12. 10. 21
Rectangle Health’s Micah Shawn and Brian Doyle join John Stamper from DentalCast Productions in a five episode series on “Live with John”. In the first episode, “Alleviating the Pains of Patient Payment Capture”, they discuss how practices can reduce the difficulty associated with patient payment capture leveraging digital solutions.
John Stamper 00:00
Hello. What’s going on, everybody? Welcome to another episode here live with John. So excited to be with you and so excited to kick off this five episode learning series with some team members and some great people that I’ve had the opportunity to learn more about from Rectangle Health. And what we’re going to do on today’s episode is we’re going to start this and we’re going to kind of head right into a lot of the solutions. And some of the things that both Brian and Micah, who I’m going to introduce here in a second, are seeing with a lot of dental practices out there. As you may have seen, the title of this first episode is Alleviating the Pain of Patient Payment Capture. And that’s what they’re going touch on today when we think about this new technical world and all of that.
So Brian Doyle is the vice president of Enterprise Sales at Rectangle Health. And Micah Shawn is the vice president of direct to provider sales at Rectangle Health. Gentlemen, how are you doing?
Brian Doyle 00:57
Great job. Thanks for having us.
Micah Shawn 00:59
Absolutely thrilled to be here with you today, John.
John Stamper 1:01
Well, so excited to have the both of you. And again, I know that we’re going to talk some specifics about a lot of the technologies that you all and your teams are helping dental practices with. But we thought before we would do that, we would hop in Brian, to maybe having you talk about some of these challenges, some of these pains that practices are feeling when it comes to patient payments. I think more importantly, what they’re dealing with in an effort to help patients pay for their services and all that good stuff. So love to start with you.
Brian Doyle 1:30
Yeah, absolutely, John. Thanks for having us. And it’s a great question. And unfortunately, I’ve been in this industry for 13 years. It’s the same question that we’ve been trying to fix or answer or help with over the better part of a decade. And the easiest way I could put this is every single dental practice I’ve experienced in my 13 years has a pain point when it comes to collecting patient payments. Nobody does exactly perfectly, otherwise we wouldn’t be on this call to discuss it. So there’s always a little bit of issues or pain points when it comes to this, and a lot of it stems from insurance.
When we think about this question, you have to look in the past for the last 30 years or so, the dental payment process would be you come in, you get your treatment, you leave, and someone bills you. Well, when you think about our day to day life as a consumer, you can’t go to the grocery store and say, hey, please, I’m going to take these groceries. Please send me a bill in the mail. It just doesn’t work anymore. It’s not how we can do business. So what we’re seeing is that becoming the larger issue because copays are getting bigger. Patient out of pocket is getting bigger. So by billing insurance, that’s good and fine, but we’re still left with a substantial amount left over.
It’s no longer the days of $510 copays that we had two options at the time, write it off or send it to collection. Now we’re talking about a large portion of our potential revenue as a dental office. So what we’re seeing on the clinic level and kind of a larger level is in today’s environment. We all know that there’s a war on talent out there. You’re probably hearing that a lot. There’s a lot of turnover in provider practices. So these staff, nobody likes asking for money. Hey, you owe me money, please, payment, right? So that doesn’t become part of their day to day responsibility because they’re responsible for the patients, which is what their job is. It’s about patient satisfaction, patient health. Most importantly, getting paid is not first and foremost, when training a new staff member.
In 99% of cases, we see outdated technology. Quite honestly, the best example I love is Netflix, Amazon. I mean, think about when you book a hotel. We do it all from our PCs or our cell phones. The airport is a good example. We used to go wait in line, get a printed ticket, or we print it from our home office, and then we go and go through security. Today we have it on our phone, we scan it, we walk through. So by having inefficient outdated technology that we in, dental is just inevitable. Unfortunately, that compounds the issue. Patients don’t want to pay with a check or cash. Certainly they want a very contactless way to make a payment.
So all of these issues kind of funnel down to the clinic level and put the staff out and the patient out, because the patients, in most cases, want to pay, but they also want it to be convenient, and they want it to be easy and streamlined, and they want to tap to pay or pay with their watch, for example. The staff is battling insurance, not covering what they think, trying to collect afterwards, making phone calls, sending paper statements in the mail. I had a provider tell me the other day that we send out statements and they come back, return address. Because when you think about what we’ve done, and especially as the millennials and gen z come in to be the payers, they’re constantly moving. They don’t have if you move to New York City after graduation, you’re moving every two, three years, right?
But what doesn’t change? Well, my email address and my cell phone personally have been the same for 25 years. So if you text me or email me that balance due or a payment link, I’m much more likely to pay. So to sum that up, we see lack of technology, staff turnover, the insurance issue, and then just the outdated technologies being the main pain points we’re seeing on a day in, day out basis.
John Stamper 5:56
Yeah, it is this storm of all of those issues that you’re talking about, right, that a dental practice who, like you mentioned, simply wants to take care of the patients, get them healthy, but on the other side does the running a business and certainly want to get paid. It’s interesting. One of the things you’re going to see everybody through this episode learning series with Rectangle Health is we’re going to go back and forth. You’re going to hear patient consumer, right? And I’ve been talking about this a lot, and that is that when I think about dentistry for all these years and we’re all still patients in our dental practice, our medical practice. But what’s changed, and I’m glad, Brian, that you brought that up, is our behavior is still of that of a consumer.
And I know that’s one of the things you guys are going touch on, and we’re going to kind of weave this through with some of your talking points, is that the patients are coming in and wanting a lot of these newer technologies. And like you mentioned, Brian, they want these issues to be solved like they do business other places. So I think that’s kind of a common thing that we’re going touch on. So, Micah, one of the things I wanted to get your thoughts on is what’s causing a lot of these pain points. I think Brian did a great job of kind of looking at things at the high level and what he’s seeing with a lot of the work that he does. When you actually get down to the practice level, what’s causing a lot of these pain points?
Micah Shawn 7:15
I think, as you said, Brian really hit a lot of the high level macro pieces that cause it. But if you think about in terms of specifics, there’s a marriage of old technology and new technology in almost every practice. Whether you’re talking about the EMR they’re using along with paper patient forms and the disconnect in getting that data into the form and also the ease of entry or the friction caused for the patient when they go to fill out that form. Especially now, nobody likes picking up the clipboard. I see offices cleaning pens and disinfecting clipboards and we’ve got this ability to solve technology problems or registration problems with technology, and they get pieced together.
So you might have one way of handling forms and then you have your credit card terminal, you have your EMR, you’re doing a whole other set of solutions for compliance and everything else that’s involved in the practice, and you have this mishmash that just doesn’t work well together. I think that’s a big player in why we have so much pain around some of these pieces. Then you add the fact that all of those pieces, each one of them has its own both actual cost and opportunity costs in terms of what are you giving up? Because that’s the way you’re doing it. What aren’t you getting? What can’t you streamline or improve on? Because that’s the way you’re doing it. So trying to make new technology and old technology work together, it creates a lot of additional pain.
John Stamper 8:59
It’s interesting because when I think of the last three to five years as there’s been this explosion in technology solutions for dental practices, what’s been encouraging to see, and I know this is a lot of the work that you guys are doing at Rectangle Health is this gap between the technologies that the practices are using and the companies being able to communicate with them. And I think not only that, but as both the both of you know, on a daily basis, you’re hearing stories from these dental practices, real live issues of what they’re dealing with. And I think that’s the speed of how you’re able to help them and alleviate these pains is what’s really encouraging. And it’s also, I think what it has shown us is this incongruence, like you talked about, of technologies.
I used to think to myself, how great would it be if a practice could just pause for like 60 days, like not see patients update all their technology, get to where they need to be. And although we didn’t want it to happen, it kind of felt like that happened a little bit in COVID, where they obviously want to slow down a little, but we know that’s not the ideal situation. And so you bring up such a good point, which is practice, this can’t slow down, right? They can’t just stop. They have to figure out ways to merge those incongruencies on the technology side. So I think that’s such an interesting point along those lines.
Okay, so where I want to go next is having you guys, maybe Brian will start with you, talk a little bit about how is now technology alleviating a lot of these pains to move practices along and I think make it convenient for patients.
Brian Doyle 10:25
Yeah, absolutely. And on the enterprise side of the world, we see really two things in the market today is multiple vendors. That’s the biggest one we see because right now, everyone’s in acquisition mode. We’re acquiring, we’re growing, we’re expanding. I haven’t seen dental expansion like this in years, if ever, quite honestly. So when there is an acquisition, there’s really one option keep the legacy systems in place or convert to one central platform. The converting to one central platform is a big lift, especially if you’re acquiring 510, 20 locations in a month or a quarter or what have you. So what inevitably happens is these Dsos or the growing organizations, or just a doctor purchasing five different practices in his region, his or her region, is there’s multiple systems.
So when we think about how that’s an issue is, let’s talk about the patient side first. The patient has multiple experiences. So if I’m going to Dr. Smith’s office, but it looks different each time. That might cause me concern on I don’t think I want to pay or this isn’t my doctor, this isn’t my practice. On the other side of it, the administrative side of it, the revenue cycle teams, the billing teams, the financial teams, they’re accessing two, three, four different platforms to run a report, to refund a patient, to access a card on file that inevitably increases the workload on an already thin workforce that the provider is dealing with on a global level.
John Stamper 12:06
Yeah, I’m so glad you brought that up. I go back to a time when I was spending time actually at a DSO and had the opportunity to speak with a lot of these, I guess you could call, like small to mid sized Dsos that were going from twelve to 15 to 20 practices. And I heard a common theme along those lines, Brian, and it was they would get introduced to some of these newer technologies and they would say, oh, my gosh, if only right, I would have done this or worked on having, like, one solution at the beginning as I grew, because you’re right, it is a real challenge. I think what’s frustrating about it at times is that they know what it would be like and the value that it would be to kind of integrate everything.
But as you grow and expand, it gets that much more challenging. Mike talked to that. Maybe another idea on how this technology is alleviating those pains, but more importantly, how you do it when you’re starting to scale and how you can get ahead of that wave.
Micah Shawn 13:05
Yeah. John, I think about a couple of things you said and that Brian have said already, and you talked about the consumer aspect of a patient. I mean, we need to move practices to the point where they’re addressing problems, the way people consume those in other parts of their life. Right. So Brian mentioned Netflix or Amazon earlier, and people are so used to that card on file payment, just being able to click and pay, it’s convenient. There’s zero friction. It’s why my wife and I both spend a fortune on Amazon every month, because it’s so easy to do and you’re not really paying as much attention to the process, meaning it just moves faster and quicker and easier.
So just enabling that in a dentalist being able to vault a card and securely have that card on file, being able to capture that payment, it’s just such a huge difference for the practice in making the transaction with their patient or the consumer frictionless. Anytime you can digitize a payment, anytime that you can simplify the process. I think about my own experiences walking into dental practice and having a QR code in the operatory so that I can scan the QR code and pay right there. I can set my next appointment right there with them in the room instead of having to check out at the front desk. From my perspective as a patient, my experience becomes much better because I already waited to get called into the practice.
In today’s world, I waited in the waiting room, I wait again in the operatory and then I wait in line to make payment. We can eliminate an entire segment of that with technology as simple as a QR code that allows payment in the operatory. So when I think about all, if we start to think about in the consumer direct to consumer sales world, people talk about the consumer’s journey. Well, patients have a journey too. And if we can simplify it, make it easier, make it frictionless, and at the same time make the practice more profitable, more efficient, there’s no reason not to do it.
John Stamper 15:29
So there’s two things that you just shared there and I’m just going to call it like it is. Right. There is a coolness factor when it comes to technology, to dental practice. Right. I don’t know what it is. I think all of us feel like the Amazons of the world just appeared one day and they never existed as startup companies. Right. Although it just feels like the wave of people that use those, I think, tend to forget. They think that’s how it always was. But for most of us that go to a dental practice, anytime there is any little incremental technology addition like what you’re talking to make those things easy, it just feels cool, right? It just feels like, wow, this dental practice is doing these things to make things easier for me.
And I think you brought up a good point, which is it’s always about patient focus and whether it be the health care and now more and more on the payment side and treating them like consumers. But you brought up a great point, I think. And that is the whole revenue cycle management part of this is in this new world, right? Where practices are wanting to scale, like you said, Brian, and they want to kind of add practices, speeding up that cash flow to be able to pay for projects, especially if they’re investing in things and so on and so forth. Makes a huge difference. It feels like there was a time not to say that AR was not important in a dental practice, but it wasn’t needed as much. Right. It just felt like that the dental practice could operate.
It feels like those days are over. And so that sense of urgency, of accelerating those payments is so crucial. I’d love to have you kind of get your thoughts on that or what you see at that macro level.
Brian Doyle 16:54
Yeah, I mean, what you just described is patient loyalty, quite honestly. And that is a big topic in all the trade shows I’ve been to in 2021 is patient loyalty. I think Michael referenced it earlier. That or John, maybe it was, you that patients are actually shopping technology on where they want to go to the dentist. Specifically the new generation of patients. If I need to call or if I need to send in a check, which I don’t have in my house to make a payment or schedule an appointment or do what have you, I’m going to go online, I’m going to go on Google, and I’m going to find somewhere that I don’t necessarily have to do that.
So the more easy it is as me as a consumer, this is why Amazon is Amazon and Apple is Apple because they make it easy. And then we have loyalty to those brands. It’s the same concept. Patients want to have the same experience they do on Amazon.com or the Apple Store where I walk in, I scan a QR code, which they’re back. Thanks to COVID, QR codes are back. But we want that now. It’s easy, it’s convenient. We have our phones up on us at all times. So what we’re talking about here is patient loyalty, which is a huge topic, and technology strengthens patient loyalty, which strengthens the correlation to make payments, which increases the provider’s revenue or bottom line.
John Stamper 18:18
Yeah, I love that. And so Micah, I know you get a lot of opportunity to get feedback from a lot of the practices using the technology. And one of my favorite things to talk about is when a practice makes the decision to implement these newer technologies and make them become a part of their day to day. And it’s like that 1st 30 days, right? Like they make the decision to do it. Change is not easy for a lot of practices, especially for a lot of these newer technologies. But then when they do and they start to get the results, there’s always that cool moment, right, where they give feedback and so on and so forth. What do you guys hear? What do you hear at Rectangle Health for those practices?
These are real time impacts that these practices get on both the patient experience side as well as the practice revenue cycle management when they implement these things. So just insight on that of what you guys hear from a Rectangle Health perspective.
Micah Shawn 19:07
There’s so many different ways to approach that. We do get a ton of feedback, I think about we’re talking about the technology and the cool technology, and one of those cool pieces of technology is Text to Pay. Just to hit on that for a minute. It’s come up a couple of times, but I think it takes the average person. I read this stat recently, I don’t know how accurate it is, but it seems directionally genuine to me. It takes seven days for the average person to respond to an email now, but they still respond to a text message in two minutes. And that’s exactly what we hear from the practices. Text to pay is like when it’s used, the patients have a 90% adoption rate. It’s huge. And we’ve actually validated that stat that’s from a recent study that we have done.
90% adoption rate. When a text is sent to the client, from what we hear from the practices, they see things like that reducing their AR substantially. I heard recently one of our clients has documented that their AR is 40% lower since they’ve implemented things like card vaulting and text to pay and online payments. Those three solutions have just a tremendous financial impact on the business side of the practice. So just real easy things to do. And then I think that some of the other things are just kind of patient feel good items like, you know, digital registration. The patient, again, this can be QR code driven. You can put a QR code in the waiting room. The patient scans the QR code and fills out the registration form on their phone instead of on the clipboard.
And the fact that they’re working on their own device that they’re comfortable with, they can do that actually by email ahead of time. However it’s done, they’re doing it in a way that they’re already comfortable interacting. A device that they already use every day. And that becomes a very positive experience both for the patient and for the staff. Because they’ve got fewer people standing there turning the clipboards. They don’t then have to figure out how they’re getting that data from the paper into the system. They’ve got it right there.
John Stamper 21:24
Yeah, I love that. So, Brian, a couple of things. Not all practices are feeling these pains, right? There certainly are practices out there that have put a lot of work and effort into incorporating these technologies and building these efficient systems in their practices. So let’s touch on a little bit about those practices that have found a way to alleviate a lot of these pains and embrace all these technologies and focus a little bit on some of the other services and solutions that you guys are helping practices with along the lines of, like, the practice management bridge and things like that.
Brian Doyle 21:55
Yeah, absolutely. There are some really great offices out there that they have it down, they get it. They collect time of service. They very low, little to no AR. They’re doing a great job. The purpose of technology, though, is to make it more efficient, make it more streamlined, and to reduce any staff error or patient miscommunication. So when we think about how do we collect better, how do we collect more, we think about things like curbside checking or digital registration is certainly a big one. We think about what happened during COVID is I couldn’t come into the practice until I was ready to be seated. So what did I have to do? The staff would either have to walk outside or they’d have to call me. How about we text me?
How about we go through a more streamlined experience that consumers are asking for today we think about adoption rate, and it’s surprising that the adoption rate is stronger on the patient or consumer side than it is on the staff side. So as the consumers continue to push digital forms, digital registration, something as simple, John, as online bill pay, I’ll give a personal story. My wife went to the dentist. We got a statement in the mail for $14. There was no online bill pay. There was no way for me to make a payment. And think about when most people are opening their mail. It’s after dinner. It’s eight, nine at night, right? The office isn’t open. So what happened? Well, I didn’t pay that bill, not because I didn’t want to, it’s because I couldn’t. So I got two more bills for $14.
If we have a QR code or have an online bill pay link, as good as we are in clinic, there’s always going to be some stragglers that get through. We need to give all flexible options in terms of engagement, ease of use, ease of access for not only the patient, but the staff as well.
John Stamper 23:52
That’s a real example. And when I think about the number of $14 invoices that are out there in dental practices all over the country, and you multiply that up, and then you think about the team time that it takes when they’re tasked with kind of following up on that, when in all reality, like you said, implementing something like this makes such a big difference. Any thoughts on that, Mike, as kind of just that management bridge and kind of tying all that together?
Micah Shawn 24:21
Well, you think about of course, there are so many costs to presenting an invoice. The benefit of sending out a $14 invoice loses its value very quickly, especially when it takes two or three or four invoices to process it, to get the person to pay it. So that’s a perfect case for someone in Brian’s demographic. A text to pay message is a perfect way to address that far less expensive. And even if you had to manually enter every single text to pay message to every potential invoice, it’s still going to be less time than the office spends processing invoices two and three and four and five times. I actually have a very similar story, and interestingly, it was a $14 invoice.
Mine happened to be two separate $14 invoices for the same doctor, different visits, and I thought I had paid it, so I ignored it for six months until I got the collections notice. But again, had I been able to pay online or check that invoice, that technology would have solved it. But I just think there’s so many things that we can see coming out of something like practice management bridge in an office as simple as the pre authorized payment. In the case of that $14 invoice having that card on file and a pre authorized payment, you know, most patients are going to be comfortable authorizing a payment for a visit up to a certain amount. In the case of that, I think we all expect to have some cost when we go to see the dentist.
And as long as we have some control over how much that amount is going to hit our card or our account, I think there’s a high level of comfort for people to say, hey, expect to pay 30 or 40 or $50 for this. I’ll pre authorize that. And just again, when you come to revenue cycle management, just the ability to ensure that as soon as you have that insurance decision that adjudication on the insurance, you can charge the remaining balance.
As soon as you would be normally processing an invoice to go through and process that payment and have the funds there in the practice and not have to spend the time doing three invoices or five invoices and then not having to process the payment when it comes in the efficiencies that it gains in the practice are you cannot put a value on the time that you get to put into real patient facing activities.
John Stamper 27:10
There’s no question. I think hearing both of your stories just reminded me that I think I have a library book that’s due from like, fifth grade, so I need to get that back and get working on that. So thanks for the reminder. All right, so as we close, it’s interesting because had we been doing this, like, ten months ago, and we would have been talking about some of the pains, the practices we’re dealing with and the technologies and the solutions that you guys are providing, we probably would have started around digital payments and all of that, around infection control. Right. And it’s interesting how we are, fortunately, moving ourselves through what has been the pandemic, what practices have gone through. And it’s encouraging that were able to talk today about what you touched on Brian, which is a lot.
Of the things that the practices are dealing with and Micah, like at the practice level, the benefits of both to the patients and the practice. But let’s call it like it is. I mean, there’s another benefit of a lot of this technology, and it’s around infection control. It’s around this new world that we live in and some of, again, some of the requests and the behaviors that patients are going to want to live by when it comes touching less things and being less involved. So I wanted to make sure that we touched on that because I think it’s important and I think it’s something that is just an added benefit that’s going to continue to be with us with a lot of the work that you guys do. So, Brian, any thoughts on that?
Brian Doyle 28:29
Yeah, actually. So during COVID up until now, we’ve never been busier because we sell contactless payments. That’s what we do as a company. Before COVID we had text to. Pay for the better part of five, six years. But it was, yeah, that’s a cool product. Maybe at some point we’ll use it. COVID came, and I think this was referenced earlier, March and April and even into May of 2020, a lot of Dsos that I work with sat together and said, all right, how do we fix some broken processes? And we deployed texting and online bill pay and QR codes immediately for them. So we have seen a boom due to COVID and what it’s caused in the digital forms in the consumers driving this conversation.
So that has been a priority for a lot of organizations, and then as they continue to grow, it becomes top of mind or will be top of mind moving forward.
John Stamper 29:33
So we did get that pause, Micah, for those couple of months when Brian was able to work with those Dsos, when they could slow down a little bit and implement a lot of those technologies, which is, like you said, Brian, that is a big deal. Listen, I had the opportunity and have been for three years of speaking to people and about a lot of these exciting technologies. And it’s not that they weren’t taking it’s not that the practices weren’t using them. It was just it really felt like an uphill battle for a lot of us in dentistry to implement these things. Change is hard. A lot of things you guys were talking about and yeah, I mean, the pandemic happens, and I think we see how quickly you were able to implement those things. But yeah.
Any thoughts on the infection control piece, Micah, and the contactless payments, all those things?
Micah Shawn 30:16
So I think you guys covered the infection control itself. But what I think is really important to remember on this is in dealing with this, consumers like to adopt new technology and move forward, not backwards. And so what we’ve done is we’ve created awareness among consumers that these things like QR codes to Pay and text to pay and digital registration forms exist. And the more they have been exposed to it, the more they expect it. When they go into a practice behaving like consumers now, it becomes their expectation. And if they don’t get their expectation, they’re going to look for what their preferred way to do it. They’re going to look for it somewhere else. So the options that are created by the things that we’ve done for infection control, the option of those become very important to practices going forward.
The stats on preferred payments, there’s one stat, and again, I think there’s a phrase, 80% of statistics are made up on the spot. This 1 may be one of those, but a very high number of people will seek a provider who accepts their preferred form of payment. And that can be as simple as being able to take an Apple Pay versus a dipped credit card or the text to Pay versus sending out an invoice and having to send a check. And to Brian’s earlier point, the fact that many households don’t even have checks today, all of these are behaviors that are changing and will be accelerated by what we did in this condition to avoid infection.
John Stamper 32:11
It always amazes me because in being able to talk with you guys and I think about what these conversations were like in dentistry, even four, five, six years ago, it felt like so many conversations in dentistry were only dental specific, right? So like us having these conversations wouldn’t spill over into the consumer world. And hearing you just say that Mike made me think about the decision that I have made at times of am I going to use a babysitter that still takes a check or I have to go to the ATM before I come home when she was with her kids? Or does she take venmo? You know what I’m saying? This is such a great example. I think the points you guys brought up are so real that this is the world that we’re living in.
And so you’re a dental practice out there watching. You’re a part of a dental team or what have you. What the work that the team at Rectangle Health is doing is so important. And I want to thank the both of you. I’m so excited about this learning series because this is just the beginning. I know you guys have a lot of people that we’re going to bring on that are going to talk about a lot of different things that you guys are doing. I do want to let everybody know that the team at rectanglehealth has put together a landing page specifically around this live learning series. It is rectanglehealth.com live. So that’s rectanglehealth.com live. You can look right below in the comments. Click on that. It’ll take you and share with you all of the great work they’re doing.
And we want to be able to let you guys know to stay tuned for all the information for episode two. We’re putting together all of that right now. We’re going to have some more team members from Rectangle Health talking about the great work they’re doing. So, Brian and Micah, I want to thank the both of you. Thanks so much for what you’re doing. Thanks for coming on, sharing your insight. I always feel confident when we have these conversations because it puts me in the shoes of a dental practice that is looking to help me solve problems, and you guys are doing that. So thanks again and best of luck with what you’re doing the rest of this year and into next year.
Brian Doyle 34:03
Thanks a lot, John.
Micah Shawn 34:05
All right, John. We really appreciate it.