Podcast: What NOT To Do (In Your Dental Practice)

You’re listening to Ascent Radio and my name is Dr. Kevin Coughlin. Today’s podcast is titled What Not to Do. You’re listening to Ascent-Dental-Solutions. My name is Dr. Kevin Coughlin and the focus of Ascent Dental Solutions is on development, training, knowledge, and a combination of teaching episodes to try to improve the health care along with the business of health care.

What Not to Do is something that I thought would be interesting to our listeners. I am a practicing dentist full time. I have 14 locations located in Massachusetts and I provide all levels of general dentistry, including IV sedation, hospital dentistry, laser care, iCat scanning, you name it and I would say we do it in our dental offices.

At this point in time, I have been providing expert help in the process and procedures of helping dentists in all phases of their career from the very beginning to the growth stage to the exit strategy. And it struck me interesting over the last couple of months, a couple of particular instances that happened that I thought I would share and open up. Although I consider myself an expert, I’m also human and the mistakes here will show an excellent example, in my opinion, of what not to do.

The first example is an individual who is periodically late for their appointments. When I say periodically late, I would say between 50 and 75 percent of the time, they are between 15 and 20 minutes late for an appointment. This is not a rare situation. I think most health care professionals deal with this.

What struck me interesting was how our company handled this particular episode. The first thing that happened is when the individual arrived at the office, they said they were sorry that they were late, they knew that they were late, but they were struck in traffic. A common excuse that we hear quite often, but it was an excuse and the individual owned up to it.

The receptionist or front desk coordinator or team member, however you’d like to refer to your employees, said to the individual, “You’re almost 20 minutes late and something like this cannot continue to happen.” And the individual turned around and walked out. I can assure you that within less than 45 minutes, I received an email saying how dissatisfied this patient was with our organization. How unhappy he was about the way he was treated. He heartfeltly tried his best to be on time for his appointment.

The results of that particular process and procedure, that in my opinion was a failure, means that we lost that individual as a patient who’s been a patient in our practice for over ten years. We also lost their wife and we lost their three children. The result of inappropriate process and procedures has a dramatic effect on your day-to-day bottom line and your reputation. At this point, I haven’t seen a social media post of this dissatisfaction, but I can assure you that will occur shortly.

The correct way that this should have been handle — and keep in mind I’m coming across as an expert in process and procedures, this is my own office and I’m someone who prides themselves on training and education. The correct way would be to first have the patient seated. Explain to the patient that their appointment was at such and such a time and that because they were running late, we would do our very best to coordinate and complete their care. In this particular case, it was a hygiene appointment. I think most up-to-date offices will have dental assistants, dental hygienists, front desk personal, doctors and associates that I think could handle a hygiene appointment, regardless of how late that patient is.

The point I would try to make in this example is the negativity should have occurred after the appointment was completed, not before or during. My personal opinion is if this was handled correctly, I think the average individual would accept the fact that they were late and they would understand that perhaps we may not be able to do as excellent a job as we would like. But in most cases, I think offices can handle this particular crisis. The result of not handling it properly was a financial hit to our company and to our reputation. And I’m sure if it’s happening to me, it’s happening to others.

So the take home point in this example is keep the negativity until after the appointment is completed and then have your treatment plan coordinator simply say to Mr. or Mrs. Smith, is there a time that is better for you so that you won’t be late? Is there a way that we can coordinate the appointment so it is easier for you and there’s less stress on you? That proper communication and relaying of that information could have created a much better outcome. In my opinion, we had the worst outcome that could possibly occur.

The second example is an individual who has 12 broken appointments over the course of two years. The patient has not been in the office for a period of two years. Out of a total of 28 teeth, 26 teeth have dental carries. Although it’s not critical, this particular patient was a Medicaid patient or MassHealth patient. And for those listeners outside the state of Massachusetts, it’s basically a government-assisted program for those individuals who are of the lower income bracket and need financial assistance.

This individual, in my opinion, was rude, they were abrupt. Their treatment plan, their radiographs, their diagnostic photos, their diagnostic impressions, everything was done. All I’s were dotted, all T’s were crossed. Her last appointment, two years ago, were to surgically remove tooth number 21 because of gross carries and inappropriate approach to endodontic or periodontal treatment, in my opinion, was valid. The tooth was deemed topless and needed to be removed.

For a variety of reasons that are not necessary to go into at this point, the patient scheduled appointments but never showed up for those appointments and on a recent visit, she arrived at the appointment on time demanding that the treatment be done. A complete and comprehensive exam had to be redone to bring her records up to date and an evaluation concurred that 21 needed to be removed.

In my opinion, this patient was a pain in the ass. This patient was miserable, rude and just someone you’d rather not treat. As a courtesy and in my opinion, I felt that because of the clinical situation, she was definitely uncomfortable, antibiotics, in my opinion, would be a short term approach and the tooth needed to be removed. I removed the tooth surgically by laying a flap vertical releasing incision, I packed the extraction site with a Collaplug and shuttered it, homecare instructions were given. A treatment plan letter was written up and signed.

What the patient really wanted was pain medication. So after I went to the entire length to do everything possible to get her comfortable, really what she wanted was narcotics. She wanted more pain medication and I refused. She then insisted and actually threatened if I did not give her a narcotic, she would go on social media and register a formal complaint and how bad a health care provider I was and how horrible our organization was.

I share this with you because how not to handle this problem, I handled it poorly. I simply said, “I’m not interested in your comments. Please remove yourself from my office and I would like to discontinue your care. Please find another health care provider. I have no interest in providing you care or service any longer.” This, of course, did nothing but infuriate the patient. And of course, she left the office demanding her records and also her final comments were, “I will put this on social media and I will make sure everyone knows how horrible you and your organization are.”

So here I am as an expert speaking to you podcast after podcast about process and procedures. The question that I pose and I assume most listeners have had this particular experience, is what do you do? Do you cave in and give the patient the narcotic just to get rid of them, do you toe the line and simply say the answer is no, accept two Tylenol and two Motrin over the counter every four to six hours for the next couple of days and if your signs and symptoms haven’t been relieved, we’ll see you again for a follow-up emergency? The way I handled it, in my opinion, was inappropriate. I took it personal. I was irritated and aggravated at the schedule, at her and a combination of other events. And in my opinion, the worst possible outcome occurred. She then went on social media and did exactly what she said.

I guess the proper process and procedure would be to be firm, be direct, don’t cave and give the narcotics because that, in the long term, is unhealthy for your patient, but to be professional, be above the fray and continue to maintain your cool no matter how difficult it is, and simply say, “I’m sorry, I can’t give you this particular medication. I believe that it will be detrimental to your health and wellbeing.” It hurts me to share these very personal stories because it’s a reflection in how, after 35 years in this profession, I still make mistakes day-to-day. But I thought, perhaps, our listeners could learn from these mistakes and try to do better than I did.

I hope you enjoyed this particular podcast titled What Not to Do. If it’s well received, which I expect it will be, you’ll hear others. Because unfortunately, these mistakes that I’m talking about occur more frequently than I’d like to admit and perhaps sometimes we learn more from the mistakes than what we do correct.

You’ve been listening to dental health matters and this podcast is Ascent-Dental-Solutions. My special thanks to Mr. Doug Foresta and his company Stand Out and Be Heard, who’s responsible for this professional podcast. I also would like to give special thanks to Mr. Aidan Crawford and his company Short Circuit Media for helping marketing this podcast and putting together these programs.

I hope you enjoyed this evening’s podcast and I look forward to speaking to you in the near future.

Podcast: Daniel Beers tells us how to target patients to maximize success

Dr. Kevin Coughlin: Good afternoon. This is Dr. Kevin Coughlin. You’re listening to Ascent Dental Solutions. This is Ascent Radio, where the focus is on knowledge, consultation, training and developing.

At this particular time, we are flattered to have a company on today’s podcast called eRelevance. One of the field and sales directors of North America is a Mr. Daniel Beers. Mr. Beers has reached out to me to try to help my organization and make suggestions in how he could improve, not just the sales, but also the service with a sort of, in my opinion, a very unique approach to target marketing, and I think it will be very valuable for our listeners to tune in.

Mr. Beers, thank you so much for taking time from your busy schedule to speak to me today. Why don’t you give me a little background about yourself and the company?

Daniel Beers:  Sure thing. My pleasure and I’m happy to be here. eRelevance was a company founded in 2013 in Austin, Texas. A seasoned team that has traded over 1.5 billion of shareholder value. Very well-funded company. We’ve seen triple digit growth three years in a row. Innovative pricing service levels and results. We serve the aesthetic industry, the dental industry with a high retention rate of over 1,000 customers delivering near-immediate ROI. We are a hi-tech-powered patient marketing service to generate more repeat business from existing customers.

Kevin:  Dan, if you don’t mind, I’m going to continue to refer to you as Daniel or Dan. But Mr. Beers, when you are talking about this targeting marketing, I’ve been marketing since 1983 and my personal opinion is many times that money has not been spent well because of my inability to really understand the marketing to really make sure that I am tracking properly. When you took time out of your busy schedule to sit down with me to see how you could help my company, basically, I know there is some proprietary information here. But in sub and substance, how do you direct and steer the appropriate clients that health care industry such as dentistry, whether it would be cosmetics, whether it would be lasers, implants, oral surgery, any of the nine specialty disciplines, how do you target that? How does it actually work?

Daniel: What we do is we are going after your existing customer database. Statistics say that 60 to 80 percent of your business comes from your existing customers. A lot of the times the doctors are going out there and they’re putting billboards and they are ramping up their website and doctors say to me, “This is how I’m marketing to my patients.”And I say, “You are not marketing directly to your patients.” And I say, “Doctor, can you tell me how many of your existing patients are driving by that billboard? How many of your patients are listening to your radio?” And they can’t tell me that?

So what we do is we monitor your patients’ behavior. We market directly to your existing patients. We monitor them through how they are clicking Google Ads, how they are going on Facebook, Instagram. Like I said, we are really monitoring what they are doing. There is two primary ways to doing patient marketing and one is to go out there and find new patients. It’s traditional and digital advertising. The problem is, what I just said is it’s hit or miss and it’s expensive and it’s hard to measure the results, and a very low conversion rate. What we do is we go after the existing patient. It is more repeat business through your existing patients.

A lot of people are saying maybe my billboards aren’t catching my patients, but my internal marketing is. And I say, “What are you doing?” Sometimes they refer to a company called Constant Contact. What they are doing with that is, technically, you’re spamming your patients. And doctors don’t like hearing that, but you are not targeting these patients. If you are going after a group of patients that would be suited for a certain laser or a certain treatment, not everybody is suited for that.

That is why we’re monitoring their behavior and we’re putting those emails directly towards those patients. We can tell you exactly what patient opened up what email, when they opened it, and what they googled and what they searched after they did that. So that allows us to be able to direct these e-blasts to those current patients. We are touching 95.7 percent of your patients through seven different marketing channels.

Kevin: Mr. Beers, when your company gathers this information, this profile on a particular group of patients that we as dentists want to attract, does that patient have the ability to, let’s just say, unsubscribe to it if they do not want to hear? How does that actually work if a Mr. or Mrs. Smith receives — I know several times a month I get a report and that report says to me so and so has unsubscribed. Which is telling me either they are getting too much information from me or the information they are getting they don’t find value in or they are just not interested anymore. Is this a similar program where someone can opt out when they choose to?

Daniel: They can opt out. We are doing three campaigns a month through seven different channels. For example, one of those channels will be text. They are going to receive that text and they can opt out of that text. If they do opt out, you do not lose that patient forever, you lose them on that one campaign. Keep in mind we are targeting these patients so we know what their interests are, we know what they’ve been researching. So we have a very low rate of people opting out or unsubscribing because we are emailing them stuff they’re already interested in, already stuff they’re looking for more information in, if that makes sense.

Kevin: Why don’t you take the listeners through the protocol that you’ve been working with me and my company on what the exact process and procedures are? Let’s say Dr. Jones or Dr. Smith is interested in contacting eRelevance, going through you or one of the other excellent sales representatives, how do they actually make the system work? Can you explain that to us?

Daniel: I would have a conversation with the doctor and what I would like to do is because I am covering all of northern America so for you I was lucky I got to drive down there, which I would rather do. But if I’m talking to a doctor somewhere in California or Ohio, we set up a demonstration over the computer. It’s a Join.me meeting and I walk them through about 22 PowerPoint slides and they’re able to ask questions and interact and I kind of go exactly what they’ll be receiving as being a customer of eRelevance.

What a practice would get is that, you get a tech-enabled service delivered by our experts. So you’ll have a client success manager that works directly for your practice. You get three targeted patient campaigns monthly. Those ten campaigns are engaged across seven different digital channels. It’s data driven and we are holding ourselves accountable because all the data is right in front of us, it’s also right in front of you.

The practice will be able to see who is clicking what, when they’re clicking it and when they’re booking the appointments. Also you’ll be able to see how they’re booking their appointments. Are they booking their appointments through text? Are they booking them through email? Are they booking them through a web landing page? So everything that we do is clearly right in front of the practice so they’re able to witness and they’ll be able to see exactly where everything is coming from.

Kevin: Is it correct to assume after a contract is signed between the organization and your company, you then provide them with your email list of patients, or does your company actually go into our computer and software systems and gather that information on their own?

Daniel: Once you go through the demonstration and you believe this is a solid fit for your practice, we’ll set you up with an on-boarding call. So you sign the contract, the contract is a year-long and then you’ll have your on-boarding call about a week later or whatever is suitable for you, and what we do is we pick your brain inside and out. It’s about a 45-minute call with your client success manager and you just tell them what your goals are, where you want to be. If you’re having an open house, we can do a campaign for that. If you’re having new doctors coming into the practice, we can send that to that.

Keep in mind that we are sending this to all of your patients, something like a Constant Contact, they’re only touching 16 to 20 percent of your current patient database. Like I said before, we’re touching 95.7. So if you’re having an open house and you have 5,000 in the database, wouldn’t you want to send it to those 5,000 instead of just having to touch 16 percent of them? That’s why these campaigns can be customized to you. Everything, like I said, is customized. We can use our before and after pictures, we can use your before and after pictures.

The way we get to your current patients is you provide us with your database. We are 100 percent HIPAA compliant so we take that database and we scrub it down. We scrub it down from people that have passed away, people that have moved, old numbers, nicknames, house numbers. We get all that out of there. So if you are telling me that you have 5,000 in the database, I can almost promise you that after we scrub that you’re probably going to have 4,500 to 4,000 in there because we’re removing all that bad data, so now we’re not wasting these emails sending them out to those people that it’s not active. So we’re getting no kickbacks because all the emails — after we scrub — are all clean so everybody will be receiving this.

Kevin: For somebody who is not as technologically savvy as yourself, how do you actually get into our database? Do we take a thumb drive and download the information or does your system actually go in there and retrieve it?

Daniel:You would send us your database. You could do it through a thumb drive, you could do it through however you thought was the safest way. The way they operate is obviously HIPAA compliant as well so there’s 100 percent safety behind all this where nobody’s information will be leaked out or anything like that.

Kevin: Okay.

Daniel:  You’re requesting the work, we’re providing the results. I want you to keep in mind that this is a service. We’re not just giving you the software and saying good luck, we’re doing all this work for you. We’re customizing everything, we’re scrubbing your database, and we’re doing every single campaign. The work on your end is we just need to get the thumbs-up on the campaign. So for a month you say, “Hey Danny, I want to do a campaign on Botox.” So we’re going to customize the campaign for your practice on Botox. We’re going to customize it, get it ready, we’ll send it to you, say it looks good, send it out.

Kevin: For real life examples, whether it’d be fillers, Dysport, Botox, laser for tattoo removals, hair reduction, the list can go on and on — facial rejuvenation, wrinkle removal or reduction. These targeted campaigns, your company has certain databases, certain criteria that knows that a Mr. or Mrs. Smith would be right for this particular brand of marketing for this particular service and that’s how you do the link. And then it’s up to them to follow up with their dentist to schedule the appointment. Is that a fair assessment?

Daniel: For the most part. Basically, as our first campaign we would probably do a general campaign where we would offer every single one of your treatments. And then from there, now we can monitor the patient’s behavior through their cell phone or through their email. So 90 percent of patients their email is tied to their Facebook or their Instagram or their cell phone number is tied to their Google so that’s how we’re able to monitor. It’s very similar to an Amazon approach. Because for such a long time, this software has been available but only for larger businesses like Amazon, like Google. We’re the first company to be able to provide this for small businesses.

Kevin: I don’t want to put you on the spot, Daniel, but I understand your company also has some very unique almost tier marketing opportunities for those individuals willing to try your company and see the success that they can get through this targeted marketing. Do you want to explain a little bit of that?

Daniel: Yeah. Just kind of break that down a little better for me here. The question you are asking is how we are able to provide this marketing service?

Kevin: My understanding is periodically, your company offers promotions. For example, I sign up today and then I refer Mr. Smith there is some benefit for us referring clients to your company. Am I correct in that?

Daniel: Correct. We have to do a whole vetting process on the practice to make sure they have a proper database. We can work with people under 1,000 in a database but we can’t guarantee our results as far as seeing five times ROI your first month, up to 14 times ROI after month three. So you have to be vetted and if you’re properly vetted through my CEO and Vice President of Sales, then we’re able to offer you a KOL program and that’s a Key Opinion Leader.

What we do then is anybody that you’re able to put in contact with myself or anybody at the company, if we can sign them up, the KOL will receive five percent annuity over a three year span monthly. For example, if you send me somebody right now that has 5,000 in their database, they pay their monthly fee, they pay their database fee, you’ll collect five percent of that annuity every month they make that payment for up to three years that they have our service. We’re seeing a 99.1 retention rate as far as people renewing our service after year one. We also would ask per testimonials. That kind of is up a handshake, we’re not holding your feet to the fire to do anything like that, but once the service speaks for itself, if you go on our website www.eRelevance.com you can see that we have several testimonies from several big doctors around the country.

Kevin: Without putting you on the spot, are you comfortable telling the listeners what the approximate investment would be for groups of let’s say between 1,000 and 5,000, between 5,000 and 10,000 and 10,000 and up? Is there a way that you can give a ballpark figure so that they know what their investment would be?

Daniel: Of course. We do have specials. There are certain times of the month they offer specials. The company is trying to hit a number as a whole. It is a startup company in year four so they try to generate MRR, Monthly Recurring Revenue, so if they’re behind in a month or ahead, they can sometimes tailor certain specials. But for the most part, our service ranges between $2,000 to $2,500 per month. That’s a monthly fee.

Typically, you have a onetime startup fee of $1,999. That’s the fee you pay if you sign up right now, $1,999. What that does is it allows us to get your database and scrub it down. It’s basically a database scrubbing fee. If you hired a third party company to go do some like that, these numbers would be tripled. So you have your one time startup fee of $1,999 then your monthly fee is somewhere between $1,999 and $2,499.

Then you pay $100 for every 1,000 patients in your database. So if you do have 5,000 patients in your database, that will be $500 added to your monthly. So if you’re paying $2,000 a month for the service, plus your $500 for your database fee, now you’re paying $2500 a month for that fee. Somebody that referred that business, they would collect five percent of that monthly. Granted we’ve worked with doctors like Dr. Grant Stevens who has almost a million patients in his database through 60 different practices. So if somebody could refer somebody like that they’d be sitting pretty for quite some time.

Kevin: I can tell you this, Mr. Beers, I’ve had personal contact with you and your company now several times, everyone has been a straight shooter, they’ve been professional and they’ve been upright. And I can tell the enthusiasm in your voice and in your actions that you want to continue to see this company prosper and provide the services that are so greatly needed and that is, in my opinion, targeted marketing.

Basically speaking, whatever our listeners are into, whether it’s cosmetics, whether it’s implant surgery, implant prosthesis, whether it’s periodontal care and treatment, you name it. It makes the most sense to target the customer or patient base that are best suited for our personalities and needs to see our practice grow. And at this point in time, eRelevance has really seen, I think, the future and has jumped on it and that’s why your revenues are high, your business is growing. Kudos to you and your company and I thank you so much.

As far as providing contact information, Dan, is there a way our listeners can reach out and get information? Could you just review the website, perhaps a telephone number or email so our listeners could follow up with your company?

Daniel: I would be happy to do that. The website is www.eRelevancecorp.com. My name is Daniel Beers. Call me Danny. But if you’re looking me up on LinkedIn or social media, it will be under Daniel. My cell phone number is 508-439-3614. I’m on the road a lot so I’m happy to text, I’m happy to call, whatever the best way to reach out to me. My email is dbeers@erelevancecorp.com.

Kevin: I can’t thank you enough for taking time and I thank your company for offering a service that is so greatly needed in health care but in dentistry in particular.

My name is Dr. Kevin Coughlin. You’ve been listening to Ascent Radio with a focus on knowledge, development, communication and training. I also want to give special thanks to Mr. Doug Foresta and his company, Stand Out and Be Heard. Without his expertise and his time and effort, this podcast could not be brought to you.

Thank you all very much for listening and I look forward to speaking to you in the near future. Enjoy the afternoon.

Podcast: Scott Dupont from Cynosure, discusses why dentists should consider laser tech

Dr. Kevin Coughlin:  Welcome! My name is Dr. Kevin Coughlin. You’re listening to Ascent Radio. This is Ascent-Dental-Solutions, with a focus on knowledge, consultation, development and training. As always, I’d like to give special recognition to Mr. Doug Foresta. Without his expertise and his company, Stand Out and Be Heard, this podcast could not be put on on a regular basis. His editing and professionalism have made it a huge success.

Today, our topic is Lasers. I want to emphasize to our listeners. This is lasers outside of the box. Or what I mean, outside of the mouth. We, as health care professionals, many times look right through the mouth and many times we miss some of the most subtle things that are most important to our patients and that’s the areas outside of the mouth.

In this particular case, I’m proud to represent and introduce Mr. Scott Dupont. Scott Dupont is a Sales Representative for Cynosure. Cynosure has been around for the last 25 years. They are located in Westford, Massachusetts and they have over 20 different platforms for lasers.

Scott, can you tell us a little bit about your company and how you see the market and the marketplace moving and the advances in lasers as you see it and your company sees it?

Scott Dupont: Thanks Kevin for the introduction. I appreciate it. We’re a locally company to western Massachusetts, world headquarters. We’ve been around for about 25 years, just celebrated our 25th anniversary. We have, as Kevin mentioned, over 20 different platforms, anything from tattoo removal, skin revitalization, wrinkle reduction, laser lipolysis, CO2 laser systems for external skin revitalization and much more.

The world that we’re in now, a lot of people are seeking aesthetic treatments, facial treatments but with zero downtime. Years passed, when the CO2 lasers came out for resurfacing, that was really the only device on the market that could produce real results. But along with real results came about seven to ten days of downtime.

Kevin, the way the market is shifting, people want treatments, they want wrinkle reduction, they want skin revitalization, they want to get rid of vascular lesions, pigmented lesions on their face, but they want zero downtime. That’s the way the market place is going. They want to look beautiful, feel great with absolutely zero downtime. So that’s the direction of the market currently.

Kevin: Let me tell the listeners an interesting story. I’m a general dentist that has been practicing cosmetics since 1983. I’ve been doing Botox and dermal fill, tooth whitening, implant surgery, temporomandibular joint treatment, almost all aspects of dentistry. Since I started implementing dermal fill and Botox over the last three years, it became enormously obvious to me that I was missing the boat.

As a clinician, I looked immediately inside the mouth, and I was amazed. I believe you can talk on the statistics that it’s estimated that about 30 million people just in the United States have tattoos on their body. And almost 85 percent of those individuals over the age of 40 are trying to remove the tattoos. We as wet finger dentists, clinicians, see tattoos around the head, the neck, the face, but actually throughout the whole body and individuals are trying to remove these tattoos.

Can you talk for a little bit about what your company has and the different wavelength s that are necessary to remove the black, the blues, the greens, and the purples, and the reds from these tattoos and the uniqueness of your company and their systems?

Scott: Yeah, that’s a great topic. Even furthermore, when you go see a tattoo artist, a lot of tattoo artists won’t tattoo over somebody else’s work. So what you are seeing now are tattoo parlors partnering up with an establishment like yourself, Kevin, where they are referring patients to you to receive tattoos removal. That way they have a blank canvas to do their work over. So it’s a pretty unique time.

We were the first company to come out with a picosecond laser technology, 755 nanometer wavelength that would effectively get rid of all colors: reds, greens, blacks. One wavelength, 755 nanometers, and that was FDA cleared to get through all colors. What is really cool about the picosecond technology versus the Q-switch technology, which has been around for 20 to 30 years, is picosecond technology will allow you to get rid of the tattoo in almost half the treatments. Before, where a person was going to get rid of the tattoo and it may take 20 treatments, PicoSure technology can pretty much cut that tattoo removal process in half.

The box has a 755 nanometer wavelength to treat all colors, particularly blacks. It also has a 532 nanometer wavelength in the box as well to help with the more aggressive reds, greens, yellows and oranges. That’s a little bit about the picosecond technology.

Kevin: Scott, not to just beat a dead horse here, but when we’re talking about Pico, for some of our listeners, can you explain the technology? What actually is a Pico? Am I correct that it’s one trillionth of a second or is it one billionth of a second, one millionth of a second? Just explain a little bit about the technology because most of us, dentists, are really in to the technology aspect of providing care and treatment?

Scott: Yeah, Kevin, it’s one trillionth of a second. It’s firing almost ten times on average faster than a standard typical Q-switch laser.

Kevin: I think for consumers, which we as dentists are looking for the best and the brightest, I do believe that your company is offering something that’s quite unique to the market. And as you alluded to without tooting your own horn, if you can take a Mr. or Mrs. Smith and remove or eliminate the colors of that tattoo in four to eight visits rather than 16 to 20 visits, you’re doing a great service, you’re saving a lot of time and a lot of potentially post-operative discomfort. Although it’s not enormously painful, it’s still something that does provide a little bit of a jerk. It’s almost like a little electric shock, am I correct? How would you describe it to the dentist thinking to get involved with tattoo removal?

Scott: I would probably describe it more like a rubber band snapping. If you were to take a rubber band and snap it against your skin, your forearm but really, really fast, that’s the kind of sensation of what a tattoo removal laser would feel like.

Kevin: Can you talk, again, a little bit again about the technology here? How do you and your company control the heat or the temperature? I believe some of your systems have a cooling system involved. Is that correct?

Scott: Yeah. Some of our systems have a cooler system built into the systems; PicoSure. What we would sell separately is a Zimmer system, it’s a Zimmer Chiller. Basically it’s a — I like to call it a mobile air conditioning system. So when you’re doing something like tattoo removal, you have a separate cooling system that sits beside the device. You turn it on and all it does is blow cool air. So as you’re doing the treatment, technically, there is a couple of different ways they do it. They’ll use the chiller to maybe flash in their face just to cool their overall body down and then after the treatment, they’ll take the chiller just to hit the spots that were treated, just to cool it down faster. So it is a separate chilling system, separate from the PicoSure technology.

Kevin: Scott, I’d like to move the topic to probably the biggest marketplace. Being a male, perhaps I’m just isolated, but with two daughters, and getting into the Botox and dermal fill, I was amazed at the number of females and also males that were interested in hair reduction to hair removal and the unwanted hair underneath the nose, around the lips, by the ears, underneath the chin area. Your systems have quite a unique, again, technology behind it. Can you talk a little bit about hair reduction and hair removal with the current systems that Cynosure offers?

Scott: Obviously, hair removal remains to be one of the top procedures requested by individuals in this marketplace. There’s two types of ways of getting hair removal. We have a couple of systems; one is called an Elite+. It has a 755 wavelength in it for skin types I, II and III. I also has a 1064 wavelength in it to treat skin types IV or V and VI. Basically, what the Elite is doing, is super fast hair removal, strictly doing hair removal, bigger spot sizes to do, bigger areas on the body. We’re talking chest, arms, legs, back and things like that.

On the face, a lot of people are tending to switch gears and using a Redscan piece on an Icon system that we have, which is an IPL system, an Intense Pulsed Light system. Smaller areas: upper lips, facial hair, ears, nose, forehead, areas that are really tiny to get a laser into, a lot of people are using the IPL system.

Then we have a Diode Laser system called the Vectus, another very high-speed hair removal system where you can do a man’s back in about ten minutes. The cool thing about the Vectus is it has proprietary technology in it called the Skintel. Skintel is a live melanin reader that will give you a live melanin index of the areas that you are treating on a body.

Say for summer months, you notice the patient you’re treating is skin type III but they’re tanned so you’re really not sure what kind of settings to use on the Vectus. You take three scans with our Skintel reader that scans the area that you’re treating and Bluetooth wirelessly sends those settings to the device based on the melanin index of that patient. Basically Skintel is an insurance policy. You think you know the skin type, you take a scan with Skintel, it will send the settings to the device based on the readings from that Skintel system, which is really cool.

Kevin: I think some of our listeners will have a different level of understanding, but basically with most lasers, you’re using the Fitzpatrick levels I, II, III, IV, V and VI, with IV, Vs and VI being mostly, let’s just say, your southern Europeans, your Hispanics, your African American’s darker pigment. The concept basically is the darker your skin is, the more the laser would get absorbed. So you’re classifying your client or patient as a I, II, III, IV, V or VI and the ability to improve and standardize those classifications will give you a better outcome. Am I correct on that?

Scott: That’s correct, yes.

Kevin: I think it’s critical again to discuss another area that I think we, as dentists, are uniquely qualified to treat, examine and discuss and that’s skin revitalization. We spend so much time trying to get the perfect shade of teeth, the perfect line for a smile, to broaden the smile, whiten the smile, close spaces, do cosmetic or orthodontic dental care. But in the end, the ability to see a better tightness, texture, and overall health of the skin is critical. And the younger that the patients start undergoing treatment, the better.

You touched a little bit about the Intense Pulsed Light or IPL. Perhaps you can discuss a little bit about skin rejuvenation and the improvements that are available, and how it certainly is a significant improvement over your conventional facials that you might get at some day spa that does not have a laser. Can you comment on that, Scott, a little bit?

Scott: I think the Icon system, the Icon which we have is the IPL system. If you’re looking for something to really address your patients’ needs and concerns — the truth be told, people have vessels on their face, they have them on their neck, on their chest, they have pigment on their upper chest area. Women, for example, have décolleté. On your nose you could have little telangiectasias, you could have sun damage. All these different types of things that really concern patients, you can control and handle with the one platform that we have, the IPL systems which is called the Icon.

Once you clear the vessels, clear the pigment, people also are going to discover we have wrinkles maybe around their eyes, or some laxity on their jaw area or chin. The fractionated laser technology which we have on the Icon, the 1540, will allow you to non-invasively stimulate collagen and create more uniform elastin. It also treats moderate wrinkles, acne scars it treats stretch marks if you wanted to do body procedures, it treats surgical scars, trauma scars, melasma, and it does skin resurfacing.

So it’s one system that you can start with the IPL, clear the vessels, close them out, take care of the sun damage, reds, browns, melasma, anything like that with the IPL, and then go over it right away with the 1540 fractionated laser resurfacing. So it’s a nice system where you can address all of your patient’s concerns.

Kevin: Scott, you touched on another point that I think we as dentists sometimes overlook. For someone like myself, I’m doing orthodontic care, bands, brackets removable, fixed and functional appliances. And in many cases, this orthodontic care is done on adolescence, somewhere between the ages of 13 and 15. And we’re focused on improving their teeth to improve their self esteem, but so many times these young men and women are suffering from facial acne. And rather than dope these young men and women up with drugs like Accutane, which have some significant effects long-term medically, the laser, quite honestly, can do a wonderful job, not just eliminating and reducing the scars from acne, but improving the overall skin condition and reducing the outbreaks of acne. Is that correct?

Scott: Yeah, that’s a 100 percent correct. When you have patients that have had severe acne issues and problems and you can treat it — after acne has been healed and diagnosed and you have scarring and irregularities over the tissue, you’d be surprised and amazed how powerful this 1540 is. It really changes those patients’ lives. A 13 , 14 year old, saying you can go several treatments with the 1540, it will completely restore their confidence back in that patient. So acne scarring, surgical scars with the 1540 will do an amazing job.

Kevin: The last topic I just like you to touch on is we hear so much about different competitors and different systems out there, but your company has also addressed the remodeling of adipose, the reduction and eliminating of adipose tissue or fatty tissues, on not only around the neck region, but throughout the body. Can you comment on what Cynosure is doing and how their system stacks up against some of the other systems on the market?

Scott: We really put one of our body contouring systems on the map in 2006 with our introduction to Smart Lipo. If anybody on the call knows Smart Lipo, it is a gold standard in laser lipolysis. The focus big areas of any patient, male or female, are abdomen and flanks. The system came out in 2006. We did a big direct consumer marketing campaign. And now when people search for Laser lipolysis, Smart Lipo comes up. It’s been branded and it’s very well-known in the industry.

What’s really cool about that, about two years ago, we launched a product called Sculp Sure. It’s our non-invasive body contouring system. It’s FDA approved for lipolysis, permanent fat destruction over the skin. So no topical, no anesthesia, no surgery. There are flat applicators that go over the skin and it’s using a 1060 Diode laser to go through the skin — any skin types I, II, III, IV, V and VI — and destroying the fat cells. Being non-invasive, your lymphatic system is naturally going to get rid of the fat cells over a 6 to 12-week process.

We have launched a direct to consumer marketing campaign for Sculp Sure so the people on the call now, if you haven’t seen it, you will probably start to see Sculp Sure billboards, Sculp Sure on transit systems, Sculp Sure in publications, Women’s Health, Men’s Health, People. So we’ve launched our non-invasive version of Smart Lipo, essentially called Sculp Sure, about two years ago and it’s our hottest product that we sell here at Cynosure.

Kevin:  Scott, once again, your expertise and your company, I can’t tell you how much I appreciate you doing this podcast to educate the healthcare professionals, but in particular, dentists. In full disclosure, I am an owner of Cynosure. I went to their continuing education courses. I was a true skeptic. I felt that there was no need for me to get involved with it. But Ascent Dental Solutions is a Radio Station and a podcast and an information forum to share ideas. And I could tell you, I was so impressed, not only with what these lasers could do, but with the way the company represented themselves, the way they taught me and trained me and educated my team.

I can just tell you, what we ultimately want to do? We want to produce the highest level of care and service for our patients. And in my opinion, anything around that head and neck, should be available to the dental profession and to our patients.

I also would tell you without any disregard or nervousness at all, these procedures are quick, they’re effective, and for the first time, I’m seeing people really say, “Thank you, Dr. Coughlin. I am so glad you were able to offer this. I had no idea you as a dentist could be doing this or would be offering it”.

So to our listeners, I would strongly recommend that you educate yourself in these areas. Each State has certainly different by-laws and regulations and perhaps we could discuss that in a little greater detail in a future podcast.

But Scott, I want to tell you at this point, your company has been outstanding. Everything that you have said that you would, do you have delivered on. And I’ve been more than impressed and that’s why I wanted you on this podcast.

Before we close, Scott, could you just give the listeners an idea of the cost structure in the various ideas of the systems that you would probably recommend for the dental community? Just so they come away with a little bit of information, and also the best way for them to reach out to have questions answered by you and your company and how they could contact your company.

Scott:  As far as cost structure, it’s kind of hard to put a number on it. I can give some parameters based on the different technologies that you’re looking to add to the practice. If it’s one technology, two technologies, three technologies, I could say a safe ballpark would be anywhere from — depending on the system — 65 to 75k thousand dollars to anywhere upwards of — depending on how many systems that you’re going to purchase, you could go to 300k, 400k, 500k. But I think every single situation is different and that’s where the salesmen at Cynosure become your consultants. So depending on what you’re looking to do and what you’re looking to treat, we can come up with a package for you.

Kevin, I really appreciate you taking the time to have me on here. If anybody needs to reach me, my name is Scott Dupont and my cell phone number is 603-231-2603. If you are not located in my immediate region, then I can definitely get you in front of the right person that would definitely take care of you, in whichever state you appear to be in.

Kevin: We’ve been listening to Cynosure, located in Westford, Massachusetts. My guest today was Mr. Scott Dupont.

Before we close, I want to share this story. We as dentists, day in and day out, for the vast majority of us, deal with insurance codes. What’s insurance going to cover or not cover, what’s the limitation of this plan? As I ventured into dermal fill, Botox, and laser treatment, there were no real insurance codes. These are fee for services procedures, they are elective procedures, and I can’t tell you how enjoyable it is to offer our patients something that they want and need, and we can provide without all the BS and the paperwork that’s associated with so much of health care today.

Scott, Mr. Dupont, I should say, thank you so much for your expertise.

You’ve been listening to Ascent-Dental-Solutions. The focus is on education knowledge, development and training. You’ve been listening to Ascent Radio. My name is Dr. Kevin Coughlin. Thank you so much for listening.

In closing, I want to thank Mr. Doug Foresta and his expertise on producing this podcast, and his company, Stand Out and Be Heard.

Thank you everybody and I look forward to our next podcast very soon. And Mr. Dupont, thank you and your company for offering this information to the health care professionals and dentists in particular.

Podcast: Dr. Kevin Coughlin answers your questions


Dr. Kevin Coughlin:   Welcome. You’re listening to Ascent Dental Solutions. My name is Dr. Kevin Coughlin, owner and creator of Ascent Dental solutions. I want to give special thanks to Mr. Doug Foresta and his company, Stand Out and Be Heard . Without his expertise and guidance, this podcast would not be available.

Today, we have a little bit of self-promotion. As you know, Ascent Dental Solutions is focused on knowledge, training, development and education. But over the last year and a half, I have been inundated with phone calls, emails, requests about what exactly is Ascent Dental Solutions? Why did I started it? What its real mission statement?

I’ve had several questions. Let’s listen to some of these questions and see where these response take us to perhaps add some expertise and maybe some additional connections to make Ascent Dental Solutions more valuable to you.

Doug Foresta: Thank you so much, Dr. Coughlin. This is Doug Foresta, of course. I thought where we’d start is, one of questions they have is; Ascent Dental Solutions, is it a dental company or is it something else? Maybe you can talk about what that “something else” is.

Kevin: Sure. First, it’s a limited liability company. It is its own entity. Really, the crux of it is why do we even have it? Why did I create it? I created it because since 2006, I was asked by Tufts School of Dental Medicine if I could provide elective information in the evening to the dental students. It was really outside of Tufts School of Dental Medicine. I provided the lectures, the seminars and information generally to senior dental students and to graduate students who were preparing to get into what I’ll call “the real world”. The business of health care, and in particular, the business of dentistry.

It was clear that the dental school, like most of the 60 dental schools, did not have the time in their curriculum, or perhaps even the expertise to talk about the business of dentistry. How do you select your first job? What are the steps? How do you make sure that that first job or career is as successful as possible? What questions to ask? How to ask these questions? What information should you obtain and how do you dissect this information to make the best decisions?

Understand that many of these young men and women, or new graduates, have had zero business experience. They are still learning the craft and the profession of dentistry and in health care and in medicine, but really lacked the educational background in accounting, legal, in business, sales, marketing to make decisions that would be informed. That really was my start.

My own personal business had grown from 1983 to present from one dental office with four dental operatories to 14 distinct dental offices, all located in western Massachusetts. Each office is self-contained, but all the offices are linked through cloud. Prior to the cloud-based systems, we were using what were referred to as T1, T2, T3 lines. Today, these businesses are all linked so digital photographs, digital impressions, clinical notes, insurance data information are all linked together for evaluation and treatment planning, and to provide a continuity of care.

During these 35 years of practicing clinical dentistry, and the business of dentistry, I would say a day doesn’t go by where someone doesn’t contact me and ask very similar questions. They fall into a variety of topics, but one topic is a group of dentists that want to emulate or copy the processes and procedures to establish a bigger footprint. They have various reasons, some are purely economical. They want to build a practice so that they are more financially secure. Others want to build a larger footprint and practice to compete against MSOs and DSOs. And others just are short of bored. They are excited, they are entrepreneurs, and they want to see how far they can take their business and they want to know the steps and processes I used to accomplish that.

Other groups are not interested in growing their business at all. They are happy with the size of their practice. They just wish it ran more efficiently, more effectively. They are looking for processes and procedures that they’ve read in one of my three books that really go into the business; the nuts and bolts of running a successful dental practice. But really, the processes and procedures for a successful business practice are similar to any successful business. What are the steps? What are the processes and procedures?

As these questions continued to occur, I felt that it would be a very efficient and effective way to partner up. I partnered up with Mr. Doug Foresta who had been listening, hearing and watching my career develop. Basically, what he said is a very efficient cost-effective way to get your information and knowledge out and share it with your profession and other practitioners are through podcasting and webinar. It’s one of the best business decisions I made, and his company Stand Out and Be Heard, has been a tremendous inspiration and have allowed me to express my views and recommendations to a much larger range of individuals. Not only that, but allowed me to network with individuals that I would not have had the luxury to network. That’s really what this podcast is about.

I have another question. Doug, go right ahead.

Doug: Sure. Thank you, Kevin. One of the things that we‘ve been getting feedback from brands, businesses, dentists, saying how we can partner with you? We like what you’re doing, we know that dentistry is undergoing a change, the profession is undergoing a change. How can we partner with you? How can we be a part of Ascent Dental Solutions? Maybe we could tell listeners a little bit about some of the opportunities and ways that we’re looking to partner with brands and individuals.

Kevin: One of the things I’ve learned over the last 35 years is no one can do it by themselves. I always relate, when I am speaking to dentists, to the clinical aspect. It’s very difficult to be an implant surgeon, a prosthodontist, a periodontist, an orthodontist, a pediatric dentist. You need experts for support and you need experts to provide the highest level of care in service.

In business, the actual business of dentistry, the partnerships are incredibly important, whether it’d be for marketing, sales, hardware, software, supplies, leaderships roles, consultations. There is an entire network out there that are at our fingertips, but we don’t know how to connect. I’m hoping through Ascent Dental Solutions that these connections can be made.

For those individuals who would like to share the partners that we’ve created over the last 18 months with 50 or so podcasts, and several webinars, and different connections, I’m suggesting that you contact and reach out to www.ascent-dental-solutions.com. On that web, you will be able to connect with me personally. And if you’re interested in linking up with Ascent Dental Solutions, with an emphasis on education, training, development and knowledge, I would welcome your expertise. The more we network, the more we educate our peers, the greater our organization becomes.

There are numerous threats, opportunities available to our profession. And depending on what side of the fence you sit, what may be a threat to one group could be an opportunity to another group. As you know, competition with dental service organizations, managed service organizations, the constant marketing of large corporations sort of honing in, competing with the solo boutique practice is relatively new to the profession.

I think we all know that it’s very, very difficult for a small supermarket to compete with Costcos. It’s very, very difficult for a small hardware store to compete with Home Depots or Lowe’s. And it may become very difficult for the solo practitioner, whether they be a specialist or a generalist, to compete with these managed service organizations.

I’m not here to say one is better or worse, one is right or wrong. But I do feel that as a profession we have to understand how do we compete with these groups, how do we work with these groups, and how do we function with these groups? There are specific processes and procedures that I’ve learnt through my own clinical training, my own business training, that I think can be helpful.

I ask you to consider reaching out to www.ascent-dental-solutions.com and consider taking your ideas, your company and yourself and interacting with us so that we can provide better information, more information, to establish us as a think tank for our profession. We’re not here to give our bias, but we’re here to provide information and data so that you can make your own decisions that are best for you, your family and your company.

Doug: Let me just say a little bit about some of the ways that we’ve already been partnering, again, with individuals and brands. One thing is if you have a message that dentists need to hear, we’d love to have you as a guest on Ascent Dental Radio. We had recently topics including; you’ve heard Jerry Jones returning to the podcast and talking about patient retention. And you’ve heard about embezzlement and the problem of embezzlement in dentistry and what dentists can do. But we’ve also partnered with great brands like VOCO. They make dentist…

Kevin:       They provide some of the best dental supplies for dentists throughout the world. Patterson Dental, Henry Schein, we’ve had marketing experts, we’ve had seminar experts such as Jenny St. George. The list is really too numerous to repeat on this podcast, but what I have received is superior feedback saying that these connections are helping our listeners. It occurred to us that by just self-promoting Ascent Dental Solutions, and saying that we’re open to listening to your ideas and suggestions, and we’re open to having you join our conversations and provide knowledge, information, training to our listeners, I don’t think there could be an easier or better way.

I hope you’ve enjoyed this podcast. You’ve been listening to Dr. Kevin Coughlin and this is www.ascent-dental-solutions.com. My special thanks to Mr. Doug Foresta. Without his expertise in podcasting, in information sharing, this podcast would not be possible. Thank you again and we look forward to speaking to you in the very near future.

Podcast: Dr. David Preble on how the ADA supports dentists

Dr. Kevin Coughlin: Good afternoon. You’re listening to Ascent Radio. This is Ascent-Dental-Solutions, with a focus on knowledge, consultation, development and training. Today’s podcast is brought to you by Stand Up and Be Heard, and a special thanks to Mr. Doug Foresta and that company. Without his expertise and knowledge, this podcast could not be put on.

Today, we have a special guest. That special guest is Dr. David Preble, ADA Practice Institute partner.

Although this is close to our 60th podcast, I personally feel that dental associations, and in particular, the American Dental Association, has perhaps more value than ever right now with the changes that are going on in our profession. I’m hoping that Dr. Preble can provide insight and knowledge to our almost 7,000 listeners.

David, thank you so much for taking time from your busy schedule. I just wanted to say thanks so much for sharing your knowledge and expertise and also your help in working with the American Dental Association. One of the first things, Dave, I wanted to ask you is right now, can you give the listeners an idea of about the average percentage of dentists that are participating in the American Dental Association?

Dr. Preble: Sure, Kevin. We have about a 63 percent market share of dentists. And that’s basically representing more than a 161,000 licensed dentists from all 50 states, the District of Columbia and Puerto Rico.

Kevin: Obviously, we’d love to see 100 percent of the practicing dentists being members. Are there particular areas that you think we could improve that number from 63 percent to higher? Are there things that the American Dental Association is working on, you in particular, to perhaps expand that base that’s already present?

Dr. Preble: As you said, we certainly want to and we are trying very hard to do that. What we are doing is trying to figure out that real value proposition for dentists at all stages of their careers. So both the young dentists, the millennials that are actually becoming now 50 percent of the dentists in the country, as well as the dentists in their mid-career and later career all get something that they want from the American Dental Association. We don’t just figure it out on our own, we try to ask them what it is that you want from us, and try to deliver that.

The ADA provides a broad range of services from legislative and regulatory advocacy, practice-based advocacy with third-party payers and governmental agencies, continuing education, peer review, scientific research, the development of dentistry policies and standards, as well as, practice management tools and resources. And we feel that all of these things are part of what dentists expect from the American Dental Association, but each individual decides for themselves whether or not it’s enough for them to actually join.

Kevin: I can tell you with my experience in Ascent Dental Solutions that there is basically those three broad categories that you touched on that individual who is just starting practice, who is recently graduated, their wants and needs are in a particular direction. And the ADA, in my opinion, is a tremendous asset to provide basically free information and knowledge to guide those new graduates through some of the trials and tribulations of either starting a practice, joining a practice, and determining do they compete with managed service organizations, do they consider joining managed service organizations, do they even know the difference?

And then you have that second group which have been probably practicing for 8 to 15 to 20 years and they are dealing with the practice management issues, the regulation issues, the day-to-day issues that perhaps their practice isn’t growing and doing as well as they’d hoped for a variety of reasons. And once again, the ADA has an enormous amount of asset to help that group.

Finally, the last group are those individuals more in the twilight of their career. Are they in a position to retire financially? Is their clinical practice in a position to pass on to another individual or group? Again, the ADA is there with knowledge, information and expertise.

When we look at these different areas, I know through previous conversations with you, you mentioned that there were probably three main areas or topics or issues that you thought were important to the dental profession. Would you like to touch base on those areas?

Dr. Preble: Sure. But before I do that, I’d like to come back in on what you said, because you really put it very well, those three different kind of stages of a career. Following graduation, a new dentist can really benefit from the services like our Career Center, which we are building to be even better and better, that really helps dentists make more informed and better decisions about where they want to practice, how they want to practice. Networking opportunities offered through the local and state dental societies, which are an integral part of the ADA, and practice development resources, even licensure guidance, loan refinancing options. We have this wonderful student loan refinancing programs that’s better than anything else that’s on the market and it’s saving young dentists thousands and thousands of dollars. Plus, of course, volunteer opportunities, continuing education, etc.

Then those dentists in that mid-career part, they can have ADA tools and resources to answer these third-party payer questions, accessed online scientific resources, etc. Then as they get into the later part of their career, we have practice transition information, insurance and what’s management options, answers to financial questions and then lots of opportunities for mentoring even new dentists. So there really is something for everyone.

But back to your question about these major areas that we keep seeing dentists say, “This is what we need help with. How can you help us?” There is the third-party payer reimbursement issues, whether they be public programs or private programs. This is something that is constantly in the dentists’ mind because this is the lifeblood of how they make their living. Along with that, there are lots of increasing regulatory burdens that we are seeing happen from governmental agencies, and even in the third-party payer private world, more regulation and how easy it is to do business. Those are the two big ones.

Of course, practice management itself, the business of doing practice is a big part of what dentists look for from the ADA. Because in dental school, we learn a lot about the art and science of actually treating patients and caring for patients, we don’t learn a lot about running a business. And that’s information that they really need and look to the ADA to give them in the most cost effective way. They can get all sorts of information from high-priced consultants, but when you are an ADA member, you get all that information for free. So it really is, I think, a good benefit.

Kevin: I think it’s not only good, it’s a tremendous benefit. And for listeners out there, I’m not here just tooting an organization. I firmly believe there is no real skin in the game, per se, with the American Dental Association. If you hire a Kevin Coughlin, I may have alternative motives that are specific to your wants and needs. The ADA is representing the profession and I think the profession comes first many times over the individual and hopefully, there can be a nice marriage and both benefit from it.

We talked a little while back about managed service organizations and dental service organizations. For some of our long time listeners, I define the managed service organization as equity-backed, venture capital-backed. This doesn’t mean good or bad, it just means that there are outside parties investing large sums of money to get a return on their investment. Whereas a dental service organization is generally run and owned primarily by practicing dentists, who also have skin in the game to make a profit and a return on their investment, but ultimately, they are the clinicians providing day-to-day care, services and expertise.

Does the ADA see any particular trends? Do they see that these MSOs and DSOs, are growing? Because based on the Health Policy Institute and other research that I’ve been able to do for previous podcast, that seems to be on the rise.

Dr. Preble: It is on the rise. First and foremost, I wanted to make sure that the listeners understand that the ADA supports ADA members and dentists to have the freedom to choose whatever practice model they decide. We are not judging whether one practice model is better than the other.

But that being said, the ADA does feel very firmly both in its policy and what we tell others is we support this conviction that the health interests of patients are best protected when dental practices and the facilities for the delivery of dental care are not only owned, but controlled by a dentist. We think this is just the best interest of the public. So there aren’t those conflicts of interests between the making of money and the care and delivery of the patient.

We do understand that dentists, some choose to not want to do the management end of practice. They would prefer to just do the care part. And having DSOs or any other type of support organization that does the business part of them for that, if that is the way they choose to do that, that’s okay. But all of those dentists agree, whether they work in a DSO environment or not, that they should have control over patient care. That’s the bottom line. It’s not just ownership on paper, but its control over how patients are treated. That’s what’s important.

Kevin: And I would concur 100 percent with that, Dave. Is there programs out there that the ADA has that can educate those dentists that are interested in learning more about MSOs and DSOs? Are there programs out there that the ADA may be able to review potential contracts, working relationships to determine whether one group may be stepping out of bounds? Are there any programs like that that the ADA has to offer to its members?

Dr. Preble: I don’t think that we’re going into that specific a detail. We have resources on the Center for Professional Success that help dentists, again, whatever stage they are in their career. Although, the Health Policy Institute research has shown that the large rise in the dentists that work in DSOs is in the younger cohort. So those younger dentists, there are resources there for them to say, “These are the things that you should evaluate in your contract. Are these things that you are comfortable doing and not comfortable doing? Are these the things you are comfortable agreeing to and not agreeing to?”

We don’t get into very specifics of evaluating particular contracts for the dentists, they’d have to hire their own legal counsel to do that. We don’t have the resources to do that for every dentist here at the ADA. But we do give them the broad ideas of what you should be looking for, what you should make decisions on your own about, what you are comfortable with and what you are not comfortable with.

Kevin: David, I want to thank you so much for your time. I want to give another plug for the American Dental Association. Your representation of what the American Dental Association is, I really think that 100 percent of our members should be members. I know I personally have been a member since 1983. I’ve had my ups and downs, I’ve had some agreements and disagreements, but in the end, the mission statement to represent the dental profession and dentists, I think, goes without saying. Your expertise, your knowledge is greatly appreciated, and especially spending your valuable time on this podcast to educate our listeners I think is terrific.

For the thousands of listeners that have been paying attention to Ascent Dental Solutions, strongly think about the American Dental Association. As competition becomes greater, financial risks become greater, educational debt. The American Dental Association has programs and options all at almost no charge to its members, granted we do pay a membership fee. But I really think it’s one of the organizations that we should be promoting and can offer much needed information to us.

We’ve been listening to Dr. David Preble. David, for some of the listeners who might not be as familiar with the ADA, is there an 800 number, a website? Is there a way that questions could be answered or information could be ascertained?

Dr. Preble: Sure. The home source of cause if just www.ada.org. That’s the easiest way to get to the home base of all the information. If dentists are looking for a specifically practice management type information and information about third-party payers and things like that, we have the Center for Professional Success, which is www.success.ada.org. Those two sources should get anybody started on a host of information.

Kevin: Thank you again so much, and thank you to the listeners. You’ve been listening to Ascent-Dental-Solutions. My name is Dr. Kevin Coughlin, with a focus on development, knowledge, training and education. Our guest today was Dr. David Preble, the ADA Practice Institute Head since 2013. Thank you so much.

Dr. Preble: Thank you, Kevin.

 

Podcast: Jerry Jones talks about the strategies behind dental patient retention

Podcast: Dave Harris, founder of Prosperident, talks about embezzlement in dentistry

Podcast: Sedation and modern dentistry

Podcast: The Benefits of Dental Therapy

Hello and welcome to Ascent Dental Radio. A program dedicated to the balance between the clinical aspect of health care and the business of health care. And now here is your host, Dr. Kevin Coughlin.

Kevin: Good afternoon. This is Dr. Kevin Coughlin and you’re listening to Ascent Radio. This podcast is brought to you by Ascent-Dental-Solutions.

I’d like to start every podcast with special thanks to Mr. Doug Foresta. His company, Stand Out and Be Heard, has been participating in over 75 podcasts. And without his expertise and his business acumen, this podcast would not be possible.

I also would like to give special thanks to the VOCO Company. They have been supplying over 40 years of dental supplies and products to the dental community.

They’re a worldwide company and have headquarters in Germany and their headquarters in South Carolina, and a special thanks to VOCO for their expertise and supporting this broadcast.

This afternoon, we have three guests. The Kellogg Foundation is a foundation that is almost totally devoted to improving oral health for our most vulnerable population. And that’s the young children under the age of 18, but particularly, those most prone to dental disease under the age of ten.

This foundation has been providing services, finances and expertise and looking for solutions to improve this epidemic situation, which is dental caries and dental disease, primarily in our younger population, and primarily the population that’s underserved in need of the greatest assistance.

Today, our guests are Dr. Mary Willard, Ms. Sarah Wovcha and Dr. Terry Batliner. The three of you, thank you so much for your expertise and knowledge in the subject of improving the situation. And special thanks again to The Kellogg Foundation for their effort and expertise in this area. I’d like to start with Dr. Willard. Mary, what do you think is the most significant problem for dental education and dental care in this particular population?

Mary: The biggest issue is access to care, I believe. We have many populations living in inner cities that have trouble getting appointments with dentists. Sometimes in places like where I live in Alaska, it’s because there are very few dentists in our remote villages and communities. Sometimes in inner cities it’s because the dentists don’t accept Medicaid or uninsured patients.

Kevin: If you had the ability to snap your fingers tomorrow, with your expertise, knowledge and background, what would you say would be the single best solution, in your opinion, to improve the situation?

Mary: I don’t think there’s one single thing that we can do, but one very effective tool is to implement the use of dental therapists in our dental teams to expand access to underserved populations.

Kevin: Sarah, if I was to ask you the same question, is there anything you’d like to add or delete to those recommendations of Dr. Willard?

Sarah: No, I think Dr. Willard has hit the nail on the head. Those are precisely the issues that we face in Minnesota.

Kevin: Dr. Batliner, with your expertise and background, is there something you’d like to add or delete or do you think that’s the significant problem and that’s perhaps one of the strongest options or solutions?

Terry: Sure, let me just define the problem a little bit more. I live in two worlds. I have three dental practices in Boulder, Colorado and around Boulder and I also am the associate director for The Centre for Native Oral Health Research at The University of Colorado where we conducted research on Indian reservations.

There really are two types of problems and Mary touched on them quickly. One is that there’s not enough providers who take Medicaid. In my role in Boulder, I’m a Medicaid provider and there aren’t very many Medicaid providers, even though the compensation is pretty good in Colorado.

And then in my role as a researcher with native communities, we see that the dentist to population ratio, which averages 1:1600 in the United States, on reservations such as Pine Ridge in South Dakota and the Navajo Nation in Arizona and New Mexico has a dentist to population ratio of 1:4000 or worse than that. So it’s very difficult for people to access care.

In combination with that, in places such as native communities or in the Medicaid population, the amount of disease is much higher. And so we find that kids three years old, perhaps in Navajo at age three, 70 percent of those kids have untreated decay. On the Pine Ridge Reservation, about 55 percent of those kids have untreated decay in our latest data. So there’s a lot of issues.

We also found that the Hispanic Medicaid population in the Metro Denver area is comparable with their degree of disease to the kids on Pine Ridge. About 55 percent of kids have untreated decay.

Kevin: I thank the three of you for that feedback. I am a practicing dentist. I still practice. I was actually in my office practicing since 7:00 this morning and I deal with all different populations. My practice is fairly large. We see on an average of about 116, 000 patient visits a year and I am quite familiar with the problem.

Since we have a variety of listeners, in your opinion Dr. Willard, what would you say the dental therapist for those who may not be up on the topic, they may not be as informed or educated, and sometimes there’s misinformation.

My personal opinion here on the East Coast, but particularly in New England, you have two schools of thought. One school of thought is they’re very much against these mid-level practitioners, these dental therapists, these expanded duties. And my personal opinion, it may not be accurate, but my personal opinion is many in the dental community find this as a threat.

If we do the SWOT analysis — Strength, Weaknesses, Opportunities and Threats — they perhaps are concerned that there’s a threat to their business and to their income. Other individuals may be concerned with quality of care, the ability to monitor the quality of care. Could you address those issues and perhaps sway the listeners how those potential issues could be misguided?

Mary: Basically, the dental therapist is a primary care provider, new team member who brings additional services and brings a different team player to the dental office. What we have is a provider who is able to provide basic restorative, preventive services and is typically from the community.

For me, that’s the big aspect of what this dental provider brings, is a familiarity with the customs and needs of the community they’re serving, especially when they come from that same community. It’s a way to provide care closer to home and also having a therapist on board is a way to provide patient navigation services as well, so services that are out of the scope of a dentist.

What we see in Alaska right now is that the dental therapists are able to provide the basic restorative and preventive services that are needed and then they can provide referrals to the dentist for the higher level care. As a result, we’re seeing that the dentists are able to perform more of the higher level services and are not spending as much time on the basic restorative.

So what you’re going to have as a dentist working with a therapist is an increase in your production, especially in those higher levels like partials, dentures, implants, crowns and visits because you got that fixed during the restoration. We’re finding that it’s increasing the bottom line for the dental practices as a whole.

Kevin: And that’s possibly a motivation to move the dental profession perhaps in a more positive direction. Ms. Wovcha, Sarah, if you were to add or comment to Dr. Willard’s assessment, would you agree, disagree, add or delete anything?

Sarah: I agree with Dr. Willard’s assessment. I would also say that if we look at the facts in terms of not only the training, but what we are seeing when dental therapists are engaged in a practice, they bear out that they are quality, efficient providers. To give a specific example of that in Minnesota, dental therapists at our training programs in Minnesota are educated side by side with dentists. When they become licensed, the exam that they undergo is in a blind setting.

In other words, the evaluators do not know whether they are evaluating a dentist or a dental therapist for the procedures that they are assessing. So it’s completely competency based. Again, they’re trained with dentists at the same institutions and they are evaluated in the same way in a blind setting.

I think the difference is that dentists are trained to do around 500 some procedures in Minnesota, for example, and dental therapists are trained to do about 50 some procedures.

So they are learning in-depth how to do these less complex restorative procedures and they’re gaining a repetitive skill set. If you just look at the sort of objective external factors of the training and the assessment, it bears out that they are competent and at least at the same level of quality as dentists.

Then when we look at how they actually perform in practice, the State of Minnesota Department of Health has done an assessment of all licensed dental therapists and have found that they are productive in practice and there have been no confirmed incidents of malpractice since they have been licensed in our state. Again, there are very objective metrics that show quality, efficiency and expanding access to care.

Kevin: Dr. Batliner, is there anything you would like to add or comment or delete from the previous two experts? Is there something that you’d like to present to our listeners?

Terry: Sure, I think the quality has been studied. Dental therapists have been studied more than any other type of providers in the last ten years and have been shown to provide quality comparable to dentists doing the procedures that they perform, which is a smaller number than dentists. I think the other thing to consider is that they can operate more cost effectively.

For example, in my practice, I pay our associates 30 percent of collections. So let’s say they do — just to make it easy — $300 an hour, so they get paid about $90 an hour.

We hire hygienists in Colorado. We pay them quite a bit in Colorado, around $40 an hour. It’s reasonable to think that I could hire, if they were legal in Colorado, a dental therapist for somewhat more than a dental hygienist. I think that’s what Sarah has found in Minnesota.

So let’s say we pay the dental therapist $45 to $50 an hour and then they can do, in our studies of their performance around the country, around 75 or 80 percent of the things that people need when they walked in the office. So it’s a cost effective arrangement. It would allow more offices to provide care to underserved groups that may be parts of programs such as Medicaid that pay based on a discounted fee schedule.

Kevin: Dr. Batliner, I’m going to do a follow up question with you. If we could snap our fingers and based on the information and data, there’s roughly 500,000 dentists in the United States at any given time. And my understanding is that roughly around 200,000 to 250,000 are actually practicing fulltime. If we could snap our fingers and create another 250,000 dental therapists tomorrow morning, what would be the motivation to have those individuals go to the population in the locations that we need?

Is there a solution or a discussion that The Kellogg Foundation and the experts in this area are looking into? Let’s just say a miracle happens tomorrow, we’ve reached through the political quagmire and we’ve got these hundred thousand plus therapists, how do we get them to the areas that we need?

Terry: The first thing is we have to recruit them from those areas. As Mary has learned in Alaska, by recruiting people from the villages and they’re trained quickly in somewhat between two and three years, where they don’t lose touch with their home community and then we found that they return to their communities. That’s number one. Number two, if you want to involve more people of color, socio-economically disadvantaged people in the education system, you have to keep it as inexpensive as possible. Because it’s difficult for people to borrow hundreds of thousands of dollars and then pay that back, as many dentists have to do.

Keeping the training as short as possible, CODA, the Council on Dental Accreditation, has kept it at three years after high school. I think that’s good. The programs need to be cost effective and quick, and that will involve more people. I think those are really the issues; recruit people from the communities, keep the training as short as possible and as inexpensive as possible so that the people we need to get trained can get trained.

Kevin: Ms. Wovcha, Sarah, let me ask you a follow up question in regards to this situation. These therapists, how would they be compensated? Do you see this as they would be compensated not only through maybe a clinic such as Dr. Batliner owns, or do you see this as a State or Federal government sponsored, and they would be compensated for their services and their education through tax dollars in some shape or form?

Sarah: What we are seeing in terms of actual practice is that they are compensated as a credentials provider with medical assistance and private insurance as well. So they’re compensated in the same way that other dental providers are compensated.

We’re also seeing that they’re eligible for loan forgiveness, for example. So they are receiving in Minnesota, for example, some government dollars and there are actually private foundations that are helping to offset the cost of education. Is that answering your question?

Kevin: It is. Part of it is selfishly, I’m embarrassed to say that I’m not as well educated in that area as I should be. I’m assuming, like Dr. Willard working in the Alaska area, there are limited number of private practices. So I’m thinking out loud now on this podcast, is the therapist coming from the community would potentially have their own facility because there’s not enough dental facilities and is there an issue or a problem? Again, in full disclosure, I personally am 100 percent for expanded duties and always have been. I think it creates competition, it provides better access to care.

And selfishly from a financial stand point, I think most business people, particularly in dentistry, realize that a dental assistant provides an enormous increase in income and so does a dental hygienist and so do dental associates. So from my simplistic point of view, why wouldn’t dental therapists also? And I think Dr. Willard touched on those bases.

But in the areas where there’s just not enough dental facilities, do you see any issues or problems with these therapists striking out on their own to create more environments for the populations to be treated?

Sarah: I don’t see problems with that. In fact, the model is well adapted to be able to expand access in regions that don’t have dentists or don’t have traditional facilities.

Let me give you an example, again, speaking from the perspective of Minnesota. In Minnesota, dental therapists can practice in any setting in which there are 50 percent or more patients on medical assistance or uninsured patients in poverty. That can be a private practice setting, it could be a community clinic, it could be a mobile dental clinic, a hospital, a school based setting. There’s a large array of settings in which they can practice.

They must be in a relationship with the dentist. In other words, they must have it’s called a collaborative practice agreement, so that they can have a level of supervision by a dentist. But they are able to work independently.

In other words, in a large state, a dentist could be practicing in Saint Paul, Minnesota and the dental therapist could be five hours away in the wilderness in Ely, Minnesota practicing. So they’re certainly well situated to do that, and they are, in fact, doing that.

Just to give an example of distribution of dental therapists compared to dentists in Minnesota, our most underserved regions are our rural regions. And according to the study of the Minnesota Department of Health, right now 74 percent of dentists practice in urban settings and only 26 percent practice in rural settings. And with dental therapists, the numbers are almost double in rural and significantly less in urban.

So 47 percent of dental therapists practice in rural regions and 53 percent in urban. So we’re seeing better distribution of dental therapists that reflects the community in need.

The last thing I would say that Dr. Batliner touched on is that the way that we compensate dental therapists in Minnesota is much more sustainable for a clinic. For example, on average, a dental therapist in Minnesota receives $45 per hour and dentists receive $75 per hour. If you calculate the savings for a clinic, and this is really quite a conservative estimate.

If they see around 1,500 patients per year and I’ll say that the providers I employ see more like 2,000 per year, the cost savings is $1,200 per week or $62,400 per year. And what we do with that funding is reimbursed in our dental providers. In other words, I can hire two dental therapists for the cost of one dentist and they can provide 50 of the most commonly needed restorative procedures in our clinic.

Kevin: First of all, I want to thank The Kellogg Foundation for putting their emphasis and financial backing to this problem. It has to be addressed, there’s no reason it can’t be addressed, and with experts like we have on today’s panel and the conversation starts to get discussed, action steps can be made.

I want to thank our three speakers and guests today. Dr. Mary Willard, Director of Dental Health Aid Therapist Educational Program at the Alaska Native Tribal Health Consortium. Ms. Sarah Wovcha is the Executive Director of Children’s Dental Services in Minnesota. And Dr. Terry Batliner is a member of the Cherokee Nation and currently working on faculty at the University of Colorado and is also the owner of Sage Dental Care with three private practices also in Colorado. Your expert opinions, in my opinion, are so important.

I can tell our audience, I know that this is a difficult subject for many, but quite honestly it’s pretty straightforward. Let’s get together as a profession. Let’s recognize the seriousness of the problem. Let’s put our heads and minds together and try to eliminate our selfish own wants and needs and see if we can tackle this from a political standpoint and educational standpoint. As I see it, it’s a nutritional issue, a motivational issue, an educational issue and with experts like on today’s panel, there’s no reason we can’t improve the current situation.

I want to say thank you to all three of you very, very much for your expertise and time. I would like to follow up. I can tell from responses that there will be many other conversations and other points of view. But you’ve been listening to Ascent Radio.

My name is Dr. Kevin Coughlin. Please, for this podcast and other information, turn to Ascent-Dental-Solutions, with a focus on knowledge, consultation, training and development.

In closing, special thanks to Mr. Doug Foresta and his company, Stand Out and Be Heard, for sponsoring this expert podcast and the production of those podcast. And I also want to give special thanks to VOCO and their financial support and their excellent products and services to the dental community.

Thank you all for listening. This is Dr. Kevin Coughlin and I look forward to speaking to you soon.  

Podcast: Developing your team members

Hello and welcome to Ascent Dental Radio. A program dedicated to the balance between the clinical aspect of healthcare and the business of healthcare. And now here is your host, Dr. Kevin Coughlin.

Kevin: Welcome to tonight’s podcast. My name is Dr. Kevin Coughlin, owner and CEO of Ascent Dental Solutions, with a focus on knowledge, consultation, development and training. I’d like to give special thanks to VOCO Dental Supply Company.

Without their generous support, many of these podcasts could not be provided. VOCO has been providing dental supplies and helping the dental profession improve the quality of care and service to patients for over 40 years.

I’d also like to give special thanks to Mr. Doug Foresta, his company Stand Out and Be Heard. Without his expertise and training most of these podcasts also would not be possible. So a special thanks to Stand Out and Be Heard, Mr. Doug Foresta.

Tonight, we have a podcast about developing team members. How do you take your staff or team members and make them more valuable and more engaged? I have several questions that have been written in and I’d like to address those questions. But to begin with, let’s talk about number one, what is important in developing your team.

Doug: The first thing I want to ask you Dr. Coughlin is — this is Doug Foresta — what I want to ask you is first of all, what is the importance? Can you say a little bit about what the importance is of developing your team towards the value of a practice?

Kevin: The first thing I would tell you is if you don’t have a successful team, you don’t have a successful business or practice. I think intuitively, all dentists understand that they’re generally the leaders of their organization. But unfortunately, most of us are not trained in leadership, we’re not trained in management, and many times, we don’t know how to facilitate our team members.

I’d like to tell everyone that when we talk about staff, staff to me means an infection. Team members mean to me individuals that share a goal and they are there to support your patient base, your business, and their main job is to improve the quality of care and service to our patients.

I’d like the listeners to understand that when a patient opens their mouth, they are a patient. But when that patient doesn’t have their mouth open, they’re actually a consumer. It’s important to understand the difference that day to day, we are not just seeing patients, we’re also seeing consumers.

And as consumers become more savvy, they have more information and data at their fingertips and this data and information can be disseminated so quickly. It is critical that you and your team understand that you’re not just dealing with patients, you’re dealing with consumers.

Doug: Can you give some examples? I know one of the things you’ve talked about is this idea that every team member is a sales person for your practice. Can you give us some examples of what you mean by that?

Kevin: Yes. I have been practicing general dentistry since 1983. I practice fulltime. I practice five days a week and sometimes I feel I practice seven days a week. I have 14 locations. I practice all forms of dentistry. I have over 150 employees and over 20 dental associates.

So when I speak to you as a consultant, as a person providing information and knowledge, I deal with these things on a day to day basis. Many of it has come from research, but most of it has come from the day to day trials and tribulations and the processes and procedures that we’ve been able to implement, that have not only improved the quality of care and service, but have improved our team members’ life and their lifestyle and my life and lifestyle, to make us more efficient, more profitable and to make it just an overall better experience.

The first thing I would tell you is your team has to understand that not only do they need knowledge in the basic dental procedures, whether that’s periodontics, endodontics, oral maxillofacial surgery, implant dentistry, temporomandibular joint or temporomandibular disorders, cosmetic procedures, sedation options, pediatrics, dental radiology, public health, the list is really extraordinary. And the ability to train your team to not just understand the clinical aspects, but in my opinion, what’s just as important is the value of these services. If Mr. and Mrs. Smith understand the procedure but don’t see the value, then I can tell you you’re going to spend a lot of time with empty unproductive chair time in your office.

Over and over, over my three and a half decades of training, education and lecturing, I have seen that many offices are well educated in the procedure, but they’re not trained in the sales. They’re not trained to educate their patient base or consumer about the value of the service. And that’s a critical piece that must be understood and must be taught.

I think there isn’t a dentist or a dental personnel out there that doesn’t realize that some individuals are just innately better at sales. In general, the medical and dental profession generally frown upon the word sales. Sales sounds unprofessional. We’re above the fray, we shouldn’t be selling anything. We provide care and treatment.

In the world that I live in, I believe that sales is positive. When you can educate, inform and motivate patients in a certain direction for a specific treatment, providing that treatment is the correct treatment and best for your patient, then sales are critically important because they motivate your patient to do what you think is best for them. And that’s not always the most expensive care, but it’s sometimes not only the most inexpensive care.

What I’ve learned over time is that you have generally five different patient types. You have the event-driven patient, the reactive-driven patient, the proactive-driven patient, the discretionary-driven patient and the regenerative-driven patient. It’s critical that your team members and you as the CEO of your office and leader understand these five different types of patients. Many times these groups will overlap.

The event-driven patient is the patient that just simply comes when something happens. Their tooth broke, they make an appointment. Their tooth hurts, they make an appointment. What motivates them is the event. The reactive-driven patient is the type of patient that knows they should, but unless something actually happens, they don’t do it. There’s some kind of motivator. Either they’ve gotten divorced and now they want better teeth, they’re looking for a new job and they think their smile is not as nice as it should be, they learn that their overall health may not be as good as it could be, they may be developing hypertension, diabetes and part of that medical issue is their dental component is poor.

The proactive patient is the patient that’s tooth-based. They want to treat one tooth at a time. They don’t look at the entire maxillofacial skeletal pattern, they don’t look at the occlusal schemes, they don’t look at the way the teeth upper and lower jaw and temporomandibular joint complex work as a very highly sophisticated tuned instrument. They’re proactive in that their tooth broke and they just want to fix that one tooth.

The next group or discretionary group is they want to look and feel better. Typically, in my experience, these are individuals that are a little older in life. They generally have been able to relinquish the responsibilities to their family and their children. Their children are generally grown, they’re out of college, they’re generally 50 years of age and older. They’re thinking about retirement and they say, “You know, this is the time for me. I want to look and feel better. I want to be a little selfish and start taking care of myself. The last few decades have been supporting other people.”

The last group are the regenerative-driven patients. What they want to know, is it worth the investment? They have the time, they have the finances, they have the knowledge, but really what they’re looking for is is there value in this care? If I do procedures A, B and C, is this going to be a good investment? Is it going to last me several years or perhaps several decades?

It is critical that you educate your team members to understand and sort of define these five groups because how you interact with these groups are going to determine your success rate and how patients accept your treatment plans.

Doug: Can you say a little bit how that ties in?  As you were saying that, I was thinking about the patient who says, “Is my insurance going to cover this procedure?” Are there certain types of clients who are more likely to just stick with what the insurance covers and then others are more likely to do other things that might not be covered by insurance?

Kevin: I attend well over a couple a hundred hours of continuing education courses every year. I’ve listened to experts not only in business, but in medicine and dentistry. And my analysis is you will always have that group of patients that no matter what you try, no matter how much you want them to believe, like and trust you, as I call it the BLT, at the end of the day if their insurance isn’t paying for it, I don’t believe they’re going to do that treatment.

However, we can improve our odds by isolating these groups of patients and trying to motivate them, try to manipulate. And I know that’s a poor use of word, but manipulate in a positive manner. What you have to try to focus on is the value. Not the cost, but the value.

Day in and day out, I simply say to a Mr. and Mrs. Smith, “I’ll be happy to remove your tooth today, but I don’t think it’s the correct or best treatment for you. In the short term, it will certainly be the most inexpensive approach, but in the long term it will be the most expensive approach.”

What I found over time is patients are motivated by time, money, sex and fear. What I mean by sex, just to make a point in this podcast, is people generally want to look good.

However, what I have found is if that individual is entering into a new neighborhood, a new job or a new relationship, that motivation, that hierarchy, moves higher to the top because they’ve been in a comfort zone. They’ve been in a relationship for years, they’ve probably allowed themselves to gain a little weight, they’re not exercising as much, their dental hygiene is not as good as it should be, they’re overall concern with cosmetics and aesthetics is less. But then there’s a changing event.

Perhaps it’s a death, perhaps it’s a divorce, perhaps it’s a new location and a new outlook on life and then that motivation of looking good and feeling good moves up. And basically why do you want to look good and feel good? In most cases, you want to have a vibrant personal relationship with another partner.

So keep in mind that in most cases there is an overlap of all these subjects. But in general, I think it doesn’t take long and it doesn’t take much education and training to understand that certain people are motivated by time — how quickly the procedure can get done, how quickly they can get in and out of their appointments because they’re very busy, they tend to be a type A personality.

The other group is that value. They don’t mind spending the money, but they want to find the value. Are they spending the money for the right reasons and are they going to get the results?

Another motivator which you can use to your advantage is fear. Many times patients have the finances, they have the time, but they don’t associate the fear and they are afraid of a root canal. In my opinion, if we could guide them to do the crown before the tooth breaks, there’s much less likelihood that they’re going to need a root canal. And when they understand it in those terms, they’re more likely to accept your treatment plan.

I’d like to share some statistics with you. Generally, the average patient in the United States, over the age of 20, spends approximately $500 a year on dental care. It’s critical that you understand that those $500 simply are telling us and our profession that most patients are treating tooth by tooth. They’re event-driven patients. They only come to see you because of an event.

Our job and your team’s job is to change them from event type patient to regenerative-driven patients. Showing them the value so that they’re looking at their entire stomatognathic system and they’re not treating one tooth, they’re treating their entire upper and lower arch and temporomandibular joint complex to get the best long term aesthetics function and cost results.

Doug: I have the last question for you here which is, thinking about when a dentist comes in and says you need this, you need this and I recommend this procedure, we’re talking about the importance of team members and sales. Do you find in general, that patients will sometimes if the team member either is the one to initiate saying I need this or maybe backs up what the dentist says, does that sometimes make the difference versus the dentist being the one to say you need this procedure?
Is there a difference in the level of trust with the patient?

Kevin: Based on my data and research almost 90 percent of all treatment plans are not accepted. For our listeners, don’t take this out of context, but a comprehensive treatment plan includes soft tissue management, hard tissue management and temporomandibular joint treatment and elective procedures. So a treatment typically would be Mr. and Mrs. Smith needs four quadrants of root planing and scaling. They need to be put on a three-month recall or re-care program.

They generally will require some kind of chemical intervention with prescriptions of Prevident, Periogard and Periostat to chemically fight their periodontal disease. And they need a comprehensive periodontal re-evaluation in three to six months.

In general, most patients will require the surgical removal of four wisdom teeth to create room and function and to reduce the chances of infection, pain and discomfort later on in ages. In most cases, almost all patients would benefit from some intervention of orthodontic care to align level raw teeth to provide stable accusal contacts on the upper and lower arch. That is a comprehensive treatment plan.

In most patients, what they’ll say is, “I’ll come in and have my teeth cleaned every six months.” And depending on how the practice evaluates their data and information, some patients would say that there are 100 percent success rate on the treatment plan because the patient had their teeth cleaned every six months.

If you want to be truthful, the reality is that patient did not accept your treatment plan. And the reason they didn’t accept it, in almost all cases, is they found no value. They were not motivated by sex, fear, money or time, and if there’s no motivation, there’s no reason to do something. That falls on the dentists and the dentist’s team members.

I think most contemporary offices would agree that a morning hurdle is critical. That morning hurdle reviews that patient’s medical history, dental history and treatment plan that has not been accepted. And that gets the team member and the dentist on the same side.

So a direct answer to your question is when a team member emphasizes a treatment and that treatment is supported and backed up by the dentist, the success rate increases by over 80 percent. But if you’ve had no morning hurdle, the dentist and the team members are not on the same page and you’re not prepared before Mr. and Mrs. Smith arrive at your office, your success rate drops by 80 percent.

It’s almost like anything. You never should go into a business meeting without a plan.

And that leads me to the last point, and a future podcast will deal with it, and that’s what I call the three Ds. You have to Design, you have to Develop and then you have to Deliver. Not only end to end service, not just clinical, but the business aspect.

The way the phones are answered, the way patients’ questions are answered, the way their insurance forms are filled out and monitored. These three Ds are critical.

For the dentist listening to this podcast, if you’re having a problem, take a look at these three Ds and focus on your design, focus on your development and lastly the way it’s delivered. And if you and your team aren’t on that same page, you cannot be delivering positive results.

The outcome is unproductive, inefficient time, lost revenue and most important, your patients are not getting the care and service they really deserve. They may think it, you may hope they’re getting it, but I think almost all good honest clinicians will realize that they’re short changing their patients.

Not every patient will do exactly what you say, but in the real world, if you can improve five or ten percent, that is huge to your bottom line. And that also is huge to the number of patients you’re providing a higher level of care and service and ultimately, that’s the goal.

Doug: Thank you, Dr. Coughlin. I wanted to reiterate that last part that far from what you said about sales being a dirty thing, truly if that person needs that — one of the things I hear you saying is if that patient really needs this and we fail to sell them on it, then we’ve actually failed their health. Our bottom line and we failed their health.

Kevin: A hundred percent, I agree. Most of us as practitioners, we get caught up in the run-of-the-mill day to day things. In the end, if you look at yourself not just as a service care provider but as a patient yourself, what you want is you want to know what’s best for you and your family and show the value of what’s best for you and your family.

And once you can show that, most people in the United States of America will find a way to get that care and treatment. Data says that almost 85 percent of all patients finance anything over $1,000. And part of not just training your team members, not just educating your team members and yourself, is you have to have financial policies that are available to allow your patients to come up with a structure to meet their financial needs.

Just like anyone, most people don’t pay cash for a car. Most patients do not pay cash for items over $1,000. And in most medical and dental care, $1,000 doesn’t go a long way.

So you have to have the financial plans, processes and procedures in place to make it easy for your patients to attain what they want. And that’s the best health, at the best price for the best service.

Doug: Thank you very much, Dr. Coughlin. I appreciate it.

Kevin: Thank you very much. You’ve been listening to Ascent Dental Solutions. My name is Dr. Kevin Coughlin. I really appreciate this time with you. I want to give special thanks to VOCO Dental Supply. Without their expertise in health, this podcast could not be presented.

And also special thanks to Mr. Doug Foresta and his podcast company, Stand Out and Be Heard. Without his expertise and production acumen this podcast would not be available today.

Thanks again for listening. I hope you enjoyed the podcast and I look forward to speaking to you in the near future.