1 00:00:00,080 --> 00:00:02,179 Hello, and welcome to the Becker's Healthcare podcast. 2 00:00:02,319 --> 00:00:03,839 My name is Chanel Banger. And today, I 3 00:00:03,839 --> 00:00:05,859 have the pleasure of speaking with Avi Weisbogle, 4 00:00:06,240 --> 00:00:08,800 the founder and CEO of Restful, powered by 5 00:00:08,800 --> 00:00:11,199 International Academy of Sleep. Avi, thank you so 6 00:00:11,199 --> 00:00:13,359 much for being here today. Please. My pleasure. 7 00:00:13,359 --> 00:00:15,405 Looking forward to it all. Perfect. Well, to 8 00:00:15,405 --> 00:00:17,405 get us started, can you please introduce yourself 9 00:00:17,405 --> 00:00:18,785 and tell us a bit about your background? 10 00:00:18,845 --> 00:00:20,685 Sure. So as you said, my name is 11 00:00:20,685 --> 00:00:21,425 Avi Weisvogel. 12 00:00:22,685 --> 00:00:24,204 Like a lot of people, I went to 13 00:00:24,204 --> 00:00:26,445 dental school. I am now a recovering dentist, 14 00:00:26,445 --> 00:00:28,289 by the way. I went to dental school. 15 00:00:28,289 --> 00:00:30,870 I graduated from NYU in 1998. 16 00:00:31,329 --> 00:00:33,109 Did a residency for a year 17 00:00:33,570 --> 00:00:37,010 and then started my journey down private practice 18 00:00:37,010 --> 00:00:38,770 lane when it was actually easy to own 19 00:00:38,770 --> 00:00:41,090 private practices because then you could just kind 20 00:00:41,090 --> 00:00:42,149 of open a practice 21 00:00:42,784 --> 00:00:43,284 and 22 00:00:43,744 --> 00:00:46,304 profit came. I I was kinda crazy because 23 00:00:46,304 --> 00:00:48,465 I knew nothing about business. And yet day 24 00:00:48,465 --> 00:00:50,465 one in my private practice, which was the 25 00:00:50,465 --> 00:00:52,625 day after my residency, somehow I was making 26 00:00:52,625 --> 00:00:53,284 a profit. 27 00:00:53,984 --> 00:00:55,759 That is kind of what played into my 28 00:00:55,759 --> 00:00:57,679 story a little bit. At some point down 29 00:00:57,679 --> 00:01:00,079 the line, sleep apnea became a passion of 30 00:01:00,079 --> 00:01:00,579 mine. 31 00:01:01,439 --> 00:01:02,960 I took a lot of courses on it, 32 00:01:02,960 --> 00:01:05,599 and no matter what I tried to do 33 00:01:05,599 --> 00:01:07,939 by going to these courses and asking questions, 34 00:01:08,000 --> 00:01:10,295 there was no path. Like, no. You wanna 35 00:01:10,295 --> 00:01:12,295 you wanna succeed in sleep apnea, go figure 36 00:01:12,295 --> 00:01:12,954 it out. 37 00:01:13,254 --> 00:01:13,754 And, 38 00:01:14,134 --> 00:01:15,814 I will say unlike a lot of dentists, 39 00:01:15,814 --> 00:01:17,174 I spent three and a half years banging 40 00:01:17,174 --> 00:01:19,015 my head against the wall, like, determined to 41 00:01:19,015 --> 00:01:19,994 figure this out. 42 00:01:20,614 --> 00:01:22,935 Ended up building a big sleep company. So 43 00:01:22,935 --> 00:01:24,314 instead of practicing dentistry, 44 00:01:25,030 --> 00:01:26,709 the long five days a week that I 45 00:01:26,709 --> 00:01:28,629 was, I started practicing dentistry one day a 46 00:01:28,629 --> 00:01:30,069 week, spending the rest of the time on 47 00:01:30,069 --> 00:01:32,329 sleep apnea and building up a big business 48 00:01:32,390 --> 00:01:35,609 surrounding that. I sold that business and then, 49 00:01:36,149 --> 00:01:37,670 had a non compete, and all I could 50 00:01:37,670 --> 00:01:40,055 do was teach. So I started teaching people 51 00:01:40,055 --> 00:01:41,355 exactly what I did, 52 00:01:41,734 --> 00:01:44,534 and that was the International Academy of Sleep, 53 00:01:44,534 --> 00:01:46,695 the company I founded. We just teach dentists 54 00:01:46,695 --> 00:01:48,695 and consulted with them on how they could 55 00:01:48,695 --> 00:01:49,195 big, 56 00:01:49,575 --> 00:01:52,030 build really big sleep practices. This is in 57 00:01:52,030 --> 00:01:54,349 addition to their dental practice. Kind of had 58 00:01:54,349 --> 00:01:55,009 a formula 59 00:01:55,469 --> 00:01:57,549 that if a dentist was gonna spend four 60 00:01:57,549 --> 00:01:59,810 to six hours a week on this and 61 00:01:59,950 --> 00:02:01,390 do what we were asking them to do, 62 00:02:01,390 --> 00:02:03,310 they'd be able to be successful at sleep 63 00:02:03,310 --> 00:02:03,810 apnea 64 00:02:04,255 --> 00:02:06,515 in addition to owning their dental practice. 65 00:02:07,215 --> 00:02:08,974 This was not for everybody. It was an 66 00:02:08,974 --> 00:02:10,915 expensive program, and we put it together 67 00:02:11,375 --> 00:02:13,555 knowing that those who did it would succeed. 68 00:02:13,694 --> 00:02:15,055 In the end, if you look at the 69 00:02:15,055 --> 00:02:17,719 top 10% of producers in dental sleep medicine, 70 00:02:17,719 --> 00:02:19,560 literally almost all of them have come through 71 00:02:19,560 --> 00:02:21,580 that program because we focus on the business, 72 00:02:21,959 --> 00:02:23,959 not the clinical. Clinical is easy. If you're 73 00:02:23,959 --> 00:02:25,959 not a dentist, I'm assuming you're not. I 74 00:02:25,959 --> 00:02:27,080 could teach you how to make one of 75 00:02:27,080 --> 00:02:28,919 these appliances in two hours. Oh. You'd know 76 00:02:28,919 --> 00:02:30,039 how to do it. You'd be as good 77 00:02:30,039 --> 00:02:30,699 as anybody. 78 00:02:31,034 --> 00:02:33,514 That being said, the business end takes time, 79 00:02:33,514 --> 00:02:35,034 and it takes a lot of learning, and 80 00:02:35,034 --> 00:02:36,175 it takes a lot of patience 81 00:02:36,715 --> 00:02:38,574 because there's so many steps to get there. 82 00:02:39,034 --> 00:02:39,534 As 83 00:02:39,995 --> 00:02:41,534 iOS was a lecture company, 84 00:02:42,395 --> 00:02:44,314 we would lecture to bring on new members. 85 00:02:44,314 --> 00:02:45,760 New members would commit to us for a 86 00:02:45,760 --> 00:02:48,400 four year period for a, large sum, about 87 00:02:48,400 --> 00:02:50,960 250 k if they wanted to do it. 88 00:02:50,960 --> 00:02:52,980 That's what we felt it took to succeed. 89 00:02:53,840 --> 00:02:55,379 One thing that was always missing 90 00:02:55,680 --> 00:02:58,159 was a good EMR for sleep. Dentrix is 91 00:02:58,159 --> 00:03:01,074 not, I you know, Eaglesoft is not. There's 92 00:03:01,155 --> 00:03:02,834 the EMRs that were out there were not 93 00:03:02,834 --> 00:03:04,594 sleep based. There were a couple that were 94 00:03:04,594 --> 00:03:06,675 out there, and they just were not very 95 00:03:06,675 --> 00:03:08,834 good. So it was always like, hey. Why 96 00:03:08,834 --> 00:03:10,215 don't you create a software? 97 00:03:10,770 --> 00:03:12,610 And I'm like, yeah. If only I had 98 00:03:12,610 --> 00:03:14,370 time. And then all of a sudden, the 99 00:03:14,370 --> 00:03:16,530 whole world changes, and I had time on 100 00:03:16,530 --> 00:03:18,069 my hands. Because instead of lecturing 101 00:03:18,370 --> 00:03:19,349 every other weekend, 102 00:03:19,810 --> 00:03:21,569 I was home for a period of about 103 00:03:21,569 --> 00:03:23,009 four or five months. And we went down 104 00:03:23,009 --> 00:03:25,349 this journey of building RESTful, the software. 105 00:03:25,935 --> 00:03:29,074 RESTful was originally intended to just be that. 106 00:03:29,294 --> 00:03:31,694 Like, a place where the the goal was 107 00:03:31,694 --> 00:03:34,194 as follows. If a dentist used RESTful, 108 00:03:34,655 --> 00:03:36,495 they would be able to do the steps 109 00:03:36,495 --> 00:03:38,335 that they needed to do in order to 110 00:03:38,335 --> 00:03:40,500 let somebody else bill for them. Because it 111 00:03:40,500 --> 00:03:42,419 does require two things. One, the dentist has 112 00:03:42,419 --> 00:03:44,099 to do their things the right way, and 113 00:03:44,099 --> 00:03:46,099 they're usually not taught the right way. And 114 00:03:46,099 --> 00:03:47,860 even if they are, there's so many shortcuts 115 00:03:47,860 --> 00:03:49,540 they could take that dent they love the 116 00:03:49,540 --> 00:03:51,219 shortcuts, and that would lead to them not 117 00:03:51,219 --> 00:03:52,915 getting paid. So I'm like, well, at least 118 00:03:52,915 --> 00:03:54,675 if we have the software, the dentist would 119 00:03:54,675 --> 00:03:56,675 have to do things their way. Turns out 120 00:03:56,675 --> 00:03:59,074 that was just the beginning. It's now morphed 121 00:03:59,074 --> 00:04:01,254 into an entire full on service 122 00:04:01,715 --> 00:04:04,194 where not only does it do that, we 123 00:04:04,194 --> 00:04:06,034 also pick up the billing end for you, 124 00:04:06,034 --> 00:04:07,560 and our team will bill it. So it's 125 00:04:07,560 --> 00:04:09,400 like, hey. Software forces you to do what 126 00:04:09,400 --> 00:04:11,800 you do well, and it also allows us 127 00:04:11,800 --> 00:04:14,219 to do our part really well. So now 128 00:04:15,240 --> 00:04:17,480 we introduced something to sleep that was not 129 00:04:17,480 --> 00:04:19,240 there. And that's what this has to do, 130 00:04:19,240 --> 00:04:21,165 by the way, with the DSO world, Predictability. 131 00:04:21,464 --> 00:04:23,384 Right? So I am also in the DSO 132 00:04:23,384 --> 00:04:23,884 space. 133 00:04:24,345 --> 00:04:26,425 Along with, partners of mine, we have created 134 00:04:26,425 --> 00:04:28,584 three dentist owned DSOs in the past eighteen 135 00:04:28,584 --> 00:04:30,985 months, couple more to come. And then all 136 00:04:30,985 --> 00:04:32,904 of a sudden, I got this great idea. 137 00:04:32,904 --> 00:04:34,824 Hey. Why not marry these two worlds that 138 00:04:34,824 --> 00:04:36,899 I work in and love both? I love 139 00:04:36,959 --> 00:04:38,899 the sleep world to change my whole life. 140 00:04:38,959 --> 00:04:40,879 Otherwise, I'd probably still be sitting there, you 141 00:04:40,879 --> 00:04:42,579 know, pulling out hairs while 142 00:04:43,199 --> 00:04:44,819 figuring out ways to survive 143 00:04:45,360 --> 00:04:47,199 in a world where DSOs are kind of 144 00:04:47,199 --> 00:04:49,439 dominating the space, and it's tougher for the 145 00:04:49,439 --> 00:04:51,139 solo practitioners to evolve. 146 00:04:51,475 --> 00:04:53,235 So if I could marry these two worlds, 147 00:04:53,235 --> 00:04:55,154 well, now at least I'd be working on 148 00:04:55,154 --> 00:04:56,834 everything I'm doing kind of in the same 149 00:04:56,834 --> 00:04:57,334 space, 150 00:04:58,115 --> 00:04:59,875 in order to do that as I mentioned. 151 00:04:59,875 --> 00:05:02,134 The DSL model is simple. Right? We love 152 00:05:02,355 --> 00:05:02,855 predictability. 153 00:05:03,314 --> 00:05:07,029 Dentistry is predictable and profitable. Right? Private equity 154 00:05:07,029 --> 00:05:08,949 comes in. They spend they're willing to invest 155 00:05:08,949 --> 00:05:10,389 their money. And if they can get that 156 00:05:10,389 --> 00:05:12,790 return, right, a normal GP practice is like 157 00:05:12,790 --> 00:05:15,829 an 18% EBITDA, and a specialty practice maybe 158 00:05:15,829 --> 00:05:17,050 around 25%. 159 00:05:17,189 --> 00:05:18,870 So if private equity knows they're gonna get 160 00:05:18,870 --> 00:05:20,774 that kind of return and then eventually be 161 00:05:20,774 --> 00:05:22,375 able to flip their money for even a 162 00:05:22,375 --> 00:05:24,714 better return, that's interesting to them. 163 00:05:25,095 --> 00:05:27,995 But they stick to bread and butter simplicity. 164 00:05:28,774 --> 00:05:30,535 Now I can tell you that every DSO 165 00:05:30,535 --> 00:05:31,974 out there, all the big ones for sure, 166 00:05:31,974 --> 00:05:33,814 have at least been pitched on sleep apnea. 167 00:05:33,814 --> 00:05:35,310 Probably most of them have tried it, and 168 00:05:35,389 --> 00:05:36,990 all of them have failed. None of them 169 00:05:36,990 --> 00:05:38,829 have ever been able to do it because 170 00:05:38,829 --> 00:05:40,669 there's so many steps from the training of 171 00:05:40,669 --> 00:05:42,189 the dentist to the training of the team 172 00:05:42,189 --> 00:05:44,829 to making sure that somebody is looking out 173 00:05:44,829 --> 00:05:46,430 for the changes. Like, so I told you 174 00:05:46,430 --> 00:05:47,790 I could teach you an oral appliance in 175 00:05:47,790 --> 00:05:49,490 two hours. Let's say I taught you everything 176 00:05:49,795 --> 00:05:50,855 I knew about 177 00:05:51,475 --> 00:05:53,634 the billing and insurance, and that'll be good 178 00:05:53,634 --> 00:05:55,795 for about six months. So somebody out there 179 00:05:55,795 --> 00:05:57,714 has to be looking to say, hey. There's 180 00:05:57,714 --> 00:05:59,475 changes coming. We're gonna have to put those 181 00:05:59,475 --> 00:06:01,714 in place. So now for me, I am 182 00:06:01,714 --> 00:06:04,410 able to bring these two worlds together where 183 00:06:04,410 --> 00:06:06,170 we work with a lot of solo dentists 184 00:06:06,170 --> 00:06:08,410 still on building sleep. These are the dentists, 185 00:06:08,410 --> 00:06:09,529 by the way, who don't wanna sell it 186 00:06:09,529 --> 00:06:10,889 to a DSO. They're just looking for a 187 00:06:10,889 --> 00:06:13,370 way to survive. And then the DSOs that 188 00:06:13,370 --> 00:06:15,610 we've created as well as other DSOs that 189 00:06:15,610 --> 00:06:17,735 we've spoken to, we believe we have an 190 00:06:17,735 --> 00:06:20,214 opportunity to do something that nobody's ever done, 191 00:06:20,214 --> 00:06:23,175 get them successful with sleep. So that's, that's 192 00:06:23,175 --> 00:06:25,254 a long intro of what gets me here. 193 00:06:25,254 --> 00:06:26,615 But, you know, I didn't go into, like, 194 00:06:26,615 --> 00:06:28,535 kindergarten or any of that stuff. So 195 00:06:29,574 --> 00:06:31,175 Love to hear it. Well, kind of in 196 00:06:31,175 --> 00:06:33,560 that same vein, what makes dental sleep medicine 197 00:06:33,560 --> 00:06:35,560 such an opportunity for DSOs? You've kind of 198 00:06:35,560 --> 00:06:36,759 already touched on it, but can you go 199 00:06:36,759 --> 00:06:38,040 into that a little bit more? So first 200 00:06:38,040 --> 00:06:38,540 off, 201 00:06:38,920 --> 00:06:40,920 you know, there's two ways of growing EBITDA. 202 00:06:40,920 --> 00:06:42,360 We all know it. There's the organic way, 203 00:06:42,360 --> 00:06:44,040 and then there's going out and buying EBITDA. 204 00:06:44,040 --> 00:06:45,100 First off, it is 205 00:06:45,774 --> 00:06:47,214 competitive right now if you wanna go out 206 00:06:47,214 --> 00:06:49,694 and buy EBITDA. There's less and less of 207 00:06:49,694 --> 00:06:51,555 the really good practices available. 208 00:06:51,855 --> 00:06:53,454 I don't know what the actual numbers are 209 00:06:53,454 --> 00:06:55,954 in terms of how much the DSOs own. 210 00:06:56,175 --> 00:06:57,855 But when you look at practices that are 211 00:06:57,855 --> 00:06:59,694 sold by brokers, they're always the same thing 212 00:06:59,694 --> 00:07:00,300 right now. 213 00:07:00,779 --> 00:07:02,939 Amazing opportunity. $1,000,000 214 00:07:02,939 --> 00:07:06,779 for operatory practice available here. There's no $2,600,000 215 00:07:06,779 --> 00:07:08,860 practices available because when a broker gets that, 216 00:07:08,860 --> 00:07:10,459 they go straight to the DSOs with it. 217 00:07:10,459 --> 00:07:12,220 And now there's less and less of those 218 00:07:12,220 --> 00:07:13,919 available. They're all getting bought. 219 00:07:15,019 --> 00:07:17,285 That's just kind of life. So then we 220 00:07:17,285 --> 00:07:19,125 start looking at different ways. Well, how can 221 00:07:19,125 --> 00:07:21,444 we grow organically? Now everybody does the same 222 00:07:21,444 --> 00:07:23,925 thing. Right? Hey. We're gonna do centralized systems. 223 00:07:23,925 --> 00:07:25,685 We're gonna put a couple percentage here, a 224 00:07:25,685 --> 00:07:26,904 couple percentage there. 225 00:07:27,764 --> 00:07:29,939 Most DSOs look for people that can place 226 00:07:29,939 --> 00:07:31,540 implants, and if not, they wanna train them 227 00:07:31,540 --> 00:07:33,800 to place implants. And most DSOs do Invisalign, 228 00:07:33,860 --> 00:07:34,759 that's a procedure. 229 00:07:35,300 --> 00:07:37,779 This is the easiest procedure. Like, doing a 230 00:07:37,779 --> 00:07:40,180 sleep apnea appliance is the easiest procedure a 231 00:07:40,180 --> 00:07:42,254 dentist can do. Really easier than doing a 232 00:07:42,254 --> 00:07:44,414 filling because it's just a scan of the 233 00:07:44,414 --> 00:07:46,914 teeth done by their team pretty much. Consult, 234 00:07:47,214 --> 00:07:49,714 scan, insert this perfectly fitted device, 235 00:07:50,414 --> 00:07:51,774 all is well. That is, by the way, 236 00:07:51,774 --> 00:07:53,694 ninety eight percent of the cases. So are 237 00:07:53,694 --> 00:07:55,589 there gonna be some complexities? Sure. 238 00:07:56,069 --> 00:07:57,750 And in those cases, if you're not trained 239 00:07:57,750 --> 00:07:59,350 up, you might have to ask for some 240 00:07:59,350 --> 00:08:01,589 help. But it is ninety eight percent of 241 00:08:01,589 --> 00:08:03,990 the cases. So no different than if a 242 00:08:03,990 --> 00:08:05,829 dentist is working on a patient and something 243 00:08:05,829 --> 00:08:07,589 comes up that's out of their scope. Right? 244 00:08:07,589 --> 00:08:10,410 They refer it out. Anyways, in this case, 245 00:08:11,324 --> 00:08:13,985 the profit margin on sleep appliances is astounding. 246 00:08:14,524 --> 00:08:16,764 Like, it's over $3,000 247 00:08:16,764 --> 00:08:18,144 profit per device. 248 00:08:18,845 --> 00:08:21,165 Now the numbers vary. If you look at 249 00:08:21,165 --> 00:08:23,485 any population, it's like at least ten percent 250 00:08:23,485 --> 00:08:25,904 of the population has undiagnosed sleep apnea, 251 00:08:26,520 --> 00:08:28,920 with that are candidates for oral appliances. More 252 00:08:28,920 --> 00:08:31,399 that are undiagnosed sleep apnea that might need 253 00:08:31,399 --> 00:08:33,740 a CPAP, but candidates for oral appliance. 254 00:08:34,200 --> 00:08:36,440 I mean, just imagine the numbers. You know? 255 00:08:36,440 --> 00:08:38,040 Imagine if all of a sudden ten percent 256 00:08:38,040 --> 00:08:38,940 of your patients, 257 00:08:39,365 --> 00:08:41,524 you are able to make an extra $3,000 258 00:08:41,524 --> 00:08:42,424 on each one. 259 00:08:43,125 --> 00:08:45,144 I'd say really good opportunity. 260 00:08:45,605 --> 00:08:48,485 You know? And, also, listen, it's how many 261 00:08:48,485 --> 00:08:51,225 GP DSOs are there out there? Now thousands 262 00:08:51,284 --> 00:08:52,725 of pump. I don't know. There's a lot. 263 00:08:52,725 --> 00:08:55,519 Probably not thousands. A lot of them. And 264 00:08:55,519 --> 00:08:57,620 what are they doing to distinguish themselves 265 00:08:58,000 --> 00:09:00,959 from the next one? It's typically the same 266 00:09:00,959 --> 00:09:02,639 thing. Now we do know that that is 267 00:09:02,639 --> 00:09:05,039 typically something private equity invests in. But if 268 00:09:05,039 --> 00:09:07,139 all of a sudden somebody's doing something different 269 00:09:07,735 --> 00:09:09,335 and they have a way of showing, well, 270 00:09:09,335 --> 00:09:11,415 we got something different here. We're doing sleep 271 00:09:11,415 --> 00:09:13,654 apnea appliances. We're doing them well. We're doing 272 00:09:13,654 --> 00:09:17,115 them predictably. They're easy for us. They're profitable. 273 00:09:17,815 --> 00:09:19,860 I mean, who wouldn't want this is my 274 00:09:19,860 --> 00:09:20,360 thought. 275 00:09:20,660 --> 00:09:22,899 Absolutely. And when you're presenting this to the 276 00:09:22,899 --> 00:09:24,899 establishment, how do you get them to see 277 00:09:24,899 --> 00:09:26,600 the advantages over the disadvantages? 278 00:09:27,059 --> 00:09:28,179 Yeah. So the first thing I have to 279 00:09:28,179 --> 00:09:29,379 do is tell them I know that they've 280 00:09:29,379 --> 00:09:30,980 tried it already. And I know that you've 281 00:09:30,980 --> 00:09:32,500 heard this pitch, and that's not ever a 282 00:09:32,500 --> 00:09:35,125 fun thing to do. Because when I was 283 00:09:35,125 --> 00:09:36,665 first starting to work with dentists, 284 00:09:37,045 --> 00:09:39,285 I would get the same call every time. 285 00:09:39,285 --> 00:09:40,404 You know? So they would see one of 286 00:09:40,404 --> 00:09:41,524 my ads, and they would call me up, 287 00:09:41,524 --> 00:09:42,725 and they say, well, you know, I tried 288 00:09:42,725 --> 00:09:44,644 this already. It doesn't work. I'm like, well, 289 00:09:44,644 --> 00:09:45,925 tell me what you did. Well, I went 290 00:09:45,925 --> 00:09:46,665 to a course. 291 00:09:47,050 --> 00:09:48,929 I did everything they told me to do. 292 00:09:48,929 --> 00:09:50,929 I treated three patients, sent them to medical 293 00:09:50,929 --> 00:09:53,330 insurance, and got denied. Now there's a little 294 00:09:53,330 --> 00:09:55,990 known fact. If you send as a dentist, 295 00:09:56,129 --> 00:09:57,809 you send a claim to medical insurance and 296 00:09:57,809 --> 00:09:59,410 it's the first claim you send, it is 297 00:09:59,410 --> 00:10:01,514 getting rejected. I don't care what it is. 298 00:10:01,514 --> 00:10:03,115 It can be an oral appliance. It could 299 00:10:03,115 --> 00:10:05,115 be an oral cancer screening. It's gonna get 300 00:10:05,115 --> 00:10:07,595 rejected. There is a system where in order 301 00:10:07,595 --> 00:10:09,434 for dentists to play in the medical insurance 302 00:10:09,434 --> 00:10:11,595 world that they have to follow that, frankly, 303 00:10:11,595 --> 00:10:13,889 most people don't know and or understand. So 304 00:10:14,049 --> 00:10:15,410 So now we're working against the fact that 305 00:10:15,410 --> 00:10:17,090 most of the DSOs have probably tried it, 306 00:10:17,090 --> 00:10:18,690 heard it, spent money on it, by the 307 00:10:18,690 --> 00:10:21,250 way, because to train a team of, you 308 00:10:21,250 --> 00:10:24,450 know, 100 dentists and, you know, 500 staff, 309 00:10:24,450 --> 00:10:26,529 that's a lot of man hours that goes 310 00:10:26,529 --> 00:10:29,075 into training them. So we have to get 311 00:10:29,075 --> 00:10:30,914 over the fact that they've spent money, lost 312 00:10:30,914 --> 00:10:31,414 money. 313 00:10:32,115 --> 00:10:33,815 But, you know, what 314 00:10:34,274 --> 00:10:36,595 I would never have told anyone until we 315 00:10:36,595 --> 00:10:38,855 got this process going was that this was 316 00:10:38,995 --> 00:10:41,169 predictable. I would have never said it. I 317 00:10:41,169 --> 00:10:43,169 would have told everyone, hey. Listen. The this 318 00:10:43,169 --> 00:10:45,090 is gonna very much vary based off of 319 00:10:45,090 --> 00:10:46,769 you. I don't know how hard you're gonna 320 00:10:46,769 --> 00:10:48,450 work. I don't know how much your team's 321 00:10:48,450 --> 00:10:50,210 gonna put into it. Now we don't need 322 00:10:50,210 --> 00:10:52,850 very much. So we did a panel here 323 00:10:52,850 --> 00:10:54,309 at Becker's here this weekend. 324 00:10:54,875 --> 00:10:57,195 And one of our DSOs that we started, 325 00:10:57,195 --> 00:10:58,634 the CEO was here, and he said, you 326 00:10:58,634 --> 00:11:00,634 know, when it comes to sleep, you don't 327 00:11:00,634 --> 00:11:02,414 necessarily want to invest 328 00:11:02,794 --> 00:11:05,034 in this team member who you're all of 329 00:11:05,034 --> 00:11:06,634 a sudden gonna have to train, and you 330 00:11:06,634 --> 00:11:08,475 don't know if that person's good and or 331 00:11:08,475 --> 00:11:10,075 even fits your team or fits the rest 332 00:11:10,075 --> 00:11:10,789 of your team, 333 00:11:11,329 --> 00:11:13,329 Russell kinda becomes that team member for you. 334 00:11:13,329 --> 00:11:15,269 We have that ability to just 335 00:11:15,570 --> 00:11:17,730 be the person that's going to help you 336 00:11:17,730 --> 00:11:20,129 take this to another level. Everyone gets a 337 00:11:20,129 --> 00:11:20,629 billing, 338 00:11:21,169 --> 00:11:23,409 executive that is assigned to them if you're 339 00:11:23,409 --> 00:11:25,490 a DSO, obviously, or if you're a dentist 340 00:11:25,490 --> 00:11:28,115 that does large numbers, which are probably only 341 00:11:28,115 --> 00:11:30,375 about a 100 that do really large numbers. 342 00:11:31,154 --> 00:11:33,315 But, you know, when we start working with 343 00:11:33,315 --> 00:11:34,995 the DSOs and we want them to start 344 00:11:34,995 --> 00:11:37,315 screening their patients, we gotta train the dentist, 345 00:11:37,315 --> 00:11:39,240 we gotta train the teams, We gotta support 346 00:11:39,240 --> 00:11:40,600 it all. We gotta show them how to 347 00:11:40,600 --> 00:11:43,320 use this because it is another EMR. It's 348 00:11:43,320 --> 00:11:45,160 not just an adjunct. The only one that 349 00:11:45,160 --> 00:11:47,800 it does work with if you're, someone who 350 00:11:47,800 --> 00:11:50,200 has an EMR is Open Dental because, well, 351 00:11:50,200 --> 00:11:52,040 it's open. You know? Open Dental makes life 352 00:11:52,040 --> 00:11:53,800 easy. Like, hey. Here's our API. Go to 353 00:11:53,800 --> 00:11:55,615 town. You know? Every other place is very 354 00:11:55,615 --> 00:11:57,154 secretive, so it doesn't work. 355 00:11:57,455 --> 00:11:59,455 But, you know, we wanna be able to 356 00:11:59,455 --> 00:12:01,075 show that this is sitting there. 357 00:12:01,534 --> 00:12:03,934 You don't have any other thing in your 358 00:12:03,934 --> 00:12:06,014 waiting room that's sitting there. Not one other 359 00:12:06,014 --> 00:12:08,860 procedure. Doesn't exist. There's no other procedure you 360 00:12:08,860 --> 00:12:10,779 could go out and learn that is this 361 00:12:10,779 --> 00:12:11,279 easy 362 00:12:11,659 --> 00:12:14,699 and this simple, and it is simple now. 363 00:12:14,699 --> 00:12:16,720 The hard part was always the business end. 364 00:12:16,779 --> 00:12:18,539 We've taken that and just made it really 365 00:12:18,539 --> 00:12:20,459 simple. So we educate the dentist. We say, 366 00:12:20,459 --> 00:12:22,424 hey. Here's what you gotta do. Follow this 367 00:12:22,424 --> 00:12:24,664 thing that says step one, and then finish 368 00:12:24,664 --> 00:12:26,264 it, and then that lets you go to 369 00:12:26,264 --> 00:12:27,384 step two. And it won't let you go 370 00:12:27,384 --> 00:12:28,825 to step two if you didn't finish step 371 00:12:28,825 --> 00:12:30,985 one. So now we're training the dentist to 372 00:12:30,985 --> 00:12:33,945 just click buttons pretty easy. Right? And then 373 00:12:33,945 --> 00:12:36,105 we have our team on the back end 374 00:12:36,105 --> 00:12:38,309 who's going to work with the team there 375 00:12:38,309 --> 00:12:39,910 to say, alright. Here's the few things I 376 00:12:39,910 --> 00:12:42,070 need you to gather from the patients. Here's 377 00:12:42,070 --> 00:12:43,670 the one or two things I need the 378 00:12:43,670 --> 00:12:45,509 doctors to do. It's all guided by the 379 00:12:45,509 --> 00:12:47,509 software. And now we're gonna get you paid 380 00:12:47,509 --> 00:12:49,590 and get you paid probably in, like, record 381 00:12:49,590 --> 00:12:51,430 timing. So when I had my business, we 382 00:12:51,430 --> 00:12:53,154 were always three months behind. I would get 383 00:12:53,154 --> 00:12:55,815 paid three months behind because everything was slow. 384 00:12:55,955 --> 00:12:57,715 Now we're, like, three weeks behind, which is 385 00:12:57,715 --> 00:13:00,514 not that different than normal dental insurance. So 386 00:13:00,514 --> 00:13:02,294 I I think it's a major advantage. 387 00:13:02,595 --> 00:13:04,514 The disadvantage is probably you've tried it. You've 388 00:13:04,514 --> 00:13:06,355 probably lost money on it. You may not 389 00:13:06,355 --> 00:13:08,355 have not every dentist is gonna wanna do 390 00:13:08,355 --> 00:13:10,220 it. You know, you can't force dentists to 391 00:13:10,220 --> 00:13:11,500 do things. We know that is not a 392 00:13:11,500 --> 00:13:13,340 model that works in the DSO space. We 393 00:13:13,340 --> 00:13:15,899 want dentists to do dentistry and concentrate on 394 00:13:15,899 --> 00:13:17,340 it. This is just an easy thing for 395 00:13:17,340 --> 00:13:19,660 them to do at. And because, listen, most 396 00:13:19,660 --> 00:13:21,200 associates are paid on collections, 397 00:13:21,754 --> 00:13:24,394 if you're collecting 3 to 4,000 and it's 398 00:13:24,394 --> 00:13:26,394 that 30 percent model, this is easy money 399 00:13:26,394 --> 00:13:28,634 for them too. So it just works all 400 00:13:28,634 --> 00:13:29,455 the way around. 401 00:13:29,995 --> 00:13:31,434 Got it. So it sounds like they kind 402 00:13:31,434 --> 00:13:33,995 of outsource the headaches to you guys. Yes. 403 00:13:33,995 --> 00:13:35,914 Very much so. Bring your headaches on. We 404 00:13:35,914 --> 00:13:36,575 love them. 405 00:13:37,029 --> 00:13:39,350 Well, yeah. I've enjoyed our conversation so far. 406 00:13:39,350 --> 00:13:40,950 But to wrap things up, can you share 407 00:13:40,950 --> 00:13:43,669 any advice to anyone from the executive suite, 408 00:13:43,830 --> 00:13:46,710 and DSOs to the chairside dentists who think 409 00:13:46,710 --> 00:13:49,370 the promise and possibility of dental sleep medicine 410 00:13:49,605 --> 00:13:51,945 on a larger scale is overrated or exaggerated 411 00:13:52,004 --> 00:13:54,264 or just can't be as fulfilling as described. 412 00:13:55,044 --> 00:13:55,365 So 413 00:13:56,164 --> 00:13:58,245 and we have to face those truths. A 414 00:13:58,245 --> 00:13:59,764 lot of them have tried it. A lot 415 00:13:59,764 --> 00:14:00,745 of them have failed. 416 00:14:01,204 --> 00:14:02,804 What I would say, this has to be 417 00:14:02,804 --> 00:14:03,704 worth a conversation. 418 00:14:04,245 --> 00:14:05,980 It just has to be, you You know? 419 00:14:05,980 --> 00:14:07,820 Hey, Avi. Tell me what's different. What do 420 00:14:07,820 --> 00:14:09,740 you do now that's different than that program 421 00:14:09,740 --> 00:14:11,259 who came to us three years ago and 422 00:14:11,259 --> 00:14:12,240 promised the world, 423 00:14:12,620 --> 00:14:14,299 and charged us $200, 424 00:14:14,299 --> 00:14:16,860 didn't deliver on? And so we would go 425 00:14:16,860 --> 00:14:18,860 through it. We'd wanna hear what they've been 426 00:14:18,860 --> 00:14:20,294 through, and I know what they've been through. 427 00:14:20,294 --> 00:14:22,855 A lot of clinical training. That is really 428 00:14:22,855 --> 00:14:25,014 what when somebody introduces sleep, that's what they 429 00:14:25,014 --> 00:14:26,235 do. They train the dentist. 430 00:14:26,615 --> 00:14:29,095 And they don't fully train the team, and 431 00:14:29,095 --> 00:14:31,174 I'm saying it out loud because they don't 432 00:14:31,174 --> 00:14:33,200 really know how to. You know, they are 433 00:14:33,440 --> 00:14:36,160 the the rules are constantly changing, and every 434 00:14:36,160 --> 00:14:38,320 insurance is different. So our software kind of 435 00:14:38,320 --> 00:14:40,080 has all the insurances built into them, and 436 00:14:40,080 --> 00:14:41,920 each one has a different protocol. So you 437 00:14:41,920 --> 00:14:43,440 just have to follow that one. Like, you 438 00:14:43,440 --> 00:14:44,899 know, you live in Idaho. 439 00:14:45,245 --> 00:14:46,845 Go to the drop down box for Idaho, 440 00:14:46,845 --> 00:14:48,684 pick the insurance. It'll kinda guide you through 441 00:14:48,684 --> 00:14:50,284 that. That took us a long time, by 442 00:14:50,284 --> 00:14:51,404 the way, to go through all that. I'm 443 00:14:51,404 --> 00:14:53,204 sure. Yeah. An extremely long this was three 444 00:14:53,204 --> 00:14:54,684 and a half years till we could launch 445 00:14:54,684 --> 00:14:57,084 it because of all this silliness. Different markets. 446 00:14:57,084 --> 00:14:59,644 Yeah. Different markets, different insurances, and changing insurances. 447 00:14:59,644 --> 00:15:01,620 We could get it straight. Listen. Imagine, 448 00:15:02,159 --> 00:15:05,039 a world where the first iPhone came out 449 00:15:05,039 --> 00:15:06,399 and they gave it to you, and you're 450 00:15:06,399 --> 00:15:08,500 like, here you go. You're set for life. 451 00:15:08,720 --> 00:15:10,799 That's not what happened. Number one, there was 452 00:15:10,799 --> 00:15:13,459 a software update every single week. Number two, 453 00:15:13,644 --> 00:15:14,144 there's 454 00:15:14,445 --> 00:15:16,704 constantly new iPhones out there and 455 00:15:17,004 --> 00:15:19,804 bigger, better, different, maybe a little less different 456 00:15:19,804 --> 00:15:21,404 now than they used to be. But, you 457 00:15:21,404 --> 00:15:24,524 know, always something better out there. The dental 458 00:15:24,524 --> 00:15:27,870 sleep software world was the iPhone one. We 459 00:15:27,870 --> 00:15:30,110 built this product. It's great today, and it's 460 00:15:30,110 --> 00:15:31,870 obsolete in six months, and we're not willing 461 00:15:31,870 --> 00:15:33,870 to spend on. Restful is never gonna be 462 00:15:33,870 --> 00:15:36,129 a finished product. Just won't be. We understand 463 00:15:36,190 --> 00:15:38,529 this world. We understand this world's always changing. 464 00:15:38,669 --> 00:15:41,865 We're changing with the world. Yeah. There's constantly 465 00:15:41,924 --> 00:15:44,245 rule changes. And those rule changes are done 466 00:15:44,245 --> 00:15:46,004 for one reason. They don't wanna pay you 467 00:15:46,004 --> 00:15:48,664 insurances. Medical insurances do not wanna pay dentists. 468 00:15:48,725 --> 00:15:50,565 Promise. They don't. They're gonna try and find 469 00:15:50,565 --> 00:15:52,245 a way to reject. So if we have 470 00:15:52,245 --> 00:15:54,424 a way to get around those rejections by 471 00:15:54,565 --> 00:15:55,625 following the rules, 472 00:15:56,559 --> 00:15:58,639 insurances have to pay. So to me, it's 473 00:15:58,639 --> 00:16:00,100 at least worth the discussion. 474 00:16:00,480 --> 00:16:02,079 Sure. We can help talk to the dentist. 475 00:16:02,079 --> 00:16:03,919 I would expect in a DSO that has 476 00:16:03,919 --> 00:16:06,000 a 100 dentists, maybe 10 of them are 477 00:16:06,000 --> 00:16:08,159 interested in trying it. Go pilot it there. 478 00:16:08,159 --> 00:16:09,535 You don't have to do a full on 479 00:16:09,535 --> 00:16:11,215 commitment, you know, where if you have a 480 00:16:11,215 --> 00:16:13,774 thousand locations, all thousand must do this. It's 481 00:16:13,774 --> 00:16:14,434 not realistic. 482 00:16:14,815 --> 00:16:16,575 It's realistic to pilot it with a few 483 00:16:16,575 --> 00:16:18,335 that wanna try it. Let them be the 484 00:16:18,335 --> 00:16:19,774 proof of the pudding. There is this isn't 485 00:16:19,774 --> 00:16:22,674 gonna be anything that's backbreaking from an expense 486 00:16:23,079 --> 00:16:24,679 standpoint. And if you give it six months 487 00:16:24,679 --> 00:16:26,360 to a year, you're going to see the 488 00:16:26,360 --> 00:16:28,839 benefits from, a, a financial end. And I 489 00:16:28,839 --> 00:16:31,019 will tell you that this creates other procedures 490 00:16:31,240 --> 00:16:34,279 for you. So I had stopped doing general 491 00:16:34,279 --> 00:16:36,360 dentistry in my practice because I didn't have 492 00:16:36,360 --> 00:16:36,860 time. 493 00:16:37,315 --> 00:16:38,995 And all of a sudden, I started getting 494 00:16:38,995 --> 00:16:41,014 all these patients referred to me 495 00:16:41,554 --> 00:16:43,475 because of sleep. Right? So they were coming 496 00:16:43,475 --> 00:16:46,615 from doctor's offices, not just from regular sources. 497 00:16:46,995 --> 00:16:48,995 Now I always say this. Imagine you're in 498 00:16:48,995 --> 00:16:51,269 a hotel like this, and we tap somebody 499 00:16:51,269 --> 00:16:52,550 on the shoulder and say, do you go 500 00:16:52,550 --> 00:16:54,629 to the dentist? About 50% of the people 501 00:16:54,629 --> 00:16:55,990 in the world don't go to a dentist. 502 00:16:55,990 --> 00:16:58,389 Wow. Yeah. It's crazy. It's like 50 go, 503 00:16:58,389 --> 00:16:59,670 50 don't. It tends to be the ones 504 00:16:59,670 --> 00:17:02,070 with insurance. They all go. However, you got 505 00:17:02,070 --> 00:17:03,834 a room full of sick people. You know 506 00:17:03,834 --> 00:17:05,214 how many of them go to the doctor? 507 00:17:05,434 --> 00:17:07,194 All of them. Yeah. And so it's like, 508 00:17:07,194 --> 00:17:08,795 all of a sudden, these patients started coming 509 00:17:08,795 --> 00:17:09,855 into my office 510 00:17:10,234 --> 00:17:10,734 that 511 00:17:11,275 --> 00:17:12,494 needed a sleep appliance. 512 00:17:13,115 --> 00:17:14,795 The reason they weren't a candidate for it 513 00:17:14,795 --> 00:17:16,394 yet, and we put them in a temporary 514 00:17:16,394 --> 00:17:18,180 device, was their teeth were a mess. 515 00:17:18,660 --> 00:17:20,420 So I started doing all these full mouth 516 00:17:20,420 --> 00:17:22,580 rehabs on these cases that started coming into 517 00:17:22,580 --> 00:17:23,799 my office as referrals. 518 00:17:24,100 --> 00:17:26,259 It created a whole huge boom. It was 519 00:17:26,259 --> 00:17:28,759 the single biggest builder of my restorative practice 520 00:17:28,900 --> 00:17:31,700 as well as just being a big business 521 00:17:31,700 --> 00:17:34,315 that, listen, it's gonna set you apart. It's 522 00:17:34,315 --> 00:17:35,835 gonna be something that when all of a 523 00:17:35,835 --> 00:17:37,194 sudden they look and they say, hey. How 524 00:17:37,194 --> 00:17:38,795 did your EBITDA go from here to here 525 00:17:38,795 --> 00:17:39,535 in a year? 526 00:17:39,994 --> 00:17:41,375 We saw you only bought 527 00:17:41,914 --> 00:17:42,734 10 new 528 00:17:43,115 --> 00:17:43,615 practices. 529 00:17:44,329 --> 00:17:45,769 There's no way all your EBITDA came from 530 00:17:45,769 --> 00:17:47,130 there. Where did it come from? Now all 531 00:17:47,130 --> 00:17:48,569 of a sudden, we have something different to 532 00:17:48,569 --> 00:17:50,410 pitch. Now all of a sudden, we may 533 00:17:50,410 --> 00:17:52,509 be a little different than your standard GPDSO. 534 00:17:52,730 --> 00:17:55,210 I mean, specialty markets are doing great. Specialty 535 00:17:55,210 --> 00:17:58,269 DSOs are doing great. That's unique. That's different. 536 00:17:58,595 --> 00:18:00,595 This is a chance for any DSO to 537 00:18:00,595 --> 00:18:02,835 really start to either stand out and or 538 00:18:02,835 --> 00:18:04,835 just, hey. You wanna increase what you're doing 539 00:18:04,835 --> 00:18:06,755 now. It's better. It's great for your patients. 540 00:18:06,755 --> 00:18:08,674 You know, the most loyal patients you have 541 00:18:08,674 --> 00:18:10,595 are the ones that you get to change 542 00:18:10,595 --> 00:18:12,934 their world. Right? So this is a stat. 543 00:18:13,420 --> 00:18:15,119 The average sleep apnea 544 00:18:15,740 --> 00:18:17,200 patient that is treated 545 00:18:17,980 --> 00:18:21,019 versus someone who's diagnosed and untreated or just 546 00:18:21,019 --> 00:18:21,519 undiagnosed, 547 00:18:22,460 --> 00:18:25,420 the treated ones live on average eight years 548 00:18:25,420 --> 00:18:25,920 longer. 549 00:18:26,355 --> 00:18:28,595 I mean, that's life changing. You know, you're 550 00:18:28,595 --> 00:18:30,035 in the store and all of a sudden 551 00:18:30,035 --> 00:18:31,794 there's something on the shelf that says eight 552 00:18:31,794 --> 00:18:33,154 years of life. What are you paying for 553 00:18:33,154 --> 00:18:34,674 it? And the quality of life has to 554 00:18:34,674 --> 00:18:36,595 go up Immediately. Significantly. Yeah. Yeah. And if 555 00:18:36,595 --> 00:18:38,755 you're interested in it, your spouse won't despise 556 00:18:38,755 --> 00:18:40,650 you anymore. It just won't keep them up. 557 00:18:40,730 --> 00:18:43,049 Yes. So, like, I not everybody who has 558 00:18:43,210 --> 00:18:44,730 who snores has sleep apnea, by the way. 559 00:18:44,730 --> 00:18:46,170 I am told I snore, so I wear 560 00:18:46,170 --> 00:18:46,830 an appliance. 561 00:18:47,529 --> 00:18:49,609 I don't have sleep apnea. I've been tested 562 00:18:49,609 --> 00:18:51,630 hundreds of times. There's, you know, 563 00:18:51,930 --> 00:18:53,930 there's a level that they call sleep apnea, 564 00:18:53,930 --> 00:18:55,930 and it's dictated by the insurance companies, of 565 00:18:55,930 --> 00:18:57,934 course. It says if you stop breathing five 566 00:18:57,934 --> 00:18:59,455 times an hour, you have sleep apnea. If 567 00:18:59,455 --> 00:19:01,855 you stop breathing 4.9 times, you're considered not 568 00:19:01,855 --> 00:19:03,695 to have it. So, obviously, there's something missing 569 00:19:03,695 --> 00:19:04,755 there. But 570 00:19:05,055 --> 00:19:06,355 when I wear my appliance, 571 00:19:06,815 --> 00:19:08,975 I feel better, plain and simple. So it 572 00:19:08,975 --> 00:19:11,630 does change quality of life. I'm better rested, 573 00:19:11,769 --> 00:19:13,130 more ready to go out and go get 574 00:19:13,130 --> 00:19:16,330 them. And it just because there's those patients 575 00:19:16,330 --> 00:19:18,890 and that loyalty factor, you know, kind of 576 00:19:18,890 --> 00:19:20,250 everything we're looking for. You know what I've 577 00:19:20,250 --> 00:19:22,410 heard over and over here this weekend? We're 578 00:19:22,410 --> 00:19:23,470 all about the patients. 579 00:19:23,865 --> 00:19:26,184 We're all about that customer service. Our patients 580 00:19:26,184 --> 00:19:28,904 are everything to us. Well, you're skipping one 581 00:19:28,904 --> 00:19:30,825 big thing that you could actually do for 582 00:19:30,825 --> 00:19:33,305 them that's really gonna make them loyal. And 583 00:19:33,305 --> 00:19:34,585 if you got the chance to do it, 584 00:19:34,585 --> 00:19:37,005 grab it. It's gotta be worth the conversation. 585 00:19:37,065 --> 00:19:38,365 You got nothing to lose. 586 00:19:38,720 --> 00:19:40,240 I don't expect to talk to, like, a 587 00:19:40,240 --> 00:19:42,240 large DSO one person and then all of 588 00:19:42,240 --> 00:19:44,320 a sudden have a yes. There'll be a 589 00:19:44,320 --> 00:19:46,000 variety of meetings that we get to to 590 00:19:46,000 --> 00:19:47,839 get to a pilot program, and hopefully, that 591 00:19:47,839 --> 00:19:50,580 would make sense for, in my opinion, everybody, 592 00:19:50,880 --> 00:19:52,400 but for at least those who are willing 593 00:19:52,400 --> 00:19:53,299 to take the chance. 594 00:19:53,884 --> 00:19:55,085 Love to hear it. Well, Avi, I wanna 595 00:19:55,085 --> 00:19:56,684 thank you once again for your time today 596 00:19:56,684 --> 00:19:58,125 and for sharing your insights on the Becker's 597 00:19:58,125 --> 00:20:00,444 Healthcare podcast. Oh, my pleasure. Thanks for having 598 00:20:00,444 --> 00:20:02,924 me. And we also wanna thank our podcast 599 00:20:02,924 --> 00:20:03,904 sponsor, Restful, 600 00:20:04,204 --> 00:20:06,905 powered by International Academy of Sleep. We hope 601 00:20:06,905 --> 00:20:08,505 you have a wonderful rest of your day 602 00:20:08,505 --> 00:20:10,265 and look forward to having you tune in 603 00:20:10,265 --> 00:20:12,105 to future episodes. Thank you so much. Thank 604 00:20:12,105 --> 00:20:13,325 you. Appreciate it.