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Oral Appliances for Sleep Apnea

by partica

The most profitable procedure in dentistry… Then why are less than 1% of all general dentists doing them?

This is a 3 part series. Part 1 will focus on the why of sleep. Part 2 will focus on how you get patients to walk through your door (It is way more complex than any dental procedure because dentists can not diagnose sleep apnea or prescribe oral appliances). Part 3 explores how to make sure you get paid maximum reimbursable amount for each patient.

I remember when I was convinced by a Pulmonologist friend to take a course in sleep medicine. The year was 1998. I was just about to graduate from dental school and never heard of sleep apnea and could not fathom what it had to do with dentistry. "Sleep Apnea is going to be HUGE in the dental world," she told me.

Well, if it was going to be HUGE, I needed to find out what it was about, so I started looking for a course to take on Dental Sleep Medicine. Finding a course on a specific subject was not so easy back then. The Internet was in its infancy stage and it was certainly not the place to go to find courses for dentists. I had to use good old-fashioned methods to find a course.

I looked in the back of the dental magazines, I called the local dental association and the ADA.

Finally, I found out about an organization that was formed to help dentists assimilate into the world of sleep medicine.

The group was called the Sleep Disorders Dental Society (this group is now known as the Academy of Dental Sleep Medicine).

Once I got their contact information, I called the SDDS and they gave me a list of the few courses that were offered. It turns out that a course was about to take place right near my house in New Jersey and my journey into Dental Sleep Medicine began there.

Dr. Keith Thornton gave the course. It was a two-day course, which taught me a lot about the science of sleep and what we could do as dentists to help treat this disease. We spent a day and a half on the science of sleep and a couple of hours with the TAP (Thornton Adjustable Positioner) appliance. We were also told there were approximately 40 million plus patients that were suffering with undiagnosed sleep apnea. After the course, we were deemed ready to treat Sleep Apnea patients. With the number of patients available for treatment, I was expecting a windfall of patients.

Now I can tell you, since the day I decided to go to dental school, my goal was to be a different kind of dentist. I did not want to be the typical drill and fill dentist. I wanted to stand out. So when I had a sleep patient referred to me for an appliance, in my first week of private practice, I just knew that sleep was going to be the way I was going to stand out. What was really remarkable about the procedure was that the hard costs for the procedure were just $250 and I got paid $3,500 for this simple 30-minute visit. For those of you math majors out there that’s a 1300% profit margin.

I am not sure about your dental school but the business of dentistry was not taught very well at my school. The instructors were always complaining about how low their level of income was compared to the effort they put into it. My instructors told me to expect an overhead level of somewhere around 65% for my private practice. As I studied the subject more it turned out that if I included my student debt and my practice loan, my overhead level was closer to 80%.

Imagine my interest level when I had a procedure that consisted of 1) a 15-minute consult, 2) upper and lower impressions and 3) a bite registration and 4) a 1300% profit margin.

Using my formula of 80% overhead a procedure that brought in $3,500 should have hard costs of $2,800, yet my hard costs back in 1999, were only $250! If there was ever a doubt of how I was going to be different as a dentist, those doubts were erased with appliance number one.

Let’s put this into perspective. I saw my first appliance patient one week after opening my practice in 1999. I was able to complete this procedure after taking one weekend course.

Nowadays, it’s even simpler. Appliances are custom fit and can be inserted in minutes. Assistants take all my impressions and the reimbursement levels have gone up! As you are reading this, I hope you are thinking, "I better go take a sleep course." If you have already taken a course and not succeeding at this, you should be thinking "I better find out how to get more appliances" (part 2 of the series) and/or "I better find out how to get paid top dollar for them" (part 3).

What’s changed in the last twenty years? As far as the science, not very much. As far as the appliances themselves go, the materials are better and stronger and of course a little more costly.

Hard costs can be between $350$550 depending on the appliance you choose. Reimbursement across the country can be as low as $1,100 (Medicare in Texas) and as high as $11,750 (PPO’s in San Francisco). This means sometimes profit margins are as high as 3250%.

Now of course, not everything is about profits but this is The Profitable Dentist magazine so we are focusing on the profits. However, if you need another reason to make oral appliance patients a huge part of your day, choose from the following:

1) It’s a stress-free procedure

2) Most of the work is done by your assistant

3) It’s the only thing we can do as dentists on a daily basis

that actually saves or extends patients’ lives

4) Did I mention it’s the most profitable procedure in dentistry by a country mile?

Let’s compare a general dentistry practice to a sleep practice. During my 13 years as a general dentist, I had two columns in Dentrix reserved for me.

One column was filled with production procedures such as crowns, endo and implants and one column was used for other procedures such as inserts, fillings and consults. It was my dream as a young dentist to have a million dollar dental practice.

A typical dentist works a 3.5 to 5-day work week. My hours as a general dentist were Monday 8AM – 7PM, Tuesday 8:30AM – 5:00PM, Wednesday 8AM – 4PM, Thursday 8:30AM – 6:00PM and Friday 8:00AM – 3:00PM. I took a small lunch break every day but Friday. All told I worked approximately 40 hours per week on patients.

I took four weeks of vacation a year. I worked close to 2,000 hours a year on patients. In order to have a million dollar practice, I needed to make $520 per hour. Add in my 70% overhead and my take home for the year $300,000. Not a bad living in any kind of way.

However, this 40-hour work week was about as stressful as I could imagine a profession being. Whether it was broken files, crowns falling off, denture adjustments or just one kid who would not stop screaming, my days were filled with stress. I was dead tired at the end of the day and all I was doing was working in the business. Let’s add in at least two extra hours per day of writing up charts, paying bills and managing staff and you wonder why dentists get burnt out after practicing for a few years.

Now let’s look at a sleep practice (Note: most sleep dentists dream of a practice like this but don’t actually accomplish this, as you will see in the next two parts of this series).

Hours of a typical sleep dentist, Monday and Wednesday 8AM – 12PM. If you are not a morning person, make your hours 12 PM – 4PM. Either way, there are two four hour days of patient time.

A sleep dentist also needs two columns in Dentrix. One column is needed for oral appliance production and one column is needed for inserts and adjustments. Each day you see five new sleep patients.

Using New Jersey (where I am from) as a guide for reimbursement numbers and a combination of 50% Medicare patients ($1,848 per appliance and 50% PPO patients ($6,750 per appliance) each patient would bring in $4,299.

Ten patients per week equal a weekly production of $42,990. Working the same 48 weeks it brings your yearly production to $2,063,520.

I will use an average of $450 for overhead even though that number can be significantly reduced with bulk discounts.

• Staff requirements consist of one part-time assistant.

• Billing gets outsourced and costs you 7% of collections.

• In this case, that number comes out to $144,447.

So you produce $2,063,520 in oral appliance production. You subtract $144,447 in billing cost and $216,000 in overhead cost including your part time assistant.

Your yearly profit comes out to $1,703,073. Add in the fact that you no longer have the stress of dentistry and that your work week consists of eight hours of patient time while outsourcing everything else.

The question you should now be asking yourself is, "What am I waiting for… and where have you been all my professional life?"

If you are interested in learning more, head out to the International Academy of Sleep Reveal 2.0 coming soon to a city near you. For more information check us out at iaosleep.org and click on the events page.

❝No matter what time it is, wake me, even if it’s in the middle of a Cabinet meeting.❞

-Ronald Reagan

❝Early to bed and early to rise, makes a man healthy, wealthy, and wise.❞

-Benjamin Franklin

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