Episode #351: Legal Strategy & Practice Growth: What Dentists Must Know to Thrive Without PPOs,  with Brian Colao

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

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

Michael Walker: Well, welcome to the Less Insurance Dependence podcast, your trusted source for insights, strategies, and expert advice to elevate your dental practice and career. I’m Michael Walker, your co-host, and I’m thrilled to bring you another value-packed episode with an industry expert. Today I’m joined by a special guest, Brian Colao, one of the nation’s leading experts on dental law, transitions, and DSO strategy. As the director of the Dental Service Organizations Industry Group at Dykema, Brian has spent years helping practice owners navigate complex legal landscapes while building more profitable, independent, and future-ready practices.

In today’s episode, we’ll be diving into the legal and strategic factors dentists must consider as they reduce their dependence on PPOs, prepare for growth, and ultimately take more control over their financial future. Brian will walk us through how insurance participation affects practice value and transition readiness, walk us through legal implications of dropping PPO plans, strategic ways to align your business model with long-term goals like exit planning or DSO partnerships, and finally, his top advice for dentists who wanna reduce insurance dependence without unnecessary risk. That’s a good idea.

Brian, it is great to have you here. Thank you so much for taking the time, and thank you for being part of our podcast.

Brian Colao: Well, thanks, Michael. It’s really a pleasure and honor to be here, and I appreciate your making time for me on your podcast.

Michael Walker: Well, we’ve got, uh, we know your background, and we were just talking, and it’s, uh, there’s a lot of things, a lot of moving parts these days, and this whole insurance is, uh, is a big one, and we’re seeing, hearing more and more conversations around that. So it’s perfectly timed to have you with us. And so I’ve got a, uh, question set up here. So let me go ahead and start off with our first one.

And the first question I have is, you know, you’ve worked with a wide range of dental practices and DSOs. From your legal and strategic perspective, how does heavy reliance on insurance impact the long-term value and flexibility of a practice?

Brian Colao: I mean, it can, you know, uh, harm the value in some situations. And I’ll tell you why. I mean, like, look at the situation we’re in right now—really, really tricky. We have, um, you know, uh, you know, inflation is at a level we haven’t seen, you know, in 25, 30 years right now. Cost of goods, uh, we haven’t seen it in 25 or 30 years at the level it is right now. Cost of labor is very, very high. With some of the, you know, tariffs and trade wars going on, the cost of goods may go up even further. And the reason this is relevant is because the reimbursement rates are not going up very much at all or staying the same. So you have this sort of unnatural situation where prices are—In a normal business, I always say this: even the plumber—you call the plumber and tell ’em you want ’em to come, you know, to your house, and the cost of fuel goes up—

Brian Colao: You know, the plumber says, "Hey, I’m sorry, there’s gonna be a $25 fuel surcharge. I just have to do it." Or, "You know, the cost of copper pipes has gone up, so I’m sorry, my rate for a house call that used to be a hundred dollars is now $125. Sorry about that." And the plumber ends up, at the end of the day, okay, because they raised prices.

Here in dentistry, we’re in an unnatural state of affairs. Costs are going up in the form of the cost of goods, in the form of the cost of labor, in the form of the cost to service your debt—because interest rates are up—and the reimbursement rates? You’re lucky if you get a couple points, a couple percentage points. You know, "Hey, great job. Congratulations. It’s going up 3% or 2%." You’re getting almost nothing.

Many reimbursement rates stay the same year over year for a while. Others go up a tiny, tiny amount, but not nearly enough to offset the increased cost. So think of it like this—I mean, EBITDA, earnings before interest, taxes, depreciation, is the gold standard for valuing practices and dental organizations.

And if you are, you know, you were used to—I’m gonna use silly numbers, Michael, that don’t make sense—if, you know, your costs were $500 and your revenue was a thousand dollars, and you’re used to having $500 of EBITDA, but now your costs are $700 and your revenue’s either a thousand or, let’s just say it’s $1,050 or just a little bit, all of a sudden your EBITDA that used to be $500 is now $350. And that will affect the value of your organization, and it could affect it substantially.

So it’s not every situation. I certainly don’t want to go on your podcast and tell everybody, "If you take insurance, you’re gonna go bankrupt," or something—you’re not. But being heavily dependent on insurance reimbursement rates, or even government programs like Medicaid or other things, creates this unnatural state of affairs where expenses go up, but your reimbursement rate stays the same or only goes up a little bit, and not enough to offset the cost. And that does, over time, erode your value.

Michael Walker: Yeah, what a great way to break that down, Brian. You remind me of—I used to own a chain of flower shops. And, um, don’t ask me how I got into that, but that’s quite a story. It involves a past marriage. I’ll leave it at that.

But the interesting thing was that we had, uh, we had—in that business, we essentially had the equivalent where we had wire services. So people would order their flowers from another city to our city, and we would fill the order, and then we’d send it out, and they took a 20% premium for every order off that. So, but there—I’ve got an order that’s booked, and I have to put it out the door at a price point that makes sense, relevant, but I have to match a design.

I can’t scrimp. I can’t do half a filling, so to speak, or—yeah, I can’t do less than a professional job. We still have to do it. But we really looked at it and we said, you know, our big exercise was, we know that it balances out our purchasing cycles with raw goods, raw materials, and thought, how much is the right percent to give us a balance plus to put us in front of people? That gives us a market that we’re pursuing and we’re intentionally going after.

So we made it very much a—so to me it’s like, don’t put your eggs all in one basket sort of thing. And there’s a benefit to it. Like, for us, we were able to position ourselves to do more high-ticket items—big weddings, big events, and things like that—that we wouldn’t have otherwise necessarily had access to. It would’ve taken longer to get there, I guess we’d say.

So I think to me, as I heard you say that, the other question I would have is: What can you—if you can’t—if you have to—if you can’t get more money from the insurance company, how can you buy better? Reduce your inventory costs? Whatever’s available? But from what I understand, Brian, that’s very difficult to do in your field.

Brian Colao: Yeah, you can do it, but you get one chance at it. Like I always say, you can’t cut your way to profitability, right?

Michael Walker: Yeah, exactly.

Brian Colao: You can go through everything one time. You can say, "Look, I haven’t looked at this in 10 years, so let me go through one time." And you might, in the short term—I mean, I would say if somebody’s listening to this that’s a practice owner and you haven’t looked at it in 10 or 15 years, you need to look at it, ’cause you are gonna find some valuable stuff the first time you go through. But after you run through one time and make some cuts and do some things, you’re kind of stuck at that point. It’s not the sort of thing that you can repeatedly go through and just keep cutting. And some people, if you’re running a lean and mean operation already, then yeah, there may not really be an opportunity for you to cut anything.

Brian Colao: And, you know, you’re gonna be stuck possibly—if you’re 100% reliant on insurance—in this unnatural state of affairs where costs and expenses go up and the reimbursement rate stays the same or only goes up a little bit. And over time—five, ten years—your EBITDA is gonna go down if you don’t make changes to that.

Now, there’s things you can do. You can introduce new lines of business for new revenue. You can leverage technology and increase your same-store growth. You can integrate specialty to add to the revenue. You can do those things. But if we were just saying everything just stays the same and we’re reliant on insurance—yeah, the numbers are gonna go down.

Michael Walker: Yeah, exactly. Thank you. I think the, uh—I was thinking—the concept of an airplane flying at an altitude of 30,000 feet, and it has to have at least a one-tenth of one degree attitude up, or eventually it’s gonna crash.

Brian Colao: Yeah.

Michael Walker: And it’s that one-tenth of upward that we have. And when you are fixed in this and you don’t look at that—and as you say, and I’m sure that’s something that you guys, you see and you do—is help companies look at those things. Look at what are the potential, what are the possibilities you can look at to make those shifts.

And based on what we just talked about, if I’m listening to something—okay, so I might just think about dropping some PPOs. So the next question I have for you is: What are the legal or contractual challenges practice owners should consider when they do start dropping PPOs or renegotiating—now that’s an interesting concept—or renegotiating insurance agreements?

Brian Colao: Yeah. I mean, okay. You have to understand what’s in your provider agreement first and foremost. And you gotta get a copy of it. I’ve got lots of clients and people I work with that say, "Oh, I’ve been with X, Y, Z—you know, payer company—you know, I’m not gonna name particular names on the show—but I’ve been with this company for years and, you know, we just… they just pay us."

I’m like, "What do they pay you?"

"Oh, I don’t know, whatever they pay us."

"Well, what does your agreement say?"

"Oh, I don’t know. Do we got a copy around here? How do we get— I don’t even know."

Or I’m representing somebody and they’re selling their organization, and somebody wants to buy it, and they’re like, "Hey, as part of diligence, they’ve asked us for all of our, you know, provider agreements with payers."

"Oh, we don’t know where they are."

Well, if you find yourself in that situation, you better get it, and you better go through it. ‘Cause the first step is—I would not counsel anybody to contemplate canceling anything or renegotiating it until you know what your rights are. You need to read the thing top to bottom.

And if, you know, if you struggle or maybe don’t understand it, you know, you can get with a lawyer or a consultant or somebody, and maybe they can help you read it and explain it to you. But one way or the other—either on your own or through the help of an advisor or a consultant—you need to understand everything that’s in there. What you have to do to terminate. I mean, you don’t want to, you know, suddenly tell them, "Hey, we’re canceling it this week," if the contract says you gotta give six months’ notice or something.

You need to understand exactly what your notice provisions are, exactly how you would go about terminating the contract, if that’s what you wanted to do. You need to understand how they can terminate it. If you start renegotiating with them and they don’t like what you have to say, what could they do back to you? You need to understand all of that stuff.

And when you have a good understanding of that, you can either, you know, cancel something—if that makes sense for you—or you can, uh, you know, renegotiate from a position of strength because you understand what all your contractual rights are under the existing arrangement.

The last thing is purely a business—you need to, if you don’t know—and it’s another thing, Michael—I ask people, "What’s your payer mix?"

"Uh, well, I, you know, I don’t know."

If you don’t know, you need to tell me—and we’re gonna use silly numbers again—if you’ve got a hundred patients, you need to tell me how many are on X, Y, Z, how many are on A, B, C, how many are on E, F, G. Like, you need to know exactly. So if you look at something and you’re like, "God, I hate these folks. They’re not paying us hardly anything."

"Oh, they’re only a half of a percent of our business."

"All right, we’re canceling that right now."

Or you look at something and you’re like, "Look, I don’t like what’s going on here, but—oh, they’re 54% of our business. Oh, we better tread lightly here until we get a backup plan in place."

So you really need to, at a granular, molecular level, understand exactly what your payer mix is, and then also understand what your rights are and what their rights are. And once you have a clear picture, you can figure out what makes sense for you and how to go about it.

Michael Walker: Yeah. That was so, so incredible. Again, it’s, um—that need—knowing your background, it’s interesting. I see a lot in the—I spend a lot of time in the dental world, in vet professionals, and, um, dental professionals, and as well as medical professionals. And there is a common thread that I find when it comes to what you just said: most of those professionals are accidental entrepreneurs.

And they don’t—they don’t look at the contract, they don’t go through. That’s not their passion. There’s people that are passionate about that, that—they love details, and they love the numbers, and they love to crunch them, and they thrive on it. They’re usually energized by stuff rather than people. But then, that’s a great place for them.

Brian Colao: Michael, you’re from Canada, so I’m gonna use an analogy that I know you can understand, okay? I wouldn’t use this for everybody, but I feel like this one will work for you.

The dental industry—and you’re talking about vets too, a lot of healthcare right now—they got caught in a line change. You know what that means. Up in Canada, you see—you get caught in a line change because everything was going one way, and then all of a sudden you wanted to put a line on the ice, and maybe you didn’t get out there quick enough, and oh my God—somebody had a breakaway and they scored a goal that normally wouldn’t have happened.

Well, that’s what we find ourselves in dentistry. Everything operated one way for a long, long time. And then all of a sudden, almost overnight—around June of ’22 and shortly thereafter—the interest rates doubled and tripled, and inflation hit rates that it hadn’t hit for 30 years ago.

Brian Colao: I mean, I was around in 1978 with my lawn mowing, cutting business, when I’d go to all the neighbors and cut their lawns. And I remember interest was like 12, 13%. So I—you know, if I had a hundred dollars, I got 12, 13 dollars on that. At the end of the year, you had a thousand dollars, you got 120, 130 dollars. That was good money when you’re like 14.

But, you know, now we’re seeing these rates that—unless you were around in 1978—and a lot of the dentists and DSOs, they weren’t around. They didn’t see this. And now you’re seeing it. So it’s a line change. We got caught in a line change here.

And, uh, to your point that you were making earlier, back in the old environment, before this sudden change of everything, you could be successful despite yourself. You could say, "Look, I went to dental school. I don’t know anything about business, but I know I just take out a loan, open up this practice, people will come. I’ll take whatever insurance pays me, and somehow, at the end of the year, there’s going to be a pretty decent amount of money there, and that’s what’s gonna work."

Those days are over.

Now you’ve got to fundamentally understand the business of dentistry. Understand your expenses. Understand where your revenue comes from, what it is in terms of reimbursement rates, and make necessary adjustments. Otherwise, you know, you’re gonna get caught in a line change.

Michael Walker: I love it. What a great analogy. That’s so true. And just for the record, maybe next year the Toronto Maple Leafs will go win the Stanley Cup.

Brian Colao: I—we’re gonna pass on that. I was up there, Michael, at the Women in DSO conference—staying right up at the Ritz-Carlton right across there. And all those hopeful fans were walking by me, and they—you know, it didn’t end very well for them. And I was up there seeing some of it unfold around me.

Michael Walker: Well, you know, the good news is, with Canadians generally, we don’t have—we generally don’t have major riots over disappointment, but we do have—we do have grumpy faces.

So yeah. You know, you’re talking about this idea of, you know, knowing what you’re going into to make a decision and having the right—knowing the numbers and stuff.

I’m a—what I do mostly is, I’m a professional mediator. And, and so, you know, we always talk about having—having your BATNA—your best alternative to a negotiated agreement, right? And that—and, uh, knowing that gives you a place of power.

And those—you know, and they—what is it, John—uh, Kenny Rogers: “Know when to hold ’em, know when to fold ’em.”

And it’s just about—to your point—kind of all of the—everything we’re talking about is built on either bringing in, to support you, the business acumen you need, or learning it yourself.

But there needs to be—to your point—if you haven’t done that since 2022, with the shift in the market, then you’re probably feeling very frustrated, maybe even overwhelmed or wondering where to turn to.

So thank you, Brian. You’re giving us some great tips and direction to sort of think this thing through differently. And I’m pretty sure that the podcast listeners are appreciating that.

And so, uh, that’s gonna take me to one of my favorite words: transition.

And so for any dentists sort of considering future transitions—so they’re looking maybe at mergers or acquisitions or DSO partnerships—how does insurance participation affect deal terms and buyer interest?

Brian Colao: Well, only in that it can affect your EBITDA. Okay? You know, EBITDA is the gold standard. You’re gonna get paid a multiple of EBITDA. Those that don’t know this—the reason we use EBITDA as the gold standard for, you know, practices and groups is—you go to a dental conference, and somebody’s got a $1 million practice, and somebody’s got a $2 million practice. And this is true, I see it all the time.

The $1 million practice costs $600,000 to operate. What’s their EBITDA? $400,000.

The $2 million practice costs $1.8 million to operate. What’s their EBITDA? $200,000.

What have we learned? The $1 million practice is twice as valuable as the $2 million practice. So this is why we use EBITDA—that’s why we do this.

So, um, if you’re heavily reliant on insurance, it’s gonna affect your EBITDA potentially, and it could affect your ultimate valuation. I mean, no one is not going to do a deal because you take insurance.

It’s so commonplace in the United States and the way we do it—and it’s coming to Canada too with that program you guys are rolling out. You guys are—you know, welcome to the party of unhappiness. You can’t wait. You guys are finally gonna join the pity party of unhappiness.

But anyway, down here in the U.S.—yeah, I mean, usually there’s almost no one that’s not gonna buy an office because you take insurance. That’s the way it is. But if it’s lowering your EBITDA, it’s gonna lower the ultimate purchase price that you get. And, you know, that’s not terrific.

Michael Walker: No, absolutely not. And I can see—yeah, that’s so funny you mentioned that. I was—it’s funny, there’s—I was just at the dentist the other day, and I noticed a sign that said that we are accepting a limited number of—whatever, I can’t remember what the acronym is for the program.

But I thought, isn’t that interesting? I hadn’t even thought about it. I said, “Yeah, we’re joining the party of unhappiness.” I like that.

Brian Colao: When we talked about that at the Women in DSO meeting in Toronto, it was very much on everybody’s mind. It’s like the Canadian—I can’t remember the acronym—

Michael Walker: Canadian dental program or something.

Brian Colao: Yeah, something like that. But what they’re saying is, the expectation of a lot of the patients is gonna be that the practice is gonna have to apply for that, and they just want to get treatment and they’re leaving—and good luck to the practice to get reimbursed.

And that’s where I said, “Welcome to the pity party,” because once you start trying to get reimbursement, you know, what you think and what you get often are two different things. So that—you know, it’s the way of the world, I guess.

But yeah, you know, the question of yours—yeah, to the extent it affects your EBITDA negatively, you know, it’s gonna affect your purchase price. But the overwhelming majority of practices in the United States take some form of insurance. So it’s certainly not gonna stop a transaction from happening.

But that’s why we tell everybody, you gotta do a checkup. If you think you’re gonna make a transition in six months, a year, two years—now’s the time to evaluate all your payer sources. Everything we were talking about earlier—should we cancel some insurances? Should we make some adjustments? Should we renegotiate things?

Because anything you can do to boost or increase your EBITDA in the next—like, let’s say you’re gonna sell in two years or something—anything you can do in the next two years to boost your EBITDA is gonna boost your purchase price, boost your enterprise value.

Brian Colao: Yeah, I mean—two points there. The first one is, artificial intelligence is the single biggest advancement in the history of the dental industry. And how it pertains to our insurance discussion:

One, it helps you diagnose more cases—ethically—because diagnostic AI can catch things that the naked eye might miss. So you can do more cases.

Two, it stops the insurance company from denying your claims, because if the AI agrees and concurs that there’s a cavity there, there’s like an objective second set of eyes on it.

And then the third thing it can do is, the AI can help you submit your claims so they’re 100% accurate. Human beings are perfectly imperfect, Michael, as you know, and we’re going to make mistakes on things.

Michael Walker: Other than us. We are—but that’s, yeah—no. Maybe.

Brian Colao: We’re good. We’re having fun today. But, you know, human beings are perfectly imperfect. And no matter how hard you try, if you do a thousand claims, you’re gonna have some errors in there. But the AI doesn’t make mistakes—I mean, unless it’s malfunctioning at a fundamental level—but the AI does not make mistakes.

If it says, "Hey, for this claim to be approved by the insurance company, these 17 things have to be checked," and I’ve been programmed—it will never submit a claim that doesn’t have all 17 of those things, you know, sort of checked on it.

And it can also auto-adjudicate claims, where it goes with the carrier and gets auto-approvals. So, you know, AI really can help with all this stuff.

But your original—your other—question is, you know, what is the threshold for evaluating insurance? Yeah, I mean, you gotta look at the reimbursement rates.

Brian Colao: I mean, the answer is kind of simple on that. If something is giving you way below market reimbursement rates—I’ll give you an example, and this is a true case that happens.

If you have to pay, due to a staff shortage—as we do all the time in the United States—$85 an hour for a hygienist, but insurance is reimbursing $40 an hour for a cleaning—I mean, you know, it’s okay now and then if you have to do it. But if that is your core business all the time, you’re gonna lose money.

And if instead the insurance company reimburses at $100 and it costs you $85 an hour, at least you’re making some profit in there.

So, you know, you gotta look at the reimbursement rates and look at your cost of labor and your overhead and see if it makes sense.

There are situations, Michael, as you pointed out, where if you have capacity, you could say, "Look, rather than us just sitting empty on these days, at least we’re breaking even or we’re only losing 10% instead of 100%."

You know, you can make some decisions like that if you have to. But if you’re in a situation where it’s literally like, "Our reimbursement rate is $40 and it’s costing us $100 for this hour"—you know, you really gotta reevaluate whether you don’t eliminate that somehow.

Michael Walker: Yeah, yeah. Thank you. That’s—you say it so much more professionally and eloquently than I do. Thank you, Brian.

Brian Colao: Well, I hope I’m adding some value here.

Michael Walker: You are. It’s all day long.

Brian Colao: I’m happy to be here with you.

Michael Walker: And the fact—and the fact that you recognized our national sport and didn’t make fun of the fact that we can’t seem to win, but that’s a whole other story.

Let’s go in—I got a question for you, kind of as we get close to wrapping up here, Brian.

What advice would you give to practice owners who are ready to take control of their revenue model—which is what we’ve been talking about—and getting the knowledge and all the things we’ve been talking about, but want to do it with minimal legal or operational risk?

Brian Colao: Okay, so the first thing—this was a cliché from the seventies or eighties—you’re old enough to remember it. Remember the old “Knowledge is power”? That little thing on Saturday morning with the cartoons? Knowledge is power. It’s true.

You’ve got no business changing anything about your operation until you understand your operation—until you’ve gone top to bottom, evaluated everything. All the things we talked about earlier on the podcast: where all your revenue’s coming from, what’s the highest percentage, what’s the reimbursement rate, what’s your right under the provider agreement, what’s the payer’s right under the provider agreement.

When you know all that, then you can say, “All right, at this point in time, let me sort of evaluate where we are.” And I think what you gotta do is—the first thing is educate yourself on all that stuff.

Understand your rights and where all your revenue’s coming from, and then you can start to make judgments. Some of ’em might be easy: “Hey, that insurance company that’s a half a percent of our business is paying us $40 when it costs us $100—cut them right out of here. There’s no point. It’s not gonna hurt our business. We can fill a half percent of our business from somewhere else. Let’s go do that.”

Things might—just start—obvious, low-hanging fruit on the tree might start to just be obvious once you have information. If you don’t have information, then things become much more confusing.

What I tell clients when I’m advising them, Michael, is: Do you want to be a caveman or a weatherman?

Remember the caveman—maybe you weren’t there—but remember, they came out of their cave and they’re like, “Oh wow, it’s raining today. Oh gosh, it’s hot today. Oh, it’s cold today. Looks like a storm.” There’s a storm happening—and they don’t know. It’s just like, they walk out and whatever life hands them is what they take.

Today we have weather satellites that say, “Oh no, it’s gonna be 92 degrees. It’s gonna rain. There’s a severe thunderstorm warning. It’s gonna be cold. This is gonna happen.” So you can plan ahead.

To do that, you had to launch into outer space a satellite to look at everything. Well, create your own control center for your practice.

Too many people are flying blind. They don’t know. If I start asking them questions:

What is your EBITDA?

– “Uh, I don’t know.”

What is your total revenue?

– “Oh, I don’t know.”

How many insurances do you take?

– “Uh, I don’t know.”

Where are your provider agreements?

– “I don’t know.”

What percent of your revenue is with each insurance company?

– “Oh wow, I’m kind of confused at that.”

What is your overhead? Tell me all your labor and what is it?

– “Uh…”

If you’re confused by all of these questions, you better build out your control center. Because if you don’t have the answers to these questions, you’re more like a caveman. You’re just—whatever life delivers is what you’re gonna take. You don’t know.

Versus, if you’ve got the answers to all these things, you can start to make really intelligent decisions.

Michael Walker: Well, you just pretty much summarized up all the key elements we’ve been talking about. And I was thinking, if you go from the caveman to the weatherman to a Formula One racing driver—the one thing they have is a very complex dashboard on their steering wheel.

But if you think about that control center they have that monitors everything about it—we’ve kind of advanced. But it’s interesting too, I think what we’re talking about is being more aware of information about your business: the flow of information, the cost, the revenues, all the different ratios that are important to a dental practice directly.

But it’s not an annual event. It needs to be something that’s regular, that’s part of your—

And I think that’s sometimes what gets left. You leave it too long and then it’s, “I don’t know where to even start.”

Brian Colao: There are technologies that’ll give this to you, Michael, in real time.

If you’re using the modern PMS systems, if you’re using other things that will sort of give you KPIs—key performance indicators—you used to have to wait 30 days to get it. You get it that day.

Like that day, you can figure out, “Hey, where are we? What’s going on today?” You click on it and it’s right there, and you can make decisions, you know, in real time.

So that’s the other thing—leveraging technology. I mean, we touched a little bit on that, but, you know, that’s critical to all of this.

Michael Walker: Yeah, exactly. So the argument is—emotionally, it might feel like it’s overwhelming, and your amygdala’s telling you that it should be—but the world’s moved on from the caveman era, and it’s into the weatherman and into moving a lot faster.

So I just—I think one of the big takeaways for me, Brian, as I’ve heard this today, is being intentional with understanding where I’ve been, understanding where I am at, and having a picture of where I’d like to go—and then reverse engineering that back.

And I kind of hear it—being intentional with the parts and moving parts.

Clearly, unless you’re an expert in all this, then you’re probably gonna need to reach out to someone like Brian and get some support to help with this. It’s tough to be an expert in everything.

It’s better to be a—I always, like with my coaching clients, I like to say, “We’re gonna take 80% of you and focus on the 20% of what you’re great at.”

And how do we help dentists do that? I think this conversation’s really helped give perspective on the broad context, but also pull it down to: there’s some next right steps that have come out of this. Or doing one thing differently. Where are you gonna start? How are you gonna start reducing insurance dependence? What do you need to look at before you start putting that into motion?

Brian, thank you.

Brian Colao: Yeah. I mean, look, I’m starting to do some teaching in dental schools. And what I teach is the business of dentistry.

I can’t help anybody fill a cavity—I don’t have a dental license—but I can teach people about the business of dentistry.

And, you know, on the first day of class, I sometimes ask the students:

– How many courses have you taken on negotiating with a landlord? None.

– How many have you taken on ordering the supplies and equipment? None.

– How many have you taken on negotiating with payers? None.

– How many have you taken on being human resources—hiring and firing, and giving raises to employees? None.

And, you know, so you don’t gotta feel bad if you’re listening to this and you’re like, “Oh my God, this is overwhelming. I don’t know anything about it.”

You can get help. And you shouldn’t feel bad.

You went to dental school to learn how to be a world-class clinician. You didn’t learn all these business things—although we’re starting to incorporate it now—but, you know, back in the day that wasn’t part of the program.

So it’s okay that you don’t know all these things. But we can help you. If you’re willing to spend the time and the effort, you can get help for all these things, and you can become good at it.

Michael Walker: Uh, would be great at it. Absolutely. So far, my—we’re parallel in that, Brian, as I coach people out on communication, conflict resolution, and change, and really focus on that people side and those difficult conversations, those money conversations, the treatment—all those things. That’s just not—most, there’s no—that’s not their field of expertise. And they didn’t go to school for it.

So Brian, we have run outta time.

Brian Colao: I’m having fun. I’m just starting to have fun—

Michael Walker: I know!

Brian Colao: —and now it’s over.

Michael Walker: That’s it. Well, that’s—you know, you left a line wide open there that I can’t go to, but…

Brian Colao: Thank you.

Michael Walker: Thank you so much, Brian, for joining us today and sharing your powerful insights on legal strategy, transitions, and the financial impact of insurance participation.

Certainly, your experience and clear advice are incredibly valuable for our listeners, especially those looking to build thriving independent practices.

As always, we say this podcast is about taking action. That’s clearly what Brian has been talking about. And 2025 can be your year of transformation.

If you are ready to move beyond PPOs, here are two steps you can take right now.

First, if you’re looking to attract more high-quality patients and grow your practice organically, I encourage you to schedule a complimentary marketing strategy meeting with Ekwa Marketing. Their team will show you exactly how to build a reliable, insurance-free patient flow through strong local SEO—search engine optimization. It’s a digital platform.

Visit lessinsurancedependence.com/marketing-strategy-meeting  to book yours.

Michael Walker: Now, I can tell you—wherever you’re picking up this podcast—there’ll be a hot link for that, so you’ll be able to grab that there. But it’s lessinsurancedependence.com/marketing-strategy-meeting  to book yours.

Second, if you want hands-on guidance to create a profitable fee-for-service model, you can book a complimentary coaching strategy meeting with Gary Takacs. Gary has helped thousands of dentists across the country reduce insurance dependence and grow true practice freedom—I love that term.

Visit thrivingdentist.com/csm  to learn more.

And Brian, if people want to get a hold of you, how would they do that?

Brian Colao: Yeah, you can reach me—uh, all my information is at dykemadso.com and you can get—you know—how to get me: email, phone, it’s all there.

And, um, one other thing I’d say is, we’ve got an industry-leading DSO conference coming up, August 6th through the 8th in Denver, Colorado. And, um, details can be found at dykemadso.com.  It’s not too late. It’s gonna be sold out, but anybody that hears this, that wants to attend—come on down to Denver, and we’d love to see you.

Michael Walker: Awesome. That’s good to hear, Brian. Uh, and when is that? 

Brian Colao: August 6th through the 8th this summer—coming right up—2025, August 6th through the 8th, in Denver, Colorado, at the Gaylord Rocky Mountain Resort, right by the Denver Airport.

Michael Walker: Yeah, I know where that is exactly. And the Broncos might be playing at home!

So if you found today’s episode helpful, please share it with a colleague or friend. Together, we can help more dentists take control of their practices and their future.

I always like to say—it’s important that, you know, we’re trying to help each—Brian here today is trying to help set you up for success. This is a great opportunity for you to help others—set them up for success.

Thank you again for joining us today, Brian. It’s been awesome, and I certainly look forward to meeting with all of our listeners. I hope you’ll come back to our next podcast on the Less Insurance Dependence Podcast.

But until then, keep moving toward a thriving, independent practice. On behalf of Brian—until next time—we’ll look forward to seeing you.