by Value is the bedrock of successful DSOs
The good news for dentist/entrepreneurs looking to expand their practices? The industry is more accepting of DSOs today than it was 20 years ago.
The bad news? Dentistry is not an easy business. Never has been. Never will be. Providing custom diagnoses to each patient and delivering service in volume is even more difficult.
Steve Bilt, CEO of OneSmile, LLC, made the comments at this summer’s SUMMIT conference for entrepreneurial dentists and experts.
All truth passes through three phases, said Bilt, who co-founded and was president and CEO of Smile Brands Inc. from 2000 until 2014, as well as a founding member and former director and president of the Association of Dental Support Organizations:
- Phase 1: The truth is initially ridiculed and ignored.
- Phase 2: It is violently opposed.
- Phase 3: It is accepted as self-evident.
“In 1998, the concept of group practice was widely ignored and ridiculed,” he said. “There was a lot of inertia in the system, which at the time was largely solo practices. In fact, in some states, it was illegal to be a multisite practice for a long time.
“In the past five to six years, we saw violent opposition to what was building up, but today we’re reached the tipping point. We’ve gone from violent opposition to, ‘Yeah, this is where the industry is headed.’
“It’s a neat place to be.”
Creating, building value
The driving force for the successful dentist/entrepreneur is the desire to build something of value, said Bilt. The owner should look at the company as if he or she were an archeologist, he advised SUMMIT attendees. “What will the ‘ruins’ of your company be 50 years from now? Incredible retail facilities? Incredible pictures of patients on the walls? Rave reviews from employees and patients? A place where patients returned for generations and employees stayed their entire careers? What kind of business have you set up for the next guy?”
Often, the best way to build value is to do the little things well, he said. “Dentistry is an embarrassment of opportunities. There are so many areas to go into, so many procedures to add.” But the entrepreneur must ask himself or herself, “How am I doing with my business today?”
“The thing that beats up companies in this sector is doing too many new things,” he continued. “You can sit in the board room and decide to add something that you’re not ready to do. It may sound great, but when you go to execute, it’s hard. So be judicious in introducing services, and be voracious doing the things you already do well.”
In a successful group practice, all the cogs line up. Goals are agreed upon, and everyone works to achieve them. “Don’t invest in a bunch of retail facilities or do a lot of TV advertising if you’re not chasing new patient flow,” he said. If the practice relies on patient recall, doctor turnover has to be addressed, but if it is aiming for new patient flow, turnover may not be quite as important.
Institutionalizing good patient care
Another characteristic of the successful practice, regardless of size? Making patients feel comfortable and in charge. “Different things make people comfortable, but somehow, some way, you have to let them feel in charge,” said Bilt.
Smile Brands practiced what Bilt called the “G3,” standing for greeting, guiding, gratitude:
- Greeting: Every person encountering a patient gives him or her a nice greeting.
- Guiding: Staffers take time to explain to patients what procedure will be done, why, and how long it will take. The patient then decides whether to proceed or not, and how.
- Gratitude: Staff thanks the patient for trusting the practice to care for him or her.
OneSmile, a DSO supporting general, pediatric and specialty providers, focuses on three words in its mission: One Smile Matters, said Bilt. The statement reminds employees and dentists to focus on the patient or teammate or vendor who is in front of them, and to work to create an equitable exchange where both parties can leave with a smile.
“This is ‘culture,’ and these are the kind of things you have to go back to the well and do over and over again,” he said. “It really is the repetition that makes it work – reminding people that we have a purpose.
“It’s critical to institutionalize these things.”
A winning strategy
Three strategic principles drive Bilt and the OneSmile team, and might be of use to other entrepreneurs as they grow their business, he said.
First, when making tough decisions, ask, “How will this feel in the light of day?” If a patient is dissatisfied, will the provider redo the work, provide a refund, admit the mistake? “Are you building something where you feel good about the decisions you make? If you don’t, I assure you, your business will crash.”
Second, remember that healthcare remains a local business. It’s true that the DSO can effectively provide some services – e.g., clinical information systems, purchasing systems – on a national basis. But the manager at the local practice is the ultimate decision-maker on all else.
Third, keep in mind that the low-cost provider always wins. “I didn’t say the ‘low-price’ provider,” said Bilt. The low-cost provider is the one who provides the highest level of care with the lowest cost structure.
“The best thing about the dental business is that a mistake can’t hurt you,” concluded Bilt. What can really hurt you is repeating mistakes.” So build a culture that doesn’t hide mistakes, but rather, views them as learning opportunities.
