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You know that choosing to be less insurance dependent is favorable for your dental practice. However, it's important to convince your patients that this choice is beneficial for them too.  It may seem challenging but, using the right words will help you gain the trust of the patients. That will result in customer loyalty and ultimately increase the retention rate of your existing customers.  Highlights Intro to today's topic > 01:01  About the built-in support system > 02:00 Addressing a question that makes almost every dentist cringe > 03:15 How to answer the question "Doctor, is this covered by my insurance?" > 09:15 About Gary’s upcoming MBA program > 21:39 Resources DOWNLOAD PLAQUE #1 DOWNLOAD PLAQUE #2 DOWNLOAD GARY'S LANGUAGE LEARN MORE REGISTER Transcript Naren: This is the less insurance dependence podcast show with my good friend Gary Tackas and myself Naren Arulrajah. Gary: We appreciate your listenership, your time, and most of all, we appreciate your intention to reduce insurance dependence in your practice. Our goal is to provide information that will help you successfully reduce insurance dependence and convert your practice into a thriving and profitable dental practice that provides you with personal professional and financial satisfaction. Gary: Welcome to another episode of the less insurance dependence podcast. I’m Gary Takacs, your co-host and we have a great topic for you today. As you saw in the headline, the topic is how to respond to the dreaded question from your patients, is this covered by my insurance. We're going to get into that question in detail and share some wonderful responses that will help your patients think differently about their dental insurance from this day forward. Hey before I do that, I just have a comment I want to start with on this episode. Recently I had a chance to talk to a number of our clients who are in the process of going out of network with PPO plans and one of my clients made the comment to me that he really appreciated having a colleague that he could talk with about the journey. Another dentist that is midway like him going through the process of successfully reducing insurance dependence and he said it's almost like a built-in support system where this dentist could talk to a colleague about the things that they were experiencing in their practice and he just made the comment that he really appreciated the fact that he could speak to someone else that's a colleague that was experiencing the same things, not only for support and encouragement but also just for perspective. So, I have a request. My request obviously if you're a listener of the less insurance dependence podcast, you're interested in reducing your insurance dependence, I bet someone that could maybe be a colleague like that for you, maybe it's someone you went to dental school with, maybe it's a dentist that you've really connected with in your CE courses, but I invite you to share the less insurance dependence podcast with a colleague, with a friend, plural even because i do think the idea of having others that speak the same language and are on the same journey can be very helpful. So please share this with one of your colleagues and that can help you as well. Anyway, let's dive into this topic, how to respond to the dreaded question, is this covered by my insurance Naren: Hello everyone this is Naren your co-host of the less insurance podcast show. Today we are going to be addressing a question that make almost every dentist that I know cringe. The reality is that if the number one way your dental office attracts new patients is by signing on to PPO plans, the number one question they'll be asked is, is this covered by my insurance? This is going to happen day in and day out and as more than 90 percent of practices in the United States and Canada have some type of insurance, you're going to hear this every day. Of course, this question gets so frustrating both for the dentist and the team member, sometimes they just accept it, they accept this is the reality. But in today's episode Gary will share some effective ways to respond to this question. So instead of letting it kind of frustrate you and instead of giving up Gary's going to talk about how you can respond to the dreaded question, is this covered by my insurance Gary: Hey Naren, I hear that question from when I’m in offices and listening, I hear that question almost incessantly when doctor is presenting treatment to the patient, especially treatment that's asymptomatic, that doesn't hurt or that's elected, doesn't necessarily need to be done and I’ve actually heard dentists in an experience of lower emotional intelligence actually sigh when they get asked that question. The patients say doctors just covered by my insurance and I’ll hear the dentist say, they're so frustrated. They know they can help the patient. They have the clinical skills and they know how it's going to benefit the patient but the truth is, the only way the patient wants to have it done is if it's covered by their insurance and if dentists hear this enough, it’s kind of creates a defeatist perspective. It's like here we go again, you anticipated happening. If something happens enough you pretty much accept it as reality. Well here it comes, here comes, here comes, and what happens sometimes Naren is that dentists quit recommending ideal treatment or elective treatment because while here comes, here comes, I don't need to bang my head against the wall. I’m not even going to present it. Naren: Can I share? Gary: It's a downward spiral, it's a downward spiral that doesn't help the dentist the practice or the patient. Naren: Yeah, let me share something that our mutual inspiration Doctor Stephen Covey said. He talks about his time quadrant and he talks about urgent and important, right, things that hurt are urgent. Of course, we're going to do it, right, like the ring phone, the burning house etc. But the benefit comes from working on the important stuff, the elective stuff, the things that you're doing today to prevent future problems, benefit both for the practice as well as for the patient. What you're saying is the patient who's typically on insurance is trained to just deal with the urgent and the doctors also give up, they're also dealing with the urgent. So, neither the practice is growing nor the patient's health is growing. So, they all are like stuck in this urgent loop and never working on the importance. So, this I think is, I mean, just reminded me of what you're saying work on the important stuff, not work on the urgent stuff. Gary:  The by-product if that happens is the practice evolves into a tooth at a time practice because you think about what are the benefits covered by insurance whether it's a thousand dollars a year twelve hundred dollars a year or rarely fifteen hundred dollars a year, that's basically one tooth. Naren: Right Gary: And so, doctors start subconsciously evolving the way they diagnosed to basically just the tooth of the year club let's just treat the most urgent tooth because that's all the patient's going to accept because that's all the insurance is going to pay for and you think about Naren: Right Gary: Think about how contrary that is to their training, to their training to be comprehensive, to help people prevent future problems Naren: Right Gary: They're literally just doing the tooth of the year club. Can you imagine if let's just relate it outside of dentistry and let's say someone wanted to carpet their house, re-carpet their house but that isn't something that would be covered by homeowner’s insurance but if there was such a thing as homeowners’ dental insurance, the insurance company would say what, one room at a time. You'd only do one room at a time and how long would it take you to re-carpet your house? Of course, that's how many rooms you have but that could take years and years and years. Is that what the consumer wants? Naren: No Gary: Does the consumer want and it'll never match, even if you buy it from the same mill if you're buying the carpet a year apart, you can guarantee where there's seams that's never going to match, Naren: Even the shade, right, one's going to have a different shade the older one then Gary: Even if you use the same lab Naren: Yeah Gary: When it's a year apart, it might be a different ceramic, there might be different materials a year later. It's never going to match; you're not serving the patient. So i want to share a response that I have taught our clients, my coaching clients to use, and i have to tell you that they have reported back to me, they say Gary I can't believe how powerful that response has been and i can't believe how looking into my patients eyes, I see them literally changing how they're thinking about their dental insurance. So, drum roll please Naren, here it comes, here comes, the patient says, is this covered by my insurance? And let's say the answer is no. Which is what it's going to be most of the time. Of course, we're not going to say no just outright like that. We're going to say no, but we're not going to say it like that. We're going to say it like this. So Naren asked me the question is if you're a patient doctor is that covered by my insurance? Naren: Doctor yeah, I would like to do it but is it covered by my insurance? Gary: Naren, unfortunately your dental insurance doesn't care about your health. In fact, they ultimately, their ultimate goal is to have you never visit the dentist because Naren if you never visit the dentist, guess what, they never have to pay claims. So, their goal is to have you never visit, they don't care one bit about your health as you know Naren, I care deeply about your health and my team cares deeply about your health. So, the ultimate answer to that is unfortunately your insurance company doesn't care about your health and as a result of that they aren't going to provide any benefits for the care that I’ve recommended. I’d like to switch the conversation here Naren, to why this treatment is beneficial to you. Now let's pause on the role playing, think about that for just a minute. Let's break it down for a minute. What did I say? In the beginning unfortunately your dental insurance company doesn't care about your health? Now let's pause here. Is that a true statement? Naren: Yes Gary: Absolutely, absolutely. In fact, they ultimately hope you never go to the den. Now some of you might be thinking, oh my gosh, that's absolutely right. Wow, and when you say that to the patient, unfortunately your dental insurance company doesn't care about your health, ultimately, they hope you never go to the dentist. What's happening now when it comes to helping the patient understand whose side, we're on. Whose side am i on, as a dentist in that role? I am on the patient side. Naren: Exactly now you're my colleague you're my you're my partner. Gary: Yeah and I’ll tell you what else is likely happening in the patient's mind. They're thinking, right, you're right. I had to fight my auto insurance company because they didn't want to pay on a little fender bender I got into. They tried to do everything they could. I had to fight my homeowner’s policy when my homeowner's policy tried to fight. They’re wonderful when it comes to taking your payments, accepting premiums, but as soon as you have to submit a claim, they're now the enemy with you and that's what goes on because everybody I know and I know that's one of those absolutes. Everybody I know has had, tried to have the wool pulled over their eyes by auto insurance, homeowners’ insurance, other kinds of insurance Naren: Speaking of that Gary just today my mother-in-law, had a leak on a roof and there's a lot of damage and they wanted to call the insurance company and they said nope. It's the guy who did the works fault, the rufus fault. So, we won't cover it. Gary: Always trying to always trying to get out of honouring their commitment Naren: But she has paid thousands and thousands maybe even tens of thousands of thousands Gary: Tens of thousands but I want you doctors I want you to really think about this. It's a great way to respond to the question. Unfortunately, your dental insurance company doesn't care about your health. Ultimately, they hope you never go to the dentist. If you never go to the dentist, they never have to pay a thing and now the patient is suddenly making a shift and notice how I finished that role playing, I said I’d like to switch the conversation to a conversation with you about why this treatment would benefit you, would benefit you. Now I’m not saying 100 percent of the patients are going to go, oh okay then let's do it, but it's changing the dialogue, it's changing the context, it's changing the dialogue and I believe our listeners here at the less insurance dependence podcast, I believe that their patients do understand the doctor and dental team is on their side. They get derailed because they fall back into those patterns of that, this is covered by my insurance but they get derailed and one of the reasons why I wanted to have this conversation and do this episode is that when you go out of network, when I’m not if, not if, when you go out of network, doctors did you hear that subtle optimism in my word selection there, when you go out of network, one of the things that's going to happen is you'll have much more patient retention of your existing patients that are in network when you go out of network because they know you're on their side. They trust you and they know you're on their side and they don't want to roll the dice and go to someone else that they may end up not trusting and they don't want to go through all of the emotional effort to re-establish trust as trust is emotional and they already have it established with you. They don't want to have to go do that somewhere else. My clients have reported they said, Gary when you first taught me that I had to take pause because it was very different from the way I’ve responded in the past three years, well unfortunately this is one of those uncovered benefits and that is an answer. It's just not the most effective answer. Naren: Gary, can I add something real-quick. We both are fans of Doctor Robert Chaldini and the number one thing he teaches as the most powerful influence principle is what he calls commitment consistency which is mindsets. So, the patient is coming with the mindset of, does is it covered by my insurance. Before you can before they are ready to listen, you need to shift that mindset and what you did just then Gary that language you used about saying insurance doesn't care about your health which taps into a mindset they already have which is insurance doesn't care about me, it's home insurance or whatever. So no point trying to convince them anything till you switch that mindset. So, I really think what you're teaching is it's so simple but from a psychological perspective, it's so powerful. Gary: Naren, years ago, I found a wonderful plaque in one of my clients, one of my clients offices in their room where they present dentistry, in the area, in the office within their practice where they present treatment and financial options and the plaque said this, think about this, this number of years ago, said beware of bargains in parachutes, hand grenades, and dental treatment, and this is a client who you'd have to understand the appropriateness of that plaque because he has a wonderful sense of humour and all of his patients know that he has a sense of humour and it said it was printed on a brass plaque that hung on the wall and it said beware of bargains in parachutes, hand grenades and dental treatment and it was kind of tongue-in-cheek but not really. Naren: Yeah, you're setting the mindset you're just making them realize guys, if it's cheap, you're going to be on the watch out Gary: Think about this Naren, can you imagine, now you're a marketing genius. Naren: Yeah Gary: Marketing savant. Can you imagine a billboard in any major city in North America? Naren: Yeah Gary: That says, the cheapest open-heart surgery available, go to can www.cheapopenheartsurgery.com. Imagine that Naren: Exactly Gary: Why doesn't that billboard say that? Naren: Because nobody will buy it and actually there is an interesting case. My daughter is in an MBA class, I mean she got into an MBA school and one of the classes, one of the professors talked about a case where India launched the cheapest car. It's a 100 000-rupee car. Nobody bought it because nobody wants to be seen as buying the cheapest car. It flopped. Gary: Conversion, how much is that in I think US dollars? Naren: I think in the us dollars you're looking at two-thousand-dollar car. So, the car was good they really, really, worked on the engineering they spent hundreds of millions but the minute they called it the cheapest car, they don't want to touch it at that time Gary: As a car nut, car aficionado, I have a two word answer no thank you. I guess that's three words, no thanks. So I have, you're going to see this in the show notes, we're going to we're going to provide this for you in the show note. So, I want you to go to the show notes, it's at lessinsurancedependence.com. Consider a plaque in your office that says something like this. Have an open mind, have an open mind, if your insurance dictates the quality of treatment you expect to receive, please let us know so we may refer you to another dentist. We choose to treat our patients better. Let me, let me read that again. Imagine a brass plaque in your consultation room or somewhere in your office that said something like this. If your insurance dictates the quality of treatment you expect to receive, please let us know, so we may refer you to another dentist. We choose to treat our patients better. Radical Naren: Yep Gary: Radical but it's the truth Naren: Yeah but I love the other quote, the other one that your client had. Gary: Hey if you have a sense of humour use the other one, the other one. Beware of bargains in parachutes, hand grenades, and dental treatment. So, if you're more serious, use the comment about we choose to treat our patients better, if you have more of a sense of humour, consider the other one. Naren: We'll put that in a pdf format. So hopefully if anybody wants to even just take it and do something with it, they can we'll do that in the show notes. Gary: And maybe it's something you could share with your team members and the point is that it is sadly nothing short of a war, a battle between your office and the dental insurance company and in between in the middle of the crossfire, are your patients, and that's what it is. If you think about it as anything less, you're not thinking about it in a clear-headed way and I think it's perfectly okay to be so bold as to say unfortunately your dental insurance company doesn't care one bit about your health. In fact, they hope you never come to the dentist. If they if you never come to the dentist, they never they never have to pay a claim. However, as you know, we care deeply about your health. That's a conversation doctors I want you to be comfortable having with your patients and our client my clients tell me that Gary I had to had to referred, I had to work on this but once I worked on it and worked on how I could present that to patients it has been received extremely well and patients have said you're right doc, you're absolutely right and I do trust you. Many times, the patient would say, tell me why I should have this done? And then it opens up a wonderful conversation about health, instead about insurance. Naren: So, you said Gary just before I wrap up, you said after that part one, then you talk about the benefits, right, just want to make sure that if somebody else Gary: You have to have a benefit statement, Naren: Yeah. Gary: Yeah and you talk about the benefits and talk about it in in the framework of the patient. Well hey I want to go ahead and put a ribbon on this one. Thanks so much for listening to this episode of the less insurance dependence podcast. Hey as a closing announcement, we have a thriving dentist MBA workshop coming up on the first Friday of December, first Friday of December, and we have very attractive tuition for that. That one will sell out. In that workshop although it's a live stream it's done virtually, although it will sell out. We offer the lowest pricing in advance of the workshop. So, go to thrivingdentist.com. Look at the one day thriving dentist MBA workshop. You'll see some very attractive tuition. In that workshop I cover the ten elements of a thriving practice and one of those elements just one is how to successfully reduce insurance dependence in your practice. Hey thanks again for listening and thanks for sharing this with your colleague’s thanks so much.

We just reached Episode #100! Woohoo! Gary wanted to do something very special for our awesome listeners to show our appreciation to you for being with us & supporting us throughout. We know that It’s every dentist’s dream to be 100% FFS. But many dentists are afraid. Afraid to lose existing patients & think it wouldn’t work in their town. In this episode, Gary decided to interview Dr. Tracey Hughes. Dr. Hughes is one of Gary’s coaching clients who have successfully resigned from all PPO plans & is 6 months into her journey being 100% Fee-For-Service. Just like all of us, her practice too was shut down for more than 30days but has now re-opened and continuing their Fee-For-Service journey. Highlights: Introduction to today’s topic > 00:55 Introduction about our special guest: Dr. Tracey Hughes > 1:31 Tracey’s experience in going out of network, especially about how she resigned from Delta which represented 51% of her patients > 4:00 Tracey talks about the experience in her practice during the first three months being completely out of network > 7.38 Tracey talks about a fun side story that took place when her practice re-opened after COVID-19 > 4:11 Tracey explains how they are a strong relationship-driven practice & how it helps when you are Fee-For-Service > 20:39 About the after photo’s displayed in the practice and how it helps in the ‘new patient experience’ aspect > 22:40 Resources SPIN NOW LEARN MORE SCHEDULE A MEETING WITH GARY Transcript Gary:  Welcome to an another addition to the Less Insurance Dependance Podcast. This is a very exciting episode for us because its episode number 100. What? Yeah, its episode number 100! So I wanted to do something very special for episode 100. And I wanted to actually do an interview. Now those of you who are faithful listeners of the Less Insurance Dependence Podcast will know that normally its just Naren and myself and we share information that will help you successfully reduce your insurance dependence. But, I kinda thought it would be super cool to have a guest on the 100th episode. And let me introduce her, her name is Dr. Tracey Hughes. First of all, hey Tracey how are you? Tracey:  Hi Gary! Thank you so much for having me, I’m doing great! Gary:  Oh, its my privilege to have you. Now let me explain to our listeners why I wanted Tracey to be on episode 100. She is a client of mine and she has also successfully navigated insurance in her practice and is now completely free for service. Its great! You know if I can share a little bit of history. In December of 2019, Tracey resigned from the last PPO plan that she was on. And the last one was Delta— Tracey:  A big one Gary:  —A big one. By the way, it represented Delta about 51 per cent of her patients. So this was not a light hearted decision. Is that a fair statement Tracey? Tracey:  That’s quite a fair statement. I was quite nervous about that actually… Gary:  You were...Rightfully so, 51 per cent of your patients were on Delta PPO. Well, she successfully resigned in December. And I’m gonna let her talk a little bit about what’s happened since. Ofcourse this year’s been different for all of us. But she had January, February, and about half of March out of network. And then like so many offices she was shut down, like all of us. She’s in Louisville, Colorado. She was able to re-open around the middle of May. In fact, I think it was May 18th. Does that sound right? Tracey:  Yes, that’s exactly right. Gary:  I only remember because it was two weeks later than us. My life smiles practice opened up May 4th and Colorado was a little bit behind us based on the numbers and you were able to successfully re-open on May 18th. Since then, you’ve had about half of May, all of June, all of July, and now all of August. Tracey:  Right...All of August...Last day of August today. Gary:  The last day, as we’re recording it is the last day of August. You know, now we have your practice, you know somewhere around six months of experience being out of network. Tracey, can you talk a little bit about your decision to resign from Delta, because I imagine there are many of our listeners thinking “gosh that sounds like me! About half of my patients have Delta, I’m not sure whether I could ever go out of network”. So would you share a little bit about your thought process? And then maybe we’ll talk about what’s happened. Tracey:  Right. I had been in-network with Delta essentially my whole dental career and I’ve been in Dentistry owned practices for about 20 years...and it just got incredibly difficult. Delta got incredibly difficult to work with. I really felt the financial strain. I think my average write off with Delta dental patients was 40% - 42% every procedure I do I had to discount my fee by 42%. And I tell you what, I was feeling it. I just didn’t have enough at the end of the month. Sometimes, it was very month to month and the strain financially of having to discount my fees was almost suffocating. I really really felt the strain of having to discount those fees and the extra work on the back end of having to track down these past-due claims and all the effort that my team members will have to put into it. There was a lot of stress and pressure on my team members, having to keep up with all the hoops we would have to go through just to get the check. Gary:  Tracey, I appreciate you for many reasons, you’re an amazing dentist… Tracey: Thank you. Gary: ...you’re clinical skills are absolutely amazing. But one of the reasons I really appreciate you is because of your integrity and I’m gonna tie this specifically into your practice. And you had one standard of care, whether the patient was a fee for service patient or a Delta patient. Correct? Tracey: That’s accurate. Gary: So you weren’t using different labs if it was a Delta patient, you weren't using like folding chairs, I’m being facetious— Gary: You have a beautiful office...absolutely beautiful… Tracey: Thank you. Gary: And your patients receive one standard of care, there’s no compromise there. So the person that was getting short changed while you were in network was you. Tracey: Right. Gary:  You were the one that was taken out a 40 to 42 percent of a cut on your fees. Tracey:  Right. And it was even above the bare minimum so I would maybe say I’m doing 10 units and the maximum was 1500 dollars and I would still have to discount all 10 units, which was really really difficult. Gary:  You know that’s one of the things that really irritates me about PPO plans. According to their contract, they can set your fees on uncovered services on services that they don’t cover at all. And they have in most states, in most PPO contracts, they have the right to set your fees whether they provide any coverage at all, which seems to me just fundamentally wrong. I mean if they don’t do service like if they don’t have any coverage for implants they shouldn’t be able to dictate your fees. However, that’s not how the PPO plans work, they use it as a lever, to adversely affect dentists and frankly, it’s one of those irritants that I feel are very unfair. Tracey, talk a little bit about what happened, as the holidays completed, we had to give a 30-day notice to Delta. All of a sudden, now here we are at the beginning of the New Year, and you’re out of network. Because there’s a fun side story about your daughter. But before we get into that talk about what happened in January February and March. Tracey:  Well, right from the start of the New Year actually it was quite exhilarating to really receive 100% of my fee for treatment. The patients were very understanding for the most part. We took several months to talk to our patients in person—thanks to your coaching Gary—my team became extremely well-trained and confident in their ability to talk to patients and explain why we were going out of network and I think that was a huge key point to our success. And as we went through the New Year and eliminated the Delta dental contract and started seeing patients it was really refreshing to see how understanding our loyal patients were. They said, ‘oh, that’s easy...You’re gonna submit the claim and the cheque will still come to me within 7-10 business days...Oh, no problem. Sometimes they needed to be reminded and they would say, ‘whoa wait, you’re not taking my insurance anymore..’ and we would just remind them how easy the process was and they were like ‘oh, that’s no big deal’. So for the most part they got it, sure I had a few people leave...um, not nearly as many as I thought so I was very happy with the patient retention. Gary:  What was my message to you? I’ll put you on the spot here Tracey— Tracey: Oh boy (laughs) Gary:  When you were thinking of going out of network and I said Tracey you’re going to lose some, there’s no getting around that if a patient only comes to you because you’re in-network, you know you may lose some. But I remember sharing with you and I said, ‘Tracey, you’re going to lose fewer than you might think’. Gary: And that became rather prophetic. Yes? Tracey: Yes, that was true, very much so. Gary:  I have vivid memories of getting text messages from you, after the first of the year you know saying ‘woohoo I’m free for service, I’m actually getting my full fee. You don’t know how liberating this feels!’ Tracey:  Its very true and I have absolutely no regrets. And I would do it all over again. And my biggest regret—oh, okay—I just said that I have no regrets, I do have a regret. I regret that I didn’t do it sooner. That’s my regret. Gary:  You don’t know how good that makes me feel Tracey. Especially for our listeners. You know, one thing that might be useful for them to know, you’re in Louisville Colorado. Tracey: Right. Gary:  Which is a suburban...Well, there’s parts of Louisville that are semi-rural still. But I would characterize it as very much a blue-collar community, is that accurate? Tracey: Yeah, I would say so. Gary: You certainly have a mix of patience like we do in Life Smiles. Tracey: We do Gary:  You have some executives that are patients of yours. You're not far from Boulder and you have some highly educated people associated with the University of Colorado. Tracey: That’s true. Gary:  Most of your patients are really just great, solid, middle class.  Tracey: They are. That’s true. Gary: So it’s not like majority of your patients are affluent. They’re working-class folks.  Tracey: They are. They very much are. Gary:  Which is very eerily similar to my own practice. We’re in Phoenix kind of our sweet spot is, right in the middle blue-collar, working-class folks and we love em. Tracey:  Yeah, and they’re very loyal people as well. They like to return the loyalty and I think, the willingness for them to stay and come back, even though we made these changes is very apparent. Gary:  How did that feel to you on an emotional level when you know the patient has made a conscious decision to stay with you. Even though it would be easier for them to go to a networked dentist. How did that feel to you emotionally? Tracey:  Well, it really warms my heart. My philosophy in practice is relationship dentistry; to create relationships with people. And we work very very hard to do that. And we see one patient at a time in our practice. We write down little notes, and when they come back, ‘oh, did you have your have your grand-baby join your family this year?’ and we kind of carry on the conversation. So, it’s very personal. And to have them being somewhat hesitant, you can see the wheels turning a little bit when we first talked with them about the changes that we were implementing. And then now we’re to the point where we’re actually going through the second appointment and re-care with them. And it’s like ‘oh its no big deal’, and they just really get it.  Gary:  Especially when you explain to them that, although we aren’t contracted with Delta you can still use your benefits here. You know, a point that I’ve made throughout this podcast is although reducing insurance dependence we’re still gonna be patient-friendly and insurance friendly. Now, the words that the patient might use, maybe not so much to you Tracey, but maybe to a team member is, ‘so you’re not taking my insurance anymore?’ Which isn’t accurate. Tracey: Yeah Gary:  Your team really had great verbal responses. “Oh no, no, we will be happy to do...we’re gonna go bat for you like we always have. We’re gonna use every dollar of benefit that you have and we’ll still file your claims. We’ll do everything we’ve done before, we’re just not gonna be contracted with it.” Tracey:  And that was a big part of it. ‘Oh, I don’t have to do the paperwork, absolutely not we’ll submit the claim electronically for you. I think that’s a big part of it too. People don’t wanna have to do the paperwork. So we still advocate for the patient, to do that for them, to be patient-friendly. Gary:  Right. Now, I’m privy to a side story, that happened when you re-opened. And your daughter, your 16 years old daughter… Tracey: Just turned 16 Gary:  Just turned 16, deserves massive compliments. Would you fill in our listeners to that side story? Tracey:  I would love to, its a fun story. I’m very proud of my daughter.  Gary: As you should be Tracey:  When I called my team to come back on May 18th, for a respectful reason my office administrator decided not to return to work, so I was short-handed at the front, coming back after being closed and figuring out all these new protocols and a little bit of higher stress because of that, and I threw my daughter into the front office administrator position. She’d never had a job, a little bit of an awkward 15-year-old in their communication. Hardly every talks on the telephone— Gary:  Wait, an awkward 15 turning 16 years old? Gary: Remember I raised four of them.  Tracey:  Right. Right…Communication skills, well I thought, well let’s just have her answer the phone and help out. And the fact that we were not in-network with Delta dental anymore or contracted with any insurances really helps streamline the efficiency of the front office. And I truly believe the fact that I was out of network wit hall networks allowed me to really come back, open the office and take the bull by the horns and really move forward successfully. And she was able to talk to patients about insurance, she was able to process payments, didn’t have to deal with all that back end following up on outstanding claims, she was able to spend her time doing what was most important. Which was establishing relationships with patients? It really made the role of an office administrator easy, that a 15 just turning 16-year-old girl came right in and...Honestly, she was probably one of my best friend’s office administrators that I’ve worked with. Now she’s back to school and I miss her and we’re training somebody else. But again training new employees without having all the restraints of the insurance is so much easier, streamlined, and efficient. Gary:  Well, and you’re being very soft-spoken about how incredible your daughter was. But I will simply report that she did incredibly well completely belied her age or experience. She was all about taking care of patients. She was all about letting people know how appreciated they are in your practice. And she gets an A++ on my report card and the data shows, the numbers show that she did extremely well. You know, I don’t think that would’ve happened if you would have lost your office administrator and still been involved...You know one time you had many plans in the practice. Can you imagine, forget her age for a minute, but anyone stepping in with no dental experience and having to navigate all the land mines of insurance? Tracey: No way. Gary:  No, she did incredibly well. So hats off to Cambie she did incredibly well. Now she got some of your value systems for sure and she may have been paying attention at home when we weren’t quite sure whether she’d been paying attention. She might have been paying attention, a little bit. Tracey: She might have  Gary: But she did incredibly well and really the success story has simply continued because now you’re in the stage as you mentioned where you’re now seeing patients returning for the next visit in hygiene. And you’re just seeing loyalty, appreciation. They are letting you know, they are voting with your feet. They are letting you know “Dr. Hughes, I’m not going anywhere else”. I would never leave your practice, I’m a patient for life. Sometimes they also use those words, but I’d rather watch their behavior. Because their behavior is, they’re with you. Tracey:  They are, they definitely have developed trust and confidence in our practice and we’ve even had a patient that was...So we allowed patients, if they seemed hesitant at all to go through this process we said ‘you know what we really understand, this is a new territory we’re treading into and we really want you to be able to try this out. Before you make any decision to leave our practice and stay with us as an outer network provider. There were a handful of patients that we would sort of trying this on. And if they were Delta as you know, the cheque would have to go to the patient. So these patients that we had long term relationships with we allowed them to go ahead and have the check assigned to the patient. We would carry the balance and we would follow up with them or they would call us and say, ‘you know I got my cheque, just as you said within 7 to 10 business days. No problem’. And they were comfortable with it then we collected their balance with a credit card. I had one patient who didn’t have such a great reimbursement out of network and he had already found a new plan with another company that had better out of network benefits. So he was so loyal, he didn’t wanna go somewhere else where maybe Delta would pay 100% he found an out of network plan, but out of network sometimes pays pretty good, it pays 100% of our fee, and he had already switched. Gary:  I mean, talk about loyalty. A patient literally on their own finding an insurance policy, that pays better out of network because they don’t wanna go anywhere else. It just warms my heart, you know to hear those stories. Tracey, we’re kind of coming to the finish line here, um one of the points that I’ve made, you know repeatedly to our listeners here on this podcast is that... a couple of things. One if you are going to be successful going out of network, one of the strongest things you can do is build the relationship-driven part of your practice. And in many ways, I think your practice is a model, relationship-driven practice. I don’t know how to ask you this question without setting you up...But would you agree? Tracey:  yeah, I agree. Its actually on the front door. That’s kind of our tagline as relationship dentistry, but yeah its really really hard. Gary:  It is at the front door. (laughs) Says relationship dentistry… Tracey: Yeah. I work very hard for that, and that’s the way I want to practice. Definitely patient loyalty in return for that is very very high. Patients want to come to us, they don’t want to go to another office and not everybody does, you can’t be everybody's dentist. Some people are more insurance-driven and that’s fine. But that opens the door for more of these patients. But we developed a relationship very early on with the initial phone call. And I like to call and welcome the patient personally. We have little things that, people like—the paraffin hand dip, the TV on the ceiling—but I think more to it is that we just take time for the patient. We see one patient as a time as I mentioned earlier. And I can really get to know the patient and they come back because of that. Gary: You know, I’ll talk about a couple of other things, as we wrap up here, the point I wanna make is that you give your patients many reasons to come to you, other than you’re on their insurance. You give them many reasons. Tracey: Right. I hope so. Gary:  You do. It’s a full list, it’s a very rich list of things that you provide. Technology, you have state of the art technology in your practice. One of the things I love about your office is that the way you have some really beautiful after photos of your patients. That’s something that you’ve really kind f taken it to an awesome level. You ask the patient to sign the after photo and write a short note. Tracey: Right Gary: Those photos are…You can’t help but be drawn to those photos. And you can’t help but read what they have to say. Every one of them has glowing praise of their beautiful smile. Tracey:  It is, and my assistant makes sure as she’s bringing the patient back that she does a tour and she stops and pauses and says, please take time to read these or take a look at these if you’d like to take your time after your appointments. So as they’re coming back up from the treatment room to the consulting room they take time to look at those photos and to read what the patients have written. Gary: Yeah, yeah...You know there are so many reasons for people to choose your office. Well Tracey, thank you...You know Dr. Omar Reed shared with me that um, sometimes people need to know that it’s been done before. Dr. Reed used to use the quote ‘if it’s been done before it must be possible.’ I’m sure you’ve heard that. Tracey: I take that one to heart actually. Gary:  Omar probably said that one time when you were at his courses...But Omar often said that ‘if it’s done before, it must be possible’. I wanted our listeners to hear from you. Hear from this 100th episode. You’ve done it, its possible, you’re in a highly competitive area. I mean it’s not like there aren’t other dental choices… Tracey: Very much so Gary:  Everywhere...You’ve done extremely well and I’ll repeat what you said earlier, you said your only regret is that you didn’t do it sooner. Tracey: That’s true. Gary:  So I just want to thank you. I treasure our coaching relationship, I’ve loved working with your team. Really when we do team meetings, their pens are smoking taking notes. And I know they’re going to apply the information that they learn. But you’re also a wonderful leader in providing them the leadership, the encouragement, and the resources to do their job well. So let me take a minute and say thanks to you Tracey, and thanks for being a voice here on the podcast. Our first interview in 100 episodes and thanks for being like a lighthouse that points the way. And nothing would make me happier than the listeners of this episode to think ‘wait a minute, if Dr. Hughes can do this, I think I can do it too.’ I’m inspired, I’m encouraged. Tracey: That’s very true. Gary: Thank you, Tracey, for being that guiding light.  Tracey:  Thank you so much from the bottom of my heart, I appreciate all your help and coaching to get us to this point. Its something I’ve been wanting to do for many many years. So thank you so much. Gary:  Oh, it’s mutual. Want to take a minute and thank our listeners of the Less Insurance Dependence Podcast, we love what we do here. Couldn’t do it without you, three things you can do to support our work; number one you can tell a colleague about the Less Insurance Dependence Podcast, there might be some dentists out there that haven’t discovered podcasts yet. Hey, let them know about Podcasts and let them know about the Less Insurance Dependence Podcast. The second thing you can do is, you can jump on iTunes and write us a review, help more dentists find us. And the third thing you can do is to hit the subscribe button. You can so that on iTunes or Google Play or whatever your podcast directory of choices. Just hit subscribe and every Thursday when we upload a new episode it’ll be automatically uploaded for your listening convenience. On that note let me simply  thank you for the privilege of your time and tell you I will look forward to connect with you n the next Less Insurance Dependance Podcast. Thanks so much.

We talk to Bullfrog and Lionhead legends Gary Carr and Mark Webley about the design of PC cult classic Theme Hospital, and how their careers twisted and turned to see them return to create a spiritual successor. Learn more about Two Point Hospital: https://www.twopointhospital.com/ Play Theme Hospital: https://www.gog.com/game/theme_hospital Download CorsixTH: http://corsixth.com/ iTunes Page: https://itunes.apple.com/us/podcast/noclip/id1385062988 RSS Feed: http://noclippodcast.libsyn.com/rss Google Play: https://play.google.com/music/listen?u=0#/ps/If7gz7uvqebg2qqlicxhay22qny Spotify: https://open.spotify.com/show/5XYk92ubrXpvPVk1lin4VB?si=JRAcPnlvQ0-YJWU9XiW9pg Episode transcription: http://noclippodcast.libsyn.com/02-the-return-of-theme-hospital Learn About Noclip: https://www.noclip.video Become a Patron and get early access to new episodes: https://www.patreon.com/noclip Follow @noclipvideo on Twitter Hosted by @dannyodwyer Funded by 4,197 Patrons. -------------------------------------------------------------- TRANSCRIPTION; - [Danny] Hello and welcome to Noclip, the podcast about video games and the people who make them. On today's episode, we pay a much needed visit to the video game doctor, as we celebrate the return of a PC cult classic. Bullfrog are synonymous with a wonderful period in time for games development in the United Kingdom. Producing many cult classics including Populus, Dungeon Keeper, Syndicate, and Theme Park. But to me, the jewel in Bullfrog's crown has always been their lesser-known follow up to the theme park management game. While becoming an instant classic in the UK, Theme Hospital is much lesser known here in the United States. So it was quite the surprise to me when, on a date with an American, the girl across the table from me mentioned it as one of her favorite games ever. I think that was the moment I decided I wanted to marry you, was when you mentioned you liked Theme Hospital. - [Lindsay] Oh yeah, that's, like, an important aspect of our relationship. - [Danny] Yeah, what do you remember about that game? - [Lindsay] I remember all the little goofy components of it, like how the people look, and how you can pop heads, and how you can deal with a million Elvis' and the helicopter comes in and has a thousand people on it, and the fancy man comes around with his top hat. - [Danny] Oh yeah, I forgot about the VIP. - [Lindsay] The fancy man. - [Danny] Yeah. And you had to make sure that he didn't, like-- - [Lindsay] See all your rats and shit, like-- So you be, like, "This way, Sir." - [Danny] Or somebody would get sick right in front of him. He kind of looked like the Monopoly man. - [Lindsay] Yeah, he was so fancy. And he, remember when he stopped by all the wards and looked in all the windows, he peaked in. He'd be like, "Oops, not that one, "no one works in there." - [Danny] I wonder how much it mattered. Because when he was walking around, I always thought, oh, I better make sure that wherever he walks we have fire extinguishers. - [Lindsay] Totally. - [Danny] But I bet it was just, like-- - [Lindsay] It was predetermined before he even landed on his helicopter or however he got there. - [Danny] I think this might be the first time I've ever worked on a Noclip project which is a game that you care about? Is that true? I guess Rocket League you liked. - [Lindsay] Rocket League I liked for a few minutes. None of the other video games you've ever done a podcast on, I mean done a documentary on, I've ever even heard of. - [Danny] Yeah. You're not a final fan of C14 fan? - [Lindsay] I've heard of Final Fantasy. I didn't know there were 14 of them, but-- - [Danny]There's way more than 14 of them. - [Lindsay] I've heard of it. Oh, really? - [Danny] Yeah. And since it is the first time I've kind of worked on something that you actually have a deep knowledge of-- - [Lindsay] Oh, I'm excited. - [Danny] If you had any questions, let me be those sort of the translator between you and the developers. What would you ask if you had any questions? - [Lindsay] Well my big question is when they are going to make a sequel. Because as fun as it is to play that pixelly thing, they better make a sequel. My real questions are about the silly things, like how the handyman could smell cabbage or just little silly components that they put in there. - [Danny] It's the doctors, isn't it, it smells faintly of cabbage. - [Lindsay] It smells faintly of cabbage, yeah. - [Danny] When you were hiring them. Oh yeah, I guess the handyman, too. - [Lindsay] Anybody could smell like cabbage in real life. Anyone could smell like cabbage. So I had that question, and also about shooting rats. Like, what that's about and sometimes you could unlock that secret level where it was just rat shooting. And that was really cool. - [Danny] It was kind of random, though. - [Lindsay] Yeah yeah, it was just like-- - [Danny] Like, why does this happen? - [Lindsay] Right, I have some experience in hospitals and I've never once shot a rat, but they thought it was important that we have that component. - [Danny] I can answer the first question. - [Lindsay] Oh, when the sequel's coming out? - [Danny] Yeah, so I decided I wanted to do this a while back, and it took a while for me to hunt down the two main dudes who worked on Theme Hospital. It turns out both of them ended up having really prolific careers and getting to the top of Lionhead Studios, who made a bunch of games. - [Lindsay] The Movies. - [Danny] They made The movies, I remember you love, which is so funny, you love The Movies because it's probably Lionhead's most obscure game. - [Lindsay] The Movies was really hard. I've never made any progress at all in that game. I think I'm doing something wrong, actually. - [Danny] And the guys who, I think both of them actually worked on The Movies as well. - [Lindsay] Well then I have further questions for them of how you achieve anything in that game. - [Danny] We'll have to leave that for another podcast. - [Danny] But I ended up finding them because they're working on a spiritual successor. So after, I think it's been eight, 19 years? Around two decades, and finally you can play a new hospital management game, it's coming out really soon, so-- - [Lindsay] Yes. - [Danny] Let me ask the questions and I'll get back to you. - [Lindsay] Report back. - [Danny] Like report back to you-- - [Lindsay] Thank you. - [Danny] On the condition of our patient. - [Lindsay] Of our fair game. - [Danny] Yeah. - [Mark] Yeah, I'm Mark Webley, I'm one of the founders and I guess I'm game director at Two Point Studios. - [Gary] I'm Gary Carr, I'm also a founder and I'm creative director at Two Point Studios. - [Mark] I kind of heard about Bullfrog, I didn't really know that much about them until I saw this EA poster, a friend of mine worked at EA, and it was a poster with all their games on, it kind of looked like interesting games. You saw this one in the middle, which is, looks incredible, I said, "What the hell was that?" And it was Populus, and I thought, wow that just looks insane, I mean, you kind of looked back at it and you might not see it, but at the time it was, in my view, whoa that looks so different and cool. - [Gary] I think I started a couple years before Mark, I think I started in 89. - [Mark] Yeah, you were definitely before me. - [Gary] So I done my first game at Bullfrog was Powermonger, I was there at the back in the Populus and I did a little bit on the data disks but not very much if I'm honest. I did a little bit actually on Syndicate, but it was called Cyber Assault when I worked on it. - [Mark] I thought it was called Quaz at one point. - [Gary] It was called Bub as well. - [Mark] Bub? Yeah. Just something easy to type. - [Gary] That's the game that we could never actually decide what it was going to be. It was in production forever. - [Danny] Back in the early 90's, the team at Bullfrog was only around eight people led by the excitable hand of a man called Peter Molyneux. The studio operated out of a makeshift office crammed into an attic above a stereo shop and a flat occupied by a chain-smoking old lady. Peter had used his charm to persuade Commodore to lend them a suite of Amiga's and it was on these computers that the team worked on games, games like Powermonger, Syndicate, Magic Carpet, Flood, and Dungeon Keeper. Gary, an artist, left for a time after they had completed the iconic Theme Park. He went to work at famed UK developers the Bitmap Brothers for a number of years before being tempted back to Bullfrog by a devilish dungeon keeper. - [Gary] Yeah, Peter has got a great way of, kind of, sort of making people believe that these things are going to be what they want them to be and he's brilliant at that and I loved the guy for it. But I wanted to come back and do something that wasn't Theme, so I kept saying, "Could the game idea possibly be a dungeon-y game?" And he sort of said, "Could be." What he meant was it could be, but it's not. So I came back, but actually it was the best decision of my life, it really was because it was great to work with Mark. We're very different people, and we both have sort of different things we bring together and we had-- - [Mark] We argue a lot. - [Gary] We argue a lot and we had total freedom. I mean, back then there was only about three or four people that had the luxury to sort of take an idea and own it, and we were one of those few. So it was a great time in our careers, we were at the right time, I think, to sort of build a team together and make that game. When Mark and I were probably at similar age and different types of experience, I'd had a bit more games experience at the time, Mark had had a lot more management experience at the time. - [Mark] But I was a lot smarter. - [Gary] Yeah, I think so. But at this point in time, I think it was when Bullfrog was splitting up into creating teams within Bullfrog because we'd gotten a little bit bigger. So Mark kicked off what was called Pluto, believe it or not, which was the design and series team that was gonna do all the theme games and I was brought in to sort of partner with Mark on this game, we had no idea what was going to be coming and it ended up being Theme Hospital. - [Mark] Well at that time, it was just me and you to start with, it was just, I mean, the team at its maximum size was probably about five or six. So it was pretty small teams, there's no producer, there's no designer, so I was programming, Gary as doing the art and-- - [Gary] And we were kind of making it up as we went along so that process kind of carried on for a while and I think that kind of originally it was a game about a hospital, a game about a theme park was kind of great, you got rides and exciting things and lots of fun just without even having to go outside the box. - [Gary] Try too hard. - [Mark] And then afterwards it was different. We kind of thought about the flow of the game the patient, the diagnosis, and the treatment of patients, but the sticking point was after. In fact, we were on the research back in Gilford, it's right next to the hospital, so we'd often spend out lunchtime walk around Dart U we'd probably get choked out now. - [Gary] Trying to get inspiration, weren't we? - [Mark] Yeah, just walking around the corridors, and just kind of seeing what's in the hospital. We're going to have lunch in the cafeteria and it was, it came to a point where I think you just, you said, "This is it, isn't it. "There's nothing more, it's just "boring corridors and plain walls." - [Gary] They're all very similar, it doesn't matter if it's the US or the UK, I think hospitals share, they always have the same floor tiles. They have these slightly curved floors where obviously they're easy to wash in up corners so the floors slightly curve, they have this kind of shiny, painted up to about waist-high where I think that can be washed down as well. - [Mark] Hosed down. - [Gary] Hosed down. And they have a few machines with little screens on them and they all sort of makeshift beds that seems to be some sort of crash unit near it. And that's it, and we just suddenly thought, Oh my God, how does this compete with things like roller coasters, and water fluids, and all that kind of color? And we got really scared and we also spent about, and this has been said many times, but we spent about a month in different hospitals trying to do some research, trying to find a game out of all that. - [Mark] Integrate on the street. - [Gary] On the street, we went to Brimley and Rolsory, and we just spent time in all these hospitals and we just kind of got so weary. - [Mark] Gary even got circumcised. - [Gary] No, I didn't. We viewed operations, we were invited to go and look around the morgue and we went into business meetings about how one hospital could strategically beat another hospital to people that have been in injuries. And it just sounds like, oh god this is so grim. - [Mark] We were setting up the ambulance. - [Gary] That's right. Do you remember that? - [Mark] Yeah yeah. - [Gary] And then we sort of went for lunch and again in the canteen that looked very much like a real canteen, they have lots of really unhealthy food. And, uh, we just suddenly I think just landed on this idea at the same time to sort of just let's just make it up. Because we actually knew nothing about hospitals, we didn't know how they really worked. - [Danny] Mark and Gary did their game design due diligence and visited hospitals all around the Greater London Area. They were kicked out of an operation for distracting a surgeon once, and almost visited a morgue before losing their nerve. It was these experiences that brought the boys to the conclusion that they were better off distancing themselves from the grim reality of hospitals as much as they could. They knew that the subject matter wasn't really the focus of the gameplay experience. It wasn't like people who played Theme Park all wanted to run Theme Parks, and the same could be true here. Through their experience they understood that the drive of this game came from the problems players would encounter and the ways in which they would solve them. So they didn't have to make a game about running a real hospital, they just had to make a game that was fun and challenging. It was around this time that Bullfrog was acquired by Electronic Arts. And when their new bosses turned up to see what the team was working on, they were, a bit confused. - [Gary] And when they'd come to the studio and have a look at all the games, it's kind of like, a hospital game? No, I don't get it. It's like, oh, think about ER and things, we were trying to jazz it up. It's actually a really popular, exciting show. They'd say, "But this isn't like ER, is it." - [Mark] I guess that's the problem. I think everybody probably would assume science fiction or fantasy-- - [Gary] Or killing or blowing up. - [Mark] Making some sim game around that would be the best possible subject matter, but I think coming up with, if we stay in kind of reality, and relatable subject, but then you twist that into something else is, makes it way more interesting. - [Danny] EA was right. It wasn't really ER. For one, Theme Hospital didn't have any real illnesses. The people in this world suffered from conditions like Slack Tongue, Bloaty Head, Kidney Beans and Third Degree Sideburns. One condition originally called Elvitus had to be changed when Elvis' estate got wind of it. The character art, which did look a lot like Elvis, was slightly changed, and the condition was renamed King Complex. Another legal faux-pas came with the original box-art of Theme Hospital, which carried a red cross. The Red Cross wasn't too happy about that, so they changed it to a green star. The guys were starting to warm up so I figured it was probably about the time to ask Lindsay's questions. First of all, what was with all the doctors that smelled faintly of cabbage? Who wrote this stuff? And why did Theme Hospital have a rat shooting mini game? - [Gary] One thing I think Lionhead and Bullfrog haven't probably promoted enough is the great writers who have actually made us look even, well, made us look way better than we actually are. Because it's actually, it's interesting, there wasn't that many visual illnesses in Theme Hospital, but a lot of people remember the wonderful names and they paint their own pictures. - [Mark] Yeah, and the descriptions of how they're contracted, so. - [Gary] So I think, but the writing was really important to us. - [Mark] There was a guy called James Leech. - [Gary] But James Leech did the original, but James also worked with a guy called Mark Hill throughout, on and off through the Lionhead days, and that was something we wanted to bring, keep that consistency of writing. So, it was probably Mark, probably is, he's really strong. - [Mark] Yeah, if you've got enough, if you've shot enough rats in a level, you could unlock a secret in between levels, you rat shoot. And it was basically just a lot of rats. You had a certain amount of time to kill as many as you can, and if you kind of chain them together, if you've got enough, if you've got a streak as it were, you could level up your weapons. - [Gary] That's right. - [Mark] And they were really difficult, I think the rat was two by one pixels, you know it was some of my best work, and you had to get a headshot. So you literally had to be almost pixel perfect, certainly in the harder levels. - [Gary] It was hard, yeah. - [Mark] And it's weird, things like that used to happen because we didn't have design documents. We didn't have, you know, we weren't scheduled to do, this week we're on this, next week we're on that. So, you know, this is just when developers just start dicking about really. - [Voiceover] Could people please try not to be sick in the corridors. - [Danny] Theme Hospital was a critical and commercial success, but once they were done post-acquisition Bullfrog saw an exodus of developers as Peter Molyneux left to form a new studio, Lionhead. Mark followed his old boss to Lionhead while Gary was part of another group that founded the studio Mucky Foot. There, he worked on the art for Urban Chaos, Startopia, and Blade 2, and left once the studio closed in 2003 whereupon he joined Lionhead to work on The Movies. By this stage the two friends found themselves in lead positions at the company. They shepherded many games through the studio during this time including Black and White, Fable, Kinect Sports, and unreleased projects such as Project Milo and "BC". They worked together at Lionhead for a decade, but as time passed the job became less like the good old days. Microsoft had acquired Lionhead in 2006 and the now 200 person studio had run into financial difficulty. So as the years wore on, the influence of their parent company was having an erosive effect on the team's creativity. Gary found it especially difficult to get his ideas to gain traction, and so he decided to leave. - [Gary] I guess the thing I enjoyed most of the Bullfrog era was definitely Theme Hospital. It just was, because it was a point when I was ready to do more than just the artwork on a game. So I felt I was much more stepping into being a kind of a co-creating role rather than just making things look as pretty as I could. Then, I enjoyed my period with Mucky Foot, which was a company I sort of helped formulate, and we had some great years there. Lionhead, I guess the challenges were always working with Peter on such ambitious ideas because Peter would, I was in a team that wasn't Fable, so my part of that was Peter would throw some incredibly outlandish ideas around and it was kind of my job to get a little group of people together to try and realize that ambition. And it was really exciting, I mean, we literally went from making things on Kinect or things like Milo and Cabige, which was a bit nice for a while, it was just weird and wonderful opportunities to try and make a difference and do something strange and interesting, so I enjoyed that, too. - [Danny] By the time Mark's tenure was coming to a close, Peter Molyneux had long left the company and Mark was creative director of Lionhead. His final act at the studio was to help get Fable: Anniversary out the door, and it was then that he stepped away from a job where he'd spent most of his adult life. - [Mark] Yeah, I mean, I was there from the beginning, and my tenure was 15 to 16 years. - [Gary] It was 16 nearly, I think. - [Mark] Yeah, I left in the beginning of 2013. But it was a long and anxious period that I was kind of working through. I mean things had changed, obviously Peter had gone, and the kind of vision for Lionhead was, well, a vision for the Europe Microsoft was free to play console stuff and it wasn't really, I wasn't really enjoying it anymore. I think that's the best thing to say. You know, I kind of, if I was going to do it again, I wanted to fall back in love with making games and-- - [Gary] You're quite an emotional person, if you don't like something, you let people know about it. - [Mark] And I sulk about it. - [Danny] Mark and Gary were free agents and worked odd jobs here and there for old friends. They enjoyed the easier workload after years of grind at the top of one of the UK's largest developers. Perhaps it was then, given the benefit of hindsight, that the two remembered just how much fun they had had working on those old games together. So it was then, one evening, when Mark was picking up pizza, Gary pitched him an idea about starting a small, independent studio, and working on games sort of like they used to, in a cramped old flat stuck above a stereo shop and a chain-smoking old lady. - [Gary] Yeah, I kind of didn't think. I thought, well who'd be interested in, you know, revisiting-- - [Mark] Two old farts you know, making old games, who's interested in it? And I think that was kind of-- - [Gary] We had to go on a journey of discovery. And actually it was when we started sort of talking to some people when we were still trying to find a partner to make this, we certainly realized there was a lot of interest. - [Mark] We did a tour, didn't we? - [Gary] We did a tour, we sort of went on the roads, and met up with a bunch of either, we were looking to either sell publish, initially, maybe do a kickstarter, or partner with a small publisher. We didn't know, you know, who would go for this. So we just sort of started looking into it. And we just literally got in the car, booked into a sort of cheap hotel, motel-type places, and just knocked on doors and that's how we started. Which was great fun because this was a couple of 50 year old guys, basically in a band back together again. - [Mark] And going on tour, so we just, our wives probably thought, look at them, they're pathetic. What do they think right now? - [Danny] Mark and Gary thought there might still be a thirst for their old sim games. The classic Bullfrog titles were still selling well over on GOG and new games like Prison Architect and City Skylines were creating a whole new generation of fans. They had considered crowdfunding the project at one point, but they were warned away by some of the developers they talked to during their road-trip. So, they wrote a pitch for a new hospital game that would evolve the ideas of a game they had made almost two decades earlier. They knew they needed financial help. The guys were experienced and understood the type of game they wanted to create would require more money and time than they personally had. They shot the pitch around to publishers, and while some were receptive, there was one in particular that seemed very keen: SEGA. They negotiated terms with SEGA from the end of 2015 right up to the summer of 2016. And as it happens, right as the deal was signed, news broke that Microsoft would be closing Lionhead Studios. So, somewhat ahead of schedule, Gary and Mark rushed to hire their new team. - [Gary] We kind of imagined we'd take them over a period of time, but Lionhead closed, and it was suddenly these brilliant people were out of work. - [Mark] Tons of brilliant people. - [Gary] And they weren't around for long. - [Mark] No, we were going to lose them. - [Gary] Companies were coming to Gilford doing presentations just going, "You should come work for us." And we, you know, we had to kind of promise-- - [Mark] That was a risky thing to do. Because obviously we had to sort of lay out a huge amount of our expenditure earlier than we would ordinarily do it, but the point thing is we made a huge advancement in the development in the game and also this team, I wouldn't swap them for the world. They're amazing bunch of people. - [Gary] Some of them have worked with us for over twenty years. But Alan, who's sat behind Mark right now, I think he was your best mate at school, wasn't he? - [Mark] Pretty much. I mean Pram, Pram reminds me of Chris. Pram literally knocked on the door, and one of the guys we've worked with for over twenty years, I hired him out of college. And now he's absolutely integral to this team. So that's the kind of things we like to do. It's to build those relationships. - [Danny] Mark and Gary founded Two Point Studios, and over the coming years built a team of 16 people to help make this game. Some were old friends and colleagues, others new kids on the block. Their game was going to be called Two Point Hospital. The spiritual successor to a Bullfrog classic. But it wouldn't be enough to simply re-make an old game. For one, Theme Hospital was a 2D game. When Edge Magazine came to visit the studio in the mid 90's, they barely took notice of it, as gamers were far more interested in 3D screenshots of games like Dungeon Keeper. But time would prove to be kinder to Theme Hospital. While those early 3D games aged quickly as 3D technology improved, 2D games have a sort of timeless, inviting quality to them. Plus, to create these sophisticated sandbox they were aiming for, Two Point Hospital would have to be in 3D. - [Gary] We knew how Theme Hospital had done better over 20 years and some of it's contemporary. - [Mark] So we needed to come up with a style which incorporated something that felt like it was fresh and up-to-date, but we felt if the game does have legs, if people do love this game and we can keep it around for long enough, won't look out of sorts in two, three, four years time. So, we went for something quite organic feeling, it doesn't feel like it's rendered, it feels more like it's made of clay or plasticine, and it feels drawn rather than engineered, - [Gary] And I think also that that art style back then was, with was certainly Theme Park and Theme Hospital had, we had quite a big proportion of female players, which back then was certainly unheard of for our types of games. Obviously something like the sims, which came later, it just blew their market wide open. But I think we didn't have an art style that was-- - [Mark] Exact not footing. - [Gary] Yeah, it kind of, it was accessible, I'm not going to be patronizing and suggest that, you know, we made something that was appealing to girls, Because I wouldn't even have a clue how that would, you know-- - [Mark] I think it felt accessible, it felt like it wasn't aimed at any particular type of gamer. - [Gary] Because you're looking at the game not from a fixed angle, you could be above or sort of, like, low down, you could kind of twist the camera. So a lot of these kind of considerations were kind of worked through and then, - [Mark] And then the US, is it Where's Wilbur in the US? Where's Wally? - [Danny] Oh yeah, Waldo they say over here. - [Gary] Waldo, that's it. And we, you know, to make something readable when you've got so much on screen, and I don't know if you need a screenshot with some of the later levels where you've got absolutely vast marks with hundreds of people on screen. To get a clean read and not get it to look noisy and kind of, I don't know, slightly put you on edge because everything's moving and they've been shimmering because everything's trying to fight for your attention was a real consideration for us. In fact, I've seen some footage that's just gone out last night, and the guy's captured all his footage top down. - [Danny] Right. - [Gary] Imagine being a designer or an artist trying to design a game that looks good from anything possible conceivable angle. It's really difficult. - [Danny] Theme Hospital was accessible, not just with both men and women, but with gamers and non-gamers, and young and old too. It was one of those games that was effortless to pick up. But after the first few missions, Theme Hospital's rough edges began to show. First of all the game got rather hard really quickly. And secondly, there just wasn't any interesting progression. Each level in Theme Hospital was almost identical to the previous one. So to combat this, the team created a world where each hospital takes places in a unique region with its own biome and its own unique needs. - [Gary] Because the regions are very different, the people in that area are very different, some are rich, some are poor regions, and some of the challenges are different. In some cases, you may be running a hospital that's actually funded rather than you get paid for curing people from the individuals, they don't pay, you just get a budget at the beginning of the level. And that just makes the plagues spin completely different, so we wanted to kind of make it stay fresh as much as possible. And also give people the opportunity to circle back and go back and do things that they probably struggled earlier on and keep that fresh by putting new challenges in there. - [Mark] And you have the ability to progress through the county reasonably easy. But if you really want to max out the game, you can kind of return to earlier hospitals, you can unlock things in later levels, you can do research, maybe unlock certain qualifications, come back to one of the earlier hospitals and train the staff in those things, upgrade those machines. - [Gary] So the game doesn't have that pinch point, which the original game had where it just got too hard for me, I think I got to about level seven and would find it a real struggle. And we didn't want to do that again. - [Danny] When I ask the guys about the features that excite them most, there's one that immediately stands out. Two Point Hospital features characters with a variety of personality traits that are not only affected by the world around them, but also by the people around them. They want you to care a lot more about your employees in this game, but more than that, this system has the ability to create wonderful emergent moments as doctors and patients clash with both each other, and the rules of the world. M This is what's real new cutting edge stuff is we've got this, the brains the little people now, is they've got these traits and of course they also have the conditions they're under combined to make quite unique animation blends, which means they do things, they react almost uniquely. It doesn't feel like it's pre-canned. You see somebody walk up to somebody and they'll respond completely different to the next person based on how those two people feel about each other. - [Danny] Could you give an example? Like is it, if two doctors don't like each other, or if they have a tough patient, or how does that sort of manifest? - [Gary] It's just patient is a good example, I mean, they as well as the personality traits, the things that are going on, if doctors has just treated a patient and they die, that has an effect on their happiness, they go on a break to the staff room, and that could end up in an argument with another doctor, and then just that argument could just-- - [Mark] And it's not all emotional, sometimes it's just that the habitual things, like you have a fantastic doctor who may just never wash his hands when he goes to the toilet. - [Gary] Right, now that has an impact on the game. It's not just funny, it actually has an impact and in fact, there was somebody who was showing the game to in San Francisco the other week, and this person has an amazing hospital, doing really well, but when you put the filter on to look at hygiene, the hospital is really clean, but all the staff are really filthy, and I mean you couldn't work it out, and she'd built this massive facility with a toilet which only had two cubicles and she put no sinks in it and no hand dryers and put no sanitizer units anywhere in the hospital. So all these doctors were working on all these patients, filthy. And we put this kind of filter over it and showed her all the instants of filth trails in the game, and Mark just went, I can see your problem. He said, "Do you ever wash your hands "when you go to the toilet?" And this girl was just so embarrassed and immediately went and put this bathroom, a sink into the bathroom, to the toilet. And all the staff just ran to cure, to wash their hands, it's that stuff. - [Mark] Everything in the game affects something else so the people, the machines, the way and the sick, and everything in your world is important. - [Gary] If you have a brilliant surgeon but he's an angry man or woman, right, your job is to try and work out how to diffuse that situation to get them to do even better. And that's kind of the fun depth that the game has. Maybe this person just needs more caffeine in their life. Maybe this person needs more weird executive toys in the office. Those kind of things, it's just you getting that extra ten percent out of their performance which is the real depth I think this game supports. - [Danny] As Gary just said in Two Point Hospital you can have an angry surgeon, man or woman. Another evolution from games past that shows not only just how far games have come in terms of representation, but also in terms of technology. If there's one thing I keep hearing when I interview designers today, it's that technology provides, it provides answers. Many design problems that used to exist in the past have been rendered moot by the advancement of technology. And Two Point's character variety is a perfect example of this. The original Theme Hospital had four main character types: A nurse who was a women, a doctor who was a man, a receptionist who was a woman, and a janitor who was a dusty-looking old man. So I asked Mike and Gary, why? - [Mark] It covered respective times people have said that we made a sexist game, but we had to make the game run in four megabytes. I mean, it was a time and memory, and it wasn't a question of, like, well doctors are just men and nurses are just women, it was just a question of like, we had to make a call with it, and I think you had new, you had different heads, but it was pretty much the same body, different jackets and stuff, and we couldn't have made-- - [Gary] I was really keen on skin tone was important. I did not want to have a particular skin tone, but we just did not have the time or the memory, mainly the memory. - [Mark] The character variation was important to us back then, and it was only 21 years ago but you very rarely got very different clothing variations and we did manage to get an element of that in. But the basic model of the man and the woman, that was the huge memory part of this. You know, so rightly or wrongly, I could have made a male nurse and a female doctor, I could have made a young janitor, I could have made a male reception administration staff. All of those things are absolutely true. You know, 20 odd years down the line it just seems critically incorrect but it wasn't our intention, I'd like to think we're quite right on. But the decision was made that the doctors were male and the nurses were female, rightly or wrongly, it was a call I made but I certainly didn't mean the offend anybody. - [Danny] But it sounds like that's something that's been changed for Two Point? - [Mark] Totally. - [Gary] Absolutely. I mean, you know, that would have, that's absolutely goes without saying, he's not trying to correct anything, it's just that we had no choice back then to make a decision, rightly or wrongly, but it was just never going to be a situation. I mean, we've got so many more other types now of staff anyway, and what they do is very different. I mean, and thank God our initiative stuff in this game do all sorts of things, they're not just manning, I mean the little bit of footage you've probably seen, it may look like, oh look, there's somebody on the reception desk again. They do all sorts of different roles. - [Mark] Yeah so we've got a marketing department which you open up later in the game, so the assistants can work, if they have the qualification, they can work in marketing, - [Gary] They're kind of civil-servant-y type people, aren't they. They do a cross of different things, but the other things is we've taken a variation to a ridiculous level now. You can have hundreds of people, in fact, somebody took a fantastic screenshot within the studio, it's on our Twitter feed, and it's just about three hundred people just jammed into section and no two, they're all completely different characters. We've got this amazing modular system which puts on things such as steam goggles if it wants to, you know, boots, every component can be different and it just randomly generates them. So you really are lucky if you see two characters that look vaguely similar. Certainly more similar people in Yorkshire than there are in our game. - [Danny] What excites me most about Two Point Hospital isn't replaying a style of game that I enjoyed in my youth, it's that this game seems to be free of the technological restrictions of its predecessor. It's full of neat little features like teaching janitors to vacuum up gDannys. So even that old dog has a new trick. The guys are busy finalizing the game so I didn't want to take too much more of their time. But before they left, I had to ask them the most important question: What new illnesses could we look forward to treating in Two Point Hospital? - [Mark] Turtle Head is an affliction where the head shrinks down to a very small and it has to be a, I'm only saying that because I know it's on our website. - [Gary] There's another one where the guy's foot is like a camel's foot and it's called Camel Toe and that has to be, that's not in there, it's just hardly been-- - [Mark] That was one of my favorites ones. I thought you liked it. - [Gary] Mark, he's trying to get that in the game. I have to say as well-- - [Mark] I say we've talked about it now in the press, so we have to put it in. - [Danny] Lads, you sound like you're having a great laugh. This sounds like a very professionally exciting period in your lives. Is that fair to say? - [Mark] I mean, 21 years ago, releasing Theme Hospital, that was an amazing time. We had such good time, and just kind of starting a studio and going "Wouldn't it be cool to be able to "recapture some of that kind of--" - [Gary] Actually we started our families. I mean, we both got married, you might have been before me. Side having your family at the beginning, I think-- - [Mark] Yeah, I hear you, Sam was born just as we started. - [Gary] There's a story: Sam actually worked with us here. Sam's Mark's firstborn, was born right at the beginning. - [Mark] Pretty much as we started. - [Gary] As we started, and he's one of the engineers and creatives on this, it's very odd, it's very strange, but that's what makes it fun, right, because we got to a stage in our careers where we just want to actually enjoy coming into work, not have to be some, the problem with games is you get promoted, that's the problem with games. And when you get promoted, you stop making games. You start becoming that person nobody likes. You have to get a game done, and it has to be done like this, and nobody likes people telling people what to do. So we've basically set up this company so nobody, we don't have to tell people what to do and no one tells us what to do and yeah, it's great fun coming into work everyday. I don't think we've had one day where I haven't felt this is the best thing I've done in my life. - [Danny] Two Point Hospital should be available to purchase on PC, Mac, and Linux around the time you hear this podcast. You can learn more about the game at twopointhospital.com. If you're interested in playing the original Theme Hospital and you should be, it's really good, it's available on GOG.com. If fact, if you're a fan of GOG, you should check out our documentary on the company and their game preservation efforts over on our YouTube channel: YouTube.com/Noclipvideo. I'd also like to recommend a patch for that game: Corsix TH. It's a tremendous community-created wrapper that updates the GOG version of Theme Hospital to work with modern resolutions with sharper graphics and updated menus. A wonderful testament to the fan passion that has surrounded this game for 19 years. As ever thanks to our Patrons for supporting our work. You can support our documentaries, this podcast, and more by joining up at Patreon.com/Noclip. You'll also get access to this podcast early via a special RSS feed. Thanks so much to Gary and Mark for their time, Lauran Carter over at SEGA for setting the whole thing up, and my wonderful wife for chatting to me about one of our favorite games. Sorry for the delay in getting this episode number two out. It was supposed to be up about six weeks ago, But then my baby girl decided to come a couple of weeks early. So we've been rather busy here in the O'Dwyer household. We have a bunch of fun podcasts planned for between now and the end of the year, so of course, keep this feed running. Until then, play some games. We'll talk again soon.