How Do I Preserve My Practice?

How Do I Preserve My Practice?
May 5, 2020

Tricia Casasanta R.D.H
⬛ ⬛Over 27 years of dental experience
⬛ Worked with single practitioners to
moderate size DSO’s
⬛ Focus on behavior change, fostering
tomorrow’s leaders, building teams
and
implementation of business systems
⬛ In tune with the ever-changing needs
of
the industry

OVERALL GOAL….
Provide
PEACE OF MIND
GUIDANCE DURING UNPRECIDENTED TIMES

WE’RE HERE TO HELP GUIDE
DENTISTS….
We are an organization that is here to help out the private
practitioner cut through the noise and navigate through these
unprecedented times and overcome the adversities.
We are not giving any tax or legal advice. Laws & materials are
subject to change, we are not able to cover all details, and each state
may have different criteria. Clients and others should independently
confirm all information and work with their professional advisers to
identify recommendation that pertain to their unique situation.

DENTISTS….
We encourage every dentist to follow state mandates, review and
adhere to the ADA and CDC guidelines and to use their best
judgment to serve and protect their patients and teams at this time

DENTISTS….

1. Who Is On Your Advisory Team
2. Protect Cash Flow and Margins
3. What level of dental care is currently permissible
4. Leadership is Critical
5. Getting ready for reopening
* Check list for Soft Opening
HOW DO I PRESERVE MY PRACTICE?

How Do I Preserve My Practice
⬛ Who Is On Your Advisory Team
⬛ Protect Cash Flow and Margins
⬛ What level of dental care is currently permissible
⬛ Leadership is Critical
⬛ Getting ready for reopening

Email: tcasasanta@spsolutionteam.com
Cell: 586.804.4491
Next Webinar: Friday May 8th @ 1PM
Title: Finding New Normal by Navigating Information Overload
⬛ Updated info from CDC & ADA on requirements for re-opening
⬛ Reintroducing the team
⬛ Addressing concerns surrounding Unemployment & HR
⬛ How to communicate with patient & teams concerns effectively
⬛ Scheduling for the "soft" opening and there after
⬛ Steps to follow when communicating with patients about their
appointment

Cell: 586.804.4491
Next Webinar: Wed May 13th @ 1PM
Title: Most dentists have lost well over $250,000 per practice
location due to covid. Find out STRATEGIES to assist in making up
the LOSSES
⬛ Rebuilding your team
⬛ Strategic Scheduling
⬛ How your hygiene department will play a role during & post covid
⬛ The new reality of Diagnosing & Case Acceptance
⬛ Leveraging the rented networks

1. Accountant
2. Human Resource Director
3. Marketing Director
4. Legal Counsel
5. Investment Banker
6. Consultant / Executive Team
7. Lead Coordinators
[Clinical, Hygiene, DDS, etc]
ADVISORY TEAM

1. Accounts Receivable
⬛ Patient Credits
⬛ Insurance Aging
⬛ Patient Aging
2. Lines of Credit
3. Credit card / Loans
⬛ Defer Payment w/out penalty
⬛ Request no finance charges
4. Production from performing emergency / urgent dental care
PROTECT YOUR CASH FLOW & MARGINS

5. Rent /Loans– if applicable
⬛ Request to defer rent payment
⬛ Ask for rent abatement – if you don’t have the PPP loan
⬛ Defer mortgage payments
6. Vendors
⬛ Suspend services for months you will not be utilizing services
⬛ Ask for abatements on equipment leases
⬛ Ask for extensions on your annual contract
⬛ Negotiate fees and lab rates, begin to shop for discounted supplies
7. Take Advantage of SBA Loans while you can
⬛ SBA7(a) Express Loan
⬛ SBA7(a) PPP –Payroll Protection Plan
⬛ EIDL – Economic Injury Disaster Loan
⬛ Local Grants

SBA LOANS
Mark Burton, CEO of the Michigan Economic Development Corporation. “While we are looking at every
resource possible to support our small businesses and workforce in the face of the significant challenges
they are facing, we know that federal loans, like the Paycheck Protection Program, will be paramount to
economic recovery efforts in the state.”
Bob Doyle, MICPA President & CEO. “Because these loans are designed to be forgiven assuming certain
requirements are met, applicants should view this opportunity more like a grant application rather than a
traditional loan.”

SBA(a) Express Loan or Bridge Loan
⬛ SBA has authorized a temporary SBA Express Bridge Loan until EIDL loan is processed
⬛ Must have a pre-existing relationship with SBA Lender
⬛ $25,000 to 1 million [ up from $350,000)
Collateral not required for loans less than $25,000
⬛ Prime + 6.5% [ negotiable – cannot exceed SBA maximum]
⬛ Fast turn around – 36 hours
⬛ Term is up to 7 years with maturity extensions permitted
⬛ Will be repaid in full or in part by proceeds from EIDL loan

EIDL – Economic Injury Disaster Loan
⬛ Max amount of loan: 2,000,000
⬛ Personal Guarantee: If the loan is more than $200,000
⬛ Collateral: May be required for loans over $25,000
⬛ Interest rate: 3.75% small business, 2.75% non-profit
⬛ Eligibility: No more than 500 employees and operational as of 01-31-2020
⬛ Term: Up to 30 years
⬛ 2 Parts
1. Grant Portion - Cash advance of up to $10,000 supposed to have been funded within 3 days
Limited - Only the first 1 million applications or 10 billion dollars to be processed
2. Loan – The rest of the loan can take up to 3-6 months to be processed and received
Only $10,000 of the loan portion can be forgiven if used towards payroll or rent express
⬛ Use of Proceeds: Purchase real estate, equipment, acquiring a business etc

SBA7(a) PPP –Payroll Protection Plan
⬛ Funds for working capital
- Deferred six months
- Repay any amount that doesn’t qualify for forgiveness over a two-year term @ 1% interest.
⬛ Converted to a grant
- Full-time equivalent employees cannot be reduced by more than 25% of the # of employees
you had on payroll February 15, 2020.
- You cannot reduce a team member’s salary or wages by more than 25%
Side note: If you had to let workers go (between February 15 and April 26, 2020). You have 8 -week
period or until June 30 to rehire 75% of the full-time equivalents – sooner of the 2 options.

⬛ Neither the government nor lenders will charge fees for the SBA application
⬛ No collateral or personal guarantees are required
⬛ Loan payments will also be deferred for six months
⬛ Has a maturity of 2 years for any amount not forgiven @ an interest rate of 1%.
Mark Burton, CEO of the Michigan Economic Development Corporation. “While we are looking at every
resource possible to support our small businesses and workforce in the face of the significant challenges
they are facing, we know that federal loans, like the Paycheck Protection Program, will be paramount to
economic recovery efforts in the state.”

⬛ What can the money be spent on?
1.Payroll costs must account for at least 75% of your expenses
-Gross wages, commissions, or tips (capped at $100,000 on an annualized basis for each employee)
-Employee benefits including payments required for the provisions of group health care benefits,
insurance premiums, and payment of the matching contribution for the retirement plan deferrals
made during the eight weeks
-State unemployment and local taxes assessed on compensation
2. Remaining 25% can be allocated for mortgage interest, rent, phone and utility charges
Side note: Rent payments to be forgiven, lease was in place prior to February 15, 2020

⬛ When should you spend the money? [ as of 05/01/2020]
- 8 weeks start as soon as the money is disbursed to the borrower
- American Institute of Certified Public Accountants [AICPA] has suggested to the SBA that the
8-week period should only begin once stay-at-home restrictions are lifted, not when loan
proceeds are received
-“If you need to spend the PPP loan money over the first two weeks, go ahead”, “However, I
would recommend spending it very cautiously and spend less than 20% on rent, mortgage
interest, and utilities so you don’t overspend. If you have the flexibility to be able to wait to
spend the loan money, I would continue to wait.” Kate Willeford, CPA and President of The
Willeford Group.
Sidenote: Webinar on Friday May 8, 2020 we will discuss how to pull employees receiving UIA to help
prepare the office for soft reopening w/out tapping into the PPP.

9. Maximize the CARES Act options you have
⬛ Don’t pay federal income tax till July ⬛ Defer payment of employer’s share of Social
Sec. tax through the end of the year
⬛ Stop paying on current SBA loans for 6 mo (to be repaid over the next 2 years)
⬛ Request Forbearance if you have a federally ⬛ Pull up to $100K from your 401K or other
backed mortgage. retirement vehicle without penalty- if needed
⬛ Receive payroll tax credit through the end of the ⬛ Take advantage of other tax savings potential
year equal to 50% of qualified wages($5,000 ( ex: ability to carryback 100% of losses as
quarterly maximum per employee) far as 2013 to offset taxable income

What Qualifies As An Emergency Care? relief of pain /swelling
⬛ Bleeding that doesn’t stop
⬛ Painful swelling in or around your mouth
⬛ Pain in a tooth, teeth or jaw bone
⬛ Gum infection with pain or swelling
⬛ After surgery treatment (dressing change, stitch removal)
⬛ Broken or knocked out tooth
⬛ Denture adjustment for people receiving radiation or other treatment for cancer
⬛ Snipping or adjusting wire of braces that hurts your cheek or gums
⬛ Biopsy of abnormal tissue
BE AVAILABLE FOR SAME DAY DENTISTRY & EMERGENCIES ….

⬛ Government orders are binding; whereas, dental association recommendations are not
example: The governor states that dental practices can be open for they are “ essential”
business, but then the state’s dental association strongly recommends that dentists only be
open for Urgent/Emergency care consistent with the CDC and ADA guidelines.
⬛ Use your professional judgement in determining if a patient is needing either urgent or
emergency care.
⬛Make sure your malpractice insurance coverage is up to date and covers the type of procedures
you are providing.

Basis principles to keep in mind….
1. Remain open on Fridays & Saturdays
2. Remain open “up to” and or past 5 pm on weeknights
3. Use tools like Lighthouse, Weave, Revenue Well etc
4. Staff with a skeleton Crew
5. Use tele dentistry for limited exams to fill schedule with emergency care/ urgent care
if allowed by your state.

What are the advantages?
⬛ Do not abandon your patients
– PPO contracts generally require you to see a patient for emergencies within 24 hour period
– Patients get upset if you are not there for them
– Patients will develop a sense of loyalty
⬛ Builds on your core values to take care of your patients as if they were family & Keeps patients
out of the emergency room
⬛ Helps to preserve the practice by….
– Creating future treatment
– Increase new patient count
– Don’t lose current patients to another dental practice who is seeing emergency cases
when you are not

5. How to Staff For Emergencies/ Preparing for Reopening ?
⬛ Employees may be getting paid more with UIA than if they were working
Most employees collecting UIA are receiving a max of $ 962 /wk
- Federal Pandemic Unemployment Compensation [ FPUC] …… $600/wk
- Unemployment Agencey [UIA] ……………………………………Up to $362/wk
- 40 hr work week : Averages $24.00/ hr
35 hr work week : Averages $27.50/ hr
⬛ Employee may fear losing unemployment if things revert backwards
⬛ Employees may have legitimate reasons why they cannot work currently:
ie: medical condition, taking care of family member with covid 19 etc
⬛ Empolyee is upset with the practice for laying them off , lack of communication

5. How to Staff For Emergencies/ Preparing for Reopening
⬛ Employees may be getting paid more with UIA than if they were working
Most employees collecting UIA are receiving a max of $ 962 /wk
- Federal Pandemic Unemployment Compensation [ FPUC] …… $600/wk
- Unemployment Agency [UIA] ……………………………………Up to $362/wk
- 40 hr work week : Averages $24.00/ hr
35 hr work week : Averages $27.50/ hr
⬛ Employee may fear losing UIA & FPUC if things revert backwards
⬛ Employees may have legitimate reasons why they cannot work currently:
ie: medical condition, taking care of family member with covid 19 etc
⬛ Employee is upset with the practice for laying them off , lack of communication

Underemployment : Is a situation which a person is employed, but their hours or wages have
been reduced or changed for reasons other than the person’s request.

Underemployment :

Situation: Person worked 13 hours @ $24
A. WBA= $362
B. Total Earning $312
C. If B is less than A, use calculations below
$312 x .5 = $156
WBA $362 - 156 = $206
D. Outcome: Person received
⬛ $806.00 from unemployment [ $206 UIA & $600 FPUC]
⬛ $312.00 from Employer
Total = $1,118 vs $962
Michigan Department of Labor and Economics Opportunity Website
States to qualify for the $600 FPUC a person must have earnings with
UIA
Underemployment :

1. Maintaining positive outlook & fostering relationships
⬛ Positive outlook lead to positive outcomes
⬛ Your attitude is contagious
2. Constant communication with your team
Working remotely or at the office
⬛ How are they doing
⬛ What are they hearing from patients
⬛ How is the A/R coming along
Laid off or furlough
⬛ Weekly or Biweekly Personal contact
⬛ Team remote gatherings
⬛ Remain transparent by communicate any updates, what you are working on, any pitfalls
LEADERSHIP

3. Stay in touch with your patients
⬛ Weekly or biweekly updates
⬛ Don’t be afraid to communicate / Marketing
- Google Ads for Emergency Dental Care
- Blip Billboards
- Webpage updates ( will improve SEO)
- Facebook post
⬛ Communicate to patients regularly
-You are open for emergency and urgent care - you are there for them
-Dentistry is safe and essential
-How the office has followed infection control all the time
-How the practice is getting ready to reopen
-The practice is open for emergencies
- Anything fun, if appropriate….
LEADERSHIP

4. Marketing
⬛ Google Ads for Emergency Dental Care
⬛ Blip Billboards
⬛ Webpage updates ( will improve SEO)
⬛ Update postcards/ mailers to include “ available for emergency dental care”
⬛ Social Media
5. Spearheading the energies to reopen the practice
⬛ Follow CDC and ADA Guidelines
⬛ Monitor PPE Inventory
LEADERSHIP

Cell: 586.804.4491
Next Webinar: Friday May 8th @ 1PM
Title: Finding New Normal by Navigating Information
Overload
⬛ Updated info from CDC & ADA on requirements for re-opening
⬛ Reintroducing the team
⬛ Addressing concerns surrounding Unemployment & HR
⬛ How to communicate with patient & teams concerns effectively
⬛ Scheduling for the "soft" opening and there after
⬛ Steps to follow when communicating with patients about their
appointment

How Do I Preserve My Practice?

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