1 00:00:00,505 --> 00:00:02,615 - Hello everyone, and thank you for tuning in 2 00:00:02,615 --> 00:00:03,935 to the Becker's Healthcare podcast. 3 00:00:04,555 --> 00:00:05,775 My name is Mariah Moham, 4 00:00:05,875 --> 00:00:07,935 and I'm absolutely thrilled to be joined today 5 00:00:07,995 --> 00:00:11,175 by Paul Bernard, CEO of inside Desks. 6 00:00:11,445 --> 00:00:13,215 Paul, thank you so much for joining us today. 7 00:00:13,225 --> 00:00:15,175 Let's jump right into today's conversation. 8 00:00:15,675 --> 00:00:19,095 Um, so when it comes to RCM, what is scale 9 00:00:19,355 --> 00:00:21,295 and why does it matter to A DSO? 10 00:00:22,315 --> 00:00:24,935 - So, great question. First off, good morning, uh, 11 00:00:24,995 --> 00:00:26,335 Mariah, thanks for having me. 12 00:00:27,225 --> 00:00:30,855 Scale is sort of this catchall word that a lot 13 00:00:30,855 --> 00:00:31,895 of people throw around. 14 00:00:32,195 --> 00:00:33,655 So I like to take a simple approach 15 00:00:33,715 --> 00:00:38,095 and basically what scale means is as you grow, 16 00:00:38,275 --> 00:00:42,375 the bigger you get, your cost per unit decreases, right? 17 00:00:42,595 --> 00:00:45,775 So the worst thing is that as you grow, 18 00:00:45,875 --> 00:00:49,175 as you get more volume, more offices, more claims, whatever 19 00:00:49,175 --> 00:00:51,735 that your costs follow a linear curve, 20 00:00:52,065 --> 00:00:54,295 which you ideally want, is you want to start bending 21 00:00:54,295 --> 00:00:55,775 that cost curve downward. 22 00:00:55,875 --> 00:00:57,175 So that's what scale is. 23 00:00:57,275 --> 00:01:00,855 And why it matters to A DSO, quite frankly, is 24 00:01:00,855 --> 00:01:05,175 because DSOs, at least in, in a large part, exist 25 00:01:05,245 --> 00:01:08,455 because of the desire for scale benefits. 26 00:01:09,195 --> 00:01:13,495 So in a process like RCM that really is driven off of, 27 00:01:14,155 --> 00:01:16,255 uh, the number of claims, the number of appointments, 28 00:01:16,255 --> 00:01:18,895 the number of patients, those types of things, uh, 29 00:01:18,955 --> 00:01:20,815 for every patient that you add 30 00:01:20,835 --> 00:01:24,255 or for every claim that you, that you bill for, uh, 31 00:01:24,315 --> 00:01:27,295 you really want to be thinking over the long term about 32 00:01:27,355 --> 00:01:29,775 how the, the cost to serve, um, 33 00:01:29,995 --> 00:01:32,535 and to, to get paid on 34 00:01:32,535 --> 00:01:35,095 that claim goes down, uh, incrementally. 35 00:01:35,275 --> 00:01:36,375 So that's what scale is. 36 00:01:37,485 --> 00:01:38,735 - Wonderful. Thank you so much 37 00:01:38,735 --> 00:01:40,095 for giving us that information. 38 00:01:40,355 --> 00:01:42,415 So, when thinking about scale, 39 00:01:42,525 --> 00:01:45,055 when do you think a DS DSO should, uh, 40 00:01:45,225 --> 00:01:46,255 begin thinking about it? 41 00:01:47,175 --> 00:01:48,945 - Well, yeah, it's interesting 42 00:01:49,065 --> 00:01:52,025 'cause most of the, the clients that we see today, not most, 43 00:01:52,165 --> 00:01:55,745 I'd say some of them at least, um, sort 44 00:01:55,745 --> 00:01:58,465 of wait till till it's sort of right in their face. 45 00:01:58,605 --> 00:02:01,705 And so I would tell you it's never, it's never too early 46 00:02:01,765 --> 00:02:04,945 to think about scale and to think about the processes and, 47 00:02:05,045 --> 00:02:08,385 and how you might scale them if you go from, you know, 48 00:02:08,765 --> 00:02:11,945 one office to five offices to 10 offices, et cetera. 49 00:02:12,045 --> 00:02:15,065 So I guess the, the simple answer is it's never really too 50 00:02:15,065 --> 00:02:16,625 early, uh, to scale. 51 00:02:17,925 --> 00:02:21,345 But you know, what's really important for I think, DSOs 52 00:02:21,345 --> 00:02:25,465 to understand is that the work changes the bigger you get. 53 00:02:25,465 --> 00:02:27,145 And what I mean by that is a lot 54 00:02:27,145 --> 00:02:29,185 of DSOs start at the single office 55 00:02:29,185 --> 00:02:30,465 level, then grow from there. 56 00:02:31,225 --> 00:02:33,665 RCM work in a single office typically is 57 00:02:33,695 --> 00:02:34,865 done by a generalist. 58 00:02:34,925 --> 00:02:36,705 So your office manager or, 59 00:02:36,845 --> 00:02:39,225 or some other administrative person in the business 60 00:02:39,735 --> 00:02:43,705 does RCM in addition to doing, um, scheduling and, 61 00:02:43,965 --> 00:02:46,065 and perhaps even treatment planning, et cetera. 62 00:02:46,525 --> 00:02:50,865 Um, as you grow, as you gather more offices, the work, uh, 63 00:02:50,925 --> 00:02:52,625 to achieve scale starts to change 64 00:02:52,625 --> 00:02:54,065 and the work becomes specialized. 65 00:02:54,245 --> 00:02:56,905 So for instance, if you have 10 or 20 66 00:02:57,005 --> 00:03:00,445 or 30 offices, you might have one person or two people, 67 00:03:00,545 --> 00:03:04,685 or three people who exclusively work on RCM, you know, 68 00:03:04,685 --> 00:03:06,445 from the, from the moment they get there till the moment 69 00:03:06,445 --> 00:03:08,045 they leave, that becomes their specialty. 70 00:03:08,785 --> 00:03:12,925 So what we usually see is we usually see people starting 71 00:03:12,945 --> 00:03:17,445 to get questions about scale around the, the 10 72 00:03:17,625 --> 00:03:21,965 to 30 unit, uh, 10 to 10 to 30 store, uh, level. 73 00:03:22,025 --> 00:03:24,125 That's usually when they start thinking about it. 74 00:03:25,365 --> 00:03:26,705 - Got it, got it. Yeah, thank you so much 75 00:03:26,705 --> 00:03:27,825 for giving us that insight. 76 00:03:27,925 --> 00:03:29,225 Uh, it's definitely interesting 77 00:03:29,225 --> 00:03:31,105 how scale can change depending on 78 00:03:31,105 --> 00:03:32,145 the level of the organization. 79 00:03:32,655 --> 00:03:35,825 What role does technology play in facilitating the scale? 80 00:03:36,805 --> 00:03:39,625 - So I think technology, especially, you know, 81 00:03:39,625 --> 00:03:42,105 when we think about dental, I came from medical and, 82 00:03:42,165 --> 00:03:45,545 and the use of technology to help facilitate scale 83 00:03:45,565 --> 00:03:48,105 and medical is, is further downfield, 84 00:03:48,165 --> 00:03:50,185 but dental is catching up very quickly. 85 00:03:51,125 --> 00:03:53,345 The, I think the first thing when you think about technology 86 00:03:53,485 --> 00:03:56,425 is, is can you get your hands on your data, right? 87 00:03:56,565 --> 00:03:58,785 And so practice management systems, 88 00:03:59,175 --> 00:04:01,785 different software vendors, et cetera, really need 89 00:04:01,785 --> 00:04:04,865 to concentrate on interoperability, right? 90 00:04:05,045 --> 00:04:06,385 Can the practice, uh, uh, 91 00:04:06,385 --> 00:04:08,265 can A DSO get its hands on its data 92 00:04:08,525 --> 00:04:10,025 to understand its processes? 93 00:04:10,045 --> 00:04:11,425 So I think the first role 94 00:04:11,895 --> 00:04:15,305 that technology plays is facilitating interoperability. 95 00:04:16,125 --> 00:04:18,265 And then I think, you know, there's different levels 96 00:04:18,365 --> 00:04:20,545 of technology, different kinds of technology 97 00:04:20,545 --> 00:04:23,465 that you can apply to help drive scale, refocus, 98 00:04:24,025 --> 00:04:26,425 particularly on automation technology. 99 00:04:26,565 --> 00:04:29,625 So doing, doing a job or doing a parts of a job 100 00:04:29,845 --> 00:04:33,585 and automating it to so that whatever, uh, person 101 00:04:33,615 --> 00:04:38,265 that works in RCM has automated steps in their process, 102 00:04:38,375 --> 00:04:39,985 that makes them much more efficient. 103 00:04:40,005 --> 00:04:41,545 So that's where we tend to focus. 104 00:04:42,365 --> 00:04:45,665 Um, but I guess I would say that there, there are a lot 105 00:04:45,665 --> 00:04:48,665 of technological, um, tools that can be used, 106 00:04:49,325 --> 00:04:52,025 but in my view, and this is coming from somebody 107 00:04:52,025 --> 00:04:53,985 that runs a software company, I would tell you 108 00:04:53,985 --> 00:04:56,305 that the most important thing for DSOs to start 109 00:04:56,305 --> 00:04:58,545 with are their business processes. 110 00:04:59,165 --> 00:05:01,505 And so technology can 111 00:05:02,465 --> 00:05:05,865 absolutely make an existing process faster, more efficient, 112 00:05:06,095 --> 00:05:09,385 more consistent, but if you apply technology 113 00:05:09,565 --> 00:05:11,345 to a broken process, you're just gonna 114 00:05:11,345 --> 00:05:12,465 get bad results faster. 115 00:05:12,605 --> 00:05:15,705 And so, uh, I really, you know, counsel people 116 00:05:15,705 --> 00:05:17,305 that think about their processes 117 00:05:17,365 --> 00:05:19,145 and think about how the processes flow, 118 00:05:19,565 --> 00:05:24,425 and then there's a whole myriad of tools that can help sort 119 00:05:24,425 --> 00:05:26,145 of take it forward from there. 120 00:05:26,245 --> 00:05:27,785 But it all does start with process. 121 00:05:29,635 --> 00:05:32,845 - Yeah, definitely. So thinking, uh, 122 00:05:33,425 --> 00:05:35,965 of what's happening right now in the industry, 123 00:05:36,295 --> 00:05:38,205 where do you see the industry today in terms 124 00:05:38,205 --> 00:05:40,285 of understanding RCM scale? 125 00:05:41,795 --> 00:05:42,965 - Well, I, I think, um, 126 00:05:43,605 --> 00:05:45,245 I think it's really just getting started. 127 00:05:45,745 --> 00:05:47,245 And, you know, when I compare 128 00:05:47,245 --> 00:05:50,445 and contrast, let's say, you know, medical versus dental, 129 00:05:50,625 --> 00:05:52,365 for instance, on the medical side, 130 00:05:52,615 --> 00:05:55,245 there are very large health systems. 131 00:05:56,025 --> 00:05:57,785 Um, we've all got them in our, 132 00:05:57,845 --> 00:05:59,505 in wherever we are in the country, right? 133 00:05:59,505 --> 00:06:00,585 Very large health systems. 134 00:06:00,685 --> 00:06:05,105 And these large entities have actually, uh, helped push 135 00:06:05,865 --> 00:06:08,345 software companies and helped push innovation 136 00:06:08,445 --> 00:06:10,145 and push sort of automation 137 00:06:10,145 --> 00:06:13,825 and a lot of other technology adoption, uh, in dental. 138 00:06:14,325 --> 00:06:17,705 Um, I think DSOs are starting to play that role, 139 00:06:17,815 --> 00:06:20,545 meaning they're bringing the whole industry forward 140 00:06:21,255 --> 00:06:24,505 from a technology perspective and from a scaling process 141 00:06:24,685 --> 00:06:26,385 and scaling technology perspective. 142 00:06:26,885 --> 00:06:28,025 So I think we're at the very, 143 00:06:28,285 --> 00:06:29,505 the really the front end of this. 144 00:06:29,505 --> 00:06:32,345 And if you think, you know, we would say there's 145 00:06:32,985 --> 00:06:36,385 probably about 25% of the, of the dental industry is, 146 00:06:36,485 --> 00:06:38,545 is consolidated into DSOs. 147 00:06:38,965 --> 00:06:41,705 Um, and that's only gonna gonna continue to grow. 148 00:06:42,585 --> 00:06:47,425 I think more and more as companies start operating as 10, 149 00:06:47,425 --> 00:06:52,065 30, a hundred, 200, 500 sort of practice 150 00:06:52,745 --> 00:06:56,025 entities, uh, scale becomes more and more important. 151 00:06:56,265 --> 00:06:57,545 I think the other, the other thing 152 00:06:57,545 --> 00:07:01,585 that's helped accelerate it more recently has really, um, 153 00:07:01,815 --> 00:07:03,705 been the fact that most of us, you know, 154 00:07:03,705 --> 00:07:05,265 were in dental went through covid. 155 00:07:05,345 --> 00:07:09,185 I, um, and Covid D was extremely clarifying in terms 156 00:07:09,205 --> 00:07:13,505 of the importance of RCM, uh, for, for just about every DSO 157 00:07:13,505 --> 00:07:15,425 that I'm aware of in that, hey, 158 00:07:15,425 --> 00:07:17,545 you don't have patients coming in, 159 00:07:17,565 --> 00:07:19,425 or they're only coming for emergency visits, 160 00:07:19,525 --> 00:07:20,585 or you, you've got shutdown, 161 00:07:20,725 --> 00:07:23,185 you better get the most you can out 162 00:07:23,185 --> 00:07:25,265 of whatever you're billing, including whatever you've 163 00:07:25,265 --> 00:07:27,505 already billed and is in your accounts receivable. 164 00:07:28,045 --> 00:07:31,265 So COVID really, I think opened a lot of people's eyes 165 00:07:31,325 --> 00:07:34,225 to the need for scale, uh, in RCM, 166 00:07:34,325 --> 00:07:36,705 and I think that's just, uh, that's just continuing 167 00:07:36,705 --> 00:07:37,945 and if not accelerating. 168 00:07:39,105 --> 00:07:41,275 - Yeah, definitely. That makes complete sense. 169 00:07:41,695 --> 00:07:44,555 Uh, and Paul, before I let you go, as of last year, 170 00:07:44,695 --> 00:07:49,035 inside Desk has acquired 11% of the DSO market with 10 171 00:07:49,055 --> 00:07:50,115 or more locations. 172 00:07:50,585 --> 00:07:53,075 What are your plans for continued growth in 2024? 173 00:07:54,625 --> 00:07:58,195 - Yeah, um, interesting question. Great question. 174 00:07:58,195 --> 00:08:02,835 We had a great 2023 wasn't just great in terms of, you know, 175 00:08:02,835 --> 00:08:06,475 our growth and partnering with a number, uh, 176 00:08:06,545 --> 00:08:08,035 greatly increasing the number 177 00:08:08,035 --> 00:08:09,915 of DSOs that, that we partner with. 178 00:08:09,915 --> 00:08:12,075 We'll certainly will certainly take those results, 179 00:08:12,135 --> 00:08:14,915 but it was also great in terms of advancing 180 00:08:15,455 --> 00:08:19,355 our understanding of all of the underlying processes. 181 00:08:19,675 --> 00:08:22,395 I think we operate our business extremely close 182 00:08:23,015 --> 00:08:25,835 to our customers, uh, in that, in 183 00:08:26,035 --> 00:08:27,875 that there's almost no distance, right? 184 00:08:27,895 --> 00:08:30,435 We consider ourselves in many cases, an extension 185 00:08:30,435 --> 00:08:31,675 of their RCM teams. 186 00:08:32,255 --> 00:08:34,475 And so we benefit greatly from that in terms 187 00:08:34,535 --> 00:08:38,595 of really in-depth understanding of the problems, 188 00:08:38,615 --> 00:08:42,155 the challenges, the blocks that, that many of our, uh, 189 00:08:42,215 --> 00:08:44,115 our DSO partners, uh, face. 190 00:08:44,175 --> 00:08:47,955 And so that helps us tremendously in terms of prioritizing 191 00:08:47,965 --> 00:08:49,235 where we want to innovate. 192 00:08:49,575 --> 00:08:51,355 And so we're gonna continue to 193 00:08:51,865 --> 00:08:53,675 keep pushing, uh, on our mission. 194 00:08:53,895 --> 00:08:55,260 And our mission's quite simple. 195 00:08:56,025 --> 00:08:59,725 We really, uh, uh, want to continue to take the, 196 00:08:59,865 --> 00:09:03,045 the cost per unit down, uh, for all 197 00:09:03,045 --> 00:09:06,245 of our customers while increasing the cash flow and, 198 00:09:06,305 --> 00:09:08,405 and collections of realized revenue. 199 00:09:09,105 --> 00:09:12,165 And so the best way to do that, we feel is, is, 200 00:09:12,265 --> 00:09:14,885 is really working in close proximity to them 201 00:09:15,265 --> 00:09:17,645 and letting them help prioritize our innovation. 202 00:09:17,745 --> 00:09:19,405 So we've got some cool stuff coming up. 203 00:09:19,985 --> 00:09:23,645 Uh, we're gonna continue obviously to, to try and, 204 00:09:23,665 --> 00:09:26,125 and get to beyond the 10%, right? 205 00:09:26,125 --> 00:09:27,205 It'd be nice to have, uh, 206 00:09:27,205 --> 00:09:29,125 many more DSOs and so we'll continue that. 207 00:09:30,025 --> 00:09:33,125 But we see some really practical artificial uses 208 00:09:33,125 --> 00:09:36,005 of artificial intelligence in very practical ways 209 00:09:36,115 --> 00:09:38,805 that we'll be introducing the first half of this year, 210 00:09:38,805 --> 00:09:42,845 partnering with some, some great partners to bring really 211 00:09:42,955 --> 00:09:47,605 what I would think are game changing uses of, uh, voice, 212 00:09:48,345 --> 00:09:49,805 uh, ai, uh, 213 00:09:49,825 --> 00:09:51,885 and some other things to, to, again, 214 00:09:51,905 --> 00:09:54,525 to help improve the productivity of our clients and, 215 00:09:54,545 --> 00:09:56,085 and reduce their cost to serve. 216 00:09:56,185 --> 00:09:58,205 And so we're gonna stay focused on that mission, 217 00:09:58,755 --> 00:10:00,405 keep getting better, keep going deeper, 218 00:10:00,545 --> 00:10:02,965 and introducing practical, uh, 219 00:10:03,285 --> 00:10:05,325 artificial intelligence technologies where we see it 220 00:10:05,325 --> 00:10:08,165 as having a real impact, uh, on our clients' results. 221 00:10:09,495 --> 00:10:10,625 - Perfect. Perfect. 222 00:10:10,735 --> 00:10:13,705 Well, I wanna thank you so much, Paul, for sharing your time 223 00:10:14,125 --> 00:10:17,425 and insights with us today, as well as Inside desk 224 00:10:17,445 --> 00:10:18,905 for sponsoring today's content. 225 00:10:19,405 --> 00:10:21,425 To our listeners, thank you so much for joining us, 226 00:10:21,485 --> 00:10:24,105 and please be sure to check out other Becker's podcast. 227 00:10:24,535 --> 00:10:25,865 Have a wonderful rest of your day. 228 00:10:26,675 --> 00:10:27,105 - Thank you.