Business Unusual: Making the Best of the New Normal

October 2, 2020
Terri Lively
Volume 54, Issue 10

We highlight creative, outside-the-box ways to make a practice successful. Hear from different dental professionals about how they enhanced their practices with new technology, techniques, and areas of oral health care they serve and the benefits it drives for their practice metrics.

Professionals could argue thatevery day in a dental practice is business unusual today. However, despite setbacks for the past 6 months or so in 2020, there are ways to be successful, although likely not ways you might have considered before a global pandemic made the phrases “unprecedented times” and “the new normal” part of our everyday conversation.

Here, we highlight creative methods for dental practice success. Our dental professionals, clinicians, and entrepreneurs share ways to enhance your practice with new technology, techniques, and areas of oral health care that can drive value to your bottom line.

Making the Oral and Systemic Health Connection in Your Practice

Eva Sadej, founder and CEO of Floss Bar, says her on-demand dentistry business model mimics what employers know as “the flu-shot people.” Floss Bar provides mobile dentistry services that come to office buildings to treat patients where they work. “It’s a mobile dental service organization [DSO],” says Sadej. “It’s essentially a platform that enables dentists and doctors to become mobile dentists and doctors and add new service lines to their practices and local communities through corporations in a turn-key solution.”

However, with the global pandemic, and no one in office buildings in which to bring dentistry, Sadej pivoted to focus on Floss Bar’s sister company, Med Bar.

Med Bar is a health care logistics company that provides mobile COVID-19 testing and response, flu shots, biometrics monitoring, and dental, vision, and hearing services. Floss Bar pivoted from orchestrating dental events and networks to medical events and networks. “The relevant thing for dentistry is the bridge between medical and dental,” says Sadej. “We have been able to cross utilize dental assistants as COVID-19 testing technicians. The sky is the limit when you really look into what a dental team can do in the medical space in partnership with telehealth doctors. We’re helping dentists integrate Med Bar into their practices so that they can make the oral to systemic health connection real.”

Both the Floss Bar and Med Bar business models share 2 primary principles. The first is bringing health care providers to the patient by going through employers instead of having patients come to an office. “The workplace is the new marketplace for health care services,” explained Sadej. “Sixty-six percent of employers want to provide health care onsite by 2022.”

The second foundational principle is to expand what the dental community can do. Sadej is helping the community realize that dental professionals can run a lot of telehealth and remote, supervised medical services through their office. For example, dental team employees can be technicians for COVID-19 testing or run part-time vision or hearing services. Sadej says that practices can set up a Med Bar room in an office that uses the telehealth functionalities. Then, Med Bar provides a network of optometrists and audiologists to refer patients to for follow-up.

The unity between medical and dental has changed. “Previously, medical-dental integration was educating patients about the connection, but not integrating medical into the practice,” says Sadej. “We are trying to help the dental community incorporate these extended, lightweight medical services for patients into the practices and then also go to the local corporations to provide mobile health and dentistry for their employees.”

The patient also enjoys an additional value proposition. Floss Bar and Med Bar services at the employer make people feel more comfortable because their human resources department endorses it by bringing the mobile services onsite. Moreover, patients can knock out many health care checkups at once for more appointment efficiency.

On the professional side, the dentists also benefit from the mobile option. The option not only provides an additional revenue source for practices for services rendered but also creates very clear referral pipelines back to the dental practice. “It’s almost like they [dental health professionals] are paid to do marketing while they are presenting to a captive audience when and showcasing themselves,” says Sadej.

Also, Sadej takes pride in the diverse makeup of the company. She says the organization employees break down into 70% minority, 53% women, and 20% immigrants. According to Sadej, different backgrounds provide a unique experience to the company. “Our team has a lot of diversity of thought and diversity of race and ethnicity,” she says.

Video Conferencing Your Way Into Patients’ Treatment Acceptance

Brant Herman, CEO of MouthWatch, says that when he started the company 8 years ago, the goal was connecting patients to providers in innovative ways. By providing affordable intraoral cameras and a platform for communication, MouthWatch® is working toward that goal.

Its cloud-based teledentistry platform TeleDent allows care providers to interact and communicate with specialists via live video conferencing. At first, the value seemed to be in new practice models, like public health and school programs, and providing care for nursing home patients. But then Herman and the MouthWatch team adapted the platform for provider-to-provider communication.

Recently, MouthWatch adapted the platform for more immediate and flexible provider-to-provider and provider-to-patient communications by making it mobile-device friendly. TeleDent now includes a secure patient portal that offers patients a convenient way to take a more active role in their oral health care.

With the onset of COVID-19 earlier this year, the needs for teledentistry shifted. Teledentistry went from being a product with a value proposition for specific practices that serve specific populations, to a channel with functionality for every practice. According to Herman, the MouthWatch intraoral cameras and TeleDent platform support the specific needs of virtually any teledentistry program. He says MouthWatch had many practices sign up in March and April when dental offices closed to all but emergency care to protect against the virus.

The rapid adoption rate was fueled by the critical nature of continuing patient communications and consultations remotely while accommodating patient behavior changes over the past 6 or 7 months. Moreover, Herman thinks these changes in patient and provider behavior will last beyond the pandemic.

“Now, there are additional infection control requirements and the additional costs that come from them,” says Herman. “Providers are asking themselves, ‘Can I meet my patients’ needs while also addressing their concerns about coming in?’”

One way he sees providers changing behavior is to shift limited exams during hygiene appointments to virtual consultations or treatment plan presentations. Not only does it save time in the chair for the patient who is already nervous about infection control practices, but it also allows patients to see the dentist in a comfortable setting—their own home.

“They don’t feel like they’re being sold dentistry,” Herman says. “They are shown images of their need for treatment. It’s a much softer sell and more like collaborating with patients.”

Monetary successes play a part in teledentistry as well. Many insurance providers are reimbursing teledentistry appointments for limited evaluations and problem-focused exams virtually. Herman says the reimbursement policy made it so practices that were closed for all except emergencies could provide care using teledentistry.“That was a game-changer,” he says.

According to Herman, teledentistry is essentially a patient engagement tool. Practices that leveraged this change offered teledentistry consults and had the hygiene team follow up with patients virtually who had procedures from January through March of 2020 that might need follow-up care. Hesays the real-time availability that teledentistry provided presented an opportunity to provide care and fill the schedule once the practice reopened.

“If they have a concern now, we’re going to address it, and we’re going to do it virtually,” says Herman. “The practices that were really on that not only brought in new patients but also were able to close some cosmetic cases for when they did reopen.”

In addition to the video conferencing, MouthWatch’s product integrates into practice management systems. It offers an integrated solution of asynchronous messaging (store and forward) with secure synchronous (live) messaging and chats. Providers can save the information from the teledentistry encounter to a patient record. “It’s an operational overhaul and a powerful growth engine,” says Herman.

Upholding Ancient Philosophy with Futuristic Technology

Joseph Sarkissian, DDS, has a private practice in Glendale, CA. His website describes his practice as biologic and homeopathic, following the philosophy of ancient Greek physician Hippocrates, “first, do no harm.” Dr Sarkissian’s holistic approach has always been important to him in his practice and private life. What’s more, he wants his practice not to feel, look, or smell like a dental office. Instead, he wants patients to feel at home, where they feel accepted with honesty and care. “My approach is to treat everyone as if they’re our family,” he says.

According to Dr Sarkissian, holistic is a term that takes into consideration the whole person, not just a dental patient. Being a holistic practitioner is not only about using biocompatible materials but also about minimally invasive methods that are tissue-friendly and facilitate healing.

What does this mean exactly? He uses fewer imposing tools for one. The BIOLASE® Waterlase iPlus® dental laser he uses was a natural fit for him because it represents a minimally intrusive approach.

“It’s more patient-friendly, which means the patients will accept it more readily as a nice alternative to the scalpel, the drill, and a lot of other invasive methods,” he says. “It’s very compatible with a holistic concept.”

Not only is the laser less imposing on patients, but it also embodies innovation. He likes how the laser’s futuristic feel makes his practice feel more cutting-edge.

“Frenectomies don’t need stitches. You don’t need blades. You don’t need to follow up forever and ever. And postoperative pain is much less. So, that’s also much easier to tackle.”

Because people are busy and want things done right away, Dr Sarkissian employs same-day dentistry and it’s more efficient with the laser’s help. He uses the laser to complement almost every aspect of same-day dentistry treatments. For example, he treats the gums around a tooth that needs a digital impression, which allows him to place the crown the same day, even when there is gum growth or inflammation.

He adds that he can’t think of an area of his practice that isn’t enhanced by the laser. He uses it to expose healed implants for their restoration with the least trauma, instead of electrosurgery. For caries restorations, he uses the laser to excavate and sterilize deep areas of the cavities to avoid root canals, which is vital to his holistic goals, especially for children’s dentistry.

“Baby molars can result in pulpotomies even with the smallest of cavities, so we can use the laser to remove the cavity gently without exposing the nerve,” he explains. “Or even if you have to perform the pulpotomy, you’re doing it with a laser rather than with toxic materials like formalin. So, using the laser to remove that section of the nerve and then capping it with a biocompatible bio-ceramic rather than aggressive materials.”

While groundbreaking in the dentistry world, Dr Sarkissian says that most patients know that lasers are more advanced for other surgery types, like neurosurgery and gall bladder surgery, so the term has a positive connotation. “They accept it much more freely,” he says.

The laser has also proven to provide significant return on investment (ROI), which is crucial to most practices. Dr Sarkissian says this is true because it’s always there and ready to include in treatments. “If you have the proper billing sequence, you’re going to have a huge benefit as far as a ROI,” he says.

According to Dr Sarkissian, with the recent pandemic, buying new technology can feel counterintuitive. Watching the days tick by without any revenue makes it difficult to invest in something. However, by taking the time to incorporate new technologies into the practice, it could provide an extra edge in the crashing market.

“There will always be patients who, if they accept your approach and trust you, then they will be willing to cover the higher costs of their dental treatment because it’s something important,” he says.

Sleeping Your Way to Success

Jonathan Greenburg, DDS, inventor of Zyppah®, and CEO and founder of Sleep Certified®, has always had the philosophy that “it’s about the patient and what you can do best for the patient.” While he is a dentist, he realized years ago that sleep apnea is an opportunity for patient care. “You have 45 million people estimated to have sleep apnea, and fewer than 10% are treated,” he says.

According to Dr Greenburg, untreated sleep apnea can lead to other serious conditions, including heart attacks, strokes, diabetes, weight gain, and Alzheimer disease. He decided to reach the additional 90% of patients who weren’t receiving treatment for their sleep apnea by taking care of one of the most persistent (and pernicious) symptoms: snoring. Using his biomedical engineering background, he invented the Zyppah, an anti-snoring mouthpiece with elastic to keep the tongue in place. He took a direct-to-consumer route to market his device to help people get better sleep. “We say, ‘Zyppah is everything in the bedroom not having to do with sex,’” he says.

Zyppah was successful in attracting patients wanting screenings for sleep apnea. Dr Greenburg said the website got 20,000 visitors a week, but unless the patients could come to one of his 5 locations of Snore Experts, a sleep apnea medical treatment facility in southern California, he couldn’t treat them. He then developed 9 certification levels for dentists to become “Sleep Certified” to treat snoring and sleep apnea.

Sleep Certified allows Dr Greenburg to refer patients to a Sleep Certified network of providers for the highest level of patient care in their area. Dr Greenburg and Sleep Certified’s new program called Sleep Certified 360, launched in May 2020. The program makes it easy for dentists to take on sleep treatment in their practice without costing them anything out-of-pocket or distracting them from their practice. The program takes care of sleep testing, telehealth, and insurance billing for the practice at no extra fee for their Charter Team Membership enrollees.

Sleep Certified also has ideas for the COVID-19 pandemic. “The most important thing coming out of COVID is for a dental office to get patients coming back to the office and wanting to spend money,” says Dr Greenburg. “We decided that with Sleep Certified 360, it’s got to be simple and not distracting to a dental office or their staff, and it’s got to bring them money now.”

At Snore Experts, everything is in one place, and patients can get treatment in under a week. Dr Greenburg sees patients and sets up a sleep test for at least 2 and sometimes even 3 nights. Multiple nights of testing provide better data and captures what’s going on with patients’ sleep. The team treats patients’ sleep apnea with oral appliances, CPAP machines, or other treatments, such as laser therapy.

According to Dr Greenburg, one of the significant issues with dental offices not being successful with sleep issue treatment is the office not being able to bill medical insurance. Moreover, patients don’t want to pay out-of-pocket with treatment price ranges from $2000 to $5000. However, Dr Greenburg’s practice and dental offices that participate in his Sleep Certified 360 program are in-network with almost all the major insurance carriers. He says his Sleep Certified offices with a Sleep Certified 360 program membership average treating 10% of their active patient base in a year for sleep apnea, which generates $1800 in revenue per patient.

“So if an office had 2000 active patients, they would typically find about 200 patients would go through [treatment] every year. With 200 patients at $1800 apiece, the dental office would be adding another $360,000 to their revenue of net profit,” he explains.

While the additional revenue sleep apnea treatment can provide is excellent, one of the best benefits is helping patients treat their snoring and restore peace in the bedroom. Also, it allows dentists to return to what they like doing best, providing care to patients.

“We went to dental school with the idea of being a doctor and not being a mechanic. Unfortunately, in many ways, we became the mechanic,” says Dr Greenburg. “Well, when treating sleep, you go back to being that doctor.”

Leveraging Technology to Alleviate Stress—for Patients and Doctors

Bryan Laskin, DDS, a private practice dentist near Minneapolis, and founder of OperaDDS™, says that to elevate dentistry from the patients,’ teams,’ and owners’ perspective, leverage technology and teamwork. He thinks of technology as part of the team.

Dr Laskin explains that humans tend to work well with humans, and dental team members want to work with patients. He says that’s an aspect the rest of the industry recognizes and understands. However, the dental industry could do more to leverage technology as part of the team, particularly with repetitive actions that don’t require a human touch.

“Technology can do things that humans can’t or don’t want to do, the mundane and boring things that do not require a human touch,” says Dr Laskin. “Good employees hate doing that because it is mind-numbing, soul-sucking work. That’s where technology shines.”

Dr Laskin explains there are some areas where innovation and technology can allow dental teams to provide better care. Specific types of technology can offer better ways to treat patients’ anxiety without drugs. Regarding therapeutic virtual reality (VR), technology calms patients in ways humans can’t, but drugs can. That is where OperaVR comes in.

Dr Laskin invented the OperaVR goggles a few years ago to overwhelm patients’ senses and distract them from what is happening while they are in the chair. Patients do not notice the sights, smells, and sounds that would otherwise make them nervous. The steps are simple. In his practice, the headset is placed on the patient’s head. The patient selects the VR experience from 6 options, ranging from sedate experiences, like an afternoon on the beach, to entertainment adventures, like a tour of Paris. The patient relaxes for a worry-free dental experience, and the dental team can get their work done.

“The number one thing we hear from practices is how much time they save,” he says when referring to OperaVR practice reviews. “We can deliver lower-stress, higher-quality dentistry.”

The benefits to the patient are apparent. Yet, they are not the only people who benefit. Dr Laskin says that one of the benefits to practitioners is they do not absorb patients’ stress all day. This pressure has detrimental effects on dentists that range from burnout to chemical dependency. “If they feel less stress, we feel less stress,” he says.

According to him, providing an anxiety-free dental experience generates the best possible word-of-mouth advertising. When practitioners exceed patient expectations by transforming the experience, they create champions for the practice.

The press is also interested in therapeutic VR. When someone buys the system, OperaVR provides a press release for the practice to announce it to the local media to build hype.

“We have had half a dozen dentists across the country get invited to speak about it on the news,” says Dr Laskin. “It’s been on CNN, and it was featured in Oprah’s magazine. And if it’s the kind of thing that Oprah talks about, then your patients will, too.”

He says the benefits start the moment dental health professionals bring OperaVR into practice. Just by offering it to patients, providers demonstrate that they care about their patients’ dental anxiety. According to Dr Laskin, many practices become desensitized to patient uneasiness and do not directly address it. He estimates that fewer than half of dental practices actively work to reduce it, which is why many patients say they hate going to the dentist. “You are letting patients know you care,” he says. “Unfortunately, I don’t think a lot of dentists are actively out there doing that.”

Dr Laskin offers the therapeutic VR for free in his practice. However, the benefits to the patient and word-of-mouth referrals have benefitted the practice a lot. “The only way you wouldn’t have a positive ROI with OperaVR is if you put it in a drawer and never tell anybody you have it,” he says.

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