Episode #387: From Insurance Pressure to Practice Freedom, with Eric Vickery

Naren Arulrajah: This is the Less Insurance Dependence podcast show with my good friend Gary Tackers 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.

Lester De Alwis: Welcome to the Less Insurance Dependence podcast. I’m your host, Lester De Alwis. This podcast is designed to help dental professionals build stronger, more profitable practices with less reliance on insurance. Before we begin, a quick message from our sponsor, who is sponsoring this episode. Ekwa Marketing is offering a complimentary marketing strategy meeting to help practices attract high quality patients and grow through strong online visibility. You can book a complimentary session through lessinsurancedependence.com/marketing-strategy-meeting, a complimentary session. And if you’re ready to move towards a thriving insurance independent practice and you’re looking for, mentorship, you can schedule a complimentary coaching strategy meeting with Gary Takacs atthrivingdentist.com/csm. Now, today I’m excited to welcome Eric Vickery. Eric has coached dental practices for over 25 years and has helped countless teams improve leadership, increased case acceptance, and stop costly cancellations in. And in today’s episode, which is titled, from Insurance Pressure to Practice Freedom, we will explore how leadership, communication, and strong systems allow practices to move beyond insurance driven limitations. Welcome, Eric. We’re so excited to have you here. Thank you for joining us.

Eric Vickery: Yeah, thank you for having me, Lester. I appreciate it. Love the show.

Lester De Alwis: Amazing. Now, let’s start here. After 25 years of coaching, what keeps dentists stuck in insurance dependence, even when they want more freedom?

Eric Vickery: I mean, the first thing that pops to mind is fear. And a lot of our clients, when I’m working with them or talking with them or just people that aren’t our clients that we’re talking with, you know, false evidence appearing real, there’s this fear that what’s gonna happen on the other side. They don’t really understand the numbers. They don’t really un they’re working out of a, out of a place of emotion and not a place of actual economics or understanding of what’s gonna happen when you do this really well. And they don’t really know how to do it. I don’t think they understand the system or how to make this a successful transition. You know, they’re so, it’s so easy to move into an out of network position first. And I think a lot of them think, oh, I now I need to be a, an only a fee for service practice as well.

Eric Vickery: They think, oh, well, all patients gotta pay me and insurance gonna reimburse them. And it doesn’t have to be that way either. You can, you can have the insurance checks come to you and charge a fair rate to everybody and be an out-of-network provider with I believe, all but two insurance companies. So there’s a way to do this in a healthy way. And even with those two that aren’t, you know, sending the check to the practice, we can do that too. And get there, get to a place of a healthy practice. And I think the economic part of it, Lester, is this, if you imagine you’re getting, let’s say you’re seeing all in network patients all day long, 10 patients a day, you’re probably getting reimbursed for, what, six a day? 5.8? ’cause I think the average write off rate’s 42% right now.

Eric Vickery: So you’re getting paid for six. Well, you have the expenses for 10, but you’re, you’re getting reimbursed at the rate of six. So you’d have to lose 40% of your practice just to break even. And that never happens. What typically would happen is maybe you lose 20% of your, of your patients that were there, and now you’re seeing eight patients. Well, you’re no longer getting paid for six, you’re getting paid for eight. So immediately your expenses go down, your profitability goes up. Now your production may go down, but you’re, but your collections is what you’re worried about. That’s what’s gonna go up. Mm-hmm . So, and if you do it the right way, it’s, it’s a very simple process that a lot of dentists just need to wrap their brains around and understand. So that, I think that’s the thing that gets in the way the most

Lester De Alwis: Amazing. And that’s a powerful point. And I think it’s basically a great way to start this discussion. Now, insurance often becomes the visible problem that, like you said, now many dentists blame insurance for low profitability. How often is the real issue, case acceptance and leadership in inside the practice?

Eric Vickery: So you’re really talking about our big three. We love leadership. We love case acceptance, we love insurance freedom. I think the first thing to understand here is that everyone on the team is a leader. And in leadership, you’re talking about being the thermostat, not the thermometer. You’re setting the tone. So if you’re, you know, a key team leader, you’re any team leader that has interaction with patients and your mentality is one of fear, or you don’t have the mindset that this is doable and you’re worried a lot, or your perspective is, I would only go to an in-network dentist ’cause of the fees, then we’ve got a problem. And so the first shift we have to understand is everyone’s a leader. Everyone has influence on your patients. And we’ve gotta shift our mindset to understand that actually being an outof network provider is really fair for the practice.

Eric Vickery: And I don’t think a lot of team members understand the profitability of a dental practice when most small businesses in America are anywhere around, are basically around 25% profitability. And a small dental practice, is a small business. So one to two doctors, and their profitably profitability point may be no different. It may be 25%, maybe higher than that. The goal would be to get it higher than that. And I think if you’re writing off 42% and your profitability points 25%, it just doesn’t add up. How do you stay in business at this rate? Team members are gonna get paid the same, the dental supply companies get, they don’t go, oh, you’ve got a network patient walking in right now, we’re gonna lower your, you know, dental supply bill by 42%. That doesn’t happen. And so we all need to know the numbers and we all need to recognize that we’re we’re leaders.

Eric Vickery: And then the second point, you brought up case acceptance. There’s only two ways to grow dental practice. And I think a lot of dentists and team members only know about the first one, more patients, more new patients, more butts in seats, overdue, unscheduled hygiene patients, more referrals, more marketing, which is fine. We need that. And there comes a point where you can only see so many patients. You’re not gonna grow the practice anymore. You only have so much square footage. You only have so much operatory space. There’s only so many hours in a day. You’re only willing to work so much. All of that. And we have to understand, the second way to grow a practice is getting patients healthier faster. So more dentistry per sit down, longer appointments, taking care of a patient, as long as possible to get them as healthy as possible, as quick as possible.

Eric Vickery: So case acceptance becomes one of the insulators and pillars of saying, okay, I’m getting 80% of my patients scheduling 60% of the dollars minimum when I do case acceptance. And am I doing that because I’m in network or am I doing that because of credibility? Great verbal skills, you know, whether it’s on the phone converting new patient callers or whether it’s in person. I’ve got great personality and people warm up to me. Well, and I know how to communicate an effective way that gets people to understand what’s going on with their dental needs. I will use the word need in this case, even though I don’t like that word. And having patients want a better word, want to move forward with more dentistry. So if you’re, if you’re able to do that both from a leadership case acceptance, growing the practice way, then you start to recognize, hey, I have some ways to be profitable that aren’t relying solely on more new patients that are in network.

Eric Vickery: And I just need in-network patients, if you love being in network, I don’t think it’s smart. I don’t think you would even say this. I want all my new patients to be from that. In-network insurance company, most dentists are going, we want to get new patients from an out-of-network source. That’s fine. Do that so that you can let this go. And Echo does a great job with their clients. And I don’t think you guys are charging 42% of new patient or patient value when they come in. If you were paying 42% of value of all of your case acceptance to a marketing company, you’d probably fire them. You’d probably say that’s unrealistic. And yet here we are saying, I need to be on the list so that I get this patient in instead of saying, I’ve got really ver really good verbal skills on the phone that I can rely on to convert a patient who has MetLife insurance, who calls to practice and go, yeah, we see patients all the time that have MetLife. They pay us. And know that you’re an OUTTA network provider and not think mentally, oh, I have to be a network for the this patient to want to see me. You’re, you’re setting your lid, your law of the lid as John Maxwell says, right? You’re setting your lid and saying, oh, I can only do this. No, you have to believe first that you can get through that as a entire team, including the doctor.

Lester De Alwis: Amazing. Amazing. Yeah. Yeah. Now, when a practice improves case acceptance and reduces cancellations mm-hmm . How does that change establ to move away from PPO dependence?

Eric Vickery: So I’ll tell you a story about a client in North Midwest state mm-hmm . are we allowed to name insurance companies on this? I don’t want to get Yeah,

Lester De Alwis: You can. You can go ahead. Okay.

Eric Vickery: . All right. So he was in network with Delta as a premier provider, not even a PPO provider. His write off rate was getting north of 35%. His, total patient population was north of 64% of the practice and his future, that was the only thing he was in net worth. And he thought, okay, I’m in trouble here because the infection is spreading. You know, this is taking over my practice and I can’t grow, I can’t do anything but start to work Saturdays or evenings. And so we ended up seeing a 20%. So we took our system and put it in place, and then we went for case acceptance. And then we went through the process over six months of resigning from Delta by having the conversations with patients. And at the end of this, what we saw was a $20,000 reduction in production.

Eric Vickery: Production went down 20,000 and collections went up 40,000 a month. Now that has a lot to do with his numbers being so high, meaning such a high write off rate in such a high percentage of practice was in network. But when you put case acceptance in play, that means people are showing up for their hygiene visit. They’re not saying things like, well, it’s just a cleaning, oh, just reschedule me. So you’re preventing cancellations with case acceptance verbiage. And the second thing is, patients understood that they wanted to take care of their dentistry. So again, they were doing more and re recognizing that insurance has a thousand or $1,500 a year play in this. And if it’s a $10,000 treatment plan, it really doesn’t matter if you’re in network or out network, you’re probably doing extended payment options with an outside company anyway for this. So once we free our minds to understand that concept and go, all right, well, I’m no longer presenting the crown of the your club here because I’m, I’m limiting myself. I’m actually talking about the whole thing in a healthy way in a, in a successful way. And again, 80% of the patients scheduling 60% of the dollars minimum. And if you don’t know what that is, your KPI trackers need to be in place for that. Then you say, I have room for improvement before I go outta network with insurance. And once you start seeing that, then you have the right and the ability to move forward with the conversations on removing yourself from that restrictive insurance plan. I hope that makes sense.

Lester De Alwis: Yeah, that does, that does. Okay. Now, when it comes to leadership shift now Yeah. What leadership chips must owners make if they want their team to confidently support an insurance light of fee for service model?

Eric Vickery: Yeah. for me it’s mindset first. And if you’re not strong, if you, if you don’t have a champion mindset yet, you’ve gotta start there. You gotta work on your self belief. And I think a lot of dentists, rightfully so think, well, if I just go to more clinical ce, I’m just gonna be a master clinician and I’m gonna feel better about who I am. I’m more confident walking in there. Well, that’s, that’s fine. Dale Carnegie, I think, started this with how to win friends and influence people, and said, what 15% of your success is foundational. It’s clinical, it’s tactical, it’s technical skills. But 85% of your success is gonna come from your people skills, leadership, case acceptance, verbiage, how you communicate with your team and your patients. And so you’re only as effective as you can communicate. We all know this. So, is your communication model effective?

Eric Vickery: Meaning this, if you’re a level 10 clinician, but you’re a level five communicator, your patients only perceive you to be a level five clinician, level five, mm-hmm . So keep going to the clinical ce, that’s fine. But if 85% of your success is coming from your people skills and your ability to work with people, are you spending CE time, energy, and money on growing your mindset, your people skills, how you interact with others? So the first shift is mindset. The second shift is how do I interact with people? So, you know, understanding your DISC personality style, your strengths, Gallup strengths finder, understanding your emotional intelligence. These are foundational for us in our leadership training. And we love training. Doctor. I’m a John Maxwell certified, coach. so are, so are our coaches on our team. And we love using his systems for things to put in place here.

Eric Vickery: And EQ for me is the, I guess the anchor, the core foundation of learning. How do I work with people? ’cause I gotta work with my team first, then I gotta be able to work with my patients. So think mindset, think relational connection with people, and how do I interact with them? How am I being received by others? ’cause if I’m not being received well, maybe I have to rely on being a network because I’m not, I don’t understand how to win people over, both from a leadership standpoint and from a clinician or dentist or provider standpoint. Am I ma making sense there?

Lester De Alwis: Right. So I think for dentists listening today and listening to this conversation, on this, episode, who wants more control this year? and what are the, what are the first practical steps they should take to move forward towards the true insurance freedom?

Eric Vickery: Oh, gosh. So many things. , I don’t know what we wanna limit it to. I don’t like overwhelming people with a lot of stats or a lot of information. Mm-hmm . I think you gotta be having fun at work. I think you gotta work on your mindset. I think you gotta understand your KPIs. I think it’s best to work with people who’ve done this before. And I know Gary’s talked about it time and time again, please don’t send a letter out. Please don’t make that mistake. We get a lot of clients at All Star Dental Academy that come to us saying, I made a mistake, I sent a letter out and I had a mass exodus. That’s not how you do this. You do this with effective communication. And I said all the time to our clients and our coaches, the answer almost always lies in effective communication.

Eric Vickery: So if you can learn how to effectively communicate both with your team as a leader and with your patients as a provider, you’re gonna have an excellent outcome when it comes to resigning from insurance. And I think the other thing you need to know is what is your total patient population that is in network by carrier? You need to know what that percentage is in each of those. So how many patients are in Emeritus Aetna, MetLife, Cigna, guardian, you know, name ’em all of those out. And then what does that, each of those percentage of by practice, number of patients, percentage of practice, and then also like Delta or Blue Cross Blue Shield, ’cause they’re handled differently. And then the next part of it is, what is my write off rate for each of those carriers? How much am I, how much is, does Aetna cost me?

Eric Vickery: How much does emeritus cost me? Because that’s gonna help you figure out patient population and percentage of write off, which of these plans should I target first and at what amount? And please don’t go like, well, I’m gonna handle 2% of my practice at a time, 2%. Two, you’ll be here forever. And you’re not gonna get ROI on the effort it takes to do this. You’re going about the wrong way. Think of like, I’m buying a mutual fund, I’m buying a lot of stocks the same time, but I’m not putting all my eggs in one basket. And so understanding the approach is important. What insurances do what, for example, I’ve had clients come to us and they’re like, I keep resigning from these individual insurance plans, but I’m over here in zealous connection, whatever it is, you know, these brella plans, I’m trying to think of the Carrington, these other, these other types plans, you know, unit toss or something like this.

Eric Vickery: And what’s happening is I’m resign from Cigna over here. I spend all this time, and then they just gobble ’em up over here, and they’re back. I’m back in network in this brella. And so knowing that you can’t do that, you can’t approach it that way. So having someone on your team who’s done this before, you know, having, I love this podcast. It’s helping so many people move in the right direction. But gosh, don’t be afraid to ask for help. I think that’s key. And then from your perspective, new patient flow, healthy, new patient flow, at some point, you know, you’ve gotta recognize, you know, at least you know, there’s a sweet spot. But let’s say adults, non-emergency, comprehensive exam, new patient flow at 15 per doctor, let’s say. And if you’re not getting that, why is that? Did, are the patients, you know, afraid of you?

Eric Vickery: Are you not winning them over? Marketing is bad, whatever that is. And lastly, I’ll say this, and I say this to all of our coaches as they help clients resign from insurance. But are your patients marrying you for the money or are they marry, marrying you because they fell in love with you? And if they married you for the money, that means they married you because they’re in network with you, right? Mm-hmm. And it’s like in the movie, in the movie, you’re rooting for them to fall in love for the real reasons, not just for the money. Here you’re deciding as you look at your insulators or your pillars of supporting your practice, saying, okay, are these patients choosing us because of our reputation, because of the service we provide, because of the clinical dentistry we offer and et cetera? Or are they choosing us? ’cause we’re on a list and they’re putting up with the lacking in those areas that we’re having, the deficiencies we have in those areas. And I want to make sure that all practices have those pillars and insulators dialed in before they ever consider resigning from an insurance plan. Meaning, I know my patients will stay with me because they love us. That’s what we want to make sure we do first.

Lester De Alwis: Yeah. Amazing. Amazing. Now, some great, some great nuggets, some great advice Australia in this podcast and in this episode, and I think you do some great work at Allstar Intel Academy. you and your team, and I think anyone listening in will love to have a chat with you or even get some advice or, you know, have, understand what’s happening with their practice. So what is the best way that they can get in contact with you?

Eric Vickery: So obviously allstar dental academy.com, see what we’re doing there. read reviews from other dentists who have done this with us. You know, we do hang our hat on great phone skills, new patient call conversion, relationship focused, training. We hang our hat there. So you can check us out there. If you just have questions, just email our co-founder Heather Nottingham. So it’s heather@allstardentalacademy.com. And just say, I heard Eric on the podcast talk about this. I have questions. She’s amazing at just jumping on and scheduling calls with you and talking about your practice and what you need and finding the right avenue, which may not be us. We are, we are no pressure company. We love just connecting and building relationships and having community. We probably work with north of 150 clients every month that are working on these sorts of things.

Eric Vickery: And we can put you in touch with those people and say, here’s been my experience of working with Allstar and how they help me either with case acceptance, with leadership, with systems in the practice, and with insurance freedom. And so again, we’re just here to help. And we have a, we have an annual event in May called the Growth Summit. We’ll actually have an insurance freedom breakout during that time. We’ve got tons of people coming into Fort Lauderdale for that. And we’d love to even see in person for two days and focus on training and growth.

Lester De Alwis: Amazing. Amazing. There you go. I think, if you’re looking to get some advice or even looking to, reach out to Eric, I think, the details of, the details of All Star Academy, they’re all Sal Academy and Eric will be available on our show notes on this episode, and, you can get in contact. So Eric, thank you for sharing such practical and honest insights today.

Eric Vickery: My pleasure. I love it. Thank you for having me on.

Lester De Alwis: So the key takeaway is this, that insurance is really the core problem. Leadership case acceptance and accountability determine whether a practice feels trapped or empowered when those, when those areas improve, insurance pressure naturally decreases. So if you are ready to take action and you want to, review your online visibility, do so by scheduling a complimentary marketing strategy meeting with Ekwa Marketing at lessinsurancedependence.com/marketing-strategy-meeting, and also if you’re looking for mentorship, you can also book a complimentary coaching strategy meeting with Gary Takacs at thrivingdentist.com/csm. Now, all these resources, what I just shared and also what Eric just shared out all complimentary, and you can basically book them for yourself and help you build a stronger and more independent practice. So if you found value in today’s episode, please share with a colleague or a friend who could benefit from reducing the insurance dependence. And thank you for listening to the Less Insurance Dependence podcast. We look forward to seeing you in the next episode.