Episode : #1,001: How to Survive Cash Flow Row

Podcast Description

Kiera and Dana offer a life raft for businesses struggling to keep cash flow in the green, including specific steps to help get your practice back on course.

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Transcript

Kiera Dent (00:00)

Hello, Dental A Team listeners. This is Kiera. And today I am jazzed. Dana, the one and only Dynamite Dana over there. She's on the podcast with me today. Dana, how are you today?

Dana (00:10)

doing pretty good. It's a beautiful day here and so I'm just excited to be on the podcast with you.

Kiera Dent (00:15)

Dana, I am so glad because you and I, feel like we're ships in the night. We see each other, we wave to each other. We love working together, but the reality of us like being on the same boat to talk to each other is few and far between, which is so ironic. But every time I see you in person, I'm like, Dana, we need to hang out more. Like, so it's fun to podcast, even though, I mean, it's a funny way to say hello. We're like here to do work, but at least we get to like have more interactions. So, ⁓ thanks for being on my ship today. I guess like welcome, welcome aboard, matey.

Dana (00:44)

Yeah,

happy to be here, Gatton.

Kiera Dent (00:48)

But today you guys, Dana and I, we were talking about like some burnout and cashflow row. So think about death row. We actually have a lot of clients that come to us. Thankfully, like once they become clients, they get off death row, cashflow row. But we thought about, think oftentimes burnout and cashflow row ⁓ go hand in hand. And so I figured, Dana, let's get into like, how do you get off of cashflow row? like death row,

you're about to go and like die like literally. ⁓ I feel it's becoming a bit more common than I've seen in the past. I'm super grateful and I just want to shout out and for all of you listening, if you're on cashflow row or you're on burnout row, ⁓ just like a huge hug, a huge hug of love, a huge hug of no judgment. Gosh, I get like emotional thinking about it I think it's so easy as a business owner to like just harp on yourself to just feel like

Like, why am I so dumb? Like, why can't I figure this out? Like, the mean girl or boy in your mind is just like vicious and wicked. And it makes me so angry that we're this way to ourselves as business owners. Cause I'm like, you know what? You're freaking strong. And like, you took these risks and like, you don't know what you're doing, but you know, you wanted to like build a great like culture for your team. You wanted to build this amazing life for your family. And yeah, it's hard. It's really hard to be a business owner. And I think I speak of this so candidly because

Like I've been on death row, like cashflow row. I've been on burnout row, like, and you just sit there and when you need to like have the most love and respect for yourself and grace, it's when we like punch ourselves and kick ourselves and yell at ourselves. And so ⁓ I thought it would be a really, ⁓ hopefully timely podcast for some of you listening of just love of no judgment, of encouragement, and maybe some like shining little stars when you need a North star right now, because

It can feel very daunting. And I want to tell you, you don't have to do it alone. ⁓ You telling yourself you're alone and on an island is your choice. And it's a choice that you don't have to stay with. There's so many ways we can help. I think even just like when we get clients that are on cashflow row, I feel like they feel they finally got a life raft sent to them when they didn't know it was even possible. And as consultants, think Dana and I and our whole consulting team are so passionate about getting you into cashflow positive and doing it with ease where it's not that hard. But

Like it wasn't overnight that you got here either. So it's not going to be overnight. get you out of there. We're to move you pretty quickly. Cause I think like, Hey, someone's like holding the lantern for you in this dark cave. Like, all right, here's the way out. can really, really help you. But really Dana, think like just again, I hope all of you listening know we come to you with love, with no judgment. You're not a terrible business owner. You're not dumb. You shouldn't have known this before. It's just, this is where we are kind of like a patient with perio, right? Like it's okay. Like this is where we are. And the great news is

There are solutions and there's a way out and there's a way to happiness again if you want. So Dana, that's kind of my like emotional pitch to start this off with. Any thoughts you have? Because I think you've seen quite a few come to you on Cash Flow Row from day one.

Dana (03:49)

This is.

Yeah, yeah. And I love just your vulnerability there, Kiera, as a business owner, because I say it to doctors all the time, like, whether it's a dental office, whether it's a consulting company, whatever business it is, it doesn't come with an instruction manual. And so we get in there with the best of intentions, we're ready to work hard, we put everything you have into it. And there are ebbs and flows in business. And sometimes it gets really, really hard. And you're right, it is the self talk that

that you have to take a look at and the blame that you put on yourself for being the reason why you got there. And you know what, it's okay, we're gonna figure it out ⁓ and we're gonna stop the bleeding and we're gonna start focusing on the things that are going to matter and are going to move it forward. And you know what, as a coach, I get the pleasure of cheering you along the way and sometimes kicking your booty when it's needed. And ⁓ it is, we are seeing it more and more and I think

it comes down to two, like knowing what cash you need, knowing what you're spending your cash on, and sometimes making some hard decisions based on that too.

Kiera Dent (05:05)

Mm-hmm. Yeah, and I think with that it's like awesome. Here we go Here's the blood like we're going to help you get out of that and I love that you said there's no instruction manual just like being a parent There's no instruction manual and so there are just different ways to do it So my big thing and in Dental A team, always like we are profitable We call it the yes model so you can say yes to everything you want in life and the Y stands for you as a person We're gonna focus on E stands for earnings and profitability

and S stands for systems and team development. So like those three things together are going to give you success with ease. So today, if you're on cashflow row or burnout row, I think oftentimes burnout comes because of cashflow. Like it is the scary piece to it. So with that, let's talk about like, what can we do if we're in cashflow row? What are some of the fastest things that will help people get out of cashflow? Dana, I'll let you take this. We're going to just kind of riff back and forth. Like you guys, this is unscripted. This is just from our knowledge of things that we do.

of like when we see offices and again this is coming from real life offices things we've actually done to get them off of cashflow row. Dana let's just riff because you've got a few that have just come and you've got a few that have been there and ⁓ they're doing well.

Dana (06:12)

Yeah, yeah, yeah,

I think it is. It's a reviewing of expenses. Is there anything we can cut that we're not cutting ourselves too lean though that we can't continue to grow? And then also, what do need to produce and produce it consistently?

Kiera Dent (06:27)

Yeah, I love that. So it's like we either need to increase our production or we need to decrease our expenses. And on the production, I will also say we need to make sure we're collecting. It's wild to me. I was talking to a doctor who's on quote unquote cashflow row and they said, Kiera, I have like $300,000 sitting in AR. And I was like, so you're really not on cashflow row. You've got the money. You just haven't collected it. So realizing that usually in dentistry, there's quite a few cashflow opportunities very quickly.

But I agree with you, Dana. Like step one is like, let's get our PNL and let's know our numbers. Is there anything on there? Like, and I'm talking like, you don't like, gosh, people get wild and they start cutting things that actually you need. Like I know your hygienists are expensive, but they also produce for you. I know billers can feel annoying, but they also collect money for you. I know your treatment coordinator can feel expensive, but they're putting money on your books. I know a consultant can feel like I'm going to cut. can do this on my own, but they're literally the only person holding you accountable and pushing you through and guiding you.

So it's one of those things of like, let's look to see like, what really is stuff to cut? And I'm talking like subscriptions that you're no longer using. This is one that it makes me wild. I don't understand this. It makes no sense to me. But when people are in cashflow row and the only thing I can come up with Dana is it's ego. That's all I can figure out. So I'm just saying to you like, Hey, I hear you. see you. Let's cut the ego and get you into cashflow positive. And then like rock on, do whatever you want from there is like holding onto equipment that you're not using. It's weird to me. Like,

Okay, so we're not like, we thought we were gonna do all these scans of the Itero. And if I look at the last six months, we literally have like taken three scans. Or I bought the CBCT, because I thought was gonna do all these implants, and I'm not doing implants. Or I have like multiple Iteros, but like we've cut back and we've scaled back like, so I only need one Itero instead of three Iteros. those are big expenses on your debt and your loan. Like, let's sell those, let's get rid of them. people, I don't know, it's like embarrassment or ego or like,

Maybe you're still like wishing for the good old glory day. I don't know what it is, but I'm like, get rid of that. Cut the cost. Like think in your own life. If you had a car that you had a car payment on, even though it's the nicest car and it's your dream car, but you can't afford food, you're going to get rid of that car. You're going to sell it and you're going to buy something more economical and affordable. Like let's just get rid of it. No one, no one cares. Like honestly, none of your colleagues know that you're selling the equipment off because you're freaking broke right now.

That's just you and it's okay. it truly like what can you get rid of? there equipment you're no longer using that you could sell that you could pawn off just to get you some cash flow quickly and cut some of that debt services? Like is there any debt service that we can get rid of for you? That's a question like but I think it's a very easy cut on the PNL. Dana thoughts on that.

Dana (09:02)

Yeah, I agree with you. then and again, I can't, I can't really decipher where it comes from. But I do you do see offices wanting to hold on to those things. And maybe it is like, well, we'll turn it around, and then I'll use it. Great, then we can get another one down the line. Right. But right now, what the immediate relief from dispensing of it will far outweigh hanging on to it until down the road, maybe we'll need it again.

Kiera Dent (09:27)

Exactly. Like it's okay. Like don't don't even stress about it. We're not we're not here for we're not here for that ego. So I think when we're looking at the PNL, let's look to see like go back to COVID days. If you were a business owner during COVID, I remember we scrubbed that PNL like, could we call the lenders? Could we put this on pause? Could we like get rid of this loan? Like those things I think are really important because that actually can free you up exponentially being buried in debt. I remember my husband when we were paying off his loans. Holy moly, he could not see outside of that debt for one second.

We can't get rid of our practice loan, but you could renegotiate your rent, like your lease. Those are things that you can do. I remember during COVID, people got very scrappy and I'm like, don't forget that scrap you just learned a few years ago. Like take those lessons and go through them. that's step one of, but be careful. Like Dana said, please don't cut things that are going, let's not cut the hygienist right away. Like I'm looking at what are the things that are nice to have, but not necessary to have. Let's cut those things.

⁓ well, I put consulting in a must have. think if they're a great consultant and they're holding you accountable and they're moving you forward, yeah, you better believe it's one of the best dollars you'll ever spend. Now, if you are not, ⁓ if they're not moving you forward, if they're just having like rando conversations with you, probably a good thing to move on. But again, you also should go to your consultant. They work for you and say, I am in cashflow row, which hopefully if they're a good consultant, they would know that. And it's like, we have to make this happen. Now there's no other options.

So after we do that, next step is let's look at our AR. Doctors, if you don't know how to run your AR, that's your aging report. Let's just go see how much money is sitting out in our AR. And let's see if it's patient portion that we could collect or if it's insurance and also why and how much is in our 30, 60, 90 and over 90 buckets. Because that over 90, like this sounds awkward, but doctors like truly you can call patients and you can collect. We can send text messages. I know that feels awkward. I know that doesn't feel like what you want to do.

But these are ways like there is cash there. Also, like, let's look at the protocol of how are we getting there? Are we not collecting when they get into the practice? We can start collecting when they come in. I was in an office yesterday and they're like, gosh, our accounts are all funky. And I was like, sweet. As soon as they walk in, let's collect the money before they even go to the back. They're like, but that's different. We've never done that. And I'm like, think about a hospital. You do that. Like you show up, you pay the money and then you go back, like switch it. It's not weird. People don't think it's weird.

It's very normal. So like, let's collect the money. Let's put some systems into place. So we stop getting into an AR crunch. And really making sure that that is something that we are very proactive on. Do you know other thoughts on AR? AR to me, think is just like this like, I don't know. It's like an endless pit. And I think I have it because when I first started the business, I had this endless pit of AR and I didn't even know it existed. And I'm like, oh, no wonder I'm broke. It's just because we're not collecting the money. And then I was like,

Sweet, let's change the system. That's a system you should put into place. But what are some other thoughts or systems you have around AR to help people get this cash?

Dana (12:16)

You

Yeah, I think AR it's it's kind of like culture. It's like a thing that you have to stay super super consistent on and work on all the time and I see it so oftentimes in practice. It's like well I pull it once a month and you know, like I that's when I work on it and I'm like no it's something that you have to set purposeful time aside. So whoever's responsibility it is making sure that every single week they have a chunk of time that can be dedicated solely to working on AR because it is also it can so

quickly grow when we haven't been paying attention to it. And so it's, I'd say, dedicated time for it and then find a cadence that works for you. Whether it's alternating patient and then insurance and then patient follow-up again and then more insurance follow-up, figure out however you can keep it super consistent and make sure you've got dedicated time every single week because it will quickly grow if we're not paying attention to it.

Kiera Dent (12:54)

Yes.

Yeah, it's a wild zone that I'm like, okay, ⁓ it's so crazy how fast it will grow on you. so it's, and just so you know how insurance works, if you don't understand this, I'm here to like give you a quick like, all right, this is how the snapshot works. So what it is, is you actually have it where like,

These insurance claims don't fall in like, okay, it's the 30th of the month. So now we go and that's when our 30 days fall into 60 days. Every day, money is moving from the 30 to 60, 60 to 90, 90, because it's based on when that claim sent. So you have to realize this money kind of like interest is how I feel of AR. It's constantly moving on you. So you can call it winning Wednesday, you can call it like taking cash on Tuesday, Thursday, but like literally have days set up for your biller and

This is a position and this is a job responsibility that I am very sticky on. They have to do it. I don't care if we're busy. don't care if patients are calling like, dang, I'm so busy. I had a patient, I can't pay your paycheck. Like that's the reality. They have to collect money. I do not care. Those are non-negotiables for me. It's two hours, Tuesday and Thursday, non-negotiables period. The house will not burn down. The practice will not burn down. Get your dang money because oftentimes that's all it is. And it's just being consistent. So billers,

Doctors, if you need to send this to your bill, like, Hey, we're on cashflow row billers. I'm talking to you. You have a responsibility to your doctor and to this office. They have produced. You need to collect this money. So get the good insurance verification, get the statements, call the insurance companies, figure out why our claims aren't getting paid. That's your job, honey. That's your job. And yes, your responsibility. Like if you want a paycheck, collect the money because that's where your paycheck's coming from. And so

and it's nothing wrong. We're not doing anything wrong. We've done the work. We did great work. Let's collect the money and make sure that we don't get this out of control. It like breaks my heart when doctors have no money and it's because team members, we let our doctors down. They did the work and honestly, team members, it breaks my heart and I'm here to say like, tis tis, shame on you. Be better than that. You are better than that. Collect the money and if you need help, tell your doctor like, hey, hire the dental team. Like we have literally brought in hundreds of thousands of dollars.

just by helping some billers because honestly, doctors, like I say, tisks on the team, which truly it is our fault, but they might not know how to do it or how to do it effectively. There's a lot of ways where we can chunk it. We can break it down. We can make it so much faster and easier for them. We can help them get rid of some of the bad debt. It's running reports differently. It's tagging things differently so they can work it. It becomes so much easier. So again, like if you're billing is a struggle, great opportunity for you to get some help and billers, please don't be afraid to ask for that help too. So.

I say that with a giant hug as well. I know it was like a stern hug, but really you've got to collect that money. So we've got cut your expenses. Look at that. Like debt services. What on earth? Just get rid of the debt. Get rid of anything you can. Next is going to be that we're collecting the money in the AR. Let's figure out how much we have there. And then next is going to be producing. Now I will go on a rant again, clearly cash and burnout. Like let's just not get there. Like I hate this. Let's get you out of there fast. ⁓

I really hate when doctors come on to calls with me and they're like, yeah, I I produced a million last year. And I'm like, that's awesome. And they're like, yeah, but we had to write off 50%. So we were only produced like 500,000. And I'm like, why did you tell me a million that only served you like high five, but you did not produce a million. I don't care that that's your office fee that feeds your ego only, but it's not real. And what you're doing is you're actually hurting yourself because you're, you're elusive to the fact that you're not producing a million, but you think you are.

but you're living on 500 bucks, it'd be like, or 500,000. It's like, oh, Dana, I make a million a year, but I only have like 90,000. Well, why are you telling me you have a million? You don't actually, like that's not even real money. That's monopoly money. I'm so glad we gave you some paper money. Like I get it, but you're in insurance. So like, let's live on real numbers so you can produce real numbers. Cause this is often where cashflow happens because you're like, well, we're making a million.

No, you're not. You're making 500,000. So either get out of network, which I strongly would not recommend, but do a block schedule, figure out how to produce, make sure you're diagnosing. And also when I hear about these cashflow row offices, normally, and doctors, I'm not a dentist, so I'm not here to tell you how to do it. I'm just here to say, whatever number you want and need to produce, you need to be diagnosing three times that amount. That's a statistic that's proven. You've got to be diagnosing enough to get that money on your schedule.

And the next piece is treatment coordinators and doctors. We've got to make sure we're closing that treatment and getting it on the books and doing quadrant dentistry, not just solo tooth. If we're watching, what are we watching for? If you're a watcher, you're scared to diagnose, just diagnose one more thing that you would normally watch. Just put it on the books. That's going to help you. But the reality is you, you truly have a moral obligation to diagnose your patients, ⁓ to tell them what needs to happen and to not judge them based on what you think their bank account is. Your job is to be a comprehensive dentist.

All right, Dana, I'm off my soapbox. You should take it away from me now. What are your thoughts on that?

Dana (18:17)

Thank

I love that and I do say yeah exactly we want to look at net numbers and if you're not happy with your adjustments then there are you know ways to tackle that through fee negotiations through you know looking at your numbers to see is it worth

changing some network status with one insurance company or making a little bit of a shift or do we just need to start, like you said, being strategic and block scheduling and maybe even one more step of, hey, yeah, we can block schedule and we've got to watch our insurance mix within our block schedule. All of those things are avenues. just kind of, you have to take a look at.

Kiera Dent (18:50)

Mm-hmm.

Dana (18:55)

the numbers and build it to be efficient, successful, get you to your goal and to also not cause burnout. I get so much pushback on block scheduling because it's like, well, my team knows how to schedule. Absolutely, right? But like, can I get you to goal with two, three crowns and a quadrant worth of fillings? Yes. Can I also get you to goal with 32, one surface fillings? Sure can. Those days feel super different.

Right? That's a lot of turnover, a lot of check in and check out and insurance verification and all of those things. And so when we build it more strategically, dang, those days feel really, really different to

Kiera Dent (19:23)

They do.

And I say this often, I'll say it again, if we have a bad schedule, that was our fault. Like I know you're like, well, patients, can like, they just want to go here. And I'm like, no, you led them there. You guide them. Doctors, are like, you are a clinician. You are an amazing doctor. We get to pick our schedule. And so like Dana said, let's build this. Let's make this incredible for us. But I think those are hopefully three quick ways for you to figure out your cashflow. If you're on cashflow row.

⁓ And please, the last thing I would say is bonus tip for you is cut the excuses. I think when people are on cashflow road, they like to sit here and excuse land. They like to sit here and blame land, which is normal. It's normal to be frustrated. It's normal to say, like it was this, it was that. was like, well, we can't hire people. Stop, stop. You're continuing this in a reality where it's like, it's just not true. I know it feels that way.

but we've got to stop the excuses. We've got to stop the blame and we've got to just say like, this is where we are. And the good news is this is what we're going to do to get out of it. It's hard. Like that takes mental discipline that you've got to have. But that's also where I think like a coach, a cheerleader, someone who's an ally with you. Like Dana said, sometimes it's a hug and sometimes it's a good like push because you need to be pushed. But hopefully these are a few things because I believe that the mental stress of cashflow row.

will create more burnout faster than anything else because you just sit here stressed out of your mind. So Dana, I hope you guys all like listen. I hope you take it. And if you are in cashflow row or you're on burnout row, please like reach out. We will do like a complimentary practice growth call with you. Like, let's see where your gaps are. Let's help you out. Let's get you out of this wildness because success with ease is very possible. And that's what I think Dana and Denali team in our.

whole company is passionate about is getting you the yes model, you as a human being so happy and fulfilled and having the life you want, getting the earnings and profit that you deserve that you are worthy of that you can totally have and getting the systems and team development to support those those top two things, just be able to say yes to whatever you want. So Dana, gosh, thanks for getting in this one. This is a solid and I just appreciate you loving our clients and getting them off of cashflow row and and into the happier land and for being on the podcast today.

Dana (21:49)

Yeah, thank you so much for having me. And you know, I just love being able to see clients like win when they came in feeling so burnt out. So it just fills me too. So appreciate it.

Kiera Dent (22:00)

⁓

I love it. Let's get you guys the W's. Let's get you those wins when you didn't think it was possible I think that's my favorite thing is turning the impossible into possible and helping you take dreams into reality So reach out hello at the Dental A team calm and as always thanks for listening We'll catch you next time on the Dental A team podcast