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Dentists looking to enter the arena of sleep medicine have many business and educational options, but too often the blueprint for real success remains elusive.
Sleep Diagnosis and Therapy recently spoke with two innovators in the world of sleep medicine who have developed a new program called Comprehensive Sleep Services™ (CSS). CSS is designed to help dentists effectively, and profitably, treat patients suffering from obstructive sleep apnea (OSA).
Prior to co-founding CSS, Ronald L. Cook, DDS and John Truitt established deep roots within the dental sleep medicine community. The ASBA chatted with Cook and Truitt to find out how CSS differs from other programs, and why dentists of all experience levels might wish to give it a try.
How well suited is dental sleep medicine to working within the telemedicine framework, particularly during the COVID-19 crisis?
It's ideally suited, and I say that based on experience using telemedicine. In the Dallas Fort Worth Metroplex, between 2012 and 2019, we treated a total of about 12,000 dental sleep patients. All of those people received oral appliances. Telemedicine came into the model in 2016, so I would say we have at least conducted telemedicine visits on more than 4,000 patients.
There's nothing speculative about telemedicine. It's tried and it's proven. There are some companies out there that are working with dentists who are not creating medical necessity. There happens to be a board certified sleep physician signing over a test, but there's never a GP visit, there's never a telemedicine visit, and that's wrong. You're going to get recouped. Not just during the Corona virus, but moving forward and doing dental sleep medicine, telemedicine is going to be an imperative if you want to be a profitable practice.
How long has telemedicine been around?
Telemedicine in general has been around for about 15 years. We were the first ones to adopt it in dental sleep medicine with our diagnostic partner, Comprehensive Sleep Medicine.
How well known is CSS at this point?
We were looking to launch at the recent ASBA meeting. We were bringing this whole program, and the pinnacle of this whole thing was telemedicine. We had already been launching this back-end program as far as the dentists being able to be reimbursed and having us handle all of their insurance through CSS. The lead of that was already going to be telemedicine, so this has nothing to do with the Corona virus, other than serendipity of timing.
This question is for Dr. Cook…As a practicing dentist, what has been your experience with telemedicine?
My experience is a little bit different. I have only been associated with telemedicine for several years. What I found is that it has decreased treatment time by two to three months.
What are the drawbacks of the traditional care routine (without telemedicine)?
I’ll provide an example to illustrate the problems. From various sources, the patient comes to me and says, "My wife complains that I'm snoring." I have him fill out the screening sheet. I show him the oral appliance and he gets excited. I say, “I know you want one of these, but the first thing we must do is go back to your primary care physician and get him to order you a sleep test.” The guy is excited about getting the appliance, but the excitement dims.
Why does the enthusiasm dim?
Now I have to send all the information I gathered to his PCP. I have to hope the patient calls his PCP. I usually then get a phone call from the PCP asking, "What do you need?" I advise him or her to please evaluate the information I just sent over and order a sleep study for the patient. You lose half of your patients right then. Once the sleep study is ordered, the PCP has no idea what to do with it. He also has no idea how to write orders to actually get the oral appliance.
So time is the major enemy here, correct?
Yes. Patients just keep dropping off as the months go by. By the time all that happens there are very few patients who could enter into treatment because they never got all of the medical necessities done—the sleep test, the diagnosis, and the actual order for the oral appliance.
What’s the scenario with telemedicine?
With the telemed visit, there is a turnaround of two weeks maximum. As long as the patient shows up on the phone or the computer screen at the right time, these orders are generated immediately. The sleep test is sent out, the patient uses it, orders are generated, and it’s all over to me, the dentist, within two weeks—and we are good to go. The patient is still excited about the treatment and the momentum has not been lost. It's a complete game changer.
Telemedicine can be done anywhere. We've had patients confer in the parking lot on a lunch break on their phone, or from a cubicle on a hand held. It happens at home on a desktop. It is truly mobile medicine. The average sleep visit, whether it's face-to-face or telemed, is around 10 minutes. Usually it's a max of 10 minutes.
It's amazing the access that this brings, how much time it cuts down, patient convenience, and then of course just best practices—such as making sure every patient has a face-to-face with a medical GP. That's honestly not happening in a lot of instances in the broader market. They will eventually get a recoup. They think they're ok doing it right now because they don't have a significant volume.
How have your experiences primed you to offer the CSS program?
When you're delivering hundreds of oral appliances per month, you see a lot. We've been audited by every insurer, and by Medicare a number of times. We came out with flying colors. We're following the rules. It's not just greater access and being able to make it quicker, it's also the correct way to do it. If you're not having a face-to-face visit with a GP, or you're not having a telemed visit, you're wrong.
Is there a misconception about getting involved in dental sleep medicine?
At the very beginning there's a complete misconception of what the dentist needs to know to be effective doing dental sleep medicine. The dentist needs to be a good dentist. They need to be a good general practitioner who understands best practices. You have a lot of individuals out there who want to learn about dental sleep medicine. They pack up the team, close the practice down for two days, and go into a course where they'll talk a lot about things that are not applicable.
The dentist becomes the professional conference attender. They keep thinking there is this other grain of magic that this next continuing education course will give them, and then back at their practice everything will be different—and it's never different. I have an issue with the whole way information is disseminated, the information itself. When I look at the marketplace, I see a lot of vendors and clinicians making money off of "new blood" coming in, and the new blood is not activating and utilizing, and most importantly helping all of these people with OSA. The end result is a dentist getting the team all excited and then they come in Monday morning and after 15 minutes of looking at what it takes: screening patients; insurance billing; and selecting appliances—they quickly go back to doing some crown preps.
I'd go to a seminar, and there was some good stuff, but it was always something to buy. Then I would not use it. And a few months later I had to buy something again and would not use it. There is nothing with dental sleep medicine to do that a dentist doesn't already have in his office. There's nothing to buy.
In our program the patient has already been educated before they get to the dentist. Our call center has already educated that patient. We're taking the administrative burden away from the dentist, and we actually give them the net profit. Somebody in our program can make $1,300 net profit for only 20 minutes of the doctor’s time, and an hour of assistance time. Those numbers are completely upside down if the general dentist is trying to do this on his or her own.
About CSS Co-Founders
Ronald L. Cook, DDS graduated from Baylor University in 1984 with a B.S. in Biology and Baylor College of Dentistry in 1988 with a Doctor of Dental Surgery. He is dual licensed in the states of Texas and Oklahoma. He is a member of the American Dental Association, the American Academy of Dental Sleep Medicine, and an American Sleep and Breathing Academy Diplomate. He has been in private dental practice since 1989, and full-time dental sleep medicine since 2012.
John Truitt has held multiple senior management roles in both publicly and privately held companies in the sleep and dental category. He was instrumental in the listing, implementation, and growth of SomnoMed and relocated from Sydney, Australia in 2006 to expand operations to the Americas. From 2011-2019, Truitt was the co-founder and CEO of Texas-based Simple Sleep Services. After studying liberal arts at the University of North Texas, and emergency medicine at the U.S. Army Academy of Medical Sciences, Truitt continued his education in dental sleep medicine, orthodontics, chronic pain management, TMJ, and maxillofacial orthopedics under the tutelage of many world-renowned clinicians.