Why Software Implementations Reveal the Truth About Your DSO

Jake Larson: Foreign. Hello everybody and welcome to another episode of Dental Operations Unpacked. I am your host Jake Larson, here with my co host Clint Barry and a good friend of ours, Jill Nesbitt. Jill, thank you so much for joining us. Uh, if anyone has been in the space for a while, you probably know Jill. She, we were teasing her about being a celebrity in the space face, but she has so much knowledge, she's so good at what she does and we're just excited that she would take a few minutes to, to chat with us today. So Jill, thank you so much for joining us today. We're really excited about this one.

Jill Nesbitt: Likewise. I love that, you know, we could be chatting all day and they were like, hey, we should probably record this. Yeah, yeah, I'm excited.

Jake Larson: Exactly what happens. Uh, for those of you that don't know. Jill. Jill, uh, do you want to give her, give our audience just a quick kind of introduction, uh, where, who you are, where you come from and what you're doing today.

Jill Nesbitt: Yeah, I've been in dentistry almost 30 years, which seems a horrific number to say, but as my teenagers would say back in the 19s is when I got involved in dentistry. Um, but I. So I've had a long career of working in practice management and CSOs and consulting and all the things and now I am the very proud founder of Optimized Dental Consulting. We have been around now three and a half years almost this fall before and I have this fantastic amazing team. And what we do is just a few things. We help people select software and know what they're buying. We help them to define and outline what their workflows are so they know how do they want to use it, not just how does it work. And then we implement it well so that we can take the load off of a team that says oh my goodness sake, we do not have time to do all the software setup and create the SOPs and communicate the change management and manage success metrics and all the extra curriculars and then we'll do the full rollout. So that is what we do and we absolutely love it.

Jake Larson: And this is why we were super excited to have Jill on today because her, she has eyes and feelers, uh, on so many different DSOs and seeing behind the curtains what's working, what's not working. Lots of different software, lots of different PMS platforms, lots of different um, uh, additional software programs and so much knowledge that comes from that. So the topic that we're going to discuss today is why software implement. Sorry, why software Implementation reveals the truth about your dso. Right. So as you get in and you start to implement some things, some truths may start to surface about what's really going on. And Jill has seen a lot of that. So Jill, what would you like to add? Just to give us a little um, uh, setup for, for that topic?

Jill Nesbitt: Yeah, we have um, thank you for highlighting the fact that we are product agnostic. So I have the incredible opportunity to work with just about every major cloud based software out there. We've already implemented projects for those and so we work with groups of all sizes. And what is coming up of late is people are like, oh, I'm going to just have the software vendor tell me what to do and we'll have maybe somebody internal just follow the instructions. What I am finding is in the work that we're doing because we focus so deeply on the entire associated tech stack, what is everything that you're using and then how are you going to use all the new features and functions, not just of a PMS but of uh, the voice, you know, the call software, the analytics platform, like all of the pieces, what we are finding is because we dig so deep, so we're like, all right, how does it work now and then how should we set it up? People are like, they've never dug in that deep to figure out what is current state. And um, what we are revealing is that software doesn't just fix the business, it reveals all kinds of truths about what's actually happening in their own organization that leadership doesn't even know. So we have ended up providing such stronger value than just a software transition, which in and of itself is a mountain of work, but it's actually giving them the opportunity to say holy cow, we don't, we don't, we A, we didn't know that was going on. B, that's a total mess. We're not doing that. And see, now that we have new software, let's do it a better way. Oh, by the way, you're the software expert, like what do you think we should do? So it's just a really great opportunity for the leadership to get visibility into things that are completely hidden because they're so deep in the weeds and for us to be a help in more ways than one.

Clint Barry: I love this so much. I feel like there's so much to learn and know about software in general that having someone that's an expert because it's like, I feel like if you're trying to build a dso, how do you be an expert in everything? Like even if you're just an office manager in a dental office, how are you going to know what every software does, what's available? Like, it's so hard to make those decisions. So I think what you're doing is super valuable. I'm excited to talk more about it.

Jake Larson: And you see it all the time where people get excited to implement something new that they were sold at a show or they heard from a friend. This works great. But then. And that's the easy part, right? Is getting excited about what the salesperson sold you on. But then when it comes to the nuts and bolts of actually getting it into the operational flow of the practice and having success with it, I feel like that's where the real work has to begin. And if. And if you fail there, then the investment is for not. Right. You're. You're really just wasting money, not getting the benefits that you were you're hoping for.

Jill Nesbitt: Exactly. I had one group that, um, the private equity firm made a great deal on credit card processing and then introduces it to all of their portfolio companies. And I was working with the group at the time, and they're, um, like, okay, so implement this. And I said, you know that this doesn't actually integrate at all with anything in your software. Like, nothing. So everyone will be duplicating manually entering no credit card auto. Like, none of it. Um, no, like, all. Think of all the things that our credit card processing does now, that's in digital text to pay. Like, all the things, like, it's. It does none of that.

Clint Barry: So they got a really good rate, Jill.

Jake Larson: Really good rate.

Jill Nesbitt: That's exactly what happened. And they're like, well, that's what we're doing. And I'm like, okay. Just so you know, like. And that's where even in the software selection work we do, we don't tell people, oh, you should do this. We don't recommend one thing over another. We just want to give you visibility. And that was actually when I decided we need to add software to selection to the work that we do. Not because we want to tell people what to do, but because we want you to have the visibility so that when you make that decision, you can balance out all the inefficiencies that you're going to lose from a, uh, gap in integration to balance out. Yep, got a great deal.

Clint Barry: Yeah. Because I think people forget, like, oh, this is going to add this much labor cost. It's like, come on, Joe.

Jake Larson: Right. Why do you feel like, um, in the industry generally right now, why is implementation such a Hot topic, like, what's changed so that this is becoming more and more common.

Jill Nesbitt: Yeah, I kind of adore Brian Claire running around right now and telling everyone that they have to get it right and do the implementation. Because the same store growth, and we've been talking about same store growth now for what, 18 months, but the market is very different. I mean, you guys know we were in a buy aggregate rollover, get great multiples. Those days are over. I was at a conference not, not very long ago, maybe a couple of months ago, and had the opportunity to listen to an investment banker that said, in fact, these dental investors, they are now very savvy to our ways. And they're expecting standardization, they're expecting that you know how to run the business. They're expecting a solid return on an operating model. And so when you need that, you can't just buy and flip. And that's why I think we're now getting so much more interest in or to have this software, or I need to standardize or I need to figure out how do I really maximize this because I'm already paying for it. And I think that's where people are saying, man, this is harder than I thought. This isn't actually working. I bought the tech, it's not giving me these results. Where's the gap? And I've seen that it's not necessarily the technology's fault. It's that we haven't taken the time to understand where does it even fit in the workflow. Maybe it doesn't actually solve the problem for your group that you thought it would help with just because of the way you're running business. And that can mean at a leadership level, when you have that level of visibility, you can make different choices. And now you can take advantage of the tech or you can exit at stage left if the business isn't really at a place that that technology is providing a solution. Are you guys seeing that same thing right now too? That there's a lot of conversation about adoption and implementation of software, whereas that was never even a conversation. People are just like, what's the new silver bullet? Like, tell me what the new cool thing is. Uh, and now I feel like it's changing to, well, how am I going to use it? Where should I pilot this? So I feel like we're getting smarter about the whole thing, but I feel like that's where we can help. And we do get really deep in those weeds to work with the teams on how can we make this go.

Clint Barry: I definitely feel like I see that more in the industry now. Um, I think probably what you said is because the industry's changed so much. Whereas before it was just like, it felt like a land grab. Everyone was just trying to get as many locations as they could get and grow as fast as they could grow because they thought the opportunity was so big, which I totally understand. But as soon as it shifts to efficiencies and like where's the advantage of having a group versus an individual practice? It has to be around efficiencies and consolidation and those type of things and so they have to take it seriously or else they're not going to see any benefits from owning a bunch of practices. So yeah, it's like it's a uh, it's a different, it's different now and even AI is throwing an even bigger wrench in it. Cause people are expecting now more efficiencies and they're looking for more efficiencies and more automation and they expect the industry to change. And so it's, and it's even hard to stay up to date on all the features of all the major platforms that are adding AI, which is crazy.

Jill Nesbitt: I feel like it is in fact my full time job to keep up with the latest and greatest in technology and not, I shouldn't say that I don't care about the latest and greatest. I guess what I care about is what are people actually working that gets results? Because I get sometimes people be like hey Jill, have you heard about such and this? And I'm like do you know of any DSOs using that? And they're like no. I'm like when they have some customers let me know because then let's see what does the workflow actually look like and is it scalable? So um, yeah, AI. I mean from the things I'm learning about AI, you have to have data integrity to actually use it well. And I uh, literally I got it, I got an email from a friend the other day. She's taken a new role with. It's not quite 300 locations and they're, they have 16PMS systems. There's for you. Like she's got her hands full.

Clint Barry: So we're going to introduce us to that dso. That's who we need.

Jake Larson: Um, so one thing, I found it interesting Jill, you've mentioned a couple of um, places where uh, the, the transition to a new PMS or implementation of new software has been uh, there's been some sort of red flag that's kind of risen up that said this isn't going to work. Like the payment, uh, processing solution. You said another one. But I'm curious, where are you seeing the most common, uh, places that, uh, that, um, decision makers are overlooking? They're just getting excited about what this tool possibly can do, but they're overlooking, like, it doesn't integrate. Seems like the most basic thing to me. Like, that should be, like, the first thing on your list. You check. But, like, what are the other things that leaders are underestimating when they go to approve some new software that they should be paying closer attention to?

Jill Nesbitt: Um, what they're. It's not even that they're overlooking something because they're trying to. They're trying to do due diligence. Right. They talk to their peers. I see a lot of CEOs calling and texting each other about, hey, you're using this and how did you do it? Or you've implemented that software and you went fast. How can I do that? Things like that. But what I, what the gap that I see, or I shouldn't say the gap. When they're working with us, what I feel like they're doing really well is they're wanting to pilot it first and they want to outline the workflow. And so when we have the opportunity to get in and say, all right, let's learn how does the, how does your process work today, and how would you like it to work? And now let's benchmark that against best practices with this software. We have found in a couple of different projects of late, some really interesting situations that end up a byproduct of the software implementation. What's happened is we have the opportunity to get in and document what is the current state workflow, how are we doing rcm, for example, in one situation, what we found, Very nice, large group. Um, we documented the whole process and we present it back to the leadership, so cfo, who is relatively new coo, and said, here's your current process. And we knew, like, my consultant did an amazing job. And then we talked about it internally. It turns out that the RCM team was focused on closing claims, which sounds like a really good idea. But what you really want your RCM team to do is focus on collecting money. And those are two very different tasks and can be incentivized, frankly, very differently. And so what they found was because of the workflow that that team had been using to close claims, even maybe when there was still a balance outstanding or a denial that had happened, just the workflow from the old software that they had in place was making it so that they wouldn't show up on reports, you wouldn't know that there was additional outstanding insurance benefits available or opportunities to collect. And that also has a downstream impact into how your doctors are getting paid. And are we collecting at uh, the percentages that we should, you know, we have benchmarks for that. Right. And when we presented that to the leadership, they were like eyes as big as saucers, jaw on the floor, they're like, we had no idea this is how things were working. And we're saying like, if we keep this process up, guys, it's not going to matter that you move to a new software. It's, it's going to be bringing old workflows and maybe bad habits over to new systems. So we said, you know what, we have the opportunity with this pilot. Let's go ahead and set up a new RCM approach that frankly is outside this old system and that's exactly what they're doing. And so like, they were so appreciative just of us running that full pilot for them to document the workflows, to show them how it can really work and then to actually have proof of concept in the pilot. Now they can get some measures and see how does this pilot and what does the revenue cycle look like and our collections percentage versus what we've been doing. And like, specifically I asked the leadership because I always do a wrap up call for kind of every segment of the services that we offer to make sure here's what we've delivered, how, you know, get feedback, how did it go? What do you think? They were so appreciative. They're like, we never expected to get this kind of insight into revenue cycle because they've been having some other challenges they couldn't get their arms around. We never expected to have that out of a software project. You guys are actually helping us, um, not just from software, but from revenue cycle visibility and then putting the new system in place. So like, that was a perfect example. I was so proud of my team that they did this work and it's so incredibly meaningful. So yeah, we're feeling really good about the value we're bringing to these groups that want to invest in not just switching software, but really doing it well. And it's kind of old and tired expression. But the digital transformation, that's the actual guts of what it looks like is you don't just switch software, you completely redesign. How are we going to run this business based on new technology?

Jake Larson: I love that.

Clint Barry: I think, uh, what's funny is, you know, if you're Optimizing to close claims. I'm guessing the intent was to make the ar, the accounts receivable look good. So they're probably looking at that metric thinking, we're amazing. We don't have balances anywhere.

Jill Nesbitt: We're killing it.

Clint Barry: That's funny. Well, that's. Yeah, that seems super valuable. I love it.

Jill Nesbitt: I had another small group that we worked with that, uh, um. In fact, their CEO was kind of. He was a little heartbroken. He's like, I had no idea that because we're running, you know, everyone on my team has got 10 or 15 years minimum of dental operations experience. They're regional managers. They've been office managers, like we speak dentistry as like our first language. Right. And then they've also done software implementations and then we leverage them, you know, content of things that we, you know, build out over the years and all this stuff. But when we went in and we again did the same thing for him. He did a software switch. He's all live. But what that switch revealed is he just doesn't have enough resources that are collecting, you know, so he's got outstanding claims and money that's sitting there. Frankly, they're very blessed. They do a lot of, um, fee for service dentistry, so they don't have to deal with a bunch of insurance. They didn't even have some fee schedules because they didn't load them in their old software. They were doing calculator math. So, like, along with the transition to new software, we're like, no, we can, we can estimate your insurance perfectly. You just have to give us the fee schedules. And they're like, oh, yeah, we don't, we don't really know where that is. Or maybe we should call like. So it just takes. So I'm just, again, the visibility of what does the team know about their job sometimes. And that's a really. Doing software is like an easy way to say, hey, we're just going to make sure, like, there's a refresher on how this works because we're switching software as opposed to like, you've been working here for a lot of years and you still don't really know your job. Huh. Huh. That's not great.

Clint Barry: So, oh my gosh, we've seen that so much. It's painful.

Jill Nesbitt: But we can. Then we can build the training and we can build the resources in through the software change. Right? So we're just giving. But that CEO and I had a conversation. He's like, I'm kind, like I feel kind of bad that I should know this or I would ever. I'm like, how else would you know this? But he then also told me, he said, you know, Julie's like, I was gonna go out and hire like a revenue cycle coach or consultant or someone to help us figure out what the problem is. And your team knows all that too. And I'm like, I know I have this amazing team. So, um, yeah, it's been really, really fun to uh, like I said, like, we just really love actually getting deep in the weeds doing this work so that these groups can get the value and run a successful practice.

Jake Larson: I think of it, I mean, uh, Jill, I'm ready to sign up for Optimize, by the way.

Jill Nesbitt: Excellent, excellent. I'm hiring by the way.

Jake Larson: Yeah, Jill needs people. It's interesting, Jill, but I don't. I mean there's nobody inside of uh, an organization that's in a position to do what optimizes a third party can do really. As I kind of look at it like to have the expertise across so many different platforms in software and technology, to have an unbiased opinion about what software you use. You're truly able to just come in uh, as a great partner and consultant resource. Yeah. To just give honest feedback to see uh, ahead 10 different steps that maybe other people. Because how many people have gone through the changes that you're going through on a regular basis to see the pitfalls and shortcomings that will if we don't do things a certain way. So I mean it makes complete sense and obviously the headaches that you're going to save people the money that you'll save them, the benefits that they'll actually get out of all their investments. I mean it becomes a no brainer. Now our intent here was not to be a full commercial for Optimize. It's just, just a fantastic solution that Jill is offering.

Clint Barry: But we just like it.

Jake Larson: We just like it. This is exciting.

Clint Barry: Jill doesn't pay us to be clear.

Jake Larson: Jill doesn't.

Clint Barry: There's, there's no money exchanging hands here.

Jill Nesbitt: No, but I'm just sitting here. Just keep it going, Keep it going.

Jake Larson: But Jill, what like uh, what advice would you give listeners? Uh, because a lot of our audience are um, operations, you know, regional managers, COOs, maybe uh, even CFOs. What advice would you give those individuals who are considering change? Um, can maybe they're feeling these needs to standardize or whatever. Where would you encourage them to start and kind of reflect some things that maybe they could do on their own?

Jill Nesbitt: So I'm going to Make a pitch for something that's free on my website that I put together actually for that very purpose. Uh, I recorded a handful of videos and we put them in this little implementation guide that's on my website. But that actually came out of, we had a project where we were working with a small group and then they did a five location acquisition. And then the woman that was running their operations for that group, they said, oh, we're going to make her an integrations lead and we're going to wrap in the software, um, implementation role into hers. Great. So my team, we had, we had worked with them, I don't know, nine months, something like that, led the other locations live and then we're going to do a handoff so that we could make sure we're setting her up to succeed and she could take it from there. But one of the things that we did is I created a checklist, effectively a successful implementation checklist with the idea begin with the end in mind so that the CEO, because she reported the CEO, so that he would know, how will he know that she's doing a good job, that those implementations are being done in a successful manner. And I had a few different categories. So from that we turned that checklist into this implementation guide. So it's all free. I mean, you have to give me your information, right? So, and I'm not going to spam you or any of that, trust me. But, um, I think what I would tell you, if you're a regional manager or you're a COO and you guys are talking about, we're going to do a software switch. This is an incredible opportunity, not just to do a data conversion and not just to do whatever you've done before, but take a step back and think, how do we want to take advantage of this opportunity to really transform our business? And I think that always starts with an assessment of walking through what are the current state workflows and then do you have someone that knows the software that you're going to well enough that they can benchmark against how that software works? So now you're talking about what, what the gaps and the opportunities are. But I think if you just start there, then you're like, then you'll realize like, there's going to be some things that you're like, oh my gosh, this is going to be amazing. The reality is there's no, there's no perfect software because you're going to find some things. You're like, uh, my old stuff works better than the new stuff in this particular area. And then people get frustrated or angry or point fingers and yell at the software vendor. Don't do that. Make a plan. Because we know you're going to have some things are going to be great, some things that aren't. But I think when you take the time to really use this process as how are we going to impact our workflows? I will tell you that, um, our software companies do a great job of they have training, they do great products, they're doing new releases all the times. Um, they have support, they have customer success, all these great teams. But it's up to you. And the more that I do this work, I realize we end up filling in a bunch of the gaps. So if you're in an uh, organization right now, the gaps that you need to fill, all the change management communications, that is up to you. Why are we doing this? What is the win? Well beyond whatever software you've chosen. So all the change management communications, that responsibility lies on your shoulders. Success metrics. Going live is not success. What does your success look like in our world? I have a checklist for every single software. Um, of what does it look like? How will I know? Black and white. Actually it's red, yellow, green. But that's another story. Um, of, um, how do you know this was a successful Go live Friends, the answer I'll give you. We're actually processing claims, we've collected the copay, we're signing our clinical notes. But create that so that you know because you guys have no idea how many times I hear we switch software and then we never got paid from the insurance cures. Like friends, you got to make sure. Did you enroll, did you set up your EFTs? Like all the things. But so the success metrics, that's on you and it's on you to define that in advance and put that in front of everyone so that people know going live doesn't mean that everything's great. Here's our checklist. I think the next thing is who's creating those custom SOPs. There's plenty of good stuff that we can lean on. The software vendor for online training, in person trainers, all that good stuff. How are you going to use it? If you're a dso, you're going to centralize some things and you're going to leave some things at the office level, which means not everyone has administrative access, which means you can't just send them, um, to the instructions on the website for the vendor because you're not actually giving that level of user permissions. To the right team member. And when you're coming off of legacy software and we need to close out a balance in one and open a balance in another. Because I wrote a check. One check goes in one system, not in two. And how do we manage? Like you need to be creating content that helps your team. Oh yeah. Who's creating this training agenda? Our software vendors do a great job with providing knowledgeable team members. But who's creating the training agenda to make sure are they going to do the role play? How are you going to factor in all the other associated technology, for example E prescribe. We're switching software. Somebody's got to be talking about, you know, what the E prescription option is and it's got to get set, uh up. And it's got to get set up that very first morning if that doctor is going to be able to write a prescription that afternoon. So like there's a lot of work. In fact I have a little iceberg, um, graphic on my website somewhere that shows like there's only a little bit that looks like you can give to the software vendor. There's a lot of work that's really up to you. If you'll do that work, it will make it so much more worth the switch. Which means you can start at the very beginning of like, why are we doing this in the first place? What are we hoping to gain? And then you can track that to see are we actually getting those benefits. So kind of a long winded answer. But there's so many good things that our teams can do to make this switch successful when they're implementing. And I don't care if you're implementing call software or a PMS or a text to pay solution, no matter what you're implementing, all of those same deliverables apply. And that's how we, that's how we do it. Every single customer.

Clint Barry: I love it. So you basically you're saying, hey, you need to have success metrics in place to end a plan. And not only that is you give, you have a free document or whatever that you have to give out to help them know what metrics to watch out for. Is that right?

Jill Nesbitt: Step by step of it. I don't know if it gets into. It has some metrics but it's the whole process of do you have change management? Do you have success metrics? What is your training guide like? It, it hits all the highlights. So yeah, I think it's actually pretty helpful. And if somebody downloads it and says I'm missing something, feel free and let Me know, I'm happy to. I'm creating more content all of the time. So, yeah, it's good stuff.

Jake Larson: I think. I love just kind of in summary of that, that whole idea, right, the go Live date, people think that's a win, but that doesn't necessarily mean you're accomplishing what you set out to accomplish. And what Jill's emphasizing here is have clearly defined metrics or milestones or checkboxes that say, hey, when these things are done and actually being used, that's when we're actually getting the benefits that we sought after, which is amazing. And, um, you guys obviously can check out Jill's website for some information. Um, Jill's pretty active on LinkedIn as well. That's a great place to connect with her. Um, she's fantastic. I'm sure that if you message her, she'd probably be more than happy to, to get in contact. I shouldn't be saying this, Jill. What's the best way for people to get in contact with. I'm just encouraging people to contact you without even asking.

Jill Nesbitt: I love it. No, I'm just here just to hang out. Right. Like, I appreciate you, Jake. Just selling my services and letting people know. Uh, no, exactly. Right. Yeah. My website I'm sure will be posted but optimized dent.com and have that free guide in there. And yeah, LinkedIn, I'm all over usually. Um, but yeah, I would love to have a conversation. In fact, I do that a lot. I have. Let's just talk about what are you trying to do. And I can hopefully bring some value just from the. I think we've collectively like our team. Even my team, just last year when there was only four of us, we together had done more than a thousand go lives. And now that I've added three more team members this year so far, um, I'm sure the number is just, you know, getting a little bit stupid. But, uh, yeah, happy to share what we're learning because you can really, you can have such a great impact on your practice, on your group when you do this. Well, and it's an expensive mistake to make if you, if you don't, if you take the time and the energy, all the opportunity cost, all the investment and this, these kind of projects fail and everyone is super upset. So if you are, I would love to say, like, avoid that, you know, put the energy into it at the front gate. But I appreciate the opportunity to be on here because there's still a lot of people that don't even know that optimize exists and what we do. And, um, I think that's an important. I think we're. I appreciate the comments early on, Clint, when you're like, I think it's an important piece of where it fits in the industry, and I'm super proud of. Of this team and of the work that we do to, um, fill this kind of. This role.

Jake Larson: Yeah, I love it. Support and help. Fantastic. Well, Jill, thank you so much for joining us. Thank you, everybody, for listening. We hope that this has, um, been insightful, uh, made you think a little bit, helped you maybe answer some questions that have been on the back of your mind. And, Jill, thank you so much for sharing your, uh, knowledge and expertise with us. Um, and we will likely have Jill on again at some point. We're, uh, obviously good friends with her, hanging out at Dykema and stuff. So thank you, everybody, for listening. Thank you for, uh, Jill, for joining us. And we'll, uh, catch you all on our next episode on dental operations Unpacked.