Adopting Digital Payments Within Your Dental/DSO

modern practice podcast

Rectangle Health sponsored a podcast hosted by Becker’s Hospital Review, “Adopting Digital Payments within your Dental/DSO”. Listen to panelists Mike Peluso, Chief Technology Officer of Rectangle Health, and Mark Lakis, Chief Executive Officer of Southern Dental Alliance, talk about how new healthcare technology solutions can support practices, especially during current market conditions.


Scott Becker 0:00
This is Scott Becker with Becker’s Healthcare. We’ve got two great leaders with us today to talk about consumerism and health care payments and technology, best strategies to help deal with those to make things more effective and more engaging payment collection systems, or toolkits. They’re going to talk about this from a DSO dental service organization perspective, we have first, the Chief Technology Officer, Rectangle Health, Mike Peluso. Second, we’ve got Mark Lakis. Mark is the CEO of Southern Dental Alliance. Two really good people, really smart people. And I think we’ll kick this off and get started. We’ll have you with us for about 20-25 minutes. In both you, Mike and Mark, just enjoy yourself. And thank you to our audience for listening in.

Mike, let me start with you with this question, then I’ll ask Mark. As we start to adapt to a new normal, what kind of changes are you seeing in dental offices in terms of practice management in patient payments?

A New Normal for Dental Practice Management

Mark Lakis 1:07
Thanks, Scott. Yeah, so as we think about the new normal, and we think about COVID, and we sort of think about that dental office or that practice manager at the dental office, the new normal is from a patient payment perspective, that office managers top priority is no longer payments. Historically, pre COVID, pre the new normal, that office manager was really focused on collecting payment and getting paid at the point of care.

Now, that office manager is focusing on a lot of other things. And then I like to call them the traffic cop. They’re worried about whether or not someone’s coming in and has filled out their COVID questionnaire, or whether someone’s come in and they have the proper PPE in place within the office or whether someone’s coming in with two kids, and the two kids can’t sit in the waiting room. So the office manager and that front desk person is now not focused on the patient payment. And really, as we talk about a lot of things today that’s sort of the biggest concern is that that shift in the new normal of how the office manager works, it’s got so many other things to focus on outside of the payment. And is there a way to continue to collect the payment, when the top priority is not necessarily the payment.

Scott Becker 2:21
And Mark, the follow up on that we’re seeing dental practice managers, leaders, administrators, it was so many different things, this COVID era, make sure patients are comfortable, make sure things are as seamless as possible, as little context as possible. So many different roles. You’re leading one of the great dental service organizations in our country. What do you sort of see from a practice management perspective patient perspective, in this new normal?

Mark Lakis 2:46
Well, thank you very much. I’m pleased to be here and happy to answer the question, I’m seeing a lot of change. And that’s extremely uncomfortable for a lot of people. So the new normal has changed. And we’re changing the way we interact with our patients. Of course, I absolutely agree with Mike that getting the money isn’t quite as important as it might have been to our staff. Safety is everybody’s top concern. Thankfully, we’ve had the opportunity to really apply some technology and our resources, resources of the DSO to really help with that. But everything from the way the doctors are treating the patients and the way their people are handling PPE, to the waiting teams and the patients waiting out in their cars. All of that has changed. And while we’ve been added for a few months, people are still getting used to it.

Biggest Challenge Facing Providers Today

Scott Becker 3:47
And, Mark, let me ask you a follow up question to that. Because at the end of the day, if dental offices aren’t getting paid, and that happened for a period of time over the last part of this pandemic, the working days, we’re getting paid nothing. We are seeing patients. Many of these practices really have been financial trouble. What are you seeing as some of the biggest challenges facing dental providers today, in terms of actually getting paid? What are you seeing today, Mark?

Mark Lakis 4:14
Well, let’s there’s the two payment streams, right? There’s the payments directly from patients and then the patient payments from the insurance companies. And we like probably most DSOs received the lion’s share of our income directly from payers. But that world has changed as well. The players themselves are evolving and changing and it’s harder to work with a team that’s based at home, through the players I mean, and we are seeing players that are flexing their muscles.

Some were very forthcoming with PPE support and funding. Others have gone the absolute opposite direction and actually become harder to deal with but the message for this conversation is around the patient payments. And we’re still collecting the vast majority of the patient payments, compared to what we were previously, there was always an opportunity to do better previously, and it has deteriorated a little. So we’re absolutely looking for better ways to make it easier for our patients to pay us.

Scott Becker 5:26
Absolutely. I see a little bit of this throughout the country, payers getting tougher, setting up more denials, more challenges, using different excuses as opaque in some spots, something very good about it. And then when patients, the West in person contact, it’s just another connection with them makes it harder to get paid. It’s part of why technology becomes so much more important. Mike, let me ask you the question, what are some of the big challenges you’re seeing, as you see provider offices, talk to Dennis, talk to DSOs. In terms of getting paid?

Mike Peluso 5:59
Yeah, as Mark said that there’s two payment streams, and there’s that insurance payment stream, and there’s that patient payment stream. And I think kind of the follow up from the first question, when when patients are coming into the offices now when they’re coming into the dental offices, they’re coming in and getting treatment, the idea of they’re coming in and spending time giving a copy of their insurance card, or giving their credit card prior to service that that time has has somewhat been eliminated. So I think the biggest challenge is, how do you get that ahead of time? How can you sort of spend some time with the patient almost virtually before they get to the office. I know everyone talks about virtual care. But dental is a very physical type of care. So we need to spend some time with the patient to get their insurance information to get their payment information.

And like Mark said, make the process seamless so that when they come into the office, they come in, they see their dentist and they leave. So if the challenge can be overcome, I think the challenge would be trying to get that credit card information, prior to care, trying to talk about payment prior to care, trying to get that insurance information prior to care. So a lot of that friction when they come in the office and have to talk about that stuff, fill out the clipboard, get a copy of the insurance card, leave a credit card, a lot of that is eliminated if you can address it prior to care.

Scott Becker 7:24
Thank you very much. And then, Mark practices adopting new payment technologies. You run a large DSO, thoughts on what are some of the major factors that hold back practices from adopting new payment technologies? Is it money? Is the implementation? Is it staff time? What does hold that practice?

Mark Lakis 7:49
Great question, I think there’s a few things. My experience has been a lot of the payment solutions that are available, particularly ones that have the power of consumerism built into them. They’re really built for medical use, and they don’t necessarily interact terribly well in a dental environment. So that’s one of our challenges. And we’ve tried a couple of different approaches to adding technology to the patient payments, and we’ve been moderately successful. But I think you’re the key for us is to find the one or the ones that are very specific to dental, and work in our environment.

A Dental-Specific Solution

Scott Becker 8:35
So one of the challenges, not just it’s just not the money, it’s not just the rotation, it’s that when you’re not doing devil specific, it just ends up putting a round, you know, a square peg in a round hole, whatever the phrase is, that then really exacerbates the problem of getting people to adopt new technology, because it just becomes so much more frictional. Fall and hassles. Mike, some of your comments on this.

Mike Peluso 9:00
I think and also to the and I love the option of a dental only solution. And we support dental only solutions for sure. I think also one of the things we have to look at is how busy the office manager is and how much we are affecting their workflow. There’s a lot of great tools out there. And we always hear the word consumerism and everybody loves the word consumerism. And I think I think every office manager and every DSO wants to implement tools to collect more payments, though, those tools though have to be not take a lot from away from the office manager, meaning make that office manager’s job easier, make that office managers, you know, ability to collect payment in a dental environment go way up. So, so again, I think the sort of one of the things that’s holding back the adoption is just that, that office managers is busy and if we can incorporate tools and we can deliver tools and deliver technology that that doesn’t take away from that off spinner doesn’t make it so they have to do more work to collect the card on file or more work to set up a recurring payment plan or, you know, more work to try and use a system designed for medical and fitted into dental we want to try and eliminate that as much as possible.

Scott Becker 10:16
And there’s another question or follow up question there is, how important the dental specific dental specific solution?

Mike Peluso 10:28
I think it’s critical. That’s a great question. And, and it’s, it’s critical to be dental specific, it’s also critical, obviously, to be consumer specific. It’s also critical for the office manager for the DSO to have options. We could all say, every medical practice should have an Uber like experience, or every medical practice should have a Netflix like experience, or every medical practice, you have an Amazon experience. There’s a lot of things, you know, I don’t know, something like 50,000 people work for Amazon. So they have a lot of resources to kind of set that stuff up.

There are tools out there that deliver card on file to dental that deliver recurring payments to dental, that deliver Text-to-Pay to dental, I think the key is, is to be able to deliver those in small pieces. You don’t want to do an all-in-one, you know, let’s say on January 1, hey, the office has to use all these features. Maybe start with a few, start with some Text-to-Pay, start with some recurring. So definitely the dental specific solution is key. And the way that that solution gets implemented. over a longer period of time the solution grows with the practice as the practice wants to use more the solution can deliver more, I think is the key.

Scott Becker 11:45
With that concept of ease of importation, we’re tackling relatively small to midsize dental offices, they don’t have separate people working on it. They don’t have a ton of staff a ton of backup, and they’re so busy as it is. It’s got to be easy to implement Thank you. Mark, any thoughts on the same issue? Dental specific solutions? Why is that important?

Mark Lakis 12:12
Dentistry in our technology is, unfortunately, pretty far behind the medical world. And I’ve come across instances where we’re just simply not capable, because of the limitations of the practice management systems primarily, to adopt something that was built for a system that’s more advanced. So I think that’s one of the bigger constraints. And I’m not against something that was initially created in the medical world. But it’s got to solve my problems at some rudimentary level, it’s got to be incredibly easy for the patient to pay us.

Another dynamic of this is, if you think about the revenue cycle, throughout dentistry, it’s just fundamentally different than medical. It’s they’re a lot more intertwined than in many medical environments.

Scott Becker 13:09
And Mark, let me ask you a follow up question to this: you run a major DSO, who decides? How do you guys decide? Yes, we’re going to try and implement this versus that. We have these practices, try it. How are those decisions made? make some decisions?

Mark Lakis 13:27
Well, Southern Dental Alliance is very doctor-focused and doctor-centric. So the ultimate decision is the doctor in the individual practices or the lead doctor have a group of practices, and the DSO provides a solution for this is what we think could help you with XYZ. Now, the team of people that get to provide that solution to the doctor is part of the power of DSL as we have experts in information technology and Chief Operating officers and regional managers. And of course, there are doctors that, you know, sit on our senior leadership team. So it’s a collaborative decision from a group of dental experts

Decision-Making Factors

Scott Becker 14:16
And what factors. What are the main factors? How important is it to make improvements in practice? Ease of implementation… Let me ask you this question and Mike that question is, because here’s a lot about it from practices. What are the main things you consider one of the main factors who decides and sounds very clear, you make sure your doctors are carrying out that decision. They also remember that decision, what are the key factors that they’re typically thinking about?

Mike Peluso 14:46
Yeah, I think in the DSO environment, you know, the DSO definitely makes the informed decision that there needs to be tools that might make life easier for the DSO staff. The front desk staff, and it makes life easier for the patient. And DSOs do do a really good job of evaluating vendors and a really good job of sorting, squeezing costs and analyzing capabilities and, and understanding implementation needs. The ultimate sort of not decision maker, but the ultimate user. Is that that office staff or the patient, but the office staff really, that they’re, they’re the ones at the front lines, and they’re the ones that are that are dealing with the patients and and it’s got to work for them, I think is the biggest thing to learn from this question is, is it’s got to work so that they can continue to do their job. And, again, going all the way back to question number one, as we pile more things on to the front desk, we need to take some things off. And if technology can take those things off, if technology can take off, the trouble of collecting payment, technology can take off the trouble of mailing a statement, technology can take off the trouble of getting a copy of an insurance card. That’s really where you start to see that the decision making of this product is making my life easier as a front desk DSL employee. And that’s where you really start to see a lot of adoption utilization.

Scott Becker 16:12
And those front desk employees, they are very binary, or they can tell pretty quickly, it’s gonna make my life easier or not. It really has to pass that test. No, no, it was some amount of warnings about getting up to speed. But it’s really a key factor, isn’t it? It’s right that DSL parents have complained that making their life easier is not. Mike, is that a fair statement?

Mike Peluso 16:37
Absolutely, absolutely there. And they know, a lot of times, they’ll know, before this, before the solution is implemented. And Mark made a great comment. You can’t take a solution designed for a healthcare institution or a hospital and put it into a dental office, that office manager, that front desk staff, even the doctor, they’re going to know that it’s not going to work well ahead of time. So it’s really critical to get it to be a dental specific solution. And to get it to, to work at the level of that front desk administrative front desk worker so they can utilize it and it makes their lives easier.

Improving Patient Experience

Scott Becker 17:14
In my fourth question, is that in terms of dental payment solutions, technology, data and technology, and how you see these things, improving overall patient experience? How can the dental payment solution improve overall patient experience?

Mike Peluso 17:34
It actually, it’s a great, great question, and it improves the patient experience. And it allows the patient to be in control of the experience. As we kind of said earlier, as an office manager, office managers are now dealing with the PP, their ability to collect payments is not as great as it is now the patient is in control. So if dental practice and a DSO organization, leverages the types of tools that can be delivered, leverages card on file, leverages recurring payment, and leverage texting payment options, now the patient becomes in control of payment. And that payment now becomes part of the overall experience. And this is where you get to those Uber like experiences or those Netflix like experiences where it’s not a matter of a patient coming in for dental services. And the office manager has to have the uncomfortable conversation about, hey, patient, you owe X amount of dollars. Now, it’s that the patients engaged before they even got to the office. They’re they’re paying without even knowing it, kind of like when we all go on Amazon or we all get in the Uber car or we even all go to a hotel, we all kind of leave that card up front. And it’s kind of taken care of as we leave. Now the patient is in control under these new types of scenarios.

Scott Becker 18:58
Absolutely, thank you in writing, trying to make it as seamless as possible, as easy as possible for them. You know, when the patient gets the bill in the mail gets called up, he has the right jack. So it was and so on. Now it’s become harder and slower. And in that it is a negative and the patient experiences patients getting that bill in the mail all the time and wants to reflect badly on everybody. So because of this, in this technology, the solution can help the patient experience. Mark any thoughts on this as well?

Mark Lakis 19:32
I think I’d be remiss if I didn’t point out the strength and power of the concept of dental support organizations as it comes to any form of technology or even change. Dental support organizations have the resources to support those people in the front office to make the logical decisions about which technologies to roll out and when and how. We’re in a wonderful part of the economy, that there’s lots of opportunities for efficiencies, that definition of DSOs, and things like improving payment technology that improves the patient experience actually results in better patient care. And that’s the goal of all the doctors that are part of our organization, they want to make sure that the patient is getting the best possible care, the easier we can make that the better.

Scott Becker 20:30
It’s really true patients’ experience is better in this area, they’re more likely to use the dentist and we’re likely to work with the dentist. And it’s likely ultimately to improve their patient here. Because things are just a little bit easier, instead of a little bit more positive about whether they want to go back where they want to go back, all kinds of things, it’s a really, really good point. Once you make a great point about DSOs  it makes it easier because rather than the small dental practice office, you have the different resources behind that to back that up. But everybody has their own IT department and so forth and so on. So thank you, Mark, very much. Mike, let me ask you this, you know, Rectangle, magnificent company, one of our sponsors today, take just a moment and tell us about when we’re thankful for your support. Take a moment and tell us about Rectangle’s, dental payment technology. What does adoption look like? Easy to adopt? What does it look like? Talk to us a little bit about that?

Scott Becker 23:18

Mark and Mike, I want to thank both of you for joining us today. Just a magnificent presentation and thoughts and where the world is moving towards. There’s payment technology. Even so something like it is important to cashless payment technologies can also be so important to improving the overall dental experience that patients have in ultimately the front office as because if it’s not better for the front office, it ultimately is going to encounter a ton of friction. So magnificent Mike blue CIO the chief technology for rectangle health. Always a pleasure to deal with you, Mike. Just straightforward and clear. A pleasure. Thank you. Mark Lakis, the CEO of Southern Dental Alliance, Rectangle Health technology company from a dental company, a great DSO. Thank you both for joining the Becker’s dental podcast and just a pleasure visit with you.

Mike Peluso 24:10
Thank you, Scott.

Mark Lakis 24:11
Thank you very much, Scott. And thank you, Mike.

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