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Point of Service Plans with Patrick O’Rourke, Host of Dental Business Radio

April 27, 2023 by John Ray

point of service plans
Dental Business Radio
Point of Service Plans with Patrick O’Rourke, Host of Dental Business Radio
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point of service plans

Point of Service Plans, with Patrick O’Rourke, Host of Dental Business Radio 

Patrick O’Rourke, the host of Dental Business Radio, uses an automobile analogy to explain Point of Service Plans available to dental patients.

You can find the video of this episode here.

Dental Business Radio is underwritten and presented by Practice Quotient: PPO Negotiations & Analysis and produced by the North Fulton studio of Business RadioX®.

About Dental Business Radio

Patrick O'Rourke
Patrick O’Rourke, Host of “Dental Business Radio”

Dental Business Radio covers the business side of dentistry. Host Patrick O’Rourke and his guests cover industry trends, insights, success stories, and more in this wide-ranging show. The show’s guests include successful doctors across the spectrum of dental practice providers, as well as trusted advisors and noted industry participants. Dental Business Radio is underwritten and presented by Practice Quotient and produced by the North Fulton studio of Business RadioX®. The show can be found on all the major podcast apps and a complete show archive is here.

 

Practice Quotient

Dental Business Radio is sponsored by Practice Quotient. Practice Quotient, Inc. serves as a bridge between the payor and provider communities. Their clients include general dentist and dental specialty practices across the nation of all sizes, from completely fee-for-service-only to active network participation with every dental plan possible. They work with independent practices, emerging multi-practice entities, and various large ownership entities in the dental space. Their PPO negotiations and analysis projects evaluate the merits of the various in-network participation contract options specific to your Practice’s patient acquisition strategy. There is no one-size-fits-all solution.

Connect with Practice Quotient

Website | LinkedIn | Facebook | Twitter

TRANSCRIPT

Patrick O’Rourke: [00:00:00] Hi. This is Patrick O’Rourke. We’ve been getting some questions and I’ve been asked about dental insurance, Point of Service Plans or the acronym POS.

Patrick O’Rourke: [00:00:13] Point of Service Plans sort of look like a PPO. They’re a hybrid between a PPO and HMO. Interestingly enough, in the medical world, these are very popular, particularly in metropolitan areas, but it looks like a PPO and then it’s put on an HMO chassis. Where, in the dental insurance world, it looks like, more often than not, they’re trying to make an HMO and cram it onto a PPO chassis, albeit a very low reimbursing PPO in most cases. All right.

Patrick O’Rourke: [00:00:00] So, the POS or the Point of Service Plan in dental insurance looks like a PPO, but the out of network benefits are going to be skewed heavily, so it’s going to incentivize or steer you in network. And then, if it says something like when you go out of network, the out of network allowable is going to be whatever we want it to be, then you’re going to get dinged again.

Patrick O’Rourke: [00:01:16] So, it’s not just the percentages are less, but also whatever they decide the allowable rate is for that plan, which probably will not be disclosed to you until the transaction or the insurance transaction is complete, is very likely to be even less, which is going to hurt the provider and cause a big balance bill for your patient.

Patrick O’Rourke: [00:01:45] I like analogies, so let me use another analogy. So, POS means something in the automobile world too. And it is not altogether uncommon for companies to give a company car as a perk, as a way to attract and retain talent. Much like dental insurance is a benefit for the employees, for them to come in and say, “Look we got great dental insurance and so here’s our point of service.”

Patrick O’Rourke: [00:02:19] If I’m using an analogy for the layperson out there that’s listening to this for whatever reason, it would your new boss is, “Welcome to the team. We’re going to give you that company car.” And then, he walks you out there to the car lot outside in the parking lot and it’s a Yugo. That’s a POS in the automobile world.

Patrick O’Rourke: [00:02:46] I hope that’s helpful. Until next time.

Tagged With: Dental Business Radio, dental insurance, Dental Practice, HMO, Patrick O'Rourke, Point of Service Plan, pos, PPO, Practice Quotient, Yugo

Teresa Duncan, Odyssey Management, Inc.

August 30, 2022 by John Ray

Teresa Duncan
Dental Business Radio
Teresa Duncan, Odyssey Management, Inc.
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Teresa Duncan, Odyssey Management, Inc. (Dental Business Radio, Episode 32)

Teresa Duncan, President of Odyssey Management, returned to the show to discuss dental insurance coverage and issues the employers may be facing. Teresa joined host Patrick O’Rourke to discuss covered changes in the market, challenges with the myriad of plan designs, PPO contracts, insurance coordinators, patient portals, and much more.

Dental Business Radio is underwritten and presented by Practice Quotient: PPO Negotiations & Analysis and produced by the North Fulton studio of Business RadioX®.

Odyssey Management, Inc.

Odyssey Management Inc. provides courses and workshops to help doctors and managers to recover revenue by streamlining billing, accounts receivable and insurance systems. Management courses are designed for beginner to advanced levels. Most popular courses are centered around dental insurance and strategic business planning.

Company website | LinkedIn | Facebook

Teresa Duncan, Owner and President, Odyssey Management, Inc.

Teresa Duncan, Owner and President, Odyssey Management, Inc.

Teresa Duncan is a speaker and writer with over 20 years experience in healthcare. Her areas of expertise include proven accounts receivable and insurance methods; and helping doctors and managers establish solid management systems. A recipient of the Educator of the Year Award by the Association of Dental Implant Auxiliaries – a component of the International Congress of Oral Implantologists, she understands the importance of continuing education.

She is the author of Moving Your Patients to Yes: Easy Insurance Conversations and an annual contributing author to the ADA’s CDT Companion Guide since 2017. Teresa is a frequent contributor to The Observer, The Progressive Dentist and Dr. Bicuspid publications. She served as a founding Trustee for the auxiliary-learning focused DALE Foundation. Teresa is a member of the National Association of Dental Plans and the National Speakers Association. Teresa also hosts her own podcast, “Nobody Told Me That!”

She has been named one of the Top 25 Women in Dentistry by Dental Products Report Magazine and is recognized yearly as a Leader in Consulting by Dentistry Today. Most recently she provided consulting assistance in the development of several modules of the American Dental Association’s Guidelines for Practice Success™. Teresa received her Master’s Degree in Healthcare Management from Marymount University.

LinkedIn |  Twitter

About Dental Business Radio

Patrick O'Rourke
Patrick O’Rourke, Host of “Dental Business Radio”

Dental Business Radio covers the business side of dentistry. Host Patrick O’Rourke and his guests cover industry trends, insights, success stories, and more in this wide-ranging show. The show’s guests include successful doctors across the spectrum of dental practice providers, as well as trusted advisors and noted industry participants. Dental Business Radio is underwritten and presented by Practice Quotient and produced by the North Fulton studio of Business RadioX®. The show can be found on all the major podcast apps and a complete show archive is here.

 

 

Practice Quotient

Dental Business Radio is sponsored by Practice Quotient. Practice Quotient, Inc. serves as a bridge between the payor and provider communities. Their clients include general dentist and dental specialty practices across the nation of all sizes, from completely fee-for-service-only to active network participation with every dental plan possible. They work with independent practices, emerging multi-practice entities, and various large ownership entities in the dental space. Their PPO negotiations and analysis projects evaluate the merits of the various in-network participation contract options specific to your Practice’s patient acquisition strategy. There is no one-size-fits-all solution.

Connect with Practice Quotient

Website | LinkedIn | Facebook | Twitter

Tagged With: Dental Business Radio, dental insurance, Dental Practice, dental practice marketing, dental staffing, Odyssey Management, Patrick O'Rourke, PPO, PPO Negotiations & Analysis, Practice Quotient, Teresa Duncan

Tom Limoli, Limoli & Associates

October 25, 2021 by John Ray

Tom Limoli, Limoli & Associates
Dental Business Radio
Tom Limoli, Limoli & Associates
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Tom Limoli, Limoli & Associates

Tom Limoli, Limoli & Associates (Dental Business Radio, Episode 26)

If you’re a dental practice which accepts dental insurance, then, like it or not, you have financial partners in your business:  the insurance companies. Tom Limoli joined host Patrick O’Rourke on this episode to detail the mistakes he sees practices making in handling dental insurance, mistakes which result in administrative burdens and costs which undermine the entire practice. Dental Business Radio is underwritten and presented by Practice Quotient: PPO Negotiations & Analysis and produced by the North Fulton studio of Business RadioX®.

Limoli & Associates

For almost half a century, Limoli and Associates / Atlanta Dental Consultants has served all facets of the dental benefits industry by streamlining and simplifying the global reimbursement process. The overall mission being to make the delivery of dentistry more affordable through information, education, consultation and service.

Their time proven, simplified, no-nonsense approach to the execution, management delivery of third-party reimbursement benefits has been implemented in thousands of both clinical and administrative operations across the country.

Website | Facebook

Tom Limoli, Limoli & Associates

Tom Limoli, Limoli & Associates
Tom Limoli, Limoli & Associates

Tom Limoli, Jr. is the prevailing expert on proper coding and administration of dental insurance benefit claims. He serves as president of Limoli and Associates/Atlanta Dental Consultants, Inc., a company that over the past quarter century has assisted dental offices in streamlining the insurance reimbursement process. Mr. Limoli’s no-nonsense approach to the management of third-party reimbursement has been implemented in thousands of dental practices across the country.

Mr. Limoli received his Bachelor of Science in Criminal Justice from Valdosta State University. Following his work with the U.S. Treasury Department’s Federal Law Enforcement Training Center, Mr. Limoli has actively investigated fraudulent claims for the insurance industry, as well as numerous other third-party fiduciaries. He is a licensed private investigator and a member of the American Association of Dental Consultants, the National Association of Dental Plans, the National Speakers Association, the National Health Care Anti-Fraud Association, and is a past president of the Academy of Dental Management Consultants.

Mr. Limoli is the editor of Dental Insurance Today, a monthly publication that addresses third-party reimbursement in the dental office. He is the author of Dental Insurance and Reimbursement Coding and Claim Submission, and co-author of Fee-for-Service Dentistry with a Managed-Care Component.

LinkedIn

About Dental Business Radio

Patrick O'Rourke
Patrick O’Rourke, Host of “Dental Business Radio”

Dental Business Radio covers the business side of dentistry. Host Patrick O’Rourke and his guests cover industry trends, insights, success stories, and more in this wide-ranging show. The show’s guests include successful doctors across the spectrum of dental practice providers, as well as trusted advisors and noted industry participants. Dental Business Radio is underwritten and presented by Practice Quotient and produced by the North Fulton studio of Business RadioX®. The show can be found on all the major podcast apps and a complete show archive is here.

 

Practice Quotient

Dental Business Radio is sponsored by Practice Quotient. Practice Quotient, Inc. serves as a bridge between the payor and provider communities. Their clients include general dentist and dental specialty practices across the nation of all sizes, from completely fee-for-service-only to active network participation with every dental plan possible. They work with independent practices, emerging multi-practice entities, and various large ownership entities in the dental space. Their PPO negotiations and analysis projects evaluate the merits of the various in-network participation contract options specific to your Practice’s patient acquisition strategy. There is no one-size-fits-all solution.

Connect with Practice Quotient

Website | LinkedIn | Facebook | Twitter

Tagged With: dental insurance, dental insurance benefits, dental insurance reimbursement, dental practice billing, dental practice management, Limoli and Associates, Patrick O'Rourke, PPO Negotiations & Analysis, Practice Quotient, Tom Limoli

Patrick O’Rourke, Practice Quotient

May 13, 2020 by John Ray

Practice Quotient
Dental Business Radio
Patrick O'Rourke, Practice Quotient
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Patrick O’Rourke, Practice Quotient

Patrick O’Rourke, Practice Quotient (North Fulton Business Radio, Episode 233)

Practice Quotient helps general dentistry practices and other specialty dental practices maximize the reimbursement they receive from dental insurance carriers. Founder and CEO Patrick O’Rourke joins the show to discuss how his firm helps significantly improve the profitability of their clients. The host of “North Fulton Business Radio” is John Ray and the show is produced virtually by the North Fulton studio of Business RadioX® in Alpharetta.

Patrick O’Rourke, Founder & CEO

Patrick O’Rourke began his career in operations management at a dental & vision insurance company in Florida, which after several acquisitions and mergers, is now MetLife. He spent five years at Humana in Atlanta selling in the large group segment (100+ employees). In addition to several awards throughout his career, he has earned many professional certifications.

Understanding the nuances involved with all aspects of risk management helped business partners rely on his expertise to guide client recommendations. He is an insurance insider that has built dental networks, worked in operations management, designed dental plans, and opened markets.

In 2013, he founded Practice Quotient, which specializes in dental insurance PPO network contract analytics and reimbursement guidance, representing the dental provider.

As a national public speaker, Patrick educates doctors on how dental managed care participation impacts up to 50% of practice revenue, the importance of diligent contract management, and how to develop criteria specific to a patient acquisition strategy for choosing the best carrier business partners.

To connect with Pat, you can email him directly or call 470-592-1680.

Practice Quotient

Patient Quotient, Inc. serves as a bridge between the payor and provider communities. Their clients include general dentist, oral surgeons, and other dental specialty practices across the nation of all sizes, from completely fee-for-service-only to active network participation with every dental plan possible.  They work with independent practices, emerging multi-practice entities, and various large ownership entities in the dental space.

Their projects evaluate the merits of the various in-network participation contract options specific to a practice’s patient acquisition strategy. There is no one-size-fits-all solution.

While their team is comprised of many individuals, both clients and carrier representatives always interact with the firm’s leadership team.

For more information, go to https://www.practicequotient.com/.

 

North Fulton Business Radio” is produced virtually from the North Fulton studio of Business RadioX® in Alpharetta. You can find the full archive of shows by following this link. The show is available on all the major podcast apps, including Apple Podcasts, Spotify, Google, iHeart Radio, Stitcher, TuneIn, and others.

Renasant Bank has humble roots, starting in 1904 as a $100,000 bank in a Lee County, Mississippi, bakery. Since then, Renasant has grown to become one of the Southeast’s strongest financial institutions with over $13 billion in assets and more than 190 banking, lending, wealth management and financial services offices in Mississippi, Alabama, Tennessee, Georgia and Florida. All of Renasant’s success stems from each of their banker’s commitment to investing in their communities as a way of better understanding the people they serve. At Renasant Bank, they understand you because they work and live alongside you every day.

Show Transcript

Intro: Live from the Business RadioX studio inside Renasant Bank, the bank that specializes in understanding you, it’s time for North Fulton Business Radio.

John Ray: And hello again, folk. Welcome to another edition of North Fulton Business Radio. I’m John Ray. And we are coming to you, yes, still virtual Business RadioX studio. No, we’re not in Renasant Bank quite yet. But hopefully, one of these days soon, we’ll be back in our studio there. But in the meantime, we still love the folks at Renasant. They’ve done a great job with the PPP loans and other help for small business. I know that myself because I worked with them on behalf of clients. So, check them out, renasantbank.com. If you want to go into the branch, you can, but you need an appointment ahead of time. So, give them a call or go to renasantbank.com for more information. Renasant Bank, understanding you. Member FDIC.

John Ray: And now I want to turn to an old friend, Patrick O’Rourke is with Practice Quotient. Patrick, how are you? And welcome.

Patrick O’Rourke: Doing awesome, John. How are you?

John Ray: I’m great, I’m great. So, Practice Quotient, tell us about your firm, tell us about you, tell us about what you do and how you serve.

Patrick O’Rourke: Okay. Well, I’m Patrick O’Rourke. I’m the founder and CEO of a firm called Practice Quotient. Everybody calls it PQ for short.

John Ray: I like that.

Patrick O’Rourke: Yeah. Practice Quotient doesn’t roll off the tongue, I guess. So, I was thinking like intelligence quotient, practice quotient. I thought that was quite clever, actually. My wife thought it was silly, but there you go. So, at any rate, our business is called Practice Quotient. And what we do is, really, the formal technical term for what we do is that we do manage dental care network contract analysis and negotiation.

Patrick O’Rourke: What clients and what most folks understand that to be is that we analyze PPO contracts, and we make sure that they’re suitable for our clients, our clients being general dentists, oral surgeons, periodontist, endodontists, anybody in the dental space, prosthodontists. We have some orthotists, and anybody that’s submitting CDT, which are there’s medical codes and the dental codes that have their own codes. So, we analyze all the contracts. And then, we make sure that they are a win/win for both the provider, i.e., our client, and for the network or payer, i.e., the insurance company. And so, I’d like to think that we’re a bridge between the provider and the payer communities.

John Ray: What you’re talking about is something extraordinarily important to a dental practice; yet, this is not something they cover in dental school, right? I mean, what best practices are when it comes to the insurance carriers that you offer through your practice?

Patrick O’Rourke: It does seem to be the case. They do not have any classes in contract reviews, statistical or actuarial analysis. No, they don’t. Or even credentialing or any of the other stuff that’s involved. We don’t do credentialing, but there’s a lot that’s actually involved with this decision, and it’s a very big decision. And so, no, they don’t teach it in dental school. I don’t know. You’d really have to go to intern school, I think. It’s a bit different, and it’s incredibly time-consuming, but it affects it, not a good portion, I would say it. It can affect up to 50% or more of the reimbursement of a dental practice or dental specialty practice.

Patrick O’Rourke: And so, you have to understand, because this is one of your biggest … It’s top two of your costs if you’re in plans. PPOs can be very useful. It just depends. There’s no one-size-fits-all solution. So, every practice kind of has its own patient acquisition and retention strategy, if you will. And well, what is that? And so, sometimes, I ask clients, and they’re like, “I don’t know.” And that’s kind of the wallet. There is one of the symptoms of, well, you’re losing money.

Patrick O’Rourke: So, if you’re outsourcing, if you just sign up for every single PPO, then what happens is you’re always on discount, you’re always on sale, right? Because if you think about what we’re doing here or what the deal is, the proposition is the dental insurance companies go to the providers, and they say, “Hey, listen. Usually, you charge $100 for this service. And if you give us a discount of 30%, we’ll pay 70,” which is great.

Patrick O’Rourke: Terrific, right? “Don’t you want new patients? And then, we’ll send you all these new patients, and we’ll give you the promotional consideration of being on our website”, woohoo, with dozens and dozens of other names, particularly in Northern Metro Atlanta. And you have the patient convenience of having claim paid as a network. You’re getting the added bonus of the full weight and breadth of Fortune 500 companies, marketing power, steering patients your way.

Patrick O’Rourke: And so, that part of it is definitely true. Now, if you’re in a managed care friendly area like, say, a New Yorker in Southern California, it’s critical that you’re in network, but there’s still fee for service, only practices. So, being in network, your dental insurance isn’t like medical insurance. It’s really a big misconception among consumers, and really, the providers as well. Medical insurance, you have to go and network if you want really any coverage.

Patrick O’Rourke: In most cases, like certainly, in HMO, but even your point of service plans. Dental PPO is a PPO by definition. Has out of network coverage, right? And dental PPO, PPOs are by far and away, it’s not even close, 85% of the entire market of dental insurance. And so, you know, it’s a very limited benefit. It’s usually 100% coverage for your preventive. So, I think, you know, office visits, X-rays, routine cleanings, then 80% for your basic, which could be, I think, extractions and fillings, and then 50% for your major works, I think, crowns, dentures, and plants, that type stuff.

Patrick O’Rourke: And that’s the most common plan. And it’s the same in or out of network in most cases. And so, people can go out of network. It’s not really a problem because you only have a thousand-dollar max. But, you know, the consumers, the number one reason why people don’t go to the dentist, or access, or health care is because they don’t have dental insurance, which I personally think is silly. But I’m not going to change the world, just me and you.

John Ray: Right. You know.

Patrick O’Rourke: We have no reason not to go to the dentist if you don’t have dental insurance, just use your HSA, your FSA.

John Ray: Right.

Patrick O’Rourke: And, you know, the number two reason is they don’t know how much it’s going to cost even if they have dental insurance because dental insurance to me is really easy and kind of it’s my bread and butter. I’ve been doing it for 20 years. But, you know, to Johnny Lunch Bucket, when you’re selling the employer group benefits ,and you’re doing an open enrollment meeting, and you just explain the medical benefits, what’s your prescription copay, how is a maternity work, and here’s your deductible, here’s your HSA and your FSA, you know, like their eyes have already glazed over, you know?

John Ray: Right.

Patrick O’Rourke: I’ve done hundreds, if not thousands of these open enrollment meetings. And the only thing I want, Johnny Lunch Bucket, remember, when he walks out of that door is he better go to a participating provider. And so, I say it over, and over, and over again, a different voice, and then we write it, and I say, we, the insurance industry, put on EOBs, put on all the marketing material. And so, you want to steer all of the members out from the insurance company to your participating providers to ensure your cost of care is manageable. In theory, you also want to make sure they go into quality providers. And you want to reward your providers for being in your network.

Patrick O’Rourke: So, that’s what’s in it for the insurance company. And just for your listeners, you know, you know this, but I’m from the insurance industry, so that’s kind of what makes us different. There are a couple of businesses or a couple of firms that do this across the country. And, you know, really, the big difference is I’m from the insurance industry. So, I help build dental insurance companies, worked with Humana for a while. I’m professionally certified in dental benefits, underwriting HIPAA, high tech Medicare, wellness, consumer-driven health care plans, several other things. None of which make me cool or hit at the neighborhood barbecue, unfortunately.

John Ray: So, what that means is you understand the inner workings and the architecture of these plans.

Patrick O’Rourke: That’s correct. Very good observation.

John Ray: Yeah. Because you’ve been there. And what I heard of, I mean, there’s a lot to unpack there, but one of the things I heard is, number one, as a dentist, you don’t automatically default to accepting every carrier that you possibly can. Say more on that.

Patrick O’Rourke: Yeah. And so, in most cases, you have different folks that are in different stages of their business. So, you know, if you’re a startup and you have empty chair time, an empty oratory, so down, at 20, flush down the toilet.

John Ray: That’s right.

Patrick O’Rourke: And so, you know, in kind of to your earlier point, if you just got out of school and you got a mountain of debt, and you open up your practice, the meter’s running and it’s your money, the bullets are alive. You’ve never owned a business before. Welcome to the entrepreneur club. You know, John, can you please get the man or woman their jacket? Now, you’re the butcher, the baker, the candlestick maker, the bookkeeper, the website person, marketing, the janitor. Oh, hey, listen, you’ve got to be a dentist, too, right?

John Ray: Right.

Patrick O’Rourke: And so, that takes an adjustment period, I think. And so, what’s important is cash flow. And so, you need to make sure, you know, step one is you need to survive. Then, you know, that’s a startup. You know, we don’t do a lot of startups, I think we’re not really doing any. I talked to a lot of folks, I’ve been to GRU over in Augusta, and it was very clear to me in the first 10 minutes, you know, I’m like, so here’s kind of the things that you need to think about. And everybody’s staring at me, you know, like I slipped into Portuguese.

John Ray: You’re like the skunk at the wedding, right? You’re bringing all the bad news.

Patrick O’Rourke: Right. And I’m like, you know, do you guys know what I’m talking about? Do you know what credentialing is? And they’re like, uh-uh.

John Ray: Oh, boy.

Patrick O’Rourke: You know, I’m like, so, here’s our contract works and what a network is. No, none of that, huh?

John Ray: Oh, wow.

Patrick O’Rourke: And so, I spent a lot of, you know—I did my talk, and then afterwards, you know, the kids had a lot of questions. I probably stayed there until like 11:00 at night, and answered all the questions, that I really feel like I was like throwing a pebble in the ocean. And so, unfortunately, there’s a lot of stuff, if you don’t do your own homework or you don’t have good advisers around you that you knew, you got to do what you got to do.

Patrick O’Rourke: So, if you’re just fresh out of school, you know, you’ve got to do what you got to do to survive. You learn a lot of things. Once you’re established, if you’re in a established stock, you know, to make this as simple as I can, when you’re looking at PPOs, it comes down to, well, how much access do you want to have as a participating provider to these various pools of discounted insurance patients, right?

John Ray: Right.

Patrick O’Rourke: This is on a scale of one to 10, you know?

John Ray: Right.

Patrick O’Rourke: And so, some clients look at it as access. Some clients look at it as how much discounting do I need to do in order to fill my schedule? Really, the same question, like we’ll give you the answer, but their perspectives are different, if that makes sense.

John Ray: Right. Sure.

Patrick O’Rourke: And so, you know, most of our practices and most of our clients, you know, tend to be top-tier docs. You know, they’re definitely established. And our job is to convince insurance companies to, you know, pay them more than they would usually pay, which I know this sounds crazy, but they’re just not in a hurry to do it, right?

John Ray: Yeah. Right.

Patrick O’Rourke: And so, we need to understand what it is about that practice that makes that practice important and a good partner for the carrier.

John Ray: So, now, if you don’t mind me interrupting, that was really an interesting statement you just made. I mean, so what you’re saying is, if I can put it in another way, you’re really a practice advocate with the insurance company. I mean, you advocate for that practice and why their business is important with the insurance company so that that insurance company will, in effect, pay more to do business with them?

Patrick O’Rourke: That’s correct.

John Ray: So, what does that mean for the bottom line of a practice? I mean, because you obviously help practices, as you say, accept less discounts, you help them pick the right kind of, I guess, portfolio, if you will, of insurance providers to do business with, right? What does that mean for a typical practice that you work with in terms of their bottom line? I mean, if you don’t want to use a real-life example, maybe you can use one that’s without a name, but it would be interesting, I think, for our folks to hear that.

Patrick O’Rourke: If I told you our actual batting average, John, you would probably use profanity and not believe me.

John Ray: Well, we’re not regulated by the FCC, so try me out.

Patrick O’Rourke: Oh, really?

John Ray: Yeah, that’s right.

Patrick O’Rourke: So, I’m going to have to give my official reply here, which is, it really depends, and this is true. So, every project is different, like where were they when they started out? Maybe they are on good contracts already. And so, we’re just doing a tune up. You know, for practices that are writing off, you know, half-a-million dollars, which happens every day, let’s just say that they’re pleased. You know, sometimes, I tell them like, look, if you’re not sending me a Christmas card at the end of this, I must have got hit by a bus, you know?

Patrick O’Rourke: So, it really depends on how bad off they are, whether anybody’s looked at these contracts. It depends on the leverage of that particular practice. You know, the projects, these projects are not easy. They are not short or brief, you know. So, they’re long-term engagements, where you have to understand exactly what the practice is doing and why. You know, this is a big portion of revenue, huge. I mean, this is it, like this is the whole enchilada. This is your wealth. And so, we need to understand how important the carriers are. We have to look at the contracts.

Patrick O’Rourke: You have to do all of the math, and then you have to go to, you know, what I call the market. And, you know, it’s not Wall Street. I’m talking about, you know, the relevant entities, and networks, and carriers that are in any given market, like we’re a national firm. We have clients from Anchorage to LA. Miami to New York, you know, but we’re based right here in Atlanta, Georgia. God bless Georgia. So, everywhere is different. So, the market in Atlanta is different than LA, or Chicago, or certainly, Boise, Idaho.

John Ray: Right.

Patrick O’Rourke: So, you have to understand all of that, then you’ve got to go out to all of these folks, and go back and forth, you know, then the carriers have to understand. And they’re all different, too, like, you know, I think that nobody wants to lump insurance carriers into some bucket. They actually care about different things. Their target client type, or patient type, or employer group varies as well. And their leadership, they’re all different.

Patrick O’Rourke: And so, they care about different things. And so, you know, we try to be as transparent as possible with the insurance carriers. And so, we give some information about the client, like this is why they’re awesome, right? And then, it comes down to numbers and we have an actual variable tool here that is just as good or better than anything the insurance companies have because that’s where I’m from. So, I had to build something.

Patrick O’Rourke: And, you know, whereas we’re using underwriting methodology based on that practice because they’re usually looking at a market. If you look at Atlanta, so they’re projecting claims out to be two or three years where we’re looking at more specific at the experience or the claims history of that specific practice. And so, you have to go out there. So, really, you’re 10 months into this thing before, you know, now, we’re going to start makes some decisions, right?

Patrick O’Rourke: And now, those decisions and the execution of these decisions are what takes the most time. And so, you have to then, you know, how are you going to execute? We usually have most of the game plan done at that point, but we’re very conservative here. And so, we’re very methodical. We want to avoid fire drills and, you know, minimize any turbulence. And by turbulence, I mean, you know, cash flow disruption, patient disruption, claims disruption, or most of all, if not the most important, staff disruption.

Patrick O’Rourke: Everybody needs to be comfortable and confident in what we’re doing and why. And, you know, so, it’s not like our—you know, we provide the guidance, and we do the math, and we provide all of the recommendations that are based on the direction that the client is giving us up to that point. Obviously, things change. Then, when we go and we sit down with the team at the practices, you know, it’s up to them to say yes or no with what their risk tolerance is going to be.

Patrick O’Rourke: If, let’s say, they wanted to—let’s say there is a major carrier, right? You know, I won’t use any names. Let’s just say you’re in a market, there’s a big carrier, and the carrier, you know, it’s 40% of your practice, right? The revenue volume. And then, we do the math. And they’re paying you 50 cents on the dollar. Well, that’s not good because your business overhead is, you know, 60, 65 five if you include your salaries, which you should. I’m sure your spouses want you to and your children.

John Ray: Sure. Yeah, they like that.

Patrick O’Rourke: Yeah. I bet your wife does too.

John Ray: Yeah.

Patrick O’Rourke: And so, if our business overhead is 65, then how can we take 50 cents on the dollar, right? That doesn’t make a whole lot of financial sense.

John Ray: No.

Patrick O’Rourke: And I don’t think you have to be Stephen Hawking to understand that, you know. But let’s say that we do the math, and then it’s 40% of the practice. Let’s just keep easy numbers. It’s a million-dollar practice. So, it’s four hundred thousand. And then, you’re like, well, okay, we’re getting 50 cents on the dollar, and we have 400,000 revenue at 50 cents on the dollar. So, that’s a ton of patients, right? That’s a lot of patients, you know. And the carrier is unreasonable. Let’s say that they’re in Atlanta just because we’re here and they go, you know what, John Ray Dentistry, you know how many dental practices we have in Alpharetta?

Patrick O’Rourke: So, you have plenty. I’m saying, tell John Ray that we appreciate all of his business and we’ll enjoy counting his money for years to come, but he either takes 50 cents on the dollar or he’s out. And we just say, you know, we’re always playing professional, like I understand, I do, like I understand the insurance carrier side. I’m like, okay, fair enough. And so, they then make their business decisions. Now, we come back to you. We’ll use you and call you Dr. John Ray, make your mama real proud.

John Ray: Yeah, that’ll come as a surprise, but anyway, go ahead.

Patrick O’Rourke: And so then, you know, I’ll come back to you, I say, “John, look, here’s the deal. So, we have a carrier X here is paying you 50 cents on the dollar, so you’re losing money, right? You understand this, right?” And then, you know, usually, the client has a few choice words for a little while. You got to wait for that to die down. And then, we say, “Well, you know, they’re not budging, and they’re not going to budge.”

Patrick O’Rourke: This is the worst-case scenario, but I think that this is really important content in case any of the provider community is listening, and even the payer community because we’re very consistent in this particular message. Rule number one is our clients got to break even, you know. So, we’re not losing money unless there’s a damn good reason why, you know. So, at any rate, so we go, okay, so you’re getting 50 cents on the dollar. We’re going to have to cancel that and terminate that agreement. You’re going to go out of network. This is what our recommendation is going to be.

Patrick O’Rourke: So then, we do a cost benefit analysis. And then, you know, then the client’s reaction is like, oh, man. Oh, that would be awful. That would be awful. What do you mean go out of network? That’s terrible. We’re going to lose patients, Pat. And I’m like, yeah, sure will. How many? They’re like, well, I don’t know. I say, “Well, I don’t know either.” If you think you’re going to lose half. They’re like, oh, half, oh, that would be a disaster. That would be a calamity. No, actually, it wouldn’t.

John Ray: Yeah.

Patrick O’Rourke: From financial perspective, you would make more money. You would. I don’t think you’re going to lose half because you told me that you were awesome for all of these reasons, right? Now, are you the Walmart of dentistry or, you know, like you tell me. And so, they either make the decision—it’s up to them, obviously. But, you know, most folks don’t hire us if they’re not going to kind of, oh, I got it, right?

John Ray: Sure.

Patrick O’Rourke: It’s up to them. But, you know, I just give the facts. We’re neutral towards it. And the bottom line is, and this happens all the time across the country, so once they understand that, they see the math, and they’re like, man, half my income is gone. I’m losing money every time I see one of these numbers. The bottom line, you don’t want any more of them, right? You’re losing money, right? Because you’re doing a good job for them, now, you’re getting referred by your patients, right?

Patrick O’Rourke: And you’re getting referred by people that they work with because where does everybody usually spend all their time? At work. Where do they get that dental insurance? At work. And so, now, you’re a victim of your own success. You get referred in more 50 cents on the dollar, now, you’re losing more and more money, right? So, if you’re at 30%, the next year, it’s going to be 40%. What are you going to do when it’s 60%? So, that’s really one of the most important things. When I’m speaking, you know, across the country, I’m like, you can’t take 50 cents on the dollar, you don’t have to hire us, right? Just stop doing that.

John Ray: Right.

Patrick O’Rourke: But that’s the conversation, there’s naturally some anxiety. But, you know, if it’s planned out properly, then I’ll tell you, you know, we’ve done hundreds of projects at this point. And, you know, they never lose half of their patients.

John Ray: Yeah. So, you’ve got the experience to bring to that, and to help, you know, reassure a dentist that life is going to be good on the other side of this project. So, because of all the other projects you’ve done and all the other, I guess, testimonials that you’ve got from satisfied clients, right?

Patrick O’Rourke: Right. Yeah. We don’t have a sales team at all actually. We’re just, now, kind of raising our visibility and, you know, I’ve had some extra time to work on the website. We are exclusively referral-based. So, you know, it’s usually current client that sent you over to us. You know, current client or sometimes there’s somebody that’s involved in an advisory capacity at that practice that cares about their long-term financial success, like maybe a CPA or, you know, a wealth manager with some of the more top-tier dental consultants that are out there.

Patrick O’Rourke: But it’s somebody that’s really invested into that practice and has some sort of stake in that practice being successful. And so then, they call here, you know, they talk to my team, you know. But every single client has to talk to me first, you know. And so then, we have a conversation and I’m fairly direct, you know, in case that’s not immediately obvious. And we talk about it like, what are you trying to accomplish? Sometimes, we’re a good fit. Sometimes, we can help you, and sometimes not. But I’ll tell you that really right up front.

Patrick O’Rourke: So, you know, you never want to jump on a project or, you know, jump into something that’s going to be two years if you don’t understand what you’re getting into. So, you know, what I tell folks, I said, “Look, we’re going to be friends for two years, so let’s make sure everybody’s very comfortable and confident with what we want to accomplish together because at the end of it, if they’re not thrilled, then there goes our marketing plan”, because that’s how we get all of our clients.

John Ray: Yeah. Well, this has been great, Pat. Great stuff from Patrick O’Rourke. He’s the Founder, CEO of Practice Quotient, better known as PQ. Pat, this has been awesome. And we know you got to get on to work with your clients. So, how about before we let you go, give us your contact information. Folks that have heard this would like to be in touch, how can they do that?

Patrick O’Rourke: Sure. You can contact our offices anytime. We’re not close. We have full staff. We haven’t furloughed anybody. We’re at 470, is the area code, 592-1680. That’s 470-592-1680 or you can submit, and contact us, inquiry on our website, which is www.practicequotient.com, P-A-C-T-I-C-E-Q-U-O-T-I-E-N-T-.com. And if you wanted to email me, you can email me at porourke@practicequotient.om. And, you know, we’re here, we’re open, we’re in Eastern Time Zone. So, if you’re listening to this and you happen to be in Anchorage, you know, we’ll send you a link to my calendar, but we can accommodate before or after business hours. Also, one thing before we go, John, I have a question for you.

John Ray: Oh.

Patrick O’Rourke: Right. So-

John Ray: I’m the one that asks the questions here. Come on.

Patrick O’Rourke: I think it’s fair play.

John Ray: Okay. Bring it on.

Patrick O’Rourke: I get one question in.

John Ray: Okay.

Patrick O’Rourke: So, I’m checking out your hair, and I’m wondering, is John like cutting his hair at home? Do you have a Flowbee, or you’re doing it yourself, or what’s going on?

John Ray: You know, when you have headphones on, it kind of takes care of that. So, if I didn’t have headphones on, you know, it’s a natural beret, headphones on.

Patrick O’Rourke: Well, next time, I’m going to be on camera then because I look like Ted Hanson.

John Ray: There you go. I love it. Patrick O’Rourke with Practice Quotient. Pat, thanks for being with us.

Patrick O’Rourke: My pleasure. Thank you, John.

John Ray: Thanks. Folks, if you’ve got headaches that involve administrative tasks, bookkeeping, marketing, presentations, maybe you’ve got a virtual workshop that needs to be planned, well, go engage with smart and reliable Office Angel. They fly in with talent and experience and get the job done, and they fly out. And they’ve been working virtually for, I think they’re 17, 18 years old now, founded by Essie Escobedo. She’s a Chief Executive Angel over there at 770-442-9246.

John Ray: If you’ve got an issue that is holding your business back, give Essie a call and explain to her what you’ve got, and she’s got answers. And if she can’t help you, she always connects you. So, officeangels.us is the website. So, be in touch with Essie Escobedo, Office Angels. And folks, just another reminder that you can listen to this show on all the major podcast apps. We’d love it if you could go on any of your favorites there, whether that’s Apple Podcast, Google Stitcher, TuneIn, Spotify, iHeartRadio.

John Ray: Go on and give us a nice review. It helps us profile great business leaders like Patrick. So, check out any of those, any of those apps and more. And you can also, of course, go to northfultonbusinessradio.com and find our complete archive of shows. Follow us on social media as well, if you would, for LinkedIn, Facebook, and Twitter. We’re at North Fulton BRX. So, for my guest, Patrick O’Rourke, I’m John Ray. Join us next time here on North Fulton Business Radio.

Tagged With: dental, dental insurance, dental managed care, dental plan, dental practices, dental specialty practices, general dentist, general dentistry, general dentistry practices, John Ray, North Fulton Business Radio, oral surgeons, Patrick O'Rourke, PPO network contract, Practice Quotient, specialty dental practices

Pat O’Rourke with Practice Quotient, Mary Becker with Best Deal Movers, and Nick Patel with Salsarita’s

May 31, 2016 by Mike

North Fulton Business Radio
North Fulton Business Radio
Pat O'Rourke with Practice Quotient, Mary Becker with Best Deal Movers, and Nick Patel with Salsarita's
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Mike Sammond, Pat O'Rourke, Mary Becker, Nick Patel, John Ray
Mike Sammond, Pat O’Rourke, Mary Becker, Nick Patel, John Ray

Pat O’Rourke/Practice Quotient

Patrick O’Rourke of Practice Quotient began his career at a dental and vision insurance company in Florida, which after several acquisitions and mergers, is now MetLife. He spent five years at Humana in Atlanta selling in the large group segment (100+ employees). He was responsible for all lines of insurance coverage for these groups including fully-insured and self-funded (ASO) medical, dental, life, disability, stop loss, pharmacy (PBM), wellness, and worksite/voluntary portfolio. It seemed that spiraling group healthcare costs pushed ancillary lines into the periphery. This tendency became magnified after the PPACA paradigm shift that left everyone on information overload. He positioned himself as an industry resource by earning several certifications, including Disability (DIA) and Dental (DBA). Understanding the nuances involved with all aspects of risk management helped business partners rely on his expertise to guide client recommendations. He is an insurance insider that has built dental networks, worked in operations management, designed plans, and opened markets. This allows him to provide valuable insights to his dental practice clients.

Mary Becker/Best Deal Movers

Best Deal Movers began as a dream that Mary’s son David had. He, along with two of his brothers, had worked at moving companies during the summer when they were home from college. In the spring of his sophomore year, David injured his arm while pitching on the college baseball team. When surgery and rehab did not bring the necessary results to be able to continue in the sport, David had to reconsider what he wanted to do. He brought the idea for a moving company to his dad, and Best Deal Movers was born. They started with one truck and an office in their home. The business has continued to grow. Today they have seven trucks and are continuing to expand. They are proud to provide excellent service to their clients, having been chosen to receive The Best of Kudzu Awards for the past three years and having been voted by Angie’s List members to receive their Super Service Award for 2013 and 2014.

Nick Patel/Salsarita’s

At Salsarita’s Fresh Cantina, they’re building a dynamic and authentically inspired fast casual Mexican brand, offering delicious food that is made the way you want it and prepared every day in-house. From wildly addictive chips that their guests truly rave about, to queso, customized burritos, tacos, salads, bowls, quesadillas, nachos, signature salsas and fresh-made guacamole, Salsarita’s Fresh Cantina thrives on making great Mexican fare fresh daily. Since their beginnings in Charlotte, NC in 2000, they have worked to perfect the notion that a restaurant should not only be fast and friendly, but also casual and delicious like no other. Today, they have locations in 19 states and are rapidly growing.

Tagged With: customer service, dental, dental insurance, food, insurance, Mary Becker, mexican food, Mike Sammond, movers, moving, Nick Patel, North Fulton Business Radio, Pat O'Rourke, Practice Quotient, restaurant, Salsarita's, vision insurance

Marie Fratoni with Get Clients Everywhere, Rick Loose with Milton Park Partners, and Elizabeth Burgner with Planned PEThood of Georgia

April 7, 2016 by Mike

Gwinnett Business Radio
Gwinnett Business Radio
Marie Fratoni with Get Clients Everywhere, Rick Loose with Milton Park Partners, and Elizabeth Burgner with Planned PEThood of Georgia
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Mike Sammond, Marie Fratoni, Rick Loose, Elizabeth Burgner

Marie Fratoni/Get Clients Everywhere

Get Clients Everywhere provides coaching support to entrepreneurs so that they find more clients, make more money, make a greater impact, and have more fun! They work with smart, talented business owners providing coaching, training, and speaking around important entrepreneurial topics that help businesses grow.


Rick Loose/Milton Park Partners

Milton Park Partners is a staffing company providing a broad array of solutions designed to meet the needs of today’s small businesses. Their purpose is to enable the small business owner to “get on with business” by relieving executives of the many burdensome and time consuming aspects of employment from hiring to well after the employee has left the organization. Business owners and their employees can rely on Milton Park Partners to be their HR department and provide a full scope of administrative and professional HR support.

Elizabeth Burgner/Planned PEThood of Georgia

Planned PEThood of Georgia reduces the overpopulation and suffering of dogs and cats through education and low-cost spay/neuter programs and to rescue, vet and place adoptable dogs and cats into good permanent homes. Adoptable is defined as dogs and cats that pose no health or safety risk, which makes the animal unsuitable for placement as a pet.


CLICK HERE
 to watch the video of this show.

 

Tagged With: dental insurance, Elizabeth Burgner, employee benefits, entrepreneur, feral cats, Get Clients Everywhere, Gwinnett Business Radio, high quality pet care, insurance, Marie Fratoni, medical insurance, Mike Sammond, Milton Park Partners, neuter, pet adoption, planned pethood of ga, planned pethood of georgia, Radiox, Rick Loose, spay, spay neuter surgery, speaking, training, vaccinations

Ted Officer and Melissa Sloan with USA Health Insurance, Jody Stewart with Vaccines 2 Go and Gwynnis Mosby with Gwynnis Mosby Makeup Academy

May 1, 2015 by Mike

Business Leaders of Today
Business Leaders of Today
Ted Officer and Melissa Sloan with USA Health Insurance, Jody Stewart with Vaccines 2 Go and Gwynnis Mosby with Gwynnis Mosby Makeup Academy
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Chris Horne, Gwynnis Mosby, Jody Stewart, Ted Officer, Melissa Sloan, Tess Turrin
Chris Horne, Gwynnis Mosby, Jody Stewart, Ted Officer, Melissa Sloan, Tess Turrin

Ted Officer & Melissa Sloan/USA Health Insurance

Melissa Sloan & Ted Officer, USA Health InsuranceWith over 20 years experience, Ted Officer has created a one-stop solution for all your health insurance needs – USA Health Insurance. From helping with the Affordable Care Act and making sure thousands of American’s are insured, to helping with Medicare, Life, Vision and Dental, Mr. Officer has created a one stop consultative solution at absolutely no charge to the consumer.

Services they provide include: 1.) Help with new existing policies 2.) Help finding the most affordable insurance on the market 3.) Needs Analysis so you have the coverage you need 4.) Dental & Vision Coverage with the best carriers on the market 5.) Medicare Coverage to cover prescriptions, hospital visits and more. 6.) Help with payments, insurance carriers, document management and so much more.

They want to roll out the red carpet to their clients to make it as easy as possible for them. They handle the Health Insurance Marketplace (also known as Hc.gov) for their clients and they submit all applications and information that is required by the government. They also handle off-market policies and ensure the best plans are selected for the consumer’s dollar. They stay educated on trends, market changes, price changes, insurance regulations and more. They help their clients to understand all of this and how it affects them each year.

If you want a company that prides itself and is built on helping you – and you are looking for experienced, dedicated, ethical people to get you insured – then call USA Health Insurance today!

Jody Stewart/Vaccines 2 Go

Jody Stewart, Vaccines On The Go (2)Vaccines 2 Go provides you and your employees with convenient on-site access to vaccinations you need. By bringing this service on-site, employers are able to give their employees a convenient way to have peace of mind that they and their family’s are protected. V2G also provides vaccines to medical sales professionals and allows them online access to their medical portal so they can send in the medical records to access hospitals and vendor services. It also saves the medical company money by allowing the sales rep to get in-home vaccines or at the National Sales Meeting, reducing the time they would have to spend in a doctors office or health department. Therefore they are not missing time from work and missing sales. Vaccines 2 Go offers three types of vaccines: Routine, Recommended and Required. They are conveniently available in all 50 states.

Gwynnis Mosby /Gwynnis Mosby Makeup Academy

Gwynnis Mosby, GM Makeup AcademyIf you’re looking for a new, exciting and lucrative career in professional makeup artistry, then look no further. The Gwynnis Mosby Makeup Academy offers a comprehensive, hands-on education in all areas of professional makeup. Their masters level classes are taught by qualified instructors who are veteran working professionals in the field of makeup with many years of experience in a wide range of areas, including beauty and corrective makeup, airbrushing and body makeup, theater and live performance makeup, high fashion makeup, runway and photography, bridal, high definition television, film, fantasy, beginning prosthetics, and special effects. They offer career development courses and help students prepare to work in the field of makeup upon completion of course programs.

Business Leaders of Today radio show

Tagged With: dental insurance, gwynnis mosby, gwynnis mosby make-up academy, gwynnis mosby makeup acaedemy, gwynnis moseby, health insurance, in-home vaccinations, in-home vaccines, insurance, insurance carrier, make-up, makeup, makeup school, medicare, melissa sloan, on-site vaccinations, ted officer, tess turrin, united health insurance, usa health insurance, v2g, vaccinations, vaccines, vaccines 2 go, vaccines on the go, vaccines to go, vaccines2go, vision insurance, vocallogic, vocalogic

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