out the
work for them and report on it and you’re going to see movement.
Richard Madow:
How do you get this done? You’re talking about managing things in a practice that is
already too busy and overworked.
Bill Rossi:
Well, the old classic is the One Minute Manager. It’s an oldie but a goldie. All that book
is is three things. You set one-minute goals, like “I want to see recall exams increase
from 180 a month to 200 by November” or something. So you talk to a person and get an
agreement and “You’re in charge of the continuing care system and I want you to see that
statistic move and that’s your goal, and you’re going to make sure the postcards go out to
people 3, 6, 12 months past due each month.” you get their agreement. So you set oneminute goals where you look a person in the eye. They got to be short, concise, and say,
“You’re gonna help this happen, right?” “Yeah, right.” And then the other two parts:
Make sure the one-minute reprimand and the one minute praising. So let’s say a month
goes by, the calls didn’t happen, nothing happened, or it didn’t happen well. You call the
person into your office and you say, “I think we had an agreement to do this, right?”
“Yeah.” “You’re not doing it.” Excuse this, excuse that. Awkward silence. “I don’t like
this. Ok, you got another month. I’ll see you in a month.” One-minute reprimand is just
one minute to make the person understand that you are upset with them in a civilized
way, and if they did it, you go one-minute praising. “I see that you’ve done this and got
this done in that time.” It’s so simple. I mean, it’s so simple, you get an agreement with
the person, you cut out the task for them, you check with them in a defined period of
time, you thank them if they did it, if they didn’t, you put them on the hot seat a little bit,
and they go, “God, Dr. Rossi is actually serious about getting this stuff done. I thought he
was just kidding.”
Richard Madow:
And great book too. One Minute Manager by Kenneth Blanchard. It’s a classic. It’s an
easy read. I think everybody that’s involved in the running of a practice should read it.
Bill Rossi:
Yeah, I actually use it all the time. It just works well. Again, might cost 12 bucks for the
book; I don t know.
Richard Madow:
Yeah, download it; it’s even less. So you’re a statistic guy. What are the really, really…I
mean, geez, you go to the computer software and start analyzing your practice with
statistics; there are ten thousand of them, and you’re just confused and frustrated. What
are the most important key things we should be looking at?
Bill Rossi:
The computer produces reams of material and it just makes it a hopeless task to try to sort
what’s going on. Almost every doctor tracks their production and collections; you want to
track your overhead and that means getting your QuickBooks report in order to see your
bottom line (whole ’nother subject) but if you can’t tell how much you’ve made in a
given month, tell your accountant to fix it so you can. You do taxes once a year; you have
to manage every month. I’ve been in business for over 20 years, 25 in my own company,
and another one doing this, about ten, and I’ve always known at the end of every month if
I made money or not or how much I made. So most doctors don’t; you gotta insist upon
it. But the key statistics I’m driving at now, production and collection, total exams, cause
as you and I have discussed, Rich, many times, exams or prophies are the best
measurement of patient flow. If you examine a patient every time they come for a
checkup, total exams, which is comprehensive exams, periodic exams, limited exams, is
the best way to measure if your patient flow is increasing or not. Looking at your
schedule if you’re busy or not is not. So you should know if your exams are going up or
down compared to last year, ok? And that helps to know, “Do we have enough hygiene
capacity?” So if you’re not watching your exam flow, to me it’s just ridiculous. And then
the other part to that is in a dental office, except for fee increases, you can’t do more
unless you see more people and do exams or you do most of the people you see
production per exams and you want to look at your production per exam. So production
per exam goes up 5% and your exams go up 5%, that’s about 10% growth.
Richard Madow:
So that’s just simply, let’s back up to that statistic. I think it’s a really important, so
you’re just saying it’s essentially the amount of production divided by the amount of
exams; track that and make sure it’s going up. Totally agree.
Bill Rossi:
I’m kitty-corner from a Target here and they keep track of how many people go through
their cash register line. That’s the exam statistic, as it were, flow, and they look at their
average sales and they hope that having good displays and merchandise, they get a lot of
people through the lines and the amount that people buy goes up.
Richard Madow:
And then they just tell everyone your credit card number. I think they blast that all over
the internet.
Bill Rossi:
Yeah, yeah, that was a bad deal. So it’s important to know that, now you can increase
your production per exam by more service: implants, endo, ortho, keeping it in-house and
by case acceptance, the calibration, which we’ll get to but…
Richard Madow:
And fee raising, my favorite.
Bill Rossi:
That’s right, and I see you referring to that is my heart and soul about practice
management. Of course you want to also, a lot of consultants were big on this, your
production per hour and your hygienist production per hour. If you want to grow, you got
to do more per patient, or more per day, or see more people, so kind of go hand in hand.
Production per hour is sort of a capacity measurement where exams and production per
exam are sort of demand measurement.
Richard Madow:
Gotcha.
Bill Rossi:
So if you’re watching those statistics and they’re moving, the practice is growing, and
usually just watching them helps.
Richard Madow:
It’s interesting, because it sounds simple cause if you’re watching those and they’re
growing and the practice is growing, then duh, but the fact is, I think if you watch them, it
almost subconsciously makes you make them grow, because nobody wants to see their
stats going the wrong way, and you kinda figure out ways and do whatever it takes to get
them to go up. So that’s one. Some people say, “I don’t need to track statistics. I just care
about my paycheck.” Well, the way to do it, to get your paycheck higher, is to actually
track these statistics, without question.
Bill Rossi:
Yeah, that’s true. Let’s use the hygienist on this because I learned the brutal way about 35
years ago. You cannot appeal to your hygienist’s sense of production per hour. That’s
anathema to them. “Well, I’m a caregiver. Screw you and your production per hour
stuff.” But if you appeal to your hygienist’s sense of professionalism, not using quotas,
like, you should be doing three fluorides for every 10 adult prophies; that’s a quota. If
you stick to the criteria where you see adults with sensitivity, exposed dentin, and lots of
previous work, more than two caries in the last year; if you’re doing that like the other
hygienist, Suzie, is doing it, production per hour match up. So the production per hour is
a reflection of you doing what you should do professionally and matching the criteria that
others are in this office. So if you appeal to your hygienist’s sense of criteria and
treatment, the production per hour will take care of itself, but if the production per hour
isn’t moving, they’re not moving.
Richard Madow:
No question about it. Ok, let’s move on to maybe our final big topic, and that’s just how
to get a better outcome and what…
Bill Rossi:
Christopher Walken. I finally thought of the guy that I want to…
Richard Madow:
That was one of the worst out-of-context segues.
Bill Rossi:
He still has hair still, but I don’t know if Christopher Walken has hair, but I’m
Christopher Walken, that’s who I want to be.
Richard Madow:
If you’re Christopher Walken, then you better give this interview more cowbell; that’s all
I can say.
Bill Rossi:
I just love that.
Richard Madow:
We need more cowbell.
Bill Rossi:
Ok, that’s it. That’s what we’ve called me before; I like that.
Richard Madow:
I’m glad you remember it and just blurted it out at the weirdest, most inopportune time.
Bill Rossi:
Like part of my brain for the past 45 minutes was trying to figure out who the heck that
was, so it finally popped up. Take that, doggone it.
Richard Madow:
If any listeners know what band does a song that mentions Christopher Walken, email me
at rich@madow.com and I’ll send you…
Bill Rossi:
Oh, come on, I know that. I have my brain working on that.
Richard Madow:
You do not, nobody knows that.
Bill Rossi:
Ok, well, I do know, god darn, I do know…ok, let’s go.
Richard Madow:
It has to be the one I’m thinking of. Ok, Christopher Walken, let’s give more cowbell and
maybe we can put a little cowbell sound effect in here and talk about better outcomes and
better productivity and profits, cause that’s a good way to have our last topic.
Bill Rossi:
Yeah, it is, and this is my sermon, right? Except for fee increases, practice production
doesn’t grow unless you see more people, do more for the people you see, as we
discussed. Patients’ behavior and choices won’t change unless you change your behavior
and choices, and this starts with reexamining and reaffirming your clinical protocol. As
you clarify your thinking, you clarify your language; as you clarify your language,
patients will understand and make better choices; as they make better choices, you’re able
to get some better outcomes. In dentistry, the limiting factor isn’t the science so much;
it’s not that you can’t get people to a state of healthy stuff. A lot of health-care
professions, like neurology and stuff, they just manage failure. You guys can get patients
to (almost anyone) great health and appearance if they make that choice, so the limiting
factor is the behavioral aspect, and when you really get that in your head, then the
discussions about communication and those sort of things isn’t on the side or in the way
of treatment; it’s central to it. So the behavioral aspect of dentistry is what determines if
people come back regularly for continuing care, refer a friend, go ahead with treatment,
stay with treatment, and so on, and it’s really critical. So I’m always telling the folks I
work with, “We all have to get a little bit better at something every year; we all have to
improve our own behavior.” I’m trying to get a little bit better every year. I’m better now
than I was a year ago or two years ago in what I do. And I think most of your clients are
that way too; they are going to continue; they are always trying to get better; they listen
to CDs and so on. So that’s why I’m real big on calibration, so I’m going to jump into
some quickies on that. Am I ok with that, Rich?
Richard Madow:
If you’re gonna talk about calibration, I’m gonna say that’s one of my favorite topics. I
think you kinda coined that term practice calibration. It’s something that I talk about all
the time; it’s something that Dave talks about all the time. We love the topic of
calibration, so. [Cowbell sound] Where’d that cowbell come from?
Bill Rossi:
Did you hit your amp there?
Richard Madow:
So go for it. Talk about calibrating the team.
Bill Rossi:
Calibration is just a huge deal for me because I work with all these different practices and
I just found it loathsome to come in and say, “You should be doing 30% crown and
bridge or your hygienist should be doing 30% perio.” That’s just to me counter to healthcare stuff, and I find myself stepping on landmines with different clients. And so I said,
“Let’s go by your values, not by my dang percentages, so work conditions in your
practice warrant an implant versus a bridge,” and so we work with each practice to come
up with their own protocols so they are clear in their own mind while they’re thinking on
recommending what they are doing. So my strongest recommendation to your listeners is
at least once a year, have a clinical policy summit with your staff or clinical protocol
summit, and what you do is start with every single procedure from adult fluoride to fullmouth X-rays, and say, “What are the protocols?” and here’s how you do it. You say to
the staff, “Let’s start with adult fluoride. I want everyone to write down the criteria that
patients would meet where adult fluoride would be indicated being in the best interest of
the patient, will be a good thing for the patient.” And so you have everyone write down,
you take about three minutes, you say no talking for three minutes, write down your list
of protocols when you see patients with these conditions, you would say a fluoride
treatment is recommended for him. So you do that and go around the room and hear
everyone’s recommendations, kinda dealing it out like decks of cards, and you put them
up on the board and test each other’s thinking. Ok, if they drink a lot of pop, but what if
they aren’t showing any decalcification or problems; should we really lean on them to do
fluorides then? Or what if they have a lot of previous dental work but it’s holding up
fine? Maybe in certain conditions, in-office stuff is better, but others, home stuff, cause
you have compliance. So what you do, you ask the doctor and staff to test each other’s
thinking, like you’re working to defend your PhD or something, and by doing that, you’re
having a dress rehearsal for what you say to the patients. And then you don’t need sales
techniques. you just come in, and you probably know the language your patients are
speaking most of the time, so if you’re clear on when you think fluorides are good and
the patient meets the criteria, the hygienist doesn’t need to be told to push or sell; you just
say, “In situations like yours, the doctor says, the research shows, we feel that it’s best to
do a fluoride treatment cause you’re getting lots of sensitivity and exposed dentin here.
So that’s our recommendation, but this is your choice. You just tell us what you want to
do and we’ll do it, so what do you want to do?” Now no one is going to leave the office
screaming high pressure sales because you asked me what I wanted to do.
Richard Madow:
But I think the point is that everybody in the practice has the same criteria so everybody
knows if a patient asks anybody, “Why do I need fluoride and what is fluoride all about”
or “Why do I need a crown?” or “Why doesn’t my insurance cover this?” everybody has
the same answer.
Bill Rossi;
Exactly, and this is really important when you have multiple hygienists. I’ve been in
many practices where I’ll see one hygienist do a fluoride. If you can’t calibrate fluorides
and get that consistent, good luck with anything else.
Richard Madow:
That’s for sure.
Bill Rossi:
It’s real simple. But one hygienist has five fluorides for every 100 adult exams, and
another one has 75 in the same practice. I’ve seen that, and if the patients go between
hygienists, they are going to hear completely different stories. You know, a very
important part of quality is consistence, and you got to have consistency between the
providers, and so that’s exactly where it’s at. And so, if you don’t spend two hours a year
on a clinical protocol summit, you’re not keeping up with the science and you assume
your staff is all psychic.
Richard Madow:
They are probably psycho but not psychic.
Bill Rossi:
Not psychic, yeah. So that is really critical. The other thing to do is thing counting, like
the classic I got from Tom Smeed, my mentor out of Kansas City, some years ago. He
just said, “When you talk to a dentist that says, ‘Look, I’ve done pretty much all the
crown and bridge; it’s done,’ you want to say, ‘Let’s close the office. I’ll put you on the
lecture circuit. You can say you did all the crown and bridge. Here’s how we did it.’ But
we can’t say that, so you say, ‘I’ll tell you what, why don’t you for the next two weeks
look into every patient’s mouth as if you own their dental condition and count how many
crowns would be getting done that aren’t getting done if that mouth was in your head,
and the other hygienist, play the same game, score separately on a day sheet or
something, and at the end of two weeks, compare your findings.’” Now there’s a couple
of reasons for this. First of all, I’ve never seen a doctor do that exercise and not see the
crown and bridge improve; it doesn’t cost anything to do. Secondly, at the end of two
weeks, you and your hygienist on the same page, that gives them confidence that if they
say something, they are not going to be left field, and it tells them to get their eyes above
the gum line. And so if you do those things, just that simple exercise, maybe every three
months do crown counting, it shakes your complacency off, and it works beautifully and
it costs nothing. But you could do fluoride counting, you could do implant counting, you
could do ortho counting. The point is calibrate the team.
Richard Madow:
Excellent point. Fantastic. Great exercise and good for your kinda office morale, good for
production, good for everything, so we are big believers in calibration here. Good stuff.
Actually, why don’t we close it out. You got a list of some patient communication
classics that really work; so we love classics, we love things that really work. Just fly
through them. What are some of the communication classics that really work?
Bill Rossi:
I know you know some of these, Rich, and I’m shameless. I’ll steal from everyone and
people steal from me too, but I’ll steal from Cathy Jameson, Greg Stanley, all those
people. I can’t remember where some of the stuff came from before. But I can remember
where this one, let’s see if you can too, remember the permission statement?
Richard Madow:
The permission statement; is that from Walter Hailey?
Bill Rossi:
It is, it is.
Richard Madow:
“We call it a permission statement. You got to ask permission.”
Bill Rossi:
Yeah, itty bitty, wasn’t he?
Richard Madow:
Itsy bitsy.
Bill Rossi:
His saying, I really liked it because it says in a nutshell what the deal is, so there’s a
million variations to permission statement, but the whole idea here is to take away the
contest between you and the patient, so you’re not feeling like you’re pressuring them
and so you can be free to recommend your best stuff based on your criteria. And they can
be free to say yes or no, but you don’t have to tiptoe around. You just remove the
pressure and ickiness. So the permission statement is saying, “Rich, I’d like the
permission to show you some things that would be useful for you. Of course, you have
my permission to accept of not accept anything I recommend, but can I proceed here?”
Richard Madow:
Like it.
Bill Rossi:
Sometimes someone will raise a hand and go, “What if the patient says no?” You go,
“Well, then, if they don’t want to hear about it, they are not giving permission, and if you
just go blah, blah, blah, blah, blah, they’re not listening anyway.”
Richard Madow:
If the patient says no, well, you say, “When you’re ready, I’m here for you,” or
something like that.
Bill Rossi:
Yeah, when you’re ready, we’re ready, because maybe you had a horrible day and you’re
sitting in the hygiene chair and you really don’t want to be told about flossing.
Richard Madow:
Absolutely.
Bill Rossi:
And so, but if you do that, it’s like basically saying our job is to do a thorough diagnosis
and give you the best advice we can based on our experience and the science. Your job is
to decide what you want to do and when you want to do it, because in our office, the
patient’s always in charge. So that’s another version, and you can do simple versions. “If
it’s ok with you, I’d like to tell you straight out what I’m seeing. It’s ok with me if you
have any questions or anything; it’s your mouth.”
Richard Madow:
Yeah, good stuff. All right, what’s another classic?
Bill Rossi:
How about the two most underused words in dentistry? Hint: It’s not “someday you’ll
need” or “I think you need” (cause those are three words) or “someday we should” or
“let’s watch this” or this if the future or “let’s send this to insurance and see what they
say,” “cause I went to dental school,” “I don’t know, it’s your mouth, I don’t care,”
“someday we should,” “you ought to consider.” So what are the two most underused
words in dentistry?
Richard Madow;
I’m gonna guess, I’m gonna say something like “I’m concerned.”
Bill Rossi:
“I’m concerned” works because you can say, “I’m concerned about this area that I’m
seeing that’s infected” or whatever. I’m driving at these two though, instead of “you’re
going to need,” “I recommend.” Just use that phrase instead of “I think you need” or
“someday you’ll need” just say, “I recommend.” “Do I need fluoride?” “No, you don’t
have to do. I recommend you do, and here’s why.” It’s the best advice I can give you and
here’s why. It’s a recommendation; it’s not a command. And if you do that with the
permission statement, you’re making your role clear. You’re the patient’s adviser, you’re
supporting the patient, and you’re not commanding; you’re not also condescending. I’ll
do it in my mouth but I tell you that you need it because when that tooth breaks, I could
say see...
Richard Madow:
I told you so.
Bill Rossi:
I told you so. To be serious about it, most of the folks we work with like their patients
and don’t want to feel like they’re pressuring them, so these techniques just work real
well.
Richard Madow:
It’s interesting you say that because recently I was having a minor pain problem and I
went to a physician. They were all over the map. I just wanted them to say, “I recommend
this, do it.” I’m never gonna get anything done.
Bill Rossi:
It’s so irritating when they do that. I think we’ve all had that experience where we go,
“Please, I want your advice. I know that I have to make the decision but can you be clear
in your recommendations?” And that brings us right back to clinical calibration, right?
Richard Madow:
No question.
Bill Rossi:
Ok, next one. The predictability trap. I can’t even remember who I got this from but it
really fits. Here’s what you, I’ll have hygienists all the time nod every time they hear this,
have you ever heard a doctor in the chair say, “Well, Rich, someday we ought to crown
that tooth cause the filling’s good and all. Now it could break tomorrow, it could break in
ten days, it could break a week from now or nine years from now,” and they keep saying
that and the hygienist’s just crawling the walls.
Richard Madow:
It is kind of a wussy approach.
Bill Rossi:
Yeah, and what happens is the doctors get caught in this predictability trap. Well, you
can’t predict anyone’s individual biology but presumably because you’ve calibrated,
when you say to a patient, “I recommend that we do this crown,” it’s because you’ve
done that equation in your head and in your own mouth you do it now. So you shift the
premise. Instead of saying, “We can do it a day from now, a year from now, it could
break, I don’t know,” you tell the patient, “It could break ten years from now, but it’s an
$800, $1,000 or $1,100 now for the crown,” the patient goes, “$1,100 is really
predictable. I don’t want to do it.” So you shift the premise. “Rich, in situations like yours
where we’ve seen this type of filling, we’ve seen the tooth break and it causes other
problems. That’s why I’m recommending we do this now. Our patients that have chosen
to get this done are glad they did; sometimes patients put it off and they are sorry they put
it off.” So what you’re doing is shifting the premise to what your experience and
judgment is, but you’re not trying to predict that person’s individual biology, so if they
don’t do it a year from now, they don’t come and go, “Aha! See, another year went by
and that cusp didn’t break off.” You’ve made the premise, “We’ve gave the advice based
on our best experience and what we’ve seen elsewhere, but we cannot predict your
biology. But if I were you, I’d do it now.”
Richard Madow:
Got it, good stuff, and good communication classics. Well, Bill, it’s come to that time
where we have to wrap it up. I would imagine, knowing you, you’ve got some great
closing thoughts for us.
Bill Rossi:
I guess I’m gonna end with the moment of Zen as we discussed. Here is another thing
that happens. It’s not that big a deal but it does make a difference. When the doctor is all
done, when the hygienists are done making the recommendation, just pausing and giving
the patient a minute, or maybe a whole five seconds to think. “So, Rich, anyway, I
recommended x, y, z now, and I’ve told you why I’m advising you to do this, but it’s
your mouth; you just tell us what you want to do and we’ll do it, so what would you like
to do?” Pause. Now most clinicians don’t do that. They kinda walk out of the room,
“Well, you know,” and then, as my associate, Shelly Ryan, who does collection seminars
says, then the treatment staff push a patient to the front desk and the front desk has to
skin a wounded bear. They really don’t have anything nailed down. And so just that
moment of Zen where you pause and let the patient tell you their decision, and if they
decide no, that’s their decision, but just give them that minute to make a decision because
often that doesn’t happen and then it just gets kinda sloppy.
Richard Madow:
I agree. Dental people feel like every minute or second of time has to be taken up by our
vocalization. I don’t know if we’re nervous or we just feel like there can’t be any science
and we just yap, yap, yap, yap, and I so agree. We talk about this many times in our
seminars where you say something and you just stop and you let there be like a little air
space in there, and typically the patient is gonna speak next, and usually it’s something
positive when they put their thoughts together and ready to talk.
Bill Rossi:
Well, in this interview I violated that rule or my own rule cause I’m blah, blah, blah, and
in these interviews I do that, but when I’m out there, I really do try to listen, and just as
you said, Rich, when you pause and listen, it’s amazing how much better the patient
compliance and relation and everything else is; it’s just amazing. But I think a lot of
doctors are uncomfortable with this because they don’t want to make the patient
uncomfortable, but if you’ve done all the above and you just pause and give them a
second, it won’t feel like pressure. And good things will happen as the patients make
better choices, etc.
Richard Madow:
No question about it. I was mentally looking for an outline. I think you gave about 46
different separate valuable tips that our practices could do, so you’re right; nobody is
gonna do all 46 of them, so pick and profit. Pick what you want to do, pick a few things,
assign someone to them, track things, make sure you do them and, Bill Rossi, just based
on your success you’ve had with practices in Minnesota and all over the country, we
know these things work. So you are up there in Minnesota and most of the practices in
that area are in the land of Prince and the Replacements and Hüsker Dü, but...
Bill Rossi:
I wanna get some more stars up here. This is getting old.
Richard Madow:
I don’t know what’s going on these days. I guess I’m an oldie, but the fact is you love
talking to people and you even will travel to practices outside of the area.
Bill Rossi:
Especially with the PPO Exorcism I find myself doing that. I’m on a mission with that.
I’m always happy to talk to your listeners.
Richard Madow:
So how so people get in touch with you?
Bill Rossi:
Ok, my company is advancedpracticemanagement.com or you can just google my name.
It’s usually amazingly still comes up pretty high and get to my website. Our phone
number is 952-921-3360. You can just call my office. If you want you can have a 20
minute conversation, but again, a conversation, so I’m interested to hear from you guys,
especially if you tried some of the stuff we talked about, let me know how it worked. But
everything that we talk about is tested; all of the stuff work.
Richard Madow:
How about somebody who wants to email you?
Bill Rossi:
I’ll give them my personal email, drossi.apm@gmail.com.
Richard Madow:
I don’t think I even have your personal email. I can’t believe...
Bill Rossi:
Yeah, you do.
Richard Madow:
Well, Bill, it’s great to have the Christopher Walken of the Madow Brothers audio series
back again. You always give great advice and this one I really love cause you just gave so
many different things. If you’re listening to this, no matter what kind of situation you
have in your practice, surely some of these will be great tips for you, so thanks for putting
this together. It’s always a pleasure speaking to you.
Bill Rossi:
My pleasure too, Rich. It’s been fun.
Richard Madow:
So for the Madow Brother audio series this is Doctor Richard Madow with our guest, Bill
Rossi and our fantastic crew here at Unsound Studios in an undisclosed location in
Baltimore, thanks so much, everyone, and we will see you soon.