1 00:00:00,080 --> 00:00:02,240 Welcome to the Becker's Healthcare Podcast. My name 2 00:00:02,240 --> 00:00:04,559 is Chanel Bunger and I'm recording live at 3 00:00:04,559 --> 00:00:05,540 the Becker's Healthcare 4 00:00:06,000 --> 00:00:07,059 Fall of 2024 5 00:00:07,599 --> 00:00:10,320 Future of Dentistry Roundtable. I'm currently sitting down 6 00:00:10,320 --> 00:00:11,460 with Frank Balcom, 7 00:00:11,839 --> 00:00:14,660 the CEO and Managing Director of Xpert 8 00:00:15,105 --> 00:00:17,425 DSO Advisory Group. Frank, thank you so much 9 00:00:17,425 --> 00:00:19,105 for joining me today. Oh, thank you very 10 00:00:19,105 --> 00:00:21,184 much for having me. Well, I appreciate it. 11 00:00:21,184 --> 00:00:22,785 And to get us started, could you please 12 00:00:22,785 --> 00:00:24,304 introduce yourself and tell us a bit about 13 00:00:24,304 --> 00:00:25,044 your background? 14 00:00:25,344 --> 00:00:27,765 Sure. Thank you. My name is Frank Balcomb. 15 00:00:27,824 --> 00:00:30,940 I am the, the CEO of Expert DSO 16 00:00:30,940 --> 00:00:32,000 advisory group. 17 00:00:32,700 --> 00:00:33,679 We are 18 00:00:34,700 --> 00:00:37,039 a advisory group in the DSO space 19 00:00:37,500 --> 00:00:40,780 made up of folks who all have at 20 00:00:40,780 --> 00:00:42,560 least 30 years experience 21 00:00:43,579 --> 00:00:44,079 running 22 00:00:44,395 --> 00:00:45,774 as many as 380 23 00:00:46,315 --> 00:00:46,815 dental 24 00:00:47,274 --> 00:00:47,774 offices, 25 00:00:48,715 --> 00:00:51,914 managing them. And we have folks who address 26 00:00:51,914 --> 00:00:52,815 all aspects 27 00:00:53,515 --> 00:00:54,174 of that. 28 00:00:54,635 --> 00:00:57,215 And we work with emerging dental groups 29 00:00:57,679 --> 00:00:58,579 to help them 30 00:00:59,439 --> 00:01:01,219 to increase margin expansion, 31 00:01:01,679 --> 00:01:02,659 reduce expenses. 32 00:01:03,359 --> 00:01:04,819 We really look to 33 00:01:05,599 --> 00:01:06,900 create the model 34 00:01:07,920 --> 00:01:09,780 that they want to duplicate 35 00:01:11,495 --> 00:01:12,635 with best practices 36 00:01:13,015 --> 00:01:14,715 across the entire platform. 37 00:01:15,734 --> 00:01:18,615 I owned a healthcare finance company for 28 38 00:01:18,615 --> 00:01:19,115 years. 39 00:01:20,055 --> 00:01:20,795 Been doing 40 00:01:21,174 --> 00:01:22,075 m and a 41 00:01:22,454 --> 00:01:22,954 since, 42 00:01:23,335 --> 00:01:25,115 and for the last 12 years, 43 00:01:26,000 --> 00:01:28,400 primarily in the northeast, but with clients all 44 00:01:28,400 --> 00:01:29,299 over the country. 45 00:01:30,000 --> 00:01:31,520 The you know, so that's the piece I 46 00:01:31,520 --> 00:01:33,939 handle. And as I said, we have 47 00:01:34,319 --> 00:01:37,219 someone who is dedicated to each area 48 00:01:37,760 --> 00:01:38,260 to 49 00:01:38,560 --> 00:01:39,859 instill best practices. 50 00:01:41,784 --> 00:01:44,104 Again, shore up the gaps and look to 51 00:01:44,104 --> 00:01:44,604 increase 52 00:01:45,545 --> 00:01:47,484 best practices across the platform. 53 00:01:48,424 --> 00:01:49,805 Love to hear it. And 54 00:01:50,344 --> 00:01:53,305 moving forward, what key experiences have shaped your 55 00:01:53,305 --> 00:01:54,364 leadership journey 56 00:01:54,770 --> 00:01:55,510 in regards 57 00:01:55,890 --> 00:01:58,450 to revenue cycle management or consulting in the 58 00:01:58,450 --> 00:02:00,850 DSO space? However, you would like to answer 59 00:02:00,850 --> 00:02:03,569 that. I hate to say it, but the 60 00:02:03,569 --> 00:02:05,750 the things that have shaped me the most 61 00:02:06,370 --> 00:02:07,109 are mistakes 62 00:02:07,650 --> 00:02:08,629 that having 63 00:02:09,090 --> 00:02:09,990 gone through 64 00:02:10,585 --> 00:02:12,745 the economic downturn. If you look at the 65 00:02:12,745 --> 00:02:14,044 landscape of lending 66 00:02:14,504 --> 00:02:17,625 where, you know, I operated for so many 67 00:02:17,625 --> 00:02:18,125 years, 68 00:02:18,745 --> 00:02:20,925 every company that was in this space 69 00:02:21,705 --> 00:02:23,165 is no longer in existence. 70 00:02:23,544 --> 00:02:24,365 They're all 71 00:02:25,370 --> 00:02:28,430 bank owned. It's Wells Fargo, Bank of America, 72 00:02:28,569 --> 00:02:29,389 US Bank, 73 00:02:29,849 --> 00:02:31,550 and, it's it's entirely 74 00:02:32,569 --> 00:02:34,590 different, and and it has changed. 75 00:02:35,610 --> 00:02:36,590 The way that 76 00:02:37,544 --> 00:02:38,044 doctors 77 00:02:38,665 --> 00:02:40,044 are able to finance, 78 00:02:41,224 --> 00:02:43,485 growth if you're not PE backed. 79 00:02:43,865 --> 00:02:45,965 You know, and I see this big movement 80 00:02:46,665 --> 00:02:48,444 to groups that 81 00:02:49,480 --> 00:02:52,379 what I feel overcome the difficult challenges 82 00:02:53,159 --> 00:02:54,219 of getting 83 00:02:55,080 --> 00:02:57,180 3, 5, 8, 10 locations. 84 00:02:57,879 --> 00:03:00,700 And then someone comes along and convinces them 85 00:03:00,920 --> 00:03:02,780 that now's a good time to sell. 86 00:03:03,645 --> 00:03:07,084 And and my belief is Heartland is a 87 00:03:07,084 --> 00:03:07,985 perfect model. 88 00:03:08,604 --> 00:03:09,504 In 1997, 89 00:03:09,965 --> 00:03:11,504 they started that organization. 90 00:03:12,365 --> 00:03:14,444 And 20 years later, they sold it for 91 00:03:14,444 --> 00:03:15,344 north of $1,650,000,000 92 00:03:17,645 --> 00:03:18,865 And then 93 00:03:20,020 --> 00:03:22,659 fast forward 2 more years, the Ontario Teachers 94 00:03:22,659 --> 00:03:23,560 Credit Union 95 00:03:24,180 --> 00:03:24,680 sold 96 00:03:25,060 --> 00:03:25,560 65% 97 00:03:26,419 --> 00:03:26,919 for 98 00:03:27,219 --> 00:03:28,280 north of $1,870,000,000. 99 00:03:30,500 --> 00:03:32,680 Oh. And and if you're a dentist 100 00:03:33,724 --> 00:03:35,025 and you're still chairside, 101 00:03:35,485 --> 00:03:36,385 you're driving 102 00:03:36,925 --> 00:03:38,944 a lot of the revenue. You're controlling 103 00:03:39,564 --> 00:03:42,365 the most expensive labor cost. And I know 104 00:03:42,365 --> 00:03:45,745 those numbers are up. But dentistry's profitable. 105 00:03:46,500 --> 00:03:49,060 And the ability to continue to run your 106 00:03:49,060 --> 00:03:49,560 model, 107 00:03:49,939 --> 00:03:51,480 you're going to make money. 108 00:03:52,180 --> 00:03:54,900 And if you run into struggles or growing 109 00:03:54,900 --> 00:03:55,400 pains 110 00:03:56,500 --> 00:03:58,784 for a fraction of the cost, you could 111 00:03:58,784 --> 00:03:59,844 vertically integrate 112 00:04:00,224 --> 00:04:01,925 an organization like ours 113 00:04:02,224 --> 00:04:04,324 to give you a track to run on, 114 00:04:04,465 --> 00:04:05,764 identify the gaps, 115 00:04:06,305 --> 00:04:07,604 identify the opportunities, 116 00:04:08,544 --> 00:04:09,044 and 117 00:04:09,985 --> 00:04:11,764 continue to do what you're doing 118 00:04:12,099 --> 00:04:13,780 and get to a point where when you 119 00:04:13,780 --> 00:04:14,439 do so, 120 00:04:15,060 --> 00:04:17,459 the first letter after those numbers is a 121 00:04:17,459 --> 00:04:17,959 b. 122 00:04:18,980 --> 00:04:21,060 Love to hear it. Well, you've already kind 123 00:04:21,060 --> 00:04:23,620 of touched on some strategy. But going a 124 00:04:23,620 --> 00:04:25,394 little bit further, could you tell us a 125 00:04:25,394 --> 00:04:28,214 little bit about, like, what specific strategic initiatives 126 00:04:28,595 --> 00:04:29,495 you are prioritizing 127 00:04:30,194 --> 00:04:32,375 for growth in patient care? 128 00:04:32,754 --> 00:04:35,555 One program that we have is DSO one 129 00:04:35,555 --> 00:04:36,375 loan program. 130 00:04:36,754 --> 00:04:38,774 And that is geared to allowing 131 00:04:40,069 --> 00:04:42,410 DSOs and emerging dental groups 132 00:04:43,029 --> 00:04:43,529 to 133 00:04:43,990 --> 00:04:46,410 find a lending partner 134 00:04:47,189 --> 00:04:49,430 as opposed to having to rely on third 135 00:04:49,430 --> 00:04:52,310 party and turning the keys to their dream 136 00:04:52,310 --> 00:04:54,785 over to someone else and hoping that they're 137 00:04:54,785 --> 00:04:57,665 gonna follow that same road map or that 138 00:04:57,665 --> 00:05:00,944 you're gonna achieve the recap that is getting 139 00:05:00,944 --> 00:05:02,964 sold, control your own destiny. 140 00:05:03,345 --> 00:05:05,925 And it's it's a model of perfect practices 141 00:05:07,230 --> 00:05:08,370 across your platform 142 00:05:09,069 --> 00:05:11,569 that will allow you to not have limited 143 00:05:11,629 --> 00:05:14,670 growth when you're relying on bank financing to 144 00:05:14,670 --> 00:05:15,569 make it happen. 145 00:05:16,350 --> 00:05:18,850 And and I did kinda skip over the 146 00:05:18,995 --> 00:05:22,194 the revenue cycle management aspect that you mentioned, 147 00:05:22,194 --> 00:05:25,074 and I'll go back to talk about that. 148 00:05:25,074 --> 00:05:25,574 Because 149 00:05:26,194 --> 00:05:28,274 3 years ago, I was sitting in an 150 00:05:28,274 --> 00:05:29,415 Amplify conference 151 00:05:29,955 --> 00:05:32,375 and they started to talk about AI. 152 00:05:33,300 --> 00:05:35,879 And I thought to myself about the Terminator, 153 00:05:36,259 --> 00:05:38,040 and I thought the war with the machines 154 00:05:38,100 --> 00:05:39,480 has started, you know, 155 00:05:40,339 --> 00:05:42,020 but when you look at it from the, 156 00:05:42,020 --> 00:05:42,920 from the inception 157 00:05:44,100 --> 00:05:46,180 of the very first phone call that you 158 00:05:46,180 --> 00:05:50,004 get, Right? When when when that prospective patient 159 00:05:50,465 --> 00:05:51,764 picks up the phone 160 00:05:52,225 --> 00:05:52,965 and calls, 161 00:05:53,904 --> 00:05:55,045 AI is affecting 162 00:05:55,504 --> 00:05:57,285 your revenue cycle management. 163 00:05:57,745 --> 00:06:00,300 Because you now you're into a situation where 164 00:06:00,459 --> 00:06:02,720 we need to convert that phone call 165 00:06:03,339 --> 00:06:04,240 to an appointment. 166 00:06:04,939 --> 00:06:07,659 And when you convert that phone call into 167 00:06:07,659 --> 00:06:09,979 an appointment, now you want to convert that 168 00:06:09,979 --> 00:06:12,620 appointment into a treatment plan and you want 169 00:06:12,620 --> 00:06:15,099 to sell the treatment plan. And along the 170 00:06:15,099 --> 00:06:15,599 way, 171 00:06:16,214 --> 00:06:18,714 there's an AI product that will 172 00:06:19,014 --> 00:06:19,514 evaluate 173 00:06:20,214 --> 00:06:22,795 the incoming phone calls and how they're handled. 174 00:06:22,935 --> 00:06:24,714 And it'll focus on keywords 175 00:06:25,254 --> 00:06:26,235 and what'll instruct 176 00:06:26,935 --> 00:06:29,595 ways that you can better address the questions 177 00:06:30,350 --> 00:06:31,889 to increase the likelihood 178 00:06:32,350 --> 00:06:34,350 that that phone call is gonna convert to 179 00:06:34,350 --> 00:06:35,009 an appointment. 180 00:06:35,389 --> 00:06:37,629 And it and it just moves on from 181 00:06:37,629 --> 00:06:38,449 there. It, 182 00:06:38,990 --> 00:06:42,189 there there's not a single aspect that once 183 00:06:42,189 --> 00:06:43,410 you make the appointment, 184 00:06:44,084 --> 00:06:44,584 there's 185 00:06:45,045 --> 00:06:47,785 AI that allows you to help diagnose, 186 00:06:48,884 --> 00:06:49,384 improve 187 00:06:49,845 --> 00:06:51,225 the, the visualization 188 00:06:51,845 --> 00:06:53,305 that the patient sees 189 00:06:53,764 --> 00:06:54,985 to sell the case. 190 00:06:55,444 --> 00:06:57,225 So you can take a look at 191 00:06:57,850 --> 00:07:00,110 exactly what's going on with the tooth 192 00:07:00,650 --> 00:07:03,449 as opposed to having someone explain it to 193 00:07:03,449 --> 00:07:05,470 you. So the visual 194 00:07:06,330 --> 00:07:07,870 aspect to help sell 195 00:07:08,330 --> 00:07:09,230 may overcome 196 00:07:09,805 --> 00:07:10,785 And the diagnosis 197 00:07:11,164 --> 00:07:12,144 may help overcome 198 00:07:12,685 --> 00:07:13,745 either an inexperienced 199 00:07:14,125 --> 00:07:16,704 practitioner, which we see a lot of in 200 00:07:16,845 --> 00:07:17,345 the 201 00:07:17,724 --> 00:07:18,865 DSO market 202 00:07:19,964 --> 00:07:20,284 and, 203 00:07:21,004 --> 00:07:21,824 the patient's 204 00:07:22,125 --> 00:07:25,669 comprehension of exactly what's going on and, and, 205 00:07:25,669 --> 00:07:27,050 you know, for case acceptance. 206 00:07:27,990 --> 00:07:30,970 So not quite as scary as Terminator, right? 207 00:07:33,509 --> 00:07:36,709 But moving forward, what significant challenges do you 208 00:07:36,709 --> 00:07:39,269 think that most dental or DSO leaders are 209 00:07:39,269 --> 00:07:41,285 facing today and how would you suggest 210 00:07:42,064 --> 00:07:42,964 addressing them? 211 00:07:43,745 --> 00:07:44,245 Well, 212 00:07:45,024 --> 00:07:46,725 one of the the challenges 213 00:07:47,345 --> 00:07:48,964 that I see is capitalizing 214 00:07:49,425 --> 00:07:49,925 growth 215 00:07:50,704 --> 00:07:51,204 internally. 216 00:07:51,584 --> 00:07:53,345 And I I think what we're trying to 217 00:07:53,345 --> 00:07:55,444 do as a DSO one loan program 218 00:07:55,899 --> 00:07:58,560 to address that and to change the mindset 219 00:07:59,019 --> 00:08:01,500 where you're not just asking someone to help 220 00:08:01,500 --> 00:08:05,019 you finance and grow your operation. You're really 221 00:08:05,019 --> 00:08:06,479 identifying a lender 222 00:08:06,779 --> 00:08:09,279 who's going to be your partner, who understands 223 00:08:09,419 --> 00:08:11,384 what your model is. And as long as 224 00:08:11,384 --> 00:08:12,365 you can demonstrate 225 00:08:12,824 --> 00:08:13,964 superior growth 226 00:08:14,904 --> 00:08:15,404 in 227 00:08:15,785 --> 00:08:18,444 what you're doing and show the trajectory 228 00:08:19,064 --> 00:08:21,884 remains consistent, as they say, the secret sauce, 229 00:08:22,585 --> 00:08:24,970 then you should be able to continue 230 00:08:25,350 --> 00:08:26,970 to grow without limitations. 231 00:08:27,750 --> 00:08:29,370 And if you take a step back, 232 00:08:30,149 --> 00:08:32,070 then you shouldn't continue to grow. You should 233 00:08:32,070 --> 00:08:32,570 identify 234 00:08:33,110 --> 00:08:35,370 what causes of that deficiency 235 00:08:36,149 --> 00:08:39,035 are bringing about, you know, the, the need 236 00:08:39,035 --> 00:08:39,855 for correction. 237 00:08:40,394 --> 00:08:43,115 And before you look at growing, the, the 238 00:08:43,115 --> 00:08:44,735 idea that we're just gonna go 239 00:08:45,434 --> 00:08:47,375 acquire additional practices, 240 00:08:47,995 --> 00:08:49,915 if you haven't shored up all of your 241 00:08:49,915 --> 00:08:50,415 processes, 242 00:08:50,955 --> 00:08:54,149 it just pushes off a problem until 243 00:08:54,529 --> 00:08:56,550 it's gonna become a larger one. 244 00:08:57,730 --> 00:08:58,790 Got it. And 245 00:08:59,170 --> 00:09:01,490 I feel like you've already shared so many 246 00:09:01,490 --> 00:09:04,210 great pieces of advice so far, but if 247 00:09:04,210 --> 00:09:06,050 you could wrap it all up into a 248 00:09:06,050 --> 00:09:07,830 tiny little package and 249 00:09:08,235 --> 00:09:10,075 if you could tell the listeners anything right 250 00:09:10,075 --> 00:09:12,575 now, what pieces of advice would you give 251 00:09:12,954 --> 00:09:15,134 to emerging leaders in this industry? 252 00:09:16,714 --> 00:09:18,815 I would say, you know, know thyself. 253 00:09:19,274 --> 00:09:20,334 Right? Decide 254 00:09:22,309 --> 00:09:24,889 what type of operation you want to have. 255 00:09:25,269 --> 00:09:26,730 Be committed to it. 256 00:09:27,029 --> 00:09:28,970 If you're going to be a CEO, 257 00:09:30,230 --> 00:09:32,950 run your business. You can't get involved in 258 00:09:32,950 --> 00:09:33,450 personalities. 259 00:09:34,149 --> 00:09:36,409 You can't get involved in these other issues. 260 00:09:36,865 --> 00:09:38,245 If you have a difficulty 261 00:09:38,705 --> 00:09:39,684 dealing with 262 00:09:40,144 --> 00:09:41,205 personnel issues, 263 00:09:41,585 --> 00:09:44,085 then bring someone in who can. You know? 264 00:09:44,384 --> 00:09:44,884 Capitalizing 265 00:09:45,424 --> 00:09:45,924 growth, 266 00:09:46,865 --> 00:09:49,125 is going to be something that's a challenge. 267 00:09:49,745 --> 00:09:50,245 So 268 00:09:50,769 --> 00:09:51,909 I would just say, 269 00:09:52,289 --> 00:09:53,509 be true to yourself, 270 00:09:54,610 --> 00:09:56,389 invest in your business, 271 00:09:57,089 --> 00:09:59,649 and stick with it. You know, get through 272 00:09:59,649 --> 00:10:03,105 the difficult challenges that you have. There's folks 273 00:10:03,105 --> 00:10:05,345 like us that you could vertically integrate into 274 00:10:05,345 --> 00:10:06,164 your operation 275 00:10:06,705 --> 00:10:07,205 for 276 00:10:07,825 --> 00:10:10,384 a a virtual c suite for a fraction 277 00:10:10,384 --> 00:10:12,625 of what it would cost, and someone who's 278 00:10:12,625 --> 00:10:15,105 been there and done that that can guide 279 00:10:15,105 --> 00:10:16,004 you through 280 00:10:16,480 --> 00:10:17,860 each one of the steps 281 00:10:18,240 --> 00:10:20,660 as you grow. You know, when do we 282 00:10:20,879 --> 00:10:21,620 get into 283 00:10:22,080 --> 00:10:25,059 a centralized function? Right? When do we 284 00:10:25,840 --> 00:10:26,899 take these steps 285 00:10:27,360 --> 00:10:30,639 at the next level and having someone who's 286 00:10:30,639 --> 00:10:32,514 been there and done that, As we say, 287 00:10:32,514 --> 00:10:34,294 experience makes all the difference. 288 00:10:34,914 --> 00:10:36,274 Love to hear it. Thank you so much 289 00:10:36,274 --> 00:10:38,115 for that advice. And thank you so much 290 00:10:38,115 --> 00:10:39,955 for sharing your insights with me today on 291 00:10:39,955 --> 00:10:42,355 the Becker's Healthcare podcast. I appreciate so much, 292 00:10:42,355 --> 00:10:44,595 Frank. Thank you very much for having me. 293 00:10:44,595 --> 00:10:46,029 It's a pleasure being here.