Dr. Derek Bock by DR

Dr. DerekMeet Bock Q2 2017

BUSINESS PRACTICE MARKETING/SOCIAL MEDIA ANSWERS FROM THE EDGE & DEVELOPMENT WTF! MARKETING! INTERVIEWS WITH DR. BEN FISHBEIN THE FUTURE IS CLEAR -BY JEFF BEHAN & DR. JO HANSEN – INTERVIEWS WITH JARRETT PUMPHREY & JOE HOGAN 2017 Speakers OCTOBER 27-28 IN ORDER OF APPEARANCE

YOUR EMCEE ANIL IDICULLAIDICULLA JEFF KOZLOWSKI COURTNEY DUNN JASON TAM CHRISCHRIS BENTSON NEAL KRAVITZ TOM CLARK DEREK BOCK AS EMCEE

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edition... COVER STORY BUSINESS PRACTICE Meet & DEVELOPMENT Derek Bock 10 The Future is Clear: Clear Correct Page 62 INTERVIEW WITH JARRETT PUMPHREY

14 MARKETING/ The Future is Clear: Invisalign SOCIAL MEDIA OFFICE LOGISTICS INTERVIEW WITH JOE HOGAN

24 35 30 It’s Not Just Your Practice. It’s Your 3D Printers Cell Phones and Toothbrushes: Moment. BY DR. CHRISTIAN GROTH Technology in the Orthodontic BY ANGELA WEBER Practice BY CHRIS BENTSON 46 88 Professional-Level Photography in This is NOT your Daddy’s Ortho! 62 5 Steps BY ANDREA COOK Meet Dr. Derek Bock BY DR. KYLE FAGALA 92 72 How to Maximize the Selling Value “How Do I Do More Invisalign?” 79 of Your Practice WTF! Marketing! BY DR. JASON TAM BY CHARLENE WHITE BY JEFF BEHAN 75 The Business Benefit of 84 Regular Clinical Photos How to Properly Target a Facebook/ ORTHOPUNDIT.COM BY DR. JEFF KOZLOWSKI Instagram Ad BY SCOTT HANSEN 106 99 The Future of Clear Aligners Three Pillars of the Modern Practice, BY DR. BEN BURRIS Part 3: You Can’t Beat the Systems CLINICAL CORNER BY DR. JAMIE REYNOLDS 56 ANSWERS FROM THE Invisalign® and Propel: EDGE H.R. INSIGHT The Next Generation Orthodontic Disruptor 21 BY DR. GARY BRIGHAM Interviews with Dr. Ben Fishbein 41 and Dr. Jo Hansen “Hey Doc! I’m Giving You My Two Weeks Notice.” BY DR. JASON BATTLE

The ideas, views and opinions in each article are the opinion of the named author. They do not necessarily reflect the views of The Progressive Orthodontist, its publisher, or editors. The Progressive Orthodontist® (“Publication”) DOES NOT provide any legal or accounting advice and the individuals reading this Publication should consult with their own lawyer for legal advice and accountant for accounting advice. The Publication is a general service that provides general information and may contain information of a legal or accounting nature. There is no guarantee or warranty regarding the information contained in the Publication and we are not responsible for any loss, injury, claim, liability, or damage (“damages”) related to your use of the information contained in the Publication or from errors or omissions in the content of the Publication. While we have worked to make our Publication and all the features in the Publication as helpful as possible, the Publication does not endorse any content provided by any feature, nor does it assume any responsibility for the interpretation or application of any information originating from such content. In addition, The Progressive Orthodontist does not endorse any content contained in any advertising on the Publication, nor does it assume any responsibility for the quality or integrity of such work. Content is property of The Progressive Orthodontist and may not be copied or otherwise duplicated without prior written consent from The Progressive Orthodontist. All content contributed to The Progressive Orthodontist magazine becomes the property of SmileMedia. The publisher assumes no responsibility for return of unsolicited manuscripts, art, photos or other content.

Q2 • 2017 | TheProOrtho.com 1 EXECUTIVE EDITOR EDITOR’S NOTE Dr. Ben Burris CLINICAL EDITOR Dr. Derek Bock

PUBLISHER Amy Bradshaw ADVISORY BOARD 2017 has turned out to be as exciting as anticipated. Dr. Jason Battle Tons of change, a plethora of awesome meetings and continued Dr. Derek Bock growth/diversification of the resources available to the modern Chris Bentson orthodontist – and that’s just in the first quarter of 2017! If you know Bridget Burris anything about me you’ll know that I firmly believe CHANGE IS Dr. Courtney Dunn GOOD and that the marketplace is the best decider when it comes Dr. Jennifer Eisenhuth to the viability of any model in any space. Through that lens, I see all Dr. Kyle Fagala of this change as positive and I choose to focus on the opportunity Dr. Jose Luis Garcia created instead of allowing fear or scarcity thinking to dominate. I Dr. Anil Idiculla would advise you to do the same. Invisalign, SmileDirectClub, General Dr. Alfred Jackson Dentists, Mid-Level Providers and DSOs are not threats, they just are. Dr. Aly Kanani We cannot control what others do or how the world turns but we can Dr. Kliff Kapus control how we react to it. The best way I can describe this mindset Dr. John McManaman (and the alternative) is with an analogy: Dr. Jamie Reynolds Dr. Nona Naghavi ––––––––––––––––––––––––––––––––––– Sarah Sharfstein Dr. Jason Tam If you visit the beach and wade out shoulder deep Angela Weber at low tide then the rising tide becomes a “threat” to you… but only if you are unwilling to move! GRAPHIC DESIGNER Megan Clark ––––––––––––––––––––––––––––––––––– ADVERTISE WITH US The future is now. There are many times more people who want SUSIE SNOW 994-202-1010 orthodontics than there are currently receiving treatment. Figure out how to do more, faster, better, more conveniently and more affordably The Progressive Orthodontist magazine and and you can’t help but thrive. Stubbornly hold on to the past and study group are your educational resources wish for the “good ole days” and you’ll drown. And you have no one for new trends, progressive insights and best practices for building a successful orthodontic to blame but yourself. You are smart, you work hard and you care… practice in 2016 and beyond. prove it. It’s actually pretty easy once you get your head right! See you in San Diego! CHECK US OUT ONLINE WWW.THEPROORTHO.COM

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Q3 • 2016 | TheProOrtho.com 5 CONTRIBUTORS

DR. DEREK BOCK DR. CHRISTIAN JOE HOGAN GROTH Dr. Derek Joseph M. Hogan Bock grew up in Christian Groth joined Align in June Massachusetts, was born, raised, and 2015 as President, near Cape Cod. practices outside of Chief Executive He remained on Detroit, Michigan. Officer (CEO), the East Coast for He completed his dental and orthodontic and a Director of his undergraduate training at the University of Michigan and now Align Technology. studies prior to is a partner with TDR Orthodontics. In 2015, Mr. Hogan is an attending Tufts University School of Dental Christian and his partners opened Motor City accomplished chief Medicine in Boston. Following dental school Lab Works, a digital orthodontic lab specializing executive with extensive experience across graduation, he completed a three-year residency in 3D printing. He has a passion for utilizing multiple industries including healthcare, in orthodontics and obtained his Master of technology in order to improve the patient and technology and industrial automation. Science in oral sciences at University of Illinois staff experience. When not in practice, Christian Before joining Align, Mr. Hogan served as at Chicago In addition to his residency, Dr. enjoys spending time with his wife and two CEO of ABB, a $40 billion global power and Derek also completed a one-year fellowship in young children, running, and cheering on the automation technologies company based in craniofacial orthodontics at the University of University of Michigan. Zurich, Switzerland. During his five years at Illinois Craniofacial Center. Recently he’s been ABB, Mr. Hogan oversaw a 25% increase in spending his free time overseeing his clinical revenues. Prior to ABB, Mr. Hogan spent 25 group The Pragmatic Orthodontic Clinical years at General Electric (GE) in a variety of Discussions; www.facebook.com/groups/ executive and management roles, including DR. KYLE PragmaticOrthodontics. He owns and operates eight years as CEO of GE Healthcare, where multi-location Pedo/Ortho practices with his FAGALA he drove significant geographic and market Pediatric dentist wife Anokhi Bock. Dr. Kyle portfolio expansion and more than doubled Fagala is the revenues from $7 billion to $16 billion. Mr. owner and Hogan earned an M.B.A. from Robert Morris University and a B.S. degree in Business and DR. JAMIE REYNOLDS orthodontist at Saddle Creek Economics from Geneva College, both in Orthodontics in Pennsylvania. Dr. Reynolds attended the Germantown, University of Michigan Tennessee. Dr. Fagala graduated in May of for both his 2013 with a certificate in orthodontics and a JARRETT PUMPHREY undergraduate master’s degree in Dental Science for his thesis and dental studies. on three-dimensional imaging of the airway. While at Michigan Jarrett Pumphrey Dr. Fagala is the course director and lecturer he was a member has been the Chief of Development of the Occlusion, a class for of the volleyball Executive Officer 1st year dental students at the University of team, earning both team captain and All- of ClearCorrect Tennessee Health Science Center. He also Big Ten honors. Dr. Reynolds attended since 2007. He has provides orthodontic treatment for children the University of Detroit-Mercy earning a led ClearCorrect at Pediatric Dental Group in Southaven and master’s degree in orthodontics. He lectures from a start-up to a Olive Branch, Mississippi. He loves music, extensively on orthodontic technology and leading clear aligner specifically the drums, and spends more practice management and is also a co-founder manufacturer that time than he should on social media. Dr. of OrthoFi. In his spare time, he has a passion services over 20,000 doctors in the US, UK, Fagala, his wife Anna, their son Charlie, and to travel, spend time with his family, and learn Australia, and Canada. Over the past decade, daughter Libby live in Germantown and attend new things. Also, as a beach bum at heart, Dr. Jarrett’s main focus has always been to ensure Highland Church of Christ. Reynolds can be found in the summertime near ClearCorrect providers receive the best a beach volleyball court covered head to toe in possible product and customer support to sand. meet their needs.

6 It’s just BUSINESS ANDREA COOK SCOTT HANSEN CHARLENE WHITE Andrea Cook’s Charlene White’s Scott Hansen is the owner in-office, hands on expertise and depth of OrthoChats, the world’s training motivates of knowledge in the leading professionally and energizes orthodontic specialty is managed chat service orthodontic clinical world renowned. for orthodontists. In teams. She bases Charlene graduated addition, he manages training systems on from Old a quickly growing practical knowledge DominionUniversity orthodontic practice gained through in 1975 and spent in Kansas City. While achieving his Masters is 20 years chairside the next five years Business experience. She works as a clinical consultant as a RDH and office manager. She founded Administration at the University of Missouri and trainer for premier orthodontic offices her company, Progressive Concepts, in 1983. - Kansas City, he was awarded a certificate of across the country. Since effectively training She has successfully consulted in over 750 achievement for his entrepreneurial work from clinical team members is a critical portion orthodontic practices in 29 years, interviewed the Regnier Institute for Entrepreneurship and to the advancement of clinical productivity over 7,000 team members, presented over 300 Innovation. Feel free to contact Scott at Scott@ and profitability Andrea works with teams to Continuing ED courses, is a highly sought OrthoChats.com, (401) 99CHATS, or chat online increase efficiency, improve communication after industry speaker, and has written and at OrthoChats.com. and guides the office to a new level of filmed 20 training products. She partnered excellence. Her years of experience include with Dolphin Management to create the working in single, double, and multi doctor DR. JASON TAM “Charlene White SOS” computer module. She practices. She has extensive experience as Dr. Jason Tam is consistently hears from program directors, clinical coordinator for a multi doctor practice the owner of MCO “We are so excited about the turnout for seeing over 120 patients per day. Andrea’s Orthodontics our event.” Charlene is passionate about experience allows her to understand and (www.mcosmiles. orthodontics. Her energy and enthusiasm address the concerns of the clinical team. com), with four for her clients and teams to succeed is locations in and unparalleled. Innovative, hard working, and around Toronto, down to earth describe Charlene. Charlene is ANGELA Canada. He currently serving on the Board of Directors for WEBER completed his Smiles 4 a Lifetime. Charlene is a Norfolk, VA dental school at the University of Toronto, native, an avid reader, and a passionate golfer. Angela Weber followed by a GPR at New York Hospital is the Chief Queens, and an orthodontic residency at Marketing Officer Boston University. for OrthoSynetics While his practice is primarily braces, he is a company a Top 1% Super Elite Invisalign Provider. His which specializes DR. JEFF work has been published in three consecutive in business KOZLOWSKI services for the Invisalign Case Gallery Publications, he has spoken for Align Technology internationally, orthodontic and dental industry. She leads a Jeff Kozlowski has a team of marketing professionals dedicated to and has been involved in several Align pilot unique perspective developing and implementing cutting-edge studies. Dr. Tam has a special interest in office on the importance strategies and solutions for their members. efficiencies and implementation. He is happily of clinical efficiency Angela has over 15 years of experience in married with two young boys and a daughter. the advertising industry with a vast knowledge in the business of of current and past trends, philosophies and orthodontics. With strategies for marketing within the healthcare a background in industry. Angela has a proven track record of Economics and Finance rather than Biology and driving new patient volume through innovate Histology, numbers and systems prevail over marketing practices. cytokines and osteoblasts. While his experience Angela holds a B.A. in Mass in orthodontics is varied - from managing a four Communications from Louisiana State University and an M.B.A. from the University doctor 5 location mega practice - to opening a of New Orleans. start-up - to lecturing around the world - the one thing that has always been constant is the importance of achieving great clinical results in the least amount of effort.

Q2 • 2017 | TheProOrtho.com 7 CONTRIBUTORS

JEFF BEHAN DR. JASON BATTLE DR. GARY E ective. Jeff Behan is a BRIGHAM Dr. Jason Battle communications Gary Brigham, DDS, received his Doctorate and consumer MSD earned his of Dental marketing Surgery with doctorate at Case specialist. He is a honors from Western Reserve fun and relevant the University University, where he speaker whose subject matter focuses on of Tennessee’s also received his certificate in orthodontics College of internal/external communication, connecting and a master’s degree in immunology. He was Dentistry. He holds a certificate of advanced with existing and prospective patients, awarded the Harry Sicher Award from the graduate studies in orthodontics and referral-building and practice branding. Over AAO for his graduate research, and served as dentofacial orthopedics from Jacksonville his career, he has worked with a diverse array an Assistant Professor of Pediatric Medicine University School of Orthodontics and of clients including Intel Corp and Delta at the Center for Craniofacial Anomalies, the earned a Bachelor of Science in Biology from Airlines in addition to numerous dental and Valdosta State University. Dr. Battle was University of Illinois at the Medical Center in orthodontic companies (Align Technology, born in Michigan, and raised in Cincinnati Chicago. He has lectured throughout the U.S. Ormco, Henry Schein and OraMetrix.) and Atlanta. His favorite pastimes are being for Align Technology since 2004, for which he He is the principal member of VisionTrust outside participating in sports, grilling received Align’s first award for his service to the (specifically BBQ), and watching athletic Communications, a company known for profession. events or documentaries on the history custom marketing solutions that serves Dr. Brigham currently is an Adjunct channel. You can usually find him spending over 1,000 orthodontic practices around the Professor of Orthodontics at the orthodontic time with family, at the gym, softball field, world. Jeff is also a founding board member graduate program at A.T. Still School of or playing flag football. Dr. Battle believes in of VisionTrust International, an international Dentistry and Oral Health, where he serves giving back to the community. He volunteers NGO serving orphaned and neglected children his time to provide dentistry to those in as the dedicated Invisalign® instructor. He is a in 17 countries around the world, and he is need at the Orange County Dental Research member of Align’s Faculty and serves on Propel currently serving as Vice President of Smiles Clinic and through the Smiles Change Lives Orthodontics’ Advisory Board. Dr. Brigham for a Lifetime, providing free orthodontic Foundation. He is also active in Kiwanis local maintains a full-time practice in Scottsdale, schools, day care centers, and camps to teach treatment to deserving kids in North America. Arizona. proper brushing and nutrition. We’ve been making clear aligners for ten years. CHRIS BENTSON We’ve gotten very good at it.

Chris Bentson is a partner of Bentson Clark & Copple, LLC based in Greensboro, North Carolina. The company serves the orthodontic community by performing practice valuations, providing recruiting services and negotiating transactions with both buyers and sellers within the United States. Chris serves as Editor-‐in-‐Chief of the Bentson Clark reSource, a quarterly newsletter focused on the business aspects of running a successful orthodontic practice. Bentson Clark & Copple exclusively provides services to orthodontists, and the reSource is an extension of the company’s commitment to provide valuable business information to orthodontists throughout the nation. Chris spends much time working in the orthodontic industry; he currently serves as a committee The most a ordable, doctor-friendly member form the AAOFTT (American Association Of Orthodontists’ Future Think Tank), an advisory committee member for The AAO Bulletin, an advisory board member for Ortho4D, and alternative in clear aligners since 2006. board member of the AAOF (American Association of Orthodontists Foundation). In addition, he is a frequent guest lecturer at AAO meetings, regional orthodontic society meetings, orthodontic resident programs, study clubs and orthodontic user meetings. Chris has authored dozens of articles published on the business of orthodontics in numerous orthodontic trade publications. Chris personally visits each client office and over the course of his career, he has personally visited over one thousand orthodontic practices in the United States, Canada and Australia. He enjoys excellent relationships with consultants and vendors within the orthodontic community. FREE UNLIMITED CASE when you sign up for free with promo code TPO117 at clearcorrect.com/doctors Paid advertising. O er available for new providers only. Expires May 31, 2017.

8 It’s just BUSINESS E ective.

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Q2 • 2017 | TheProOrtho.com 9 BUSINESS & PRACTICE DEVELOPMENT

THE FUTURE IS CLEAR: CLEAR CORRECT Interview with Jarrett Pumphrey

PROORTHO: HOW DOES submitted all the materials, they will PROORTHO: WHAT RESOURCES CLEARCORRECT WORK? receive their proposed treatment setup DO YOU OFFER DOCTORS? WHAT PUMPHREY: ClearCorrect within 2 to 3 days. Once the treatment EDUCATIONAL RESOURCES DO aligners work by gently moving teeth setup is approved, the doctor can expect YOU OFFER? DO YOU HAVE A incrementally into alignment over time. their first phase (up to 12 sets of aligners) USER MANUAL? DO YOU OFFER Patients must wear their aligners 22 hours to be shipped out within 7 days. COURSES? A COPY OF ANY INFO a day, every day, and wear retainers after THAT IS AVAILABLE TO PROVIDERS? treatment to ensure the best results. PUMPHREY: Though ClearCorrect –––––––––––––––––– does not require a certification for PROORTHO: HOW MUCH DOES IT I think our ability to Providers to start submitting cases, we do COST? DO YOU DO REFINEMENTS? offer many educational resources to guide PUMPHREY: We offer three treatment pivot easily, to make the those new to aligner therapy. Anyone can options for doctors: “Limited 6”, “Limited changes we need to make access our Support site at https://support. 12”, and “Unlimited”. Limited 6 is our clearcorrect.com/hc/en-us that has an most affordable treatment option at USD to ensure our doctors’ ever-growing bank of articles and videos $495*, intended for minor adjustments for doctors to view at their discretion. and orthodontic relapse cases. This option success and happiness, Providers can also sign up for basic includes up to 6 steps of treatment (single makes me the most proud. and advanced webinars on our Support or dual arch). Limited 12, for USD $795, site conducted by our Clinical Advisor, offers 12 steps of aligners, which is ideal –––––––––––––––––– orthodontist Dr. Ken Fischer. for easy to moderate clear aligner cases. For both “Limited” options, revisions are PROORTHO: ARE THERE VOLUME PROORTHO: WHAT HAS YOUR USD $120.These revisions include up DISCOUNTS? BIGGEST ACCOMPLISHMENT to 6 or 12 more sets of aligners for the PUMPHREY: Providers can receive SINCE YOU HAVE BECOME CEO OF Limited 6 or 12 options, respectively. Our volume discounts depending on how CLEARCORRECT? OF WHAT ARE Unlimited treatment option includes as many cases they submit per quarter. Our YOU MOST PROUD? many aligners as needed to complete a volume discounts vary by country, so PUMPHREY: I think our ability to case (including free revisions) for a flat providers should consult our Terms and pivot easily, to make the changes we need rate of USD $1295. All treatment options Conditions for more information. to make to ensure our doctors’ success include one free set of retainers as well. and happiness, makes me the most proud. Information about our treatment PROORTHO: WHAT IS THE ClearCorrect has grown and matured so options can be viewed here: https:// MANUFACTURING PROCESS? much over the past decade. We’ve built support.clearcorrect.com/hc/en-us/ PUMPHREY: Once the doctor has a solid team of professionals who are articles/206416878-Treatment-Options approved the treatment setup, the models passionate and dedicated to servicing our *Pricing may be different in other countries. of the patient’s teeth will be 3D-printed. providers. Providers can consult their terms and conditions Then the plastic is thermoformed to the for pricing. model, laser-marked and trimmed by our PROORTHO: WHAT HAS BEEN custom robots.Finally, the newly made YOUR BIGGEST CHALLENGE? PROORTHO: WHAT IS THE aligner is polished, inspected, packaged PUMPHREY: Our biggest challenge TURNAROUND TIME? with the rest of its phase, and shipped to has always been meeting demand. While PUMPHREY: Once the doctor has the provider. there are worse problems to have, our

10 It’s just BUSINESS BUSINESS & PRACTICE DEVELOPMENT

first priority is servicing our providers results of quality clear aligners. If they DECENTRALIZED? and creating a quality product. We’ve now know that the doctor they trust loves and PUMPHREY: We’re always excited overcome this with our delivery routinely recommends our product, they will want about advances in 3D-printing out the door within seven days. ClearCorrect and this is why patients will technology—especially where our continue to want ClearCorrect in 2017. providers are concerned. As always, we –––––––––––––––––– will adapt to meet our doctors’ needs. PROORTHO: WHY WILL DOCTORS ClearCorrect has WANT TO USE CLEARCORRECT PROORTHO: CAN YOU TALK MORE IN 2017? ABOUT THE AMOUNT OF THE been growing strong PUMPHREY: Doctors continue MARKET CLEARCORRECT HAS NOW to integrate ClearCorrect into their AND WHAT OPPORTUNITY IT HAS for the past ten years practice because of the quality of our TO GROW? now with more than aligners, speed of service, and the ease PUMPHREY: ClearCorrect has been and affordability of our system. Our growing strong for the past ten years now 22,000 providers in four aligners are used successfully in complex, with more than 22,000 providers in four combination cases regularly. The countries. We’re very excited about our countries. turnaround time from case submission plans for international expansion and you –––––––––––––––––– to receipt of aligners is the fastest it’s can expect many announcements about ever been. ClearCorrect providers can that in 2017. ClearCorrect is going to PROORTHO: WHAT DO YOU HAVE view their treatment setups within 2-3 continue to be a big part of how the clear UP YOUR SLEEVE FOR 2017? days after we receive their scans or aligner industry grows and changes. PUMPHREY: 2017 is going to be our impressions and their patient’s aligners best year yet. We’re working on providing are manufactured and out our doors PROORTHO: CAN YOU DISCUSS our doctors with even more control and within 7 days. As always, our providers CC’S PLANS TO SCALE? greater flexibility with their clear aligner can contact our stellar support team 24/7 PUMPHREY: We’ve already scaled cases. That’s all I can say for now, but it’s should they require any assistance. up considerably in anticipation of our going to be awesome. international expansion. We’ll be opening PROORTHO: HOW WILL THE another dozen countries this year. You PROORTHO: WHY WILL PATIENTS DECREASING SIZE AND COST OF can hear more about what to expect from WANT CLEARCORRECT MORE IN 3D PRINTING MACHINES FIT INTO ClearCorrect moving forward in our 10th 2017? THE CLEARCORRECT OVERALL Anniversary video located at https://www. PUMPHREY: We know that patients STRATEGY? DO YOU EVER SEE THE youtube.com/watch?v=ytDk8nk80l0. already want the ease, aesthetics, and PRINTING FUNCTION BECOME

Q2 • 2017 | TheProOrtho.com 11 Business Intelligence for the Orthodontic Practice.

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THE FUTURE IS CLEAR: INVISALIGN Interview with Joe Hogan

PROORTHO: THIS YEAR MARKS can achieve with our products. At the visualization and patient experience. ALIGN’S 20TH ANNIVERSARY IN Orthodontic Summit this past November So we’ve been describing it as metal vs. BUSINESS…HOW DO YOU VIEW I had a doctor walk up to me and say, plastic, but that’s not really accurate. The THE PROGRESS THE COMPANY HAS “Joe, you know you have to tell your truth is that we’ve invented a digitized MADE IN THAT TIME? team to quit comparing Invisalign process for orthodontics and we believe HOGAN: Twenty years ago Align was to metal braces. You finish better, it’s you’re going to pretty much just move founded on a simple premise: a piece of faster, and it’s better for a patient from a teeth digitally within ten years. plastic can move teeth. People use words dentition standpoint. You’re better; quit like “revolutionary” and “disruptive” to apologizing for what you do. Just go out –––––––––––––––––– describe it. But I don’t think anyone could and state that you’re better.” He said, have predicted what this company would “They should be telling you or a patient Analog has lost every become and the impact it would have on why in the world you’d ever glue metal people – doctors and patients – around to someone’s teeth, especially a teenager.” game in the last 20 the world. I sat there with my mouth open. I know You think about where we are today not every orthodontist feels that way, years, and I think it will and what we have done at Align in what but that viewpoint is growing and it is is, in the history of orthodontics, a tremendously gratifying to know that we lose this one as well. relatively short period of time. Invisalign are creating products that inspire that –––––––––––––––––– aligners can be used to successfully kind of confidence and passion in our treat almost every type of malocclusion, customers. This is a digital world, it defines our and more than 4 million patients have age. It really does. So when you think now started treatment with Invisalign. PROORTHO: CAN YOU TALK about Invisalign versus braces, you’re not And that’s globally – the strength of the ABOUT YOUR ANALOG VERSUS making a choice between plastics and Invisalign brand is worldwide, not just in DIGITAL VIEW OF THE MARKET? metal, you’re making a choice between North America. And it’s taken hundreds HOGAN: You know, the difference digital and analog. And analog has lost of millions of dollars invested to build between Invisalign and traditional wires every game in the last 20 years, and I that. But we’ve invested even more than and brackets isn’t really about plastic think it will lose this one as well. I’m not that in our technology and innovation – aligners vs. metal braces – it’s about saying it will all be Invisalign treatment. cumulatively, it’s a billion dollars invested analog vs. digital in terms of the whole There will be other companies out there since Align was founded. We’ve built the approach to treatment. With Invisalign offering clear aligner treatment – and world’s biggest 3-D printing capabilities, treatment, we’ve been using all of the they’ll also be digitally based. So I think one that is incredibly scalable and efficient digital tools of the modern world to over the next two to three years doctors from an operational standpoint. So after move teeth where you want them to go. are going to have to make the choice to 20 years, a great deal of partnership Whether it’s 3D design or 3D printing, embrace the digital future or to keep one with doctors, and a huge investment in digital scanning to digitize physical forms, foot in the past. technology and brand, we’re in a great data mining and complex algorithms, the position with a really strong platform for internet, social media – over the last 20 PROORTHO: SO HOW DOES THIS future growth. years we’ve been harnessing all of these FIT INTO OR SHAPE ALIGN’S VISION But I think the biggest and most technologies in an end-to-end digital FOR THE FUTURE? rewarding change is in how orthodontists process. A digital process that delivers HOGAN: I think digital technology view Invisalign treatment and the great outcomes, but also advantages has the potential to make orthodontic confidence they have in what they in terms of treatment planning and treatment and straight teeth mainstream.

14 It’s just BUSINESS BUSINESS & PRACTICE DEVELOPMENT

We know there are about 2.8 million and we’re excited about the opportunities malocclusions over the last several years case starts in North America each year. this brings for us and for the orthodontic with open bite, deep bite, premolar And while it amazes me that Invisalign, industry. Will we get to those 70 – 100 extraction cases…but what will really be a product that offers convenience, million patients? Maybe not – but we can a game changer for orthodontists and aesthetics, comfort, straight teeth and so definitely get a lot more than 2.8 million. their patients are the products coming for on, has just 14 percent of that market, People want a great smile – we just have to younger patients. We’re really focusing on there is something that amazed me even figure out how to get it to them in a way teen patients and younger patients, and more when I started: there are 2.8 million that feeds their wants and needs. in the near future, you’ll see solutions for orthodontics starts in North America a teen Class II cases and palatal expansion year, but there are actually 70-100 million PROORTHO: HOW DOES ALIGN that take those treatment approaches into people that need to have their teeth STAY COMPETITIVE WITH NEW the digital age. straightened. Either, you know, preserve PRODUCTS ENTERING THE We’re going to pair our continued dentition over time or from a functional MARKET? investment in innovation with increased or aesthetic standpoint. And a large part HOGAN: I think several things keep investment in consumer marketing and of our vision is making orthodontics truly us competitive. One of those things is in connecting potential patients with available to those people. There is no way attitude – we’re not fearful of competition, Invisalign providers who are going to you can do that with a traditional practice but we are realistic about the fact that give them the treatment they want. These model of putting wires and brackets competition will increase and the best initiatives cover a lot of ground, from a on teeth – people just aren’t going to thing we can do is stay focused on big push in Invisalign Teen marketing to do it. The only way to truly expand the things that benefit our customers. First a new global Invisalign brand campaign market for orthodontics is through clear is our ongoing investment in R&D to to the next generation of Doc Locator, aligner therapy. That means building continuously improve Invisalign and with improved analytics and filters for consumer awareness on an even greater iTero technology – things like Invisalign connecting consumers with providers. level, products and treatment models at G7 and the latest version of Invisalign We’re also focusing more on conversion multiple price points for consumers and Outcome Simulator for iTero. Second is – are the consumers who search for an doctors, a digital approach to treatment, our commitment to making treatment Invisalign provider or contact Align for greater efficiency throughout the process. applicable and predictable for every help finding a doctor actually getting Those are all things we’re working on, patient possible. We’ve gone after specific Invisalign treatment? And if not, why not?

Q2 • 2017 | TheProOrtho.com 15 BUSINESS & PRACTICE DEVELOPMENT

PROORTHO: YOU MADE give them new or different tools. They distribution thought process that they A PRETTY CONTROVERSIAL weren’t thinking of how consumers would had all along. They just thought digital MOVE TAKING A STAKE IN embrace the technology and drive the way was going to replace analog and it was SMILEDIRECTCLUB AND SUPPLYING photographs are used. all going to stay the same. We can’t do THEM WITH CLEAR ALIGNERS. that. That’s why we decided to do the HOGAN: I know, it kicked off a lot of –––––––––––––––––– SmileDirectClub deal – because digital discussion about what Align’s doing, why changes the model. Consumers can and we would do that, why does that make We’re really excited will demand the accessibility and options sense, where’s Align going? I know there is about what we’re doing to that digital technology affords. In no way a lot of passion in the industry about this do I want to minimize the importance of topic. connect more consumers our relationship with orthodontists and I think Kodak offers some valuable their role in treatment. But we all need to insight into what’s happening with the to Invisalign providers this realize that our world is changing and get SmileDirectClub model and why we year. in front of how it impacts this industry can’t afford to ignore it. Kodak is a great and where it creates new opportunities example of a company that seemed –––––––––––––––––– and markets for all of us. prepared for the shift from analog to And that’s what we have to figure out digital, but still missed the way the What they missed is that photography – how do all of these things fit together? market was headed (missed the emerging is a means of communication, as we see How to we identify and pull together the opportunity). Kodak saw the move to today on Pinterest, Instagram, and other emerging opportunities for Align and for digital photography coming – they were platforms. We take a photo on our phone our customers? We have a chance to help years ahead of anyone else on that and today and you don’t even have to send a shape this model and how consumers and they spent billions of dollars and hired the word if you’re somewhere, you just send Invisalign customers can benefit from it. best digital imaging engineers to figure a picture to someone. It’s become mass That’s why we took a 17 percent stake in out how to make the shift. But they failed communication – you’re not usually the SmileDirectClub business and a seat to understand that digital technology trying to capture a perfect image. You’re on the board. We don’t have control, but wouldn’t just change photographic capturing and sharing a dozen things in we have a voice. And I think it is really equipment and processes – it would the course of the day. important that Align, the company that change the entire environment. They They missed that, they missed that the created the clear aligner business and has were thinking only of professional digital part was going to change their valuable relationships with orthodontists photographers and how digital would environment, they hung on to that same and the industry, has a voice in this.

16 It’s just BUSINESS BUSINESS & PRACTICE DEVELOPMENT

SmileDirectClub isn’t clinically focused, their protocol get referred to an Invisalign help you fine-tune treatment outcomes, they don’t have R&D and clinical research provider. And that’s happening. But we especially for teens. With the support and and university relationships and all of the know now that it’s not effective to just recommendation of our North America insight and lessons learned that we bring send those consumers to the Invisalign Clinical Advisory Board, we announced to the table. And you want someone with Doc Locator. Those consumers were a recommendation for weekly aligner those insights involved in this. really interested in improving their smile changes to reduce treatment time up to50 with clear aligners – they went through percent and to improve the efficiency of PROORTHO: HOW IS THE the photos and the impressions and treatment for the doctor and give patients SMILEDIRECTCLUB RELATIONSHIP they’ve been told “you don’t qualify for a shorter – and therefore better – overall WORKING SO FAR? SmileDirectClub,” so right off the bat treatment experience. HOGAN: We’ve been learning a we need to convince them to try again And we’re really excited about what lot about SmileDirectClub and this within a doctor’s office. Some of the we’re doing to connect more consumers emerging market for treatment since things we learned are if they can’t get in to Invisalign providers this year. We’re we announced the supplier relationship to see a doctor right away, they don’t want launching the next generation of last July. One of the things we absolutely to go. If the doctor is going to charge a Invisalign branding with the “Made believe is that SmileDirectClub is not a consultation fee for them to come in, they to Move” campaign, we’re going after market detractor, and they’re not really don’t want to go. This is a different type of teens in a big way, and we’re focusing on competing with Invisalign providers. patient – cost, convenience are important improving consumer programs with a lot Remember, SmileDirectClub is offering a to them, but so is a doctor that says “you of great updates to Invisalign Doc Locator maximum of 20 aligners, no attachments, want clear aligner treatment, let’s figure and a patient concierge service to help no IPR, no SmartTrack material. Those out how to make this work for you with with appointment scheduling. No other are all features and innovations we reserve minimal hassle.” company does more to bring new patients for Invisalign clear aligners through SmileDirectClub could not exist to Invisalign practices, and we’ve got a lot Invisalign providers. And as recently without Invisalign treatment and the of new programs to build on that benefit as a month ago, even with increased technology that makes digital treatment launching this year. marketing by SmileDirectClub and with aligners possible. We created a growing awareness among consumers, brand that resonates with consumers PROORTHO: FINALLY, WHAT’S we found that there is less than a 4 and that they really want. Those THE TAKE-AWAY AFTER THESE percent overlap between the minor tooth consumers are opportunities – certainly FIRST TWO YEARS WITH ALIGN? movement protocol that SmileDirectClub for a doctor-directed, at home treatment HOGAN: I joined Align because of the follows and Invisalign cases. That model where they can get a lower cost huge opportunity to grow the market, confirms to us that SmileDirectClub is option. But they’re also opportunities for capture a greater share of that market, reaching a different type of consumer. orthodontists to get a new referral stream, expand internationally, etc. And I’m as Those consumers are concerned with especially if together we can determine excited as ever about those opportunities. price, they’re focused on convenience – how to best address the wants and needs But what I love is that this industry is and some of them are in rural areas where of that type of potential patient. purposeful. It’s really unbelievable how there isn’t an orthodontist nearby. That’s much more confidence people exude with not something many of us think about. a beautiful smile, a smile they’re proud of. And we’ve learned there are a reasonable PROORTHO: WHY WILL And in this world of social media, where number of SmileDirectClub patients ORTHODONTISTS WANT TO USE everyday images are put on Facebook or coming to SmileDirectClub because they INVISALIGN MORE IN 2017? Twitter and live forever online, people are were either told they weren’t a candidate HOGAN: There are three things that so much more self-conscious about their for Invisalign aligners and were offered are really important for us in terms of smile and their looks. Certainly, more braces instead, or they were quoted a our ortho customers: great outcomes for than they ever were when I was growing price that they can’t afford – but they still the broadest possible range of patients; up. So this is about more than health. want straighter teeth with clear aligners. treatment that is good for your practice’s Orthodontists help break down this They are highly motivated, but they want bottom line; and best possible patient barrier that people have about how they treatment on their terms. experience. We’ll continue to invest in look and how they smile and how they And that impacts how we help products and research that further those can express their feelings. It’s a wonderful turn referrals from SmileDirectClub priorities. I talked about our focus on purpose, and I’m really glad that we’re a into Invisalign patients. One of the teen treatment and solutions that are part of that. most important parts of our deal with coming for younger patients. At the end SmileDirectClub is that cases outside of of last year, we released Invisalign G7 to

Q2 • 2017 | TheProOrtho.com 17 From analog to digital. From metal to plastic. We’re moving.

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ANSWERS FROM THE EDGE

20 It’s just BUSINESS ANSWERS FROM THE EDGE

Where is the profession going? What will orthodontics look like in the future? How will we outcompete others who are vying for the same patients? These are some of the biggest questions in orthodontics so we thought we would add a regular feature to The Progressive Orthodontist Magazine where we ask ProOrtho FE members to share their thoughts. If you’ll read this with an open mind you have a chance to expand your options! Featuring Dr. Ben Fishbein and Dr. Jo Hansen

Interview with PROORTHO: HOW DO YOU FEEL PROORTHO: WHAT ARE YOU ABOUT THE PRESENT AND FUTURE MOST EXCITED ABOUT THESE DAYS Dr. Ben Fishbein OF ORTHODONTICS? ARE YOU WHEN IT COMES TO PRACTICING OPTIMISTIC OR PESSIMISTIC? WHY? ORTHODONTICS?

FISHBEIN: I am very optimistic about FISHBEIN: Technology. Clear Aligners. the future of orthodontics. Less than Three dimensional printing. Online 10% of the United States population communication. currently receives orthodontic treatment. As technology continues to improve, I PROORTHO: WHAT IS YOUR expect us to be able to treat more cases BIGGEST CHALLENGE? with clear aligners and the cost of using clear aligners to go down. This opens FISHBEIN: Patient education. It is still up 2 doors: 1. More patients wanting difficult for patients to understand the orthodontic treatment due to ease of difference between an orthodontist and Dr. Ben Fishbein is the treatment and better cosmetics and 2. dentist, as well as the difference between orthodontist and owner of Fishbein More affordable treatment options. This clear aligner treatment from a doctor Orthodontics with four locations allows me to remain optimistic about our versus smile direct club. surrounding Pensacola, Florida. Dr. profession. Fishbein serves as the official smile PROORTHO: WOULD YOU ADVISE provider for the Pensacola Blue ––––––––––––––––––– YOUR KIDS TO FOLLOW YOUR Wahoos – the minor league baseball FOOTSTEPS AND BECOME AN team of the Cincinnati Reds. He also We have the ORTHODONTIST? WHY? serves on the board of the EscaRosa greatest profession in Dental Society, and has lectured at FISHBEIN: Without a doubt yes. a number of orthodontic residency the healthcare field. We have the greatest profession in the programs, dental societies, and healthcare field. Orthodontic treatment orthodontic meetings. Dr. Fishbein Orthodontic treatment is low risk high reward. As technology is proud to have been chosen as is low risk high continues to improve, a higher percent Pensacola’s ‘best orthodontist’ by of the population will be able to afford both the Pensacola News Journal reward. As technology orthodontic treatment. Our profession and Pensacola Independent News will change as technology improves and in 2013, 2014, and 2015. He serves continues to improve, teledentistry increases, but in my opinion, on a number of leadership boards in a higher percent of the an orthodontist will always be needed to the Pensacola Florida area as well. correctly diagnose and treatment plan. Dr. Fishbein is proud to be a Board population will be able Certified Orthodontist, and strives for the best results for every patient. to afford orthodontic Dr. Fishbein has a special interest in the ways technology can make treatment. orthodontics more efficient. –––––––––––––––––––

Q2 • 2017 | TheProOrtho.com 21 ANSWERS FROM THE EDGE

Interview with PROORTHO: HOW DO YOU FEEL With clear aligners, I can treatment ABOUT THE PRESENT AND FUTURE plan the case from my couch and when Dr. Jo Hansen OF ORTHODONTICS? ARE YOU I get to the office, the patients seem to OPTIMISTIC OR PESSIMISTIC? WHY? be happier. They can eat whatever they want, they can brush more easily, and HANSEN: By nature, I am an optimist. rarely do others even notice they are I believe the future of orthodontics could in orthodontic treatment. In addition, not be brighter. However, our profession we are destroying the inconvenience of has to change with the times. We can’t be traditional orthodontic care by seeing our stuck in the orthodontic treatments of 30 patients for far fewer appointments. Win- years ago. Although the “rules” of tooth Win-Win. movement haven’t changed, the method and speed at which we accomplish our PROORTHO: WHAT IS YOUR objectives has progressed significantly. BIGGEST CHALLENGE? With accelerated orthodontics and strokes on our keyboards, we are able to change HANSEN: As with any business, our As one of the first 100 female our patients’ self-image, self-respect, and biggest challenge is to determine when orthodontists in the country, self-confidence. Isn’t that amazing? and how to pivot. When is the right time Dr. Hansen has been afforded Today’s technology also gives us to change fees, change our treatment the opportunity to help lay the the opportunity to reach many more methodology, open another practice, etc.? foundation for other women in potential patients than the phonebook & Sustainable businesses are always looking orthodontics. In addition, Dr. newspaper of the past. With the transition for the perfect time to pivot, especially Hansen has been on the leading to digital marketing and growth of clear as the pace of change in our industry is edge in the digital revolution aligner treatments, we are able to scale our accelerating exponentially. of dentistry and orthodontics. practices faster, provide more affordable As one of the early adopters of treatments, and increase the access to PROORTHO: WOULD YOU ADVISE technology such as digital record care. YOUR KIDS TO FOLLOW YOUR taking, 3-D oral scanning, and As orthodontics has become a right of FOOTSTEPS AND BECOME AN Invisalign, Dr. Hansen has always passage for many families in America, it is ORTHODONTIST? WHY? been an innovator. In 2016 her encouraging to see that today’s technology practice was honored as one of is helping more families afford treatment. HANSEN: Although I failed to the 5000 fastest growing private As an orthodontist, nothing makes me convince either of my kids to become businesses in the U.S. by Inc. happier than to imagine a world with orthodontists, it’s still the best profession Magazine. more beautiful smiles. in the world, and I don’t imagine my Dr. Hansen enjoys volunteering opinion changing. Orthodontics is clean, at her church, going on mission PROORTHO: WHAT ARE YOU most discomfort happens away from the trips, and sponsoring various MOST EXCITED ABOUT THESE DAYS office, no emergencies, and all changes civic organizations. She is a WHEN IT COMES TO PRACTICING are positive! No matter how different our mother of two and lives with her ORTHODONTICS? practices may look over the next twenty husband in the Kansas City area. years, orthodontists are still going to be HANSEN: A few years ago, I decided radically impacting people’s lives. ––––––––––––––––––– to focus on the Invisalign portion of my As our industry morphs, the next I’m not sure there is practice. Now, about half of our cases are generation of orthodontists will have the Invisalign and I can’t imagine practicing pleasure and ability to treat thousands a better legacy to leave in the future without a ClinCheck. So, more cases than I have done in my career. you could say that I am a clear aligner Aside from my faith, I’m not sure there is than a world with more junkie. a better legacy to leave than a world with beautiful smiles. more beautiful smiles. ––––––––––––––––––– 22 It’s just BUSINESS ANSWERS FROM THE EDGE

Q2 • 2017 | TheProOrtho.com 23 MARKETING, SOCIAL MEDIA & EVENTS

IT’S NOT JUST YOUR PRACTICE. IT’S YOUR MOMENT. Stay ahead of the curve and your competition, and seize your moment with this advice from industry experts By Angela Weber and OrthoSynetics

Success isn’t something you can simply START WITH YOUR FINANCIALS GET A STRONG PARTNER hope for. It’s earned. And in order to #1 Don’t measure your success on just #2 A strong financial analyst is thrive in this fast-paced environment, one metric. someone who knows your business and you’ll need a plan to get there. We ‘ve the industry. compiled these trends and tricks related You are working crazy hours. Your to key areas of a practice’s success. These schedule is always full. Yet you are not They’ll also listen to your concerns and are divided into five key components: seeing a major impact on your bottom needs before using their own knowledge goal setting/tracking, marketing, practice line revenue come December. How can and expertise to turn your needs into expenses, revenue and the new patient this be? A common misconception is both quantitative goals (revenue amount, experience. measuring your performance solely on production levels, breakeven, etc.) and the number of contracts. It’s definitely strategic approaches (spend less hours YOU CAN’T SCORE IF YOU DON’T the main income driver, but not the only in one location vs. another one, hire an HAVE A GOAL. approach to measure your performance. associate, reduce low-volume patient Knowing your financials can help you For example, a doctor who had decided to hours, convert to a low-cost practice, etc). set goals and reach them. switch to modern, low-cost brackets with What we’ve then created is a roadmap By: Houssem Aouididi, OrthoSynetics a massive production scheduling. This we’ll use to reach everyone. Financial Analyst switch at the surface seemed successful to the doctor—there was a surge in new PUT IT IN ACTION patients and lots of demand. However, the #3 Hone your preliminary financial It’s the end of the year and dare you ask doctor called us and informed us of his projection with your financial planner “So, how’d we do this year?” Gulp. This decision and sought our advice on why he until it’s perfect. passive approach to business management was “working harder for less revenue.” might have worked just fine in the past, So we took a deep dive into his This is important because after you’ve when each business owner enjoyed a wide financials and came to the conclusion met with your financial analyst and you’ve market share and never had to worry that the practice was not financially ready set goals, you’ll tweak your plan until it’s about competition, but no longer. Today, for the sudden strategic shift. The doctor perfect. Using the financial projection this approach is a direct path to nowhere. didn’t have enough saved capital (or as a tool and as a budget for getting it And goals aren’t for nothing – they’re planned financing) to sustain the massive all done. The plan comes in the form of to get you somewhere. Which is why in upfront costs of those new brackets. Of a package that includes the preliminary order to keep up with an increasingly course, sales will cover those costs, but the financial projection, breakeven analysis fierce competition, doctors are now issue resides in the “timing impact” and to emphasize the point of sales that you compelled to do things they’ve never done not the “value impact” of the new service. never want to dip below as well as some before. And if production goals aren’t It’s a mistake that many doctors make. charts and scorecards. A monthly or set ahead of time and closely monitored, A mistake that could very well send a quarterly follow-up with your financial practice owners end up having a hard successful practice into financial troubles. analyst will give you a “budget vs actuals” time maintaining and building their So the moral of this tale is that before you analysis. Unless a major unforeseen event customer base. Not to mention, they add to your revenue stream or change happens that will materially impact the aren’t prepared to stop and react to the something up, it’s crucial to go through projection, this approach will make your damages that may occur in a timely an in-depth financial analysis. And then practice stand out from the crowd and manner. set goals for both the short term and long ahead of your competition. This is something I see a lot of: doctors term. Think: In six months, what do you calling us to help them set realistic goals want to be better? And in three years, both financially and organizationally. where you do you want your practice to be?

24 It’s just BUSINESS MARKETING, SOCIAL MEDIA & EVENTS

opportunity to know you. Let your off those YouTube cobwebs and get going. BEAT THEM AT THEIR OWN customers know who you are, what you And, did you know the only content GAME stand for, and that you have a personality on Google that’s in color are clips from Market your practice like the big players that makes them want to trust you and YouTube? Now that’s SEO gold. without spending the big bucks like you. In addition, Live Video has also By: Angela Weber, CMO OrthoSynetics So that when a person sees your become increasingly popular and a marketing they think, “They get me.” And way to connect creatively with patients Between backyard competitors and the then later when they need something, like and potential patients. This real-time virtual competition, your business needs braces, they’ll actually go to you. information positions you as cutting edge more than teeth to survive. It needs a in the market. So consider Live Video voice. A brand. IT’S ALIVE: YOUR BRAND HAS A to announce the kick-off of a contest or Players like Smile Direct Club and PULSE. contest winner. Or, use Live Video to Invisalign are poised to spend big bucks #4 If a picture is worth a thousand show a behind-the-scenes team huddle or on marketing in 2017. In fact, you’re words, a video is worth a hundred team events like CPR training or CE. And probably starting to see and hear Smile thousand. if you’re still itching to do a How To, do Direct Club ads in your market. They it in Live Video. It’ll hold their attention advertise everywhere – on Pandora, People are consuming information and entertain them at the same time. Keep Instagram, and Facebook. and using it in a million different ways. videos under 3 minutes. Anything longer So what’s the difference between their Kids are consuming and producing and you lose people. ads and potentially your practice’s ads? more video content than ever. So why Smile Direct knows who they’re talking to shouldn’t you? If you haven’t made video A CALL TO ACTION: MAKING and they’re hitting them on all of the right production a part of your marketing and THEM ACT NOT REACT channels. communication plan, it’s time to add it in. #5 Everything should push toward And while you can’t compete on a After all, people today would rather growing your practice. national level like they can, you can watch things then read them. So the compete on the local level in a big way. next time you sit down to write a long All your marketing messages should To compete with the big guns or local instructional “how to” stop and think: have a simple call to action– a direct competitors, you need to first understand “Would a quick video be easier to digest?” thing that people can do to show they your target market and give them the If the answer is yes, then it’s time to dust got it, they like it, or they are interested

Q2 • 2017 | TheProOrtho.com 25 MARKETING, SOCIAL MEDIA & EVENTS

in it. If your social media right now patient: gets little to no response, your call to • Using a scanner for records and action isn’t strong enough. You’re not storing them digitally can save you space compelling people to act. For example, and money on storage space do you continue to post content that your • Eliminate impressions typically taken audience is ignoring? The evidence lies to fabricate appliances and work with a in the post engagement. If your posts are lab that accepts digital scans to create 3D getting little to no engagement it’s time to models put down the mouse and re-evaluate your • Removing impressions from strategy. Use every opportunity to engage the practice saves patients from this and create conversations. The same uncomfortable procedure and shows applies to your local community efforts. If the doctor values the patient’s time by you have a booth or table at a local event, minimizing appointment time.This also consider how you will draw engagement reduces chair time which allows the that ultimately drives action. doctor to see more patients • Scanner investments can also be THE PATIENT EXPERIENCE IN AN recouped with savings from in-house lab ON-DEMAND WORLD costs (i.e. materials, additional employee How to keep it personal with patients time, etc.) wanting it now, now, now. By: Gretchen Estapa, Vice President Client #7 Listen and You’ll Find Opportunity Services Communication While orthodontists strive for perfection in their treatment outcomes, In today’s instant messaging, web chat some patients just want a quick cosmetic friendly environment, patients want fix. Listening to patients’ needs and being to know you’re there for them when clear on results that can be achieved they need you. And now because of all will open your practice to a particular this wonderful technology you are but demographic that you are currently are you sure this new relationship isn’t missing. Offering limited treatment a roadblock? Are you able to answer options to accommodate special occasions patient’s questions directly or are you like weddings, graduations, etc. This simply referring them back to your office particular program can be easily targeted or site? And what about new patients? at Bridal Shows or specific targeted Are they left feeling like you answered Facebook advertisement. their questions, or are they left with even more? If your patients are left feeling confused this could lead to some serious HARNESS THE POWER OF frustration. And frustration usually leads SMART PURCHASES. to unhappy patients who will soon be How to make every dollar count. looking for someone else. So, check for By: Kim Delle, Procurement Director roadblocks! Make sure your patients are receiving the attention and the communication they deserve and most #8 Track your purchases like you track importantly they expect. your fantasy football team:

#6 Scanners make a good impression Every dollar spent on supplies directly decreases your bottom line. Tracking As we move forward into the digital era, every item your practice buys will give doctors are finding uses for their digital you the visibility you need to see where scanners for things besides Invisalign. your money is going. Here are a few examples where a If you don’t have an online system for scanner can benefit both you and the tracking, at minimum record the product

26 It’s just BUSINESS MARKETING, SOCIAL MEDIA & EVENTS

number, description, quantity and price you can set a monthly budget. Sharing #12 Get the remaining balance paid for each purchase in a spreadsheet. this budget with your staff will help without going gray. Then assign a category to each item so keep the practice on track. Compare the you know whether the product is used budgeted amount to your actual spend You know those patients you have who directly on the patient (such as brackets each month for each category so you can find it difficult to make payments towards and wires) or as overhead (such as office see where improvements can be made. the end of their contract, well here’s a way supplies, sterilization pouches, etc.). Assigning accountability to a trusted staff to get them to pay. First, try using a third Finally, total the extended cost each member for helping to manage expenses party financing company to wrap up the month to really understand what is being according to the budget, can give you a payment plan.The responsible party may spent on supplies. partner within the practice to help inspire be able to extend their payment terms the whole team to be cost conscious. using a third party finance company. You #9 Analyze your spending like a teen Budgets are “living” documents that can get your remaining contact balance analyzes text messages. should be reviewed, managed, and paid and they have the convenience of adjusted regularly to maximize their spreading their payment plan out over a Most teens look at a simple text effectiveness. few more months to make their monthly message and read tone and meaning into payment affordable. every single word. Now, we’re not saying you need to become obsessed with what KEEP THE CASH FLOWING #13 To Medicaid or not Medicaid? you’re spending, but we do think it’s How to mantain and increase your important to take a deep dive into what top and bottom lines. You need to find the right mix for your your actual purchases are to see where By: Sandy Luparello, Senior Director practice. Providers may sign up with you could be cutting costs. Practice Financial Services Medicaid to help build their initial patient For example, your supply spend should base, however, they may look back and be compared to the number of new #11 Be open and honest about fees. realize they do not have room on the contracts signed along with your active schedule for any private pay patients. It is patient base. Also, the number of new A common approach to selling a important to determine the cost of seeing starts last month should roughly mirror contract is to utilize the insurance benefits a Medicaid patient on a monthly basis, the number of bracket or aligner sets to reduce the monthly payment. However, and the reimbursement payment versus that were purchased. Waste and loss are I suggest a flat-fee approach, not including a private or commercial-based customer the side effects of not monitoring your the insurance benefit that not only makes who may come in less frequently and spending on supplies. And while bells the sale easier, and also pays out the their reimbursement rate. If you realize and whistles are nice, ask yourself if the contract prior to the patient finishing his/ that you have no room for commercial same task can be accomplished with a less her treatment. patients, it may be a good time to rethink expensive, quality product. If the patient has insurance funds, the your payor mix. balance will be paid off sooner – making it a win for the doctor and the responsible #14 Money talks and it can also walk –––––––––––––––––– party. By being transparent with fees, out the door. The easier you can make you’re empowering your front desk with the knowledge they’ll need to answer calls Monitoring missed over-the-counter moms understand how for those shopping around. For example, collections is one of the most important much things are going to they can say our contracts are in between and most missed forms of revenue. It is the $4,000 and $6,000 with a flat-fee of important to develop a system that can cost, the easier it will be for $200.00. identify accounts that are not collected When moms are at their kid’s little when the patient keeps an appointment. them to spread the word. league game, they’ll be talking about their Monitoring this is an opportunity to stop Orthodontist, what your flat fee is and money from walking out of the door. This –––––––––––––––––– how they compared to other orthodontists is a topic that should be discussed in your #10 Give yourself an allowance. For around town. Which in turn, makes team meetings so your staff is aware and supplies, that is. those moms your mouthpiece for more can simply ask for it. Most patients are business. So the easier you can make them simply unaware and would gladly pay Once you know what you’re understand how much things are going when prompted to. actually spending and have found and to cost, the easier it will be for them to implemented opportunities to lower costs, spread the word.

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Cell Phones and Toothbrushes: Technology in the Orthodontic Practice By Chris Bentson

I recently attended the 2017 AAO EMR, electronic medical record), and checking on this statistic. Turns out Winter conference in Fort Lauderdale. horizon planning, a method of how Jack was likely correct. Here’s what we The meeting’s theme was around to plan for all these changes. Wow, learned. technology and the orthodontic indeed. The Mobile Marketing Association specialty. I learned a great deal –––––––––––––––- of Asia originally reported this data, from some great speakers, Dr. Greg stating that, out of 6 billion people Jorgensen, Dr. Neal Kravitz, Dr. Are we perhaps on the planet (several years ago), 4.8 Aaron Molen, Dr. Edward Lin and Dr. over-engineering billion have a mobile phone while only Christian Groth presented lectures, 4.2 billion own a toothbrush. (https:// along with myself, SteveMcEvoy from our approach in our blog.dentalimplants-usa.com/more- MME Consulting and Jack Shaw. Jack practices by leveraging mobile-phones-than-toothbrushes- Shaw, a futurist, kicked off the meeting too much on technology fact-or-fiction). and spoke about what technology Jamie Turner of 60 Second Marketer might look like in the orthodontic as the “reason to come attempted to determine the validity of practice in 2020. That was interesting to my practice” vs. this statement. Turner did a Google as he talked of dental tourism, the search using the phrase, “number browning of America, cultural smile differentiating your of mobile phones worldwide,” preferences, robots at the front desk practice with more and learned that there are 4.6 and in the clinic, 3-D printing and billion mobile phone subscriptions CLIP (continuous liquid interface personal, practical, worldwide. Yet, the true number of production), a new plastic called relational messaging like phone owners is more complicated carbomorph that conducts electricity, than it seems. In some parts of the the IofT (internet of things), intraoral “brush your teeth”? world, people have more than one wearable devices, intelligent agents, –––––––––––––––––– subscription. When this variable was IBM’s Watson, cobotics (human’s In his lecture, Jack Shaw, the considered, the number of mobile interfacing with machines), cognitive futurist, offered a statistic that perhaps phone owners dropped to 4.2 billion. computing, blockchain technology you have heard: of the 7.2 billion Mr. Turner had even more difficulty (a technology, used by bitcoin, that humans in the world, 4.2 billion had determining how many people own leverages cryptography and group cell phones in 2016 and 3.2 billion had toothbrushes. Colgate reported data stored in an immutable chain of toothbrushes. Yep, more people own having 34 percent of the market transactions that has the capability a cell phone than own a toothbrush. share in manual toothbrushes. to transform how we deal with I was skeptical so I asked one of Oral-B stated the yearly toothbrush money, crypto-currency, and the our team members to do some fact market is $5 billion. By calculating

30 It’s just BUSINESS BUSINESS & PRACTICE DEVELOPMENT

the cost of toothbrushes on Amazon, in China in 1498, where coarse boar the toothbrush, apt to get better he determined an average cost to hairs were attached to handles made growth results in your practice vs. be $3.00 in the US, but closer to of bamboo or bone. Boar bristles were showing their airway in a consult? $1.55 worldwide. Ultimately, Mr. used until 1938 when nylon bristles Our company, Bentson Clark Turner concluded that approximately were introduced by the company and Copple, LLC, has expertise 3.22 billion toothbrushes were Dupont de Nemours. The first nylon in analyzing how much income a sold last year. And although it is toothbrush was called Doctor West’s practice produces for the owner/ almost impossible to determine the Miracle Toothbrush. doctor and then translating that data actual numbers of toothbrushes or http://scienceillustrated.com.au/blog/ into a conclusion of a given practices mobile phones, the statement that ask-us/who-invented-the-toothbrush/ current value. The data we see shows there are more mobile phones than So what, if anything, does this that overheads are incrementally toothbrushes seems to have some have to do with your practice? In increasing, moving from the low validity. (http://60secondmarketer. this disruptive era in dentistry 50th percentile range ten years ago com/blog/2011/10/18/more-mobile- and the specialty of orthodontics, to the upper 50th percentile range phones-than-toothbrushes/) are we perhaps over-engineering in current years. The self-reported The toothbrush has been around our approach in our practices by overheads given over the last 34 years for a long time. Early forms of the leveraging too much on technology as in the JCO published practice studies toothbrush are mentioned as early the “reason to come to my practice” backs up what we are seeing. The as 3000 B.C. when Egyptians and vs. differentiating your practice with JCO data shows a migration from Babylonians used ‘chew sticks’ which more personal, practical, relational 49% average overhead in 1981 to 59% were thin twigs with frayed edges messaging like “brush your teeth”? Is average overhead in the most recently used to rub against the teeth. The the time spent talking with a patient published 2015-practice study. first bristle toothbrush was invented and providing this old school device, The reasons for this increase in

31 It’s just BUSINESS Q2 • 2017 | TheProOrtho.com 31 BUSINESS & PRACTICE DEVELOPMENT

overhead are many and include the computers according to data presented your deployment of technology is a economy, higher fees for certain at the AAO Winter meeting and we’ve choice but it doesn’t attract patients to appliances, orthodontists retiring seen practices with fifty or more. your practice or grow your practice. later since the great recession, more The costs to purchase, maintain, and Relationships driven around a leader completion from GP’s, Pediatric replace all this technology is one of that expresses his or her values to practices and the ever increasing the biggest reasons behind increasing the employees who then deliver number of DSO’s. However, the overheads. Most practices work four that message to the consumer is the primary drivers of higher overheads in days a week, with many working less. current key metric to differentiation the last decade have been technology Are the DSO’s really so crazy thinking and growth. The coveted internal spend and marketing spend according that five or six patient days a week and referral, the desire to bypass the GP to our data. evening hours make sense? If you and go directly to the consumer, Just think about the capital required measure return on capital invested, the desire to create an awesome today for digital radiography, CBCT, –––––––––––––––––– customer experience and grow a scanners and now digital printing on practice is driven more by establishing the horizon? The old analog pan- Choose your purchases relationships with orthodontic ceph may have cost $19,000 or so wisely for the market consumers than by relying on your for a top shelf model, but it lasted 25 technology deployment to create the years and produced a product that position you have and difference between your practice and allowed orthodontists to accurately the patient you want to others in your drawing area. diagnose and treat cases. Today To be sure, the landscape is digital radiography is the standard attract. competitive and a certain deployment of care and these machines are being –––––––––––––––––– of technology is required today. replaced about every eight years due they are the smart ones. Choose your purchases wisely for to mileage (number of images taken) We’re also using technology to the market position you have and at anywhere from 40-70 thousand let consumers know who we are, the patient you want to attract. dollars a pop. Want to go the CBCT where we can be found, and what Understand what you need and route and you’re looking at 125K plus, we’re about. The time and money what you don’t where technology and these numbers are down from we spend on our websites, Facebook, is concerned and double down on the 200Kper each figure for such a review sites, billboards, print ads, investing time deciding what you’re machine just ten years ago. Last year television, radio, producing video’s, about, what your value system is, scanners were flying off the shelves Twitter, Instagram, patient portals, and relentlessly expressing those surpassing sales of CBCT machines appointment reminders and all the conclusions to your staff, your at a cost ranging from 25K and up rest are eating away at the practice patients, and your community. per each. Yes, you can buy a hobby budget. Handing out toothbrushes allows you digital printer for about 4K dollars, Practice owners tend to want to rely the opportunity to talk to them, and but a commercial grade digital printer on technology as the reason to “choose that conversation (not about how to with delivery, installation, and training me”; however the common thread we brush) may just be the secret sauce will run about 25K today. We need a observe in growing practices has little for practice growth you’ve been in network of computers to run practice to do with leveraging technology as search of. Oh, and send a text to your management systems and talk to all the differentiator and much more to patient asking how they’re enjoying these technology “investments” we’ve do with practice culture and patient that toothbrush you gave them, don’t made. The average practice has eleven experience. Our observation is that worry – they all have a cell phone.

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3D PRINTERS By Dr. Christian Groth

Think back to your childhood. If (remember that the edges have to be to any thermoformed appliances. The someone told you that at some point 90 degrees) and compare that to a most well-known example of an FDM in the relatively near future you would pyramid cut into 20 slices – the 100 printer is the Makerbot(Image 1). be able to create physical objects slice pyramid will appear to have a from the digital world, would you much smoother surface than the 5 have believed them? Probably not. slice pyramid (Figure 1). For those orthodontists reading this that have been practicing for five or more years, when you graduated FIGURE 1 from your residency program did you believe that there would come a day While there are dozens of 3D when the coveted alginate impression printers available ranging from several would be considered a relic of the thousand to several hundred thousand IMAGE 1 past? Probably not. 3D printing, also dollars, they all use one of a few known as additive manufacturing, is technologies. Each technology has its STEREOLITHOGRAPHY nothing new. Stereolithography was own pros and cons that must be taken first introduced by Chuck Hall in 1984 into account when considering a 3D Stereolithography (SLA) utilizes but not until the last few years has printer. a focused laser to selectively cure a 3D printing been within the reach of photo-sensitive resin. Like FDM, the orthodontists and orthodontic labs. I FUSED DEPOSITION MODELING original patents have expired resulting hope to shed some light on this rapidly in a slew of lower cost options for SLA changing technology and help you Fused Deposition Modeling (FDM) printers. The laser draws the cross wade the waters of the evolving 3D is the simplest printing technology, section of the object layer-by-layer, printing world. but also the least useful for an causing SLA printers to be generally The basic idea of 3D printing is orthodontist. A plastic filament is a slow, but very accurate, printing quite simple to understand. Take any fed through an extruder where it is method. A post-curing process is object and divide it into slices. Every heated and laid down on the print bed. required after printing is completed slice has 90-degree edges. Each slice FDM printers are widely available and to ensure that all resin is cured. This represents a layer of printed material relatively inexpensive since the patents is an important step that should and the more slices that the object have expired; however, the extruder not be skipped as the uncured resin is split into means that more detail tips can only get so small until they can be toxic and we don’t want this will be conveyed in the final product. clog. This results in a visible stair- transferred to our patients. There are Imagine a pyramid cut into 5 slices stepping on the model which transfers a wide variety of materials that can

Q2 • 2017 | TheProOrtho.com 35 OFFICE LOGISTICS

be used for SLA printing, including are the EnvitionTECPerfactory Vida POLYJET FDA-approved dental materials. The (Image 3) and the Juell 3D from Park FormLabs Form2 printer is a common Dental Research (Image 4). Polyjet printing is the closest entry-level SLA printer currently method to traditional 2D printing as available (Image 2). it was adapted from InkJet printing technology. An array of nozzles sprays liquid resin which is immediately cured by an ultraviolet light. Advanced polyjet printing allows for multi-material printing. Stratasys is currently the only company producing polyjet-style printers (due to active patents). Due to the lack of competition, this style of printer is more expensive but also has greater quality control compared to SLA, FDM, or DLP-style printers. While there is no post-curing with this type of printer, there is a post-printing washing process using a pressure IMAGE 2 washer. This process eliminates a waxy support resin that is used as a DIGITAL LIGHT PROCESSING scaffold during the printing process. Polyjet style printers are the most Digital Light Processing (DLP) IMAGE 3 popular type of printer for commercial is fundamentally the same as SLA labs to utilize when printing dental printing with the exception of the models. The Stratasys OrthoDesk light’s origin. Instead of a single laser is the best option for orthodontic having to draw out the individual applications (Image 5). layer, a DLP printer utilizes a high definition projector to flash the entire layer image at one time, making the printing process significantly faster than SLA printing. Think of the difference between drawing an image versus stamping the same image, and now multiply that by several hundred layers. Like SLA, a post-curing process is required. DLP printers are widely available but the two most popular for orthodontic applications IMAGE 4 IMAGE 5

36 It’s just BUSINESS OFFICE LOGISTICS

USES FOR PRINTERS From soldered appliances to acrylic offices to offer minor tooth movement retainers, printed models have the at a fraction of the cost that was In orthodontic practice, 3D printers ability to streamline the fabrication previously possible. The example are allowing the use of intraoral process and eliminate the dreaded shown is a patient who did not wear scanners for far more than creating impression! his retainers. We were able to offer study models. 3D printed models In addition to traditional clear aligners fabricated in our office can be used for any appliance that orthodontic appliances, printed at a very reasonable cost. This case can be created on stone models. models are now allowing individual required 7 aligners to complete (Case 1).

CASE 1

Q2 • 2017 | TheProOrtho.com 37 OFFICE LOGISTICS

There are multiple software people who call because a new retainer any printer. Ask lots of questions platforms that allow us to design does not fit isn’t significant enough because more often than not the and export our own staged aligner to track. We make it a point to ask people selling you a printer won’t offer setups (OrthoAnalyzer(3Shape), whether the retainer was being worn this type of information without being Elementrix(Orametrix), Orchestrate regularly. If not, we bring the patient asked. 3D(Orchestrate Technologies), iRok in for an updated scan. (iROK DDS) are among the most How does it work? It is rather –––––––––––––––––– popular). This has opened the door simple and there are several ways In my mind, 3D for new and often less expensive of making it work. If you own the printing’s role in our treatment options previously printer you can create a new model unavailable to our patients. With the every time a patient calls with a lost field will continue to growth of DIY aligner options, the retainer (pulling the digital model out evolve. I believe that ability to offer a less expensive and of your archives). If you don’t own a less comprehensive option in our printer, or don’t want to print a new the majority of us will practices is becoming increasingly model for every lost retainer, you can have 3D printers in our more important, as long as the patient choose to store the models or give understands what the compromises them to the patient and have them offices at some point in are. Whether these are new patients return the model to your office for the future. to your practice or previously treated retainer fabrication. Since printed patients who may not have been models don’t break after removing the –––––––––––––––––– diligent with retainers, there is a space clear retainer this can be done as many In the current 3D printing in the services that we offer for this times as the patient loses their retainer landscape, I believe that it makes type of treatment. without having to update the scan or the most sense to outsource models One of the best uses of 3D printed take a new impression. until one understands how printed models is retention. If you could models fit into one’s practice model. eliminate office visits for lost retainers, CONSIDERING A PRINTER Investing tens of thousands of dollars would you? Some of you reading may into a commercial grade printer think that people like coming to your Purchasing and implementing a may not make the most sense with a office but let’s be honest, everybody 3D printer isn’t the same as plopping technology that is rapidly changing. is busy and if people can eliminate an a LaserJet printer into your office. The less expensive options may work extra trip anywhere, don’t you think There are requirements that must be out well but many are finding that the they will want to do that? In my taken into account before making small build envelope does not allow experience, parents and patients love the decision as to which printer will them to keep up with the demand being able to get replacement retainers work best for any given situation. easily, forcing them to invest in a 2nd without having to come to the office 3D printers are sensitive pieces of printer or outsourcing models when for an impression. You should love equipment. Placing them where the print volume is high. In my mind, it because it clears your schedule for they can be bumped or dust can 3D printing’s role in our field will other money-making procedures, or accumulate will lead to failed print continue to evolve. I believe that the allows you to cut down on the number jobs and possible printer breakdowns. majority of us will have 3D printers in of staff members working. A common In addition, some print resins emit an our offices at some point in the future. question is whether the retainers will odor that should be properly vented. Whether the time is right for you to fit. While I don’t have exact numbers, All this is to say: make sure that you make the investment is a question that I can tell you that the number of do your homework before purchasing only you can answer.

38 It’s just BUSINESS I DID IT! THE FUTURE IS NOW FOR IN-OFFICE 3D PRINTING

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40 It’s just BUSINESSpropelortho.com H.R. INSIGHT

“HEY DOC! I’M GIVING YOU MY TWO WEEKS NOTICE.” By Dr. Jason Battle

“Hey, Doc! hiring employees from other offices that that they would agree with me. I sent I’m giving you my two weeks notice.” didn’t fit in with their old offices, who both ladies to lunch with my staff and were stuck in the mindset of practicing asked for feedback. They unanimously These can be some of the most stressful orthodontics a certain way. Many would agreed that we should hire the one with words that we hear in our practice. Many have fond memories of the 90’s and early less experience. This came as a surprise; of us take it as a failure when an employee, 2000’s when orthodontics was easy, there I was skeptical if she had the experience especially a long term employee, wants to was little competition, GPs referred all of leave us. I don’t believe this has to be the their orthodontic cases, and production/ –––––––––––––––––– case. In my ten years of private practice, collections/bonuses increased every year. Many would have I’ve had a lot of employees come and go. The world is very different now, and we My goal, like most, was to have long term, must adapt. fond memories of the 20-30 year employees who would retire at A few years ago I decided to take a 90’s and early 2000’s my office and earn a gold watch. However, different approach to hiring and wanted to the reality of life in 2017 is that people share the remarkable results that occurred when orthodontics was move, and they aspire to become more from that decision. Our office was looking easy, there was little than your assistant/front desk/treatment for a new financial coordinator. We had coordinator. You have dreams and so do very little time to find one. I interviewed competition, GPs referred your employees. I think that encouraging multiple candidates, and the choice came your employees to follow their dreams down to 2 people. One was a financial all of their orthodontic (even if it means leaving your office) is coordinator at another orthodontic cases, and production/ the best thing that can happen to your office, she had ten years of experience, practice. seemed mature and capable of doing the collections/bonuses I use to hire all of my employees, like job. The other had one year of front desk increased every year. The most orthodontists, without any input experience at an endodontic office and from other staff members. I figured one year experience as an orthodontic world is very different now, “let’s find the best person, with the most treatment coordinator. To me the choice experience and plug them into the job was obvious, but for this decision I let and we must adapt. that I need them to do.” I ended up the staff have a little more input, thinking ––––––––––––––––––

Q2 • 2017 | TheProOrtho.com 41 H.R. INSIGHT

or the maturity to do the job. One staff to ultimately earn more. Within three can become great players in the right member came to me and said, “We know months, she learned how to become a system. your systems and the office that you want, good clinical assistant, eventually earning • The players have to be able to play trust us on this.” So based on my staff’s an orthodontic certificate. Patients together to win. You can have all of the advice, I reluctantly hired the employee already liked her from their experience talent in the world and the best game with less experience. What happened next with her at the front desk and were more plan, but if your players can’t work was incredible. The entire staff trained her, than willing to let her treat them, even together, you will fail. guided her when she made a mistake and knowing that she had little experience. fully embraced the new employee. After Don’t be afraid to promote from within. I brought these elements into my that, I let my current employees hire all of Give your current employees a career practice to create my winning team. First, my future employees. track that allows them to become more I determined what kind of office I wanted We were able to make another than who they are today. to have, and that fit my personality. Next, successful hire when the twin of a former Playing and watching sports all my life, I designed systems, protocol and a culture employee, who was working at a bar at I’ve learned that there are three elements which fit these desired goals. Then, I hired night, came to help with scheduling at my to forming a championship team: good/great staff that fit my system and front desk. From her experience behind a understood what I was trying to build. bar, I knew that she could work quickly, • Good/great players. You have to have I trained them in these concepts so that multi-task while delivering excellent players who are good at what they do and they wouldn’t have to ask permission on customer service and everyone liked her want to get better. It should be obvious, how to deal with a situation. They know sister (our former employee). She quickly but you can’t win with bad players. the core values of our office “Make it work became a front desk superstar and a • Good systems/schemes that fit the for the patient, get the patient to a happy favorite of our patients. Three years later, team’s personality. Creating the proper place” and our answer to any question/ we were looking for a clinical assistant organizational structure with good situation should reflect those core values. but couldn’t find someone to fit our systems allows the right players to thrive Unfortunately, this was not enough system. She jumped at the opportunity in that system. Average players can to create a winning team. We still had to expand her role in our office and become good players, and good players conflicts; the team didn’t always work well

42 It’s just BUSINESS H.R. INSIGHT

together and sometimes team members opportunity to evaluate how the potential an employee or how fast they can perform would leave because of those conflicts. new staff member presents to the office if a procedure. These days personality, the After turning over most of the hiring they are on time. It also gives the potential understanding of your office culture, process to my current team, these hire an opportunity to see if our office is a flexibility, and ability to be a team player conflicts disappeared. The teamwork is place that they would like to work in and matter more than clinical skills. Clinical better, more efficient and my staff is giving if the drive from their home is acceptable. skills can be taught and strengthened. an average of three months of notice • Working interview. During our when they are leaving. They do not want 2nd opportunity to spend time with a So embrace change. Staff turnover can to put their teammates (and friends) into potential new hire, we evaluate character, be a very good thing for your practice. a bad situation by making a quick hire personality and determine if they can do It allows you to 1.) reset your payroll by and working with someone that they don’t what is on their resume. getting rid of overpaid staff members. mesh well with. Now when staff members • Lunch with the staff only. Finally, I’ll 2.) add new systems and protocol, which leave it is because they move, get married send my entire staff to lunch with the entrenched staff member may resist. or go back to school. We still average potential new hire and allow them to 3.) bring in fresh ideas and perspective about two years with each staff member interact in a social setting without me. to a stale environment. 4.) eliminate/ but finding new good/great employees modify costly benefits which may hinder is never a problem. Somebody usually After three meetings we have a good the practice’s growth. 5.) make drastic knows someone that knows someone that feel for the person that we are hiring. If changes to the scheduling 6.) modernize fits our system and is a good teammate, they have met my basic requirements your business plan to reflect the reality awesome resumes “magically” appear of looking professional, being on time of today’s orthodontic market. 7.) form on my desk or a current staff member and capable of doing the job, the choice a more cohesive team. 8.) develop your steps up their role in the office to avoid of who to hire is the employees’. I don’t current employees. bringing the wrong player aboard. have to like them: I just need them to be reliable employees, who are willing to Our interview process has three steps: learn and work well with others. • Initial meet and greet. This is our Don’t get caught up in the experience of

Q2 • 2017 | TheProOrtho.com 43 Web Solutions Designed For Dentists

MARKETING, SOCIAL MEDIA & EVENTS

PROFESSIONAL-LEVEL PHOTOGRAPHY IN 5 STEPS By Dr. Kyle Fagala

How important is great photography away from Auto is the first step to great or “bokeh” of a DSLR with its Portrait to your social media efforts? Well, ask shots. mode. It achieves this not by widening yourself this: Are you more prone to “like” the aperture, but instead by using both a darkly lit, overly contrasted smartphone SET YOUR CAMERA MODE TO camera lenses simultaneously to capture shot, or a gorgeous, professional-level APERTURE PRIORITY different portions of the subject and then photo with a creamy, blurry background A quick note on how cameras work: the combining the elements digitally. Pretty and smooth lighting? The latter, of course! aperture refers to how wide (or narrow) cool stuff! An entry-level DSLR camera (as a hole in your camera opens to allow opposed to a “point-and-shoot” or light into the camera’s sensor. Aperture –––––––––––––––––– smartphone camera) can take your also impacts how much of your photo is It might seem like a lot photography from pretty good to in focus, and it’s measured in f-stops. A of information, but the professional-grade. All you need is a basic “wide” aperture is a lower number, like Canon or Nikon DSLR package, which f2.8, and will translate into less of your process will become second you can find on Amazon for a great price. photo being in focus. A “narrow” aperture nature quickly, I promise. Try picking up a simple 50mm fixed lens is a higher number, like f11, and most of And it’s worth the effort! with a low f-stop for especially gorgeous your shot will be in focus. There’s another –––––––––––––––––– portraits. element to this concept (bear with me!) Using a DSLR (and using it right!) can and that’s distance. If you’re right up SHOOT IN RAW be a bit overwhelming, though; I know. on top of your subject, less of your shot This is another technical concept, but But you’re likely taking similar shots over will be in focus with a wide aperture, a you can typically shoot either RAW files or and over, so let’s focus in on the systems low f-stop number. However, generally JPEG files. JPEG files come compressed, that will support us in those situations. speaking, from the typical distance from ready to go and upload, but you are adding which you shoot patients, a wide aperture your edits on top of this compressed STEP AWAY FROM AUTO! (low f-stop) will get their entire face in file when you shoot in JPEG. RAW It might seem like Auto mode is focus while blurring the background files essentially let you make changes to the easiest approach, since the camera beautifully. All of that to say this: set your shot’s raw form, almost like you’re should know what it’s doing, right? your camera to aperture-priority mode making adjustments in the camera. Got an Well, unfortunately, this isn’t the case and turn the aperture down around f3.2 underexposed photo that’s actually a great with most cameras, as it will frequently or so. You should notice an immediate shot of a patient? That’s easy to fix with a over or underexpose a shot, blow out a improvement in the quality of your RAW file; JPEG, not so much. Shooting background, set too much in focus, etc. portraits this way. in RAW is not absolutely necessary, and Don’t worry; I’m not going to ask you to Of interest, the new iPhone 7 Plus you can produce some beautiful photos by set things to Manual, but turning that dial mimics the blurred background effect shooting in JPEG. However, shooting in

46 It’s just BUSINESS MARKETING, SOCIAL MEDIA & EVENTS

RAW can change your entire photography shot-specific changes needed. You don’t transparent .png format, load it up into practice, and I highly recommend it. It’s have to do much, and you can often save your photo-editing software and apply it important to note, however, that you can’t your regular edits as a preset to apply to whenever you export your shots. Or try upload a RAW file (the extension is .CR2) future photos very quickly. You can also iWatermark Pro on your phone, which without editing it first and then export it take a photo on a DSLR, upload, and then makes it very easy to add a watermark to as a more program-friendly file type, like a e-mail it to yourself so you can edit it on any image. That’s what we use at Saddle JPEG. So... your smartphone if you don’t want to pay Creek Orthodontics. the high price tag associated with most It might seem like a lot of information, EDIT YOUR PHOTOS! desktop editing software. but the process will become second nature Very rarely do we share photos without quickly, I promise. And it’s worth the editing, but that doesn’t mean we’re WATERMARK THOSE BAD BOYS effort! A DSLR camera and decent lens doing facelifts in Photoshop. Usually, Watermarking your photos can serve will produce excellent images that make we just add some contrast, adjust the two purposes: making your photos harder your posts more shareworthy and help you exposure a bit, decrease the blacks (this to steal (yep, it happens all the time!), and stand out from the crowd. will deepen the black tones, rather than branding your images consistently. If you lightening them), and make any other have a copy of your practice’s logo in a

Q2 • 2017 | TheProOrtho.com 47 ADDITION BY SUBTRACTION. Supercharge your No Sale patient follow-up while drastically minimizing time spent getting patients to say YES. Mind blown.

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Invisalign The Next Generation

58 It’s just BUSINESS Open Here ------> CLINICAL CORNER

& Propel: The Next Generation Orthodontic Disruptor

Q2 • 2017 | TheProOrtho.com 59 CLINICAL CORNER

INVISALIGN® AND PROPEL: THE NEXT GENERATION ORTHODONTIC DISRUPTOR By Dr. Gary Brigham

At their most recent Summit in orthodontic treatment. While Baby of Propel’s Excellerator™ drivers⁷, my November 2016, Align Technology Boomers, in particular, have shown preferred device is the Excellerator formally promulgated the now adapted an increasing interest in orthodontic PT, which I found to be ergonomically recommendation of a 7-day aligner treatment, many will consider it only if it efficient and effective in delivering MOPs exchange format that essentially is less obtrusive, more socially acceptable, as well as providing greater patient reduces Invisalign treatment time to and fast. Orthodontic practitioners today satisfaction with the procedure. Initially, approximately half of what it traditionally are now faced with new and challenging I was pleased with being afforded the required with the previously proposed treatment time constraints that have opportunity to have my patients exchange 2-week aligner exchange. Recently, the grown significantly more critical in the aligners every 7 days, which effectively internationally renowned educator and past several years. reduced aligner treatment time to clinician Dr. Tom Pitts promoted his most half of what it had traditionally taken. recent seminar with a brochure titled INVISALIGN AND MOPS However, when Dr. Thomas Shipley Exceptional Esthetics in Less Time. In a Manual osteoperforations (MOPs), (Peoria, Arizona) originally proposed recent addition to Colgate’s Oral Health previously referred to as micro- a 3-day aligner exchange protocol with Network for Professional Education and osteoperforations, is an orthodontic documented cases, demonstrating Development format, The Fastest Way modality supported by both theoretical exceptional clinical results with no root to Straighten Teeth with Orthodontic science¹-² and individual practitioner resorption as evidenced by iCat® imaging, Treatment was prominently featured. reported clinical experience.3-6 I was compelled to follow his lead. Over The question generated from these Specifically, disruption of the cortical the past year, we have experienced developments is: “Why this apparent layer of the dentoalveolar bone (as little significant success with this protocol. collective corporate and clinical focus as 3mm in depth, according to Alikhani For more challenging cases, we have on accelerated orthodontic treatment?” et al.¹) creates a cascade of both pro- found that when educating patients on Specifically, what do these prominent inflammatory cytokines and chemokines how to identify and monitor their own leading professional institutions associated with osteoclastic activity and aligner tracking and empowering them to and educators know that so many subsequent accelerated bone remodeling. determine their own aligner exchange rate orthodontic practitioners who are already One cytokine, in particular, macrophage (3,4,5,6, or 7 days, abbreviated to what is experiencing interest from their patients colony stimulating factor (M-CSF), now referred to as a 3/5/7 day exchange), in acceleration but do not yet realize that appears to play a significant role in this we have experienced greater success it is integral to their practice futures? process by dramatically stimulating with continuous tracking and treatment What these companies/educators osteoclastic motility and spreading, progress, particularly when patients fail to recognize is that patients are growing and by enhancing osteoclastic survival, wear the aligners the recommended 20-21 increasingly impatient. By the time migration, and chemotaxis. This is the hours per day. adolescents reach their teens, they are theoretical science believed to underlie already inundated with ever increasing MOPs. Although MOPs has not been CASE STUDY 1 educational and technological demands, studied clinically, an important study in a Case 1 illustrates our experience. extracurricular activities including rat model at New York University appears The patient, a 14½-year-old male, had sports that often now require rigorous to confirm the science. previously undergone Phase I treatment out of state competition schedules, and In this article, I will illustrate what I and presented for Phase II consideration maintaining an online identity distinctly have seen in my practice. Other practices (Figure 1). However, a serious contender different from their everyday social may have different experiences, but these for a professional junior hockey league, reality. In addition, Millennials and cases illustrate how MOPs has been he expressed concern that braces Baby Boomers alike are now mimicking implemented in my practice. Having would complicate his ability to use a teens in their diminishing capacity for used and previously described my clinical mouthguard during sports, and that both patience and compliance with experience with all three generations wearing elastics and attending adjustment

60 It’s just BUSINESS CLINICAL CORNER

visits would be challenging due to CASE STUDY 2 CASE STUDY 3 his extensive practice, competition, and Case 2, a 26-year-old male, presented Case 3, a 52-year-old female presented travel schedule. Accordingly, Invisalign with an anterior open bite with with a history of nightly wear of a sleep Teen® and MOPs were recommended as inadequate incisor and gingival display apnea appliance that postured her a viable treatment protocol to address his and a reverse smile arc (Figure 4). MOPs mandible forward into a muscle-splinted concerns and was subsequently elected by using the ExcelleratorPT with Invisalign position where occlusal function was the patient. The patient underwent MOPs was proactively recommended and no longer possible or comfortable due using the Excellerator PT to conduct accepted by the patient. The Nicozisis to incisal trauma exacerbated by a steep dentoalveolar perforations from molar to Extrusion Protocol, which adds a interincisal angle (151°) (Figure 7). molar in both arches and was instructed significant amount of treatment aligners Invisalign was recommended to improve to exchange the total of 66 aligners every but effectively addresses the reverse smile her incisor relationship while maintaining 3,4,5,6, or 7 days according to his tracking arc, was incorporated into the Clincheck®. the forward mandibular position so that performance. The patient completed The patient underwent MOPs from she could continue to wear her sleep treatment in a total of 12 months and 2 canine to canine in both arches and was apnea appliance. The incisor changes weeks (Figure 2 and 3). instructed to exchange the total of 41 and more obtuse interincisal angle aligners every 3,4,5,6, or 7 days according enabled a hinge axis of closure of the to his tracking performance. The patient mandible in the therapeutic forward completed treatment in 10 months and 1 mandibular position to maintain the open week (Figure 5 and 6). airway created by the sleep appliance while restoring masticatory function without incisor trauma. The patient also underwent MOPs from canine to canine in both arches using the ExcelleratorPT and was instructed to exchange the total of 48 aligners every 3,4,5,6, or 7 days according to her tracking performance. The patient completed treatment in 8 months and 1 week (Figure 8). FIGURE 1: CASE 1 INTRAORAL AND FACIAL PRETREATMENT PHOTOS

FIGURE 4: CASE 2 PRETREATMENT INTRAORAL AND FACIAL PHOTOS

FIGURE 7: CASE 3 INTRAORAL AND FACIAL PRETREATMENT PHOTOS

FIGURE 2: CASE 1 INTRAORAL AND FACIAL POSTTREATMENT PHOTOS FIGURE 5: CASE 2 INTRAORAL AND FACIAL POSTTREATMENT PHOTOS

FIGURE 3: CASE 1 POSTTREATMENT PANELIPSE FIGURE 8: CASE 3 INTRAORAL AND FACIAL FIGURE 6: CASE 2 POSTTREATMENT PANELIPSE POSTTREATMENT PHOTOS

Q2 • 2017 | TheProOrtho.com 61 CLINICAL CORNER

FIGURE 9: CASE 3 POSTTREATMENT PANELIPSE

Incorporating MOPs into our Invisalign practice has provided an unparalleled opportunity. MOPs have improved our practice efficiency, increased our FIGURE 10: CASE 4 PRETREATMENT PHOTOS FIGURE 13: EXAMPLE OF AN INVISALIGN productivity, and attracted new patient CASE UNDERGOING BOTH MOPS AND PULSE referrals from our MOPs patients. For our VIBRATION AS AN AID TO ALIGNER SEATING practice, the combination of Invisalign and MOPs is clearly our gold standard. This article may describe uses of osteo perforation in general and/or an INVISALIGN AND PULSE ExcelleratorTM series driver specifically VIBRATION that have not received 510(k) - clearance In my own practice, I found that a or premarket approval from FDA. Propel significant number of my patients do Orthodontics markets the VPro5TM as a not in fact properly seat their aligners high-frequency vibration aligner seater. This as directed. With the introduction of article may describe uses of high-frequency adjunctive pulse vibration in conjunction vibration technology in general and/or the with aligner treatment, our practice has FIGURE 11: CASE 4 POSTTREATMENT PHOTOS VPro5 specifically that are outside of our experienced enhanced treatment progress labeling. Propel Orthodontics provided and results when the pulse vibration financial support to the author. is used to help patients ensure that the aligner is seated properly. For these Resources purposes, we have incorporated Propel’s VPro5TM into our aligner treatment 1. Alikhani M, Raptis M, Zoldan protocols due to its favorable price point B, Sangsuwan C, Lee YB, Alyami B, FIGURE 12: CASE 4 POSTTREATMENT PANELIPSE and the fact that it requires only 5 minutes Corpodian C, Barrera LM, Alansari of use per day. Patient cooperation with CONCLUSION S, Khoo E, Teixeira C. Effect of micro- the device has been highly consistent. The concerns of orthodontic osteoperforations on the rate of tooth The following case is an example of my practitioners appear to be universal: 1. movement. Am J Orthod Dentofacial experience: More patients, 2. Increased profitability, Orthop 2013; 144(5):639-48. 3. Reduced chair time (clinical efficiency) CASE STUDY 4 and practice stress, 4. Increased Case 4 illustrates our experience with 2. Teixeira CC, Khoo E, Tran patient satisfaction and comfort, and 5. pulse vibration and Invisalign treatment. J, Chartres I, Liu Y, Thant LM, Increased patient and doctor referrals. A 47-year-old female presented with In my personal experience, Invisalign Khabensky I, Gart LP, Cisneros G, bimaxillary moderate incisor crowding, in conjunction with modalities such Alikhani M. Cytokine expression and a right posterior open bite, a steep as MOPs and pulse vibration devices accelerated tooth movement. J Dent Res interincisal angle with inadequate incisal appears to address all of these concerns. 2010; 89(10):1135-1141. guidance. The patient elected to use a Importantly, these modalities appear to pulse vibration device. The patient was position practices in the direction toward 3. Nicozisis JL. Accelerated compliant and used the device 5 minutes where orthodontics as a profession per day and exchanged the total of 53 orthodontics through micro- appears to be gravitating. With increasing aligners every 7 or more days according osteoperforation. Orthod Practice US. patient demand for unobtrusive treatment to her tracking performance. The patient 2013 March/ April; Volume 4 No 3, and less treatment time, Invisalign and completed treatment in 13 months and 2 56&7. MOPs appear to be the gold standard in weeks. meeting these challenges.

62 It’s just BUSINESS CLINICAL CORNER

4. Shipley TS. The use of Propel to cyclical device in orthodontics. Orthod frequency acceleration on alveolar bone. increase aligner progression. Orthod Pract US 2010; 1:10-15. J Dent Res 2012; 91(4): 413-419. Practice US. 2014 March/ April; Volume 5, No 2, 52-56. 13. Bowman SJ. The effect of vibration 20. Leethanakul C, Suamphan S, on the rate of leveling and alignment. J Jitpukdeebodintra S, Thongudompom 5. Shipley TS. Proactive treatment Clin Orthod 2014; 48:678-688. Pavlin U, Charoemratrote C. Vibratory with Propel. Orthod Practice US. 2015 D, Anthony R, Raj V, Gakunga PT. stimulation increases interleukin-1 March/April; Volume 6, No 2: 38-39. Cyclic loading (vibration) accelerates beta secretin during orthodontic tooth tooth movement in orthodontic movement. Angle Orthod Sept 2015; 6. Brigham G. The Propel® System: the patients: a double -blind, randomized Vol. 85; No.5: 900-900. next generation orthodontic disruptor. controlled trial. Semin Orthod 2015; Orthod Practice US. 2015 September / 21:187-194. 21. Lobre W, Callegari B, Gardner G, October; Volume 6 No 5. Marsh C, Bush A, Dunn W.Pain control 14. Woodhouse NR, DiBiase AT, in orthodontics using a micropulse 7. Brigham G. Increasing micro- Johnson N, Slipper C, Grant J, Alsaheh vibration device: A randomized clinical osteoperforation efficiency with Propel’s M, Donaldson AN, Cobourne MT. trial. The Angle Orthodontist: July new Excellerator PT. Orthod Practice Supplemental vibrational force during 2016, Vol.86, No.4: 626-630. US. 2016 March/April; 56-58. orthodontic alignment: a randomized trial. J Dent Res May 2015; 94(5): 682- 8. Peptan AI, Lopez A., Kopher RA, 689. Mao JJ. Responses of intramembranous bone and sutures upon in vivo cyclic 15. Yadav S, Dobie T, Assefnia A, tensile and compressive loading. Bone Gupta H, Kalajzic Z, Nanda R. Effect 2008; 42:432-438. of low-frequency mechanical vibration on orthodontic tooth movement. Am J 9. Vij K., Mao JJ. Geometry and Orthod Dentofacial Orthop Sept 2015; cell density of rat craniofacial sutures Vol. 148; No.3:440-449. during early postnatal development and upon in vivo cyclic loading. Bone 2006; 16. Kalajzic Z, Polusa EB, Utreja A, 38:722-730. Dyment N, Nihara J, Xu M, Chen J, WANT A Uribe F, Wadhwa. Effect of cyclical 10. Kopher RA, Nudera JA, Wang X, forces on the periodontal ligament SUBSCRIPTION TO O’Grady K, Mao JJ. Expression of in and alveolar bone remodeling during vivo mechanical strain upon different orthodontic tooth movement. Angle THE PRO ORTHO wave forms of exogenous forces in Orthod Mar 2014; 84(2): 297-303. rabbit craniofacial sutures. Annals of Biomed Eng 2003; 31:1125-1131. 17. Lala A. Vibrational therapy in MAGAZINE? orthodontics: Realizing the benefits. 11. Nishimura M, Chiba M, Ohashi T, Ortho 2016; Vol.1; Issue1: 24-27. Sato M, Shimizu Y, Igarashi K, Mitani SUBSCRIBE AT H. Periodontal tissue activation by 18. Judex S, Rubin CT. Is bone THEPROORTHO.COM vibration: Intermittant stimulation formation induced by high -frequency by resonance vibration accelerates mechanical signals modulated by experimental tooth movement in rats. muscle activity? J Musculoskeletal Am J Orthod Dentofacial Orthop 2008; Neuronal Interactions 2010: 10(1):3-11. 133:572-583. 19. Alikhani M, Khoo E, Alyami B, 12. Kau CH, Nguyen JT, English Raptis M, Salgueiro JM, Oliveira SM, JD. The clinical evaluation of a novel Teixeira CC. Osteogenic effect of high-

Q2 • 2017 | TheProOrtho.com 63 CLINICAL CORNER

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914.458.7550 888.851.0533 or HenryScheinOrtho.com www.dentalfone.com © 2017 Ortho Organizers, Inc. All rights reserved. M1035 2/17 U.S. Patent No. 7,621,743, 7,238,022 B2, 7,618,257 B2, 6,976,839 B2, and foreign patent numbers. Q2 • 2017 | TheProOrtho.com 65 BUSINESS & PRACTICE DEVELOPMENT

MeetDerek Bock

66 It’s just BUSINESS BUSINESS & PRACTICE DEVELOPMENT

We caught up with Dr. Derek Bock and he was PROORTHO: HOW DID YOU MEET YOUR AWESOME WIFE? HOW DID generous enough to find time in his busy schedule YOU CONVINCE HER TO MARRY to answer a few questions. As one of the most YOU? :) recognizable orthodontists on the planet, Dr. Bock BOCK: I absolutely fell into that one. will have a great deal of influence shaping the I’m a big believer in Karma and Fate. I live my life by the golden rule and try profession in the decades to come. I’d suggest you and give more than I take. I didn’t always pay attention to what he has to say! live my life this way, but my wife Anokhi has helped me over the last 17-years pontificate the meaning of ‘it all’. We met in Dental School in Boston, at Tufts University School of Dental Medicine. We were both in the same dental class, and fate brought us together in the first semester. She’s been with me from the beginning of my professional journey, and I plan on her being there to the end. She is my Compass Rose and keeps me pointed in the right direction. Like many of us, I have the tendency to take on too many projects at once. She helps me organize the juggle that must ensue. Most people don’t know that Anokhi was originally going to apply to orthodontic residency programs. The troubling part for me was that she is smarter than I am, and her class rank was higher than mine. I used to think, how the hell am I going to get into a program when I have to compete against her? Luckily, she fell in Love with Pediatric Dentistry in a 3rd-year externship and changed her track. She convinced me to move out to the Midwest, where she grew up, for both of us to pursue post-graduate training, under the premise we were going back east. Once again, she’s smarter than I am; We’ve been in the Chicagoland area ever since. She also manipulated me into opening up Pedo-Ortho practices with her, something I was 100% against BUSINESS & PRACTICE DEVELOPMENT

coming out of residency. Like I said, she’s the practice during busy times. Once the understanding that we won’t be here the Compass Rose. dates are established, Anokhi and I decide forever to help them and do things for when and where we want to take our 6-7 them. The sooner they learn to stand on PROORTHO: TELL US ABOUT YOUR weeks of vacation throughout the year. their own 2 feet the better. It’s way too FAMILY - YOU’RE ALWAYS ON THE After we figure those blocks out, we fill in easy to spoil your kids; you have to go out GO WITH YOUR KIDS. HOW DO YOU long weekend trips in between the longer of our way to avoid it. It will pay off in the MAKE THE TIME FOR BALANCE? vacations to balance out the time. end when they become independent global BOCK: Anokhi and I have a completely Travel and experiences are some of citizens. integrated lifestyle with our practices and the most important things I can give my personal life. There is absolutely no way children. The more that I can break them PRORTHO: WHAT HAVE YOU to compartmentalize different facets of out of the ‘bubble’ that they live in, the FIGURED OUT ABOUT AN your existence; they always bleed into each better. There is NOTHING I love more ORTHO-PEDO SETUP THAT other. We’ve embraced the bleeding and than spending time with my children and MOST ORTHODONTISTS DON’T use it as a lesson of accountability for our when it’s exploring new parts of the world UNDERSTAND? 4 children. It’s extremely liberating to on vacation, even better. I want my kids BOCK: I’ve figured out how to not think own every second of your schedule. That to appreciate the opportunity that we can like an orthodontist when it comes to this being said, we work very hard so that we provide for them, but I will not accept business model. The failure I see with most can play even harder. We set up a master entitlement. They fully understand that orthodontists that romanticize the model is schedule a year in advance on a rolling our lives are integrated now and that it that they just want the control. They want basis. We figure out all the high and low won’t always be that way. From a very the pediatric dentist under their thumb, production points in the schedule for the young age, we’ve taught our children that to funnel patients their way. It doesn’t year. We establish ‘blackout’ dates where independence is the first attribute that work that way, it has to be symbiotic to be nobody, is allowed to take time away from they need to develop. They have a deep wildly successful. The orthodontic practice

68 It’s just BUSINESS BUSINESS & PRACTICE DEVELOPMENT

is only a healthy business entity if the pediatric dental practice is a really vibrant place to be. We spend the majority of our external marketing focus and dollars on the young pediatric dental patients. We’ve spent years studying how young families consume both products and services within the communities that we serve. It all started by swimming upstream away from what our competitors were doing with their marketing. We used grassroot marketing efforts, to position ourselves in front of these young families as a quality- driven practice that was already part of their current lifestyle. We have to make the little ones happy, and their parents, in order to have a shot at their orthodontic business downstream. We go out of our way to make our office environment feel like another room in our patient’s ------All the practices were in neighboring home. We kill them with kindness and towns, that made the patient population convenience; removing as many obstacles It’s extremely liberating drive 15 minutes for service. The town has as possible. Once the young pediatric over 25,000 people, and they were forced population is happy, our only job is to keep to own every second of to drive 15 minutes?! I saw an opportunity them that way for the next 10+yrs. We your schedule. That being to give this underserved community rely on our pediatric dental population to a Pedo-Ortho experience that they’ve drive 60% of our orthodontic new patient said, we work very hard never seen before. The marketing plan of exams. There has to be a symbiotic culture so that we can play even attack is different than our main practice in the office for this to be a reality. We because the population consumes products spend a lot of time on role playing with harder. and services differently. We are drawing the entire team. The secret is quietly patients in through more mainstream supporting the orthodontic practice from ------outlets, such as Radio and Billboards. within the pediatric dental side. The start-up practice since getting out of We are still working the guerilla warfare second a patient family feels that it’s a residency. The new satellite office is in an grassroots marketing plans that have sales push, they’re gone. It has nothing entirely different demographic than our created our brand momentum. Whenever to do with sales. It has everything to do affluent main practice location. Our main I’ve started a scratch practice, I always have with trust, brand strength and automatic practice is located in Lake Forest, IL which ‘struggle amnesia’ and I’m dissatisfied with consumption. Once you gain momentum, possesses an average gross household its performance. We produced just over you just have to keep doing the right thing income of almost $300k within a 3-mile $700,000 our first year out of the space; and produce quality results in a convenient radius of the office. The new location is I probably should be happy?! My biggest environment. in Round Lake Beach, IL which is about piece of advice for anyone contemplating 20 miles away and possesses a gross opening up satellite practices is to analyze PROORTHO: YOU RECENTLY household income of $50k. The new whether you can ramp up marketing in OPENED A NEW OFFICE. WHY? office location is in a primarily Hispanic your main practice first for increased HOW’S IT GOING? DO YOU area. Most people ask me why we brought production. This is far more profitable and RECOMMEND OPENING UP A our high end, concierge brand out to that far less of a headache. When we analyzed SATELLITE? town? It came down to the basic fact that our main practice, we didn’t feel that we BOCK: We opened another location there was no orthodontist or pediatric could get the patient population to drive almost a year ago. This will be my 3rd dentist servicing that community directly. in an additional $2-3 million dollars of

Q2 • 2017 | TheProOrtho.com 69 BUSINESS & PRACTICE DEVELOPMENT

revenue a year, so we branched out. are already numerous vendor deals their clinical game. It’s a geographically arranged for the group that helps offset restricted group that houses some of the PROORTHO: YOUR PRAGMATIC the increasing overhead we face in private biggest and most influential Key Opinion ORTHODONTIST GROUP IS THE practice. These deals only get better with Leaders (KOL’s) in our profession today. LARGEST LEGITIMATE ORTHO greater member numbers, and with an It’s protected by a Non-disclosure act and GROUP ON FACEBOOK BY FAR. WHY ever increasing mental cohesion. If we has become an open training ground for IS IT SO SUCCESSFUL? WHAT DO can all get our brains pointed in the right accelerated clinical learning. There is a PEOPLE LEARN THERE? direction, we have a powerful weapon small membership fee associated with BOCK: There are over 2800 against the changing orthodontic climate. the group that serves two purposes. 1) it orthodontists in that group, it’s crazy to It’s something I’m working on with helps offset the hired administrative help see how far it has come. It seems like just members every day. that I employ to run Both groups. 2) it yesterday that it was only a few of us ‘tooth makes you have some skin in the game to nerds’ talking about mechanics and clinical –––––––––––––––––– fully utilize all the power that is contained efficiencies. The success of the Pragmatic within the group. I require a commitment Orthodontist is multifactorial. Firstly, it’s It’s crazy to see the to the group for regular posts, interaction, 100% orthodontic specialists and residents cultural change in your and clinical learning. This group is not for which help with the quality of material everyone, only those willing to dedicate posted. Secondly, the molded culture is office when you go themselves. I have capped membership at its life source. It has taken a couple of 200 members for 2017, and 300 member’s years to help guide the ‘group thought’ of from 25 aligner cases a lifetime. There’s a science behind group being a safe, respected place to ask clinical year to 200, it’s electric. creation; a perfect titration of number and orthodontic questions. Orthodontists are skill set. trained to do the exact opposite. We’re The thing that I didn’t groomed in residency to attack each other PROORTHO: YOU’RE A MEMBER in morning presentations, and hold our see in my practice for OF ORTHO EXCHANGE AND ground in case defense. It’s part of my years was the untapped PROORTHO FE. TELL US ABOUT legacy to break down this antiquated BEING IN ALL THESE GROUPS. WHY mentality and help people embrace their limited treatment with IN ALL OF THEM? WHAT DO YOU colleagues and treat them as PEOPLE, GET OUT OF THEM? IS IT WORTH not competition. People often ask me Invisalign. THE TIME AND MONEY? why I allow Orthodontic residents into –––––––––––––––––– BOCK: Outside of the groups that I the group. It’s simple; we’re training these run, I only spend time in OrthoExchange young orthodontists to think critically in PROORTHO: YOU STARTED THE and ProOrtho FE. These groups offer a diverse environment that has common PRAGMATIC ORTHODONTIST: ELITE something unique that I am lucky to be a respect and professionalism. There is no - WHAT IS THAT ABOUT AND WHAT part of. OrthoExchange is a really young more important group of individuals to IS INVOLVED? progressive group of orthodontists. The mold than them! It was a ton of work for BOCK: The Pragmatic Orthodontist: members of OrthoExchange are thirsty for the first couple years to get a large group of Elite is a smaller splinter group off the knowledge and are on a constant quest for Alpha Orthodontists to cooperate, but it’s main Pragmatic group. For some of us, it improvement and growth. There’s not a finally there and it is AWESOME. was formed out of necessity. 75% of the day that goes by, that I don’t pick up a pearl elite group members have been practicing that pertains to the struggle of running a PROORTHO: WHERE DO YOU orthodontics for 10+ years. We needed practice. ProOrtho FE is on its own planet. SEE IT GOING? WHAT ARE SOME a place where a certain clinical mindset I’ve never seen such an assembly of true BENEFITS OF MEMBERSHIP? had already been achieved. Most of the Orthodontic BALLERS. The members BOCK: Let’s be honest, there is a ton Elite members are the major mentors in of this group are functioning so far in the of power in an organized group of 2800 the larger Pragmatic group. They’re on future as it pertains to the global thought orthodontists. I would like to leverage the front lines helping train and guide process that I feel small in nature. I used the power of the group to negotiate the younger orthodontists. We needed to think that I was unique in the way I relationships with companies that are a place where we could openly learn off processed the business of dentistry until I beneficial for us as a profession. There each other; those already at the top of joined ProOrtho FE. Extremely humbling

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and worth every penny. Both of these groups are an absolute steal if you can gain access!

PROORTHO: WHAT DO YOU THINK ABOUT MKS AND HOW DO YOU THINK MEETINGS LIKE THAT WILL CHANGE THE PROFESSION? BOCK: I have been fortunate to participate in the last 2 MKS events. The energy from the last meeting was crazy. I’ve never attended a meeting where the entire crowd was simultaneously connected and stimulated. It was the feeling of a viral facebook thread where everyone was glued to every response. I have never witnessed such a large group of progressive doctors ‘drinking’ in the knowledge. I can’t wait for this year!

PROORTHO: YOU’VE RECENTLY GOTTEN SERIOUS ABOUT INVISALIGN. WHY? HOW HAVE YOU IMPLEMENTED? HOW IS IT GOING? BOCK: I was the typical orthodontist when it came to Invisalign. I had no problem converting Invisalign patients into Damon Clear braces. I would only treat patients in Invisalign if I absolutely had to; 20-25 cases a year. I had carved out a really efficient clinical system using the Damon PSL system, and I saw no reason to change. I then started to see some extremely well-executed Invisalign finishes, in the Pragmatic Orthodontist, that were more efficient than what I was doing in fixed!!! How could this be?! I dedicated the last year to learning advanced level Invisalign mechanics directly from talented clinicians like Jonathan Nicozisis and Maz Moshiri. I learned to set up my clinchecks to mimic my PSL mechanics with lateral development and torque control. I’ve been ecstatic about the progress and results. For those of you who follow my posts online, you know I document cases extremely well. Stay tuned for a few hundred well-documented Invisalign cases, demonstrating my clinical journey.

72 It’s just BUSINESS BUSINESS & PRACTICE DEVELOPMENT

With the advancements in technology treatment. I love putting on braces, and enough to teach and share what I’m doing and business models, aligner therapy the control of finessing the finish and what I have done. This has nothing will be a large portion of how we treat to do with ego, I offer my mentorship as orthodontic cases in the future. If we PROORTHO: WHAT KEEPS YOU UP karmic repentance for mistakes made in don’t ‘own’ the mechanics of moving AT NIGHT? the past. Not a single person possesses teeth in plastic, we’re going to miss out Bock: Everything! Over the years I’ve all the answers. I’ve dedicated the last on a large portion of new orthodontic learned to leave the practice problems at few years of my life to sharing my work, patients entering the market. The word the practice. If I wake up in the middle my passion, and my thoughts in hopes of of mouth advertising that your Invisalign of the night about the practice, it’s a real stimulating orthodontists to critically think patients bring is far greater than your problem and needs immediate attention. and collaborate. I’m a ‘doer’, my biggest fixed patients, especially in the Teen Everything else about the practice is insecurity is that I haven’t done enough. segment. Kids talk, and they are liking inconsequential and can get addresses in I worry about the future of our the flexibility that aligners give them with due time. profession in the current environment. their busy schedules. It’s crazy to see the The things that have been waking me up There is confusion in the marketplace as cultural change in your office when you for the last few years are more about legacy. to who should be performing orthodontic go from 25 aligner cases a year to 200, it’s I was talking to a friend the other day treatment. Is it the general dentist, the electric. The thing that I didn’t see in my about philosophical perspective and self- orthodontist, the pediatric dentist, a practice for years was the untapped limited awareness. I told him that I believe you computer algorithm? This is an interesting treatment with Invisalign. I’ve had a huge can only truly get backward perspective time indeed, but my concern is for those increase in the 8-10 month limited adult on life once you’ve traveled through all orthodontists that don’t actively embrace treatment segment. This was the area of 7-levels of the inferno. Until you’ve truly the change that is coming. The number my practice with the lowest conversion made all the ‘real’ mistakes, you’re just of patients that will seek orthodontic rate; these adults wouldn’t accept braces speaking in conjecture. I, unfortunately, services is going to exponentially increase and the general dentist down the street was have made a lot of real mistakes. I want in the coming years. What have we done treating them in Invisalign. Orthodontists people to remember me for what I did as a profession to educate that patient need to be better at modulating our pricing to help other people avoid some of those population as to who they should see for model in cases like this with Invisalign. mistakes. What wakes me up almost their treatment? That scares the shit out of Don’t get me wrong, I still do a ton of fixed every night is the fear that I didn’t do me, and keeps me awake at night!

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“HOW DO I DO MORE INVISALIGN?” By Dr. Jason Tam

This is a question heard quite often in providers of Invisalign have “only” started what did not. Even better is studying the conversations amongst orthodontists. In or completed 300 treatments lifetime. ClinCheck at each appointment to hone in order to increase the amount of Invisalign Although we like to tell the public and on where a treatment may or may not have treatments in their practice, many doctors pat ourselves on the back because of the gone off track. spend a lot of money trying to get more statuses bestowed upon us, these numbers patients in the door. It isn’t marketing that are very low when you take into account 3. Bored on a Friday evening with no is needed. Patients know about Invisalign case experience. Think about how many friends and have nothing to do? :) In and ask for it by name. Many doctors cases of fixed you had to do in order to feel the comfort of your own home, you can will get excited about aligners and start a confident and proficient? How good were access the Aligntech Institute, a wonderful bunch of cases, only to stop a short while you after 300 cases of fixed? In order to resource with archived lectures and treated later because treatments are not running feel more comfortable with Invisalign, it cases. There is enough information on as planned. You can develop a sustainable, is fortunate/unfortunate that you need do this site to help almost every orthodontist long-term increase in Invisalign case more to gain more experience. improve their treatment outcomes and counts, but you need to expand the scope help develop ideas on how to treat cases of what you feel comforatable treating –––––––––––––––––– that you encounter. with Invisalign. If you’re only treating In order to feel more mild crowding or spacing cases, it isn’t too comfortable with 4. With that new knowledge in mind, much of a stretch to do more Invisalign by Invisalign, it is fortunate/ you’ll want to increase your case count. moving to more difficult treatments. The easiest is to provide patients with unfortunate that you need Invisalign at the same cost as metal braces, HERE ARE SOME OF MY do more to gain more or even less (the blasphemy!). Many THOUGHTS: experience. parents and patients come in wanting 1. The reason why we are experts with –––––––––––––––––– Invisalign, but choosing fixed because of braces is because we went through 2-3 cost. Look at this as an investment in your years of additional training with braces. 2. You don’t have to attend local study education with this treatment modality. The majority of us also have practices that clubs or the Summit to learn how to use You will absolutely take a bit of a hit in have more fixed than plastic. It is through Invisalign. Use your existing treatments production and cash flow to start off with the hundreds and thousands of cases that as learning cases. Having a ClinCheck if you’re not increasing your overall start we have discussed and had meaningful simulation from the beginning of count, but learning how to use Invisalign, practice with. While most orthodontists treatment, and being able to use this to developing patients who will talk about feel that we should own the aligner compare actual treatment results at the you with their friends, and establishing a space, we don’t deserve it by default end of a course of aligners can be very reputation as the Invisalign expert in your because of tooth movement. Even Elite valuable to show you what worked, and area can be very good for the long term.

76 It’s just BUSINESS BUSINESS & PRACTICE DEVELOPMENT

------6. Be reasonable with your progression • Premolar extraction for profile where It is very interesting in selecting cases with Invisalign. You there is no crowding wouldn’t start off the first day of residency • Surgical cases to see the change in with a surgical case, severe A/P correction, the entire team when or a four premolar exo case. It may be It is very interesting to see the change in prudent to progress with cases like this: the entire team when the doctor believes the doctor believes in in Invisalign and is able to deliver results Invisalign and is able to • Mild crowding/spacing with it. The TC feels more comfortable • Moderate crowding/spacing with the treatment recommendation, the deliver results with it. • Open bite staff look forward to seeing results, and ------• Anterior Crossbite those taking new patient calls will also 5. Many doctors will tell patients that improve their approach to addressing part of the treatment will start off with • Less than half step A/P correction questions about Invisalign. This creates braces and once specific movements are • Severe spacing a snowball effect and can result in an completed, Invisalign will be used. A • Severe crowding nonextraction increase in case starts. Whether we like it good alternative to this might be to see • Lower incisor exo or not, patients are going to demand this what you can accomplish with Invisalign, • Premolar/molar extraction in severely treatment modality. The only way we can and then use braces as a backup if needed. crowded cases justifiably own the space and be seen as This is better for the patient experience • Posterior crossbite experts is to learn how to use Invisalign and will also help you define the properly and use it more. Here’s to a boundaries of what you are able to achieve • Full step A/P correction practice with more plastic! with aligners. • Unilateral single tooth posterior crossbite

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THE BUSINESS BENEFIT OF REGULAR CLINICAL PHOTOS By Dr. Jeff Kozlowski

There has been a considerable specific number of millimeters thick, the practice. See my article in Orthodontic recent discussion on Ortho 101 and angles need to be trimmed to the exact Products for how to set up your camera ProOrtho FE about the benefits of number of degrees, and they need to be to take consistently good photos with regular clinical photography in the soaped to a high polished shine. All for ease. Top quality photos can and should practice of orthodontics. At the core what - to look pretty in glass cases on be done in less than 5 minutes and if done of this conversation is whether or not the wall? These “excellent” models are properly can have a positive impact on there are any business benefits to taking required by the ABO when acceptable your business. Here are 5 ways that taking clinical photos. Ben made the point rough cut models would suffice which regular clinical photos can benefit your that if your business was not doing well is an enormous waste of time and effort practice. then why would you spend time and in the name of “excellence”. The pursuit money focusing on top quality photos of excellence is fine, but if the cost of EDUCATION - Excellent photos when you could be using that time and pursuing it hurts your business or your may be required if you are planning to money growing your practice. The patients then it’s overkill. This is the curse put them on a 50-foot screen to lecture point seemed simple enough but alas the of the orthodontist. at the Forum or want to use them discussion raged on about why photos for journal articles or other research. were important. As someone who has ------Most orthodontists are not lecturers or taken a full set of photos for every patient Top quality photos can researchers so other than lecturing or at every appointment for nearly a decade, and should be done in research, how can photos be used for I have some insight into the benefits of education. clinical photography. So in light of this less than 5 minutes and • Team - By having consistent photos discussion, I thought I’d share a few ideas if done properly can we can train all team members about on how I see regular clinical photography the progressive nature of orthodontics. fitting into the business of orthodontics. have a positive impact New assistants can see how treatment on your business. is provided and develop a better Before we dive into the business benefits understanding of clinical procedures by of clinical photography, the first thing ------reviewing even a few cases from start we need to do is differentiate between If the process of taking excellent or even to finish. Better training leads to better excellent and acceptable quality photos. acceptable quality photos is excessively clinicians which lead to a more efficient Do the clinical photos need to be excellent time-consuming for the practice and the office. to accomplish the goals for our practice patient then it obviously costs the practice • Patients - Clinical photos can be and patients? No, they don’t! Think of money. However, I do believe it is possible used to educate the patient on how their it like the ABO requirements for study to take excellent quality photos with a participation with elastics and hygiene can models. The model base needs to be a relatively minimal time impact to the shorten their treatment time and require

Q2 • 2017 | TheProOrtho.com 79 BUSINESS & PRACTICE DEVELOPMENT

fewer appointments while achieving the saves me HUGE amounts of time by EFFICIENCY - I’ve already mentioned best result. Education = Money being able to pull up these photos, email numerous ways that taking regular ------the PCD and discuss the case as needed. clinical photos can enhance the efficiency I don’t have to call the patient in for an of your office but I’ll add one more that No one can remember additional visit just to see what the PCD combines the first two points. Educating exactly what the wants me to look at before discussing the yourself as to the mechanics and case. Time = money. treatment you provide will make you a patient’s teeth looked • Patients - Ever get a call to your office better orthodontist. Period. Many of us like at the last visit so from a patient or parent with a clinical THINK we know exactly how our cases how can you know question? “The wire doesn’t run back to progress clinically throughout treatment my last brace” or “There is no bracket on but unless you are regularly reviewing the what resulted from my last tooth”. What most scheduling outcomes of your clinical decisions I’m your decisions at that coordinators do is respond with “Come willing to bet you are underperforming in for an appointment and we’ll check with respect to efficiency. No one can appointment? it out!” This means more appointments remember exactly what the patient’s teeth ------which means less efficiency. Having looked like at the last visit so how can you COMMUNICATION - An extension of regular clinical photos allows our admin know what resulted from your decisions education, communication is an important team to answer these questions just by at that appointment? You can’t! Many part of the orthodontists daily life. opening the patient’s imaging saving us a orthodontists continually plod along • PCD’s - Ever get a call from a PCD few appointments every day. And when with “retie, retie, retie” appointment wanting to discuss the progress of a case the question from the patient is “How do after appointment without being able to with you? Usually, the patient is “in the I wear my rubber bands” we can email compare the changes that have occurred in chair” which is code for “drop what you them a photo to show them because we the name of orthodontic progress. I credit are doing and come answer my very take the buccal photos with the elastics in my regular use of clinical photography and important call”. Many of us have practices place. This saves a huge amount of time regular evaluation of my mechanics and that rely to a certain extent on maintaining and also ensures the patients are wearing treatment progress to my improvements as good relationships with our PCD referrals. their elastics properly. Communication = a clinical orthodontist. This self-learning Having clinical photos from every visit Money has led our practice to continually

LOWER OCCLUSAL SHOWING 2ND VISIT WITH RIGHT BUCCAL SHOWING ELASTICS WIRE CINCHED AT 6’S

80 It’s just BUSINESS BUSINESS & PRACTICE DEVELOPMENT

average 11-12 appointments to complete treatment. Efficiency = money. ------I believe that regular clinical photos are such an important part of practice that they should take the place of before and after models as a standard of care in • Consistency by a reduction in errors on what they can see in the photos that record taking. Our clinicians enter the photos into the they never noticed at home. Our TC’s ------imaging software on our “office” days communicate to patients that we are one CONSISTENCY - There are many (which are “non-patient” or “non-doctor” of the few orthodontists who take these ways that clinical photography can make days). This reduces the amount of team photos at every visit to ensure that we your practice more consistent but let me time taken out of our fully loaded patient follow the progress of treatment and finish highlight just two. days. But the real reason for this is to in a timely fashion. Now I can’t say that • The first 10 years of my career I have the clinicians quickly review the I’ve ever had a patient say they chose us practiced in a group practice where we intra-oral photos to ensure that everything because we take photos at every visit, but “co-treated” every patient. Basically, this was done as noted in the chart from I can say that it is part of our culture of means that you saw all the patients on the appointment. On occasion, they education, communication, and efficiency your schedule whether you treatment will catch things like doors open, ties that people appreciate. And that has to be planned them or not. You may have never or chains not placed properly, elastics worth something, right? Differentiation = seen the patient before. Time is taken in the wrong direction or brackets that Money to review the plan and where they are in mysteriously came loose between finishing In summary, while taking photos will treatment. But what did the teeth look the appointment and taking the photos. not necessarily make you more money if like at the last appointment? If it’s tough A quick visit to the office and we can set you and your practice are starving, there for one orthodontist to remember exactly these things straight rather than allowing are many befits to the business by taking where the patient was in treatment at the them to “cook” for 8-10 weeks and set these photos. I believe that regular clinical last visit, it’s impossible for more than one the patient’s treatment behind schedule. photos are such an important part of to carefully follow the treatment progress. Consistency = Money practice that they should take the place of So if you have more than one orthodontist before and after models as a standard of treating your patients during their time in DIFFERENTIATION - Because regular care in record taking. Heck, if the ABO braces you should strongly consider taking clinical photos are something we’ve done were willing to review my last 100 finished regular photos. This way the doctor of the since the inception of my practice over cases from start to finish via clinical day can see exactly what the teeth looked 8 years ago it has become part of our photos at every appointment I might like the last visit and know if a change in culture. In the new patient exam, parents actually decide to become board certified. mechanics or treatment plan is required to are often amazed at how their child’s continue making progress. teeth look on the photos. They comment

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WTF! MARKETING! By Jeff Behan

If thinking about your practice marketing stand with a few of the new facts impacting 1) IF YOU HAVE TO READ THE has you scratching your head and saying effective marketing communications today. WHOLE THING TO GET THE VALUE WTF, this article is for you. If on the other You’ve probably heard me say that FROM IT, IT WON’T DELIVER. hand, you think you have it all figured out, consumers (your potential customers) it’s also for you. In this case, WTF stands now have the attention span of a gnat. You I’ve always believed that a practice for “Website”, “Twitter” and “Facebook” can debate whether that’s good or bad but brochure’s primary job is to look good and – and whether you are active on these it’s hard to argue any alternative facts :-). to feel good to the touch. It will never be social media platforms or not, they have So what do you do with this knowledge? read by the vast majority of people who shaped consumer expectations so that those I think it has very strong implications for hold it in their hands, yet holding it in their who use the least words to communicate your marketing and, specifically, the content hands is an important and legitimizing effectively wins. Less has never been more of your marketing. moment for the business it represents. I than it is today. Whether you’re designing a website, long for the day when brochures are no The fact is, even we marketing formulating a social media post, or longer a necessary part of the marketing communications specialists add a developing a print piece, like a brochure, arsenal but don’t believe we’re there yet. tremendous amount of knowledge every keep in mind that there isn’t enough Ritalin Traditional marketing tools (print or year and many of the truths we held to be out there to manage the attention deficit web) are set up using a series of headlines reliable just a short time ago have been disorder of the consumer mind. Following like, “Our Services”, “Our Team”, “Our challenged and found wanting today. are a few of the guidelines I use when Doctors”, “What Sets Us Apart” and the like. Staying on top of what’s new is always evaluating marketing content, whether These “headers” inform the reader of what exciting, but my guess is most readers just presented on-screen or in print. they will find in the section that follows. need the chance to evaluate where they Unfortunately, consumers typically don’t

Q2 • 2017 | TheProOrtho.com 83 MARKETING, SOCIAL MEDIA & EVENTS

read the section that follows. Consider, not, and if you aren’t using photos of actual instead, headlines that actually deliver your patients for whom you have delivered an 3) VIDEO NEEDS TO HAVE key message at a glance, like, “Invisible awesome aesthetic result, you’re missing a DIFFERENT FORMS FOR DIFFERENT Treatment”, “Our Board Certified Doctors”, huge opportunity to set yourself apart from PLATFORMS. “Join Our Family”. I call this “skim value” the competition. I’m not talking about your and it applies to every form of advertising records photos. (It’s not about showing I’m passionate about incorporating video and marketing. This approach, along with the occlusion.) I’m talking about lifestyle into your practice marketing, especially the prudent use of bullet points (not more photos of your patients living large with video that features your patients. But one of than two sets of bullets on any spread), their amazing new smiles. the new secrets to success that we’ve learned will greatly improve your chances of This means you ought to capture is the importance of having different types communicating what actually sets you patient photos every year and make sure of videos and even different versions of apart. If you can’t select the main point you use them. If you have the budget, it’s your primary videos. For example, since for each section and put it in the title, you totally worth doing a professional photo Facebook’s feed auto-plays video without probably need to spend some time working shoot. When we do these, we like to shoot the audio, as you scroll down the timeline, on your messaging. around town and incorporate iconic street it’s helpful for the videos you use on Having skim value is even more views and other local landmarks into the Facebook to work without audio. Speak to important on the web where the average background so that prospective patients your producer about creating video content website visitor spends less than a minute will know, without a single word, that these that includes the following graphics: perusing an entire site. I learned to write are not stock photos. If you don’t have the copy as the production director for a group budget to do a shoot (around $1,000) you o Your logo (or animated logo screen) of radio stations starting when I was only 17 can ask patients to share their own smile o Your contact information (web address and to this day I tend to write in thirty and photos. In this time when selfies rule, or web and phone) sixty-second increments. This ability has most patients can share great, lifestyle o Text or subtitles with key messages served me well not only for public speaking photos from their phones. They may not (especially those that might inspire the but for the creative writing I do for the web. be sufficient resolution for printing, but viewer to click) work well on-screen (web and/or video). If 2) ACTUAL PATIENTS ARE YOUR you find the idea of asking patients to share It’s important to note that this is another MOST POWERFUL TOOL. photos for you to use in marketing your area where “less is more” so shorter clips practice daunting, you’re not building the are best. And whether you are creating new For many patients, the prospect of right kind of relationship with them. In a videos or you have an existing video that looking better in order to feel better is what healthy practice, patients are thrilled that you’d like to repurpose, consider working motivates their interest in orthodontic you would consider using their photos. The with your producer to create shorter clips treatment. It’s an aesthetic motivation, very act of asking them turns them into for social media and other web viewing. whether they are tuned into that fact or raving fans. You can (should) still use your longer-form

84 It’s just BUSINESS MARKETING, SOCIAL MEDIA & EVENTS

videos (those over 5 minutes) in the office successful marketing endeavor. You begin 4) YOU DON’T HAVE TO TELL on the big screen. with the end in mind – do you want them THE WHOLE STORY TO HOOK THE If you’re on Twitter, you know how to click a link, visit your website, schedule LISTENER. challenging it can be to communicate a consultation? Then, you make it easy and something worthwhile in only 140 desirable for them to do just that. Many When creating content it’s important to characters, but it’s an excellent habit to get marketing initiatives fail because they miss grab the viewer or reader’s attention within into because it sets the standard for quick number 2 or number 3. Others fail because the first few seconds, but even if you do digestion. they give the viewer/reader too many that it’s important to remember what you’re I recommend that you always start the choices in the call to action, which often trying to accomplish with the content marketing communication process by leads to inaction. you’re creating. If your desire is for me to asking three questions: ------schedule a consultation, you don’t have to include all of the reasons I might possibly 1) What action do I want the reader/ A thirty-second ad goes want to schedule an appointment – I call viewer to take? that spilling all your candy in the lobby. 2) How can I make it easy for them to by pretty fast, but it It’s good to save some of the good stuff for take that action? actually contains the the second, third, fourth and fifth times a 3) How can I make it desirable for them typical consumer needs to “see” you online to take that action? equivalent number before being ready to meet you in person. If you put everything out there (for example, If you answer those three questions well of characters as three on your website) you’re breaking one of the and you can deliver that message with a new rules of effective marketing. Save some photo and 140 characters or less – or in a tweets. candy for the consult and you’ll get more short video – you’re well on your way to a ------yesses.

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Q2 • 2017 | TheProOrtho.com 85

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HOW TO PROPERLY TARGET A FACEBOOK/INSTAGRAM AD By Scott Hansen

In our practice, we get in front of our who represents my target mom. She location, but do not live in the location. target market (TM) primarily by using happens to be a 35-year-old lady in our Because we have geographically sensitive Facebook and Instagram ads. Both practice with whom we particularly enjoy patients, don’t waste your money showing platforms allow us to specifically define working with. Surrounding her picture, your ads to area visitors. our TM and measure the ad’s effectiveness I have articulated her demographic quantitatively. Unfortunately, Facebook characteristics and other important 3. BE SPECIFIC WITH makes it easy to waste money on information that reminds me of her GEOGRAPHIC TARGETING untargeted ads, like “Boost Post.” So, emotional disposition and intellectual when constructing a new Facebook ad, qualities. Geographic targeting when creating these tips should help you more clearly a Facebook ad is a little tricky. Because target your likely patients. ------Facebook targets by circular radius only, If you can’t clearly to target efficiently, you must use both 1. START WITH A CLEAR the “include” and “exclude” features. To UNDERSTANDING OF YOUR describe whom you are create more efficient targeting, start by TARGET MARKET targeting, you will waste including your target area, then move outside of your target area and exclude Understanding your TM is the easiest money showing your ads the surrounding areas that you do not way to save money on any marketing to unlikely patients. typically draw patients from. activity. By not wasting resources After targeting, you are left with a delivering your Facebook ads to people ------geographic area that accurately represents who are not likely patients, you will save your potential patient pool. your resources to reach people who are 2. CHOOSE “PEOPLE WHO LIVE IN more likely to buy. THIS LOCATION” 4. TARGET BASED ON To adequately define your target DEMOGRAPHICS/INTERESTS market, think about their demographic When clicking through the campaign characteristics, wants, needs, desires, and options, by default, Facebook selects For our practice, we primarily serve fears. In my office, posted on an 8.5” X “Everyone in this location.” “Everyone” conservative, upper-middle-class moms. 11” paper, I have a picture of someone will include people who are visiting the Hence, we filter our audience for age,

CHOOSE ”PEOPLE WHO LIVE IN THIS LOCATION” TO TARGET RESIDENTS INSTEAD OF VISITORS

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USE THE ”INCLUDE” AND ”EXCLUDE” OPTIONS WHEN GEOGRAPHIC TARGETING TO BETTER TARGET YOUR AREA gender, political preference, household network. the Facebook user is on Wi-Fi, they are income, home ownership, etc. For most of us, our TM is composed more likely in buy-mode because they are Using the ad filters effectively is of savvy moms who are efficient at stationary and more likely at home. If contingent upon your understanding of navigating the internet. The audience they are stationary, they are more likely your target market. If you can’t clearly network, which just means “wherever to have the time to browse your site and describe whom you are targeting, you will on the internet Facebook wants to post contact your team. waste money showing your ads to unlikely your ad,” will produce a higher volume Remember: The primary goal of all patients. To give you reference, most of of clicks, but will also generate a greater of our marketing is to produce a desired our ads are targeted to 5,000 people or number of false/accidental clicks. Think action. fewer. about all the times you are using an app It takes time to properly establish My philosophy is that if I can show our and misclick on an ad! an effective Facebook ad campaign. ads 15 times per week to our narrowly For our ad setups, I use Instagram However, with careful effort, you can defined TM, it will far outperform and Facebook feeds. I do not do “Right be sure that you are not wasting your showing our ads 1 time per week to a 15 Column” ads or “Audience Network” ads valuable marketing resources reaching times more broadly defined TM. because of the higher volume of junk people more likely to buy dentures than clicks. Additionally, I only run the ads braces. –––––––––––––––––– when users are connected to Wi-Fi. If With careful effort, you can be sure that you are not wasting your valuable marketing resources reaching people more likely to buy dentures than braces. –––––––––––––––––– 5. SELECT THE BEST AD PLACEMENTS

There are several different strategies for ad placement. In a traditional Facebook ad design, the user can choose to place the ads on the Facebook feed, the right- hand column, Instagram, or the audience SELECT THE BEST AD PLACEMENTS TO AVOID MISCLICKS

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THIS IS NOT YOUR DADDY’S ORTHO! By Andrea Cook

“I have been doing this for 25 years Along with the CDC Guidelines for ask for during an inspection. You must and no one has died yet; restaurants don’t Infection Control in Dental Health-Care have these available for the inspector. sterilize their silverware; we don’t have Settings, you may have additional state Having the results in a labeled binder in blood in orthodontics; the guidelines are regulations that require compliance. or near the sterilization area will make for dental offices; this is costing a lot of I will address some of the most locating them easy for any team member. money.” These are some statements of common areas of non-compliance in resistance I have heard from orthodontists today’s orthodontic offices based on my during presentations and when working experiences: 3. INSTRUMENT RINSING with my orthodontic clients. After cleaning, instruments should be As Ben Burris states at the MKS 1. ALL STERILIZERS MUST BE rinsed with water to remove chemical or meeting “This is not your daddy’s TESTED ON A WEEKLY BASIS detergent residue. ortho meeting”. The same applies to Correct functioning of sterilization cycles CDC guidelines, 2003 our sterilization areas and instrument should be verified for each sterilizer by the reprocessing protocols. Things have periodic use (at least weekly) of Biological There are many “no rinse” solutions on changed. There are more infectious indicators (BIs) (i.e., spore tests). Test strip the market. These typically contain a rust diseases, compromised patients, and should be placed inside the package. inhibitor that can be eliminated during a a higher level of education on how to CDC guidelines, 2003 rinse process. Based on the sterilization prevent infection. protocol you have in your office rust I understand the resistance but the All sterilizers must be tested on a inhibitors may be necessary but must be reality is as a practicing orthodontist, weekly basis regardless of the number added after the rinse process. the CDC has developed Guidelines for of cycles ran, patients were seen, or days Infection Control in Dental Health- worked. I receive questions about satellite 4. TRANSPORTING Care Settings in 2003 that consolidates offices that only see a few patients or are CONTAMINATED CRITICAL AND recommendations for preventing and only in that location one day a week/ SEMICRITICAL PATIENT-CARE controlling infectious diseases and month. The guidelines state “on a weekly ITEMS managing personnel health and safety basis” not based on a number of patients Contaminated instruments should be concerns related to infection control seen or other parameters. handled carefully to prevent exposure in dental settings with which you must to sharp instruments that can cause a comply. The cost for non-compliance 2. RESULTS MUST BE RECORDED percutaneous injury. Instruments should can be minimal until you receive an AND KEPT IN THE OFFICE be placed in an appropriate container at inspection from the state dental board Results of biological monitoring should the point of use to prevent percutaneous or OSHA. The fine may be substantial be recorded and sterilization monitoring injuries during transport to the instrument but the reputation damage may be records (i.e., mechanical, chemical, and processing area. CDC guidelines, 2003 irreparable. Most of you will never biological) retained long enough to comply receive an unannounced inspection in with state and local regulations. Many offices chose to move to cassettes your career but that is not a reason for CDC guidelines, 2003 for compliance with this guideline. If non-compliance. It is the right thing to This is one of the first documents that a you opt not to move to cassettes or do for you, your team, and your patients. state dental board or OSHA inspector will do not have a sterilization protocol or

92 It’s just BUSINESS OFFICE LOGISTICS

system to support the use of cassettes, 6. HANDPIECES Clinical contact surfaces can be directly you can achieve compliance by putting For processing any dental device that contaminated from patient materials the instruments in a plastic tray with can be removed from the dental unit air either by direct spray or spatter generated a locking cover at the point of use to or waterlines, neither surface disinfection during dental procedures or by contact transport them into the sterilization area. nor immersion in chemical germicides is with DHCP’s gloved hands. These surfaces an acceptable method. Dental handpieces can subsequently contaminate other 5. STORAGE OF UNWRAPPED and other intraoral devices attached to the instruments, devices, hands, or gloves. STERILIZED INSTRUMENTS airlines and/or waterlines must be sterilized Barrier protection of surfaces and Semicritical instruments that using heat. equipment can prevent contamination of are sterilized unwrapped on a tray CDC guidelines, 2003 clinical contact surfaces but is particularly or in a container system should be effective for those that are difficult to clean. used immediately or within a short This is one of the top noncompliance Barriers include clear plastic wrap, bags, time. When sterile items are open to areas for many offices. Based on the cost sheets, tubing, and plastic-backed paper or the air, they will eventually become of the handpieces and time to reprocess other materials impervious to moisture. contaminated. Storage, even temporary, I find this done often on an end of day Because such coverings can become of unwrapped semicritical instruments is or week basis. Based on the Spaulding contaminated, they should be removed and discouraged because it permits exposure classification the high-speed handpiece is discarded between patients, while DHCP to dust, airborne organisms, and other classified as a critical instrument as it can is still gloved. After removing the barrier, unnecessary contamination before use on a penetrate soft tissue or bone. As a critical examine the surface to make sure it did not patient. instrument, it must be cleaned, lubed, become soiled inadvertently. The surface CDC guidelines, 2003 individually packaged, and sterilized after needs to be cleaned and disinfected only each patient use. if contamination is evident. Otherwise, Most of the instruments in an after removing gloves and performing hand orthodontic office fall into the semicritical 7. CLINICAL CONTACT SURFACES hygiene, DHCP should place clean barriers category. The days of storing all the In the dental operatory, environmental on these surfaces before the next patient. instruments in a drawer or rack are surfaces (i.e., a surface or equipment that If barriers are not used, surfaces should gone. Storage of seldom used items does not contact patients directly) can be cleaned and disinfected between patients should be in a closed container based become contaminated during patient care. by using an EPA-registered hospital on how they are used. If the instrument When these surfaces are touched, microbial disinfectant with an HIV, HBV claim (i.e., is used individually it should be used agents can be transferred to instruments, low-level disinfectant) or a tuberculocidal individually, if it is used as a group they other environmental surfaces, or to the claim (i.e., intermediate-level disinfectant). can be packaged together for storage. nose, mouth, or eyes of workers or patients. Intermediate-level disinfectant should

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be used when the surface is visibly the turbine and air and waterlines and sterilization, most offices can eliminate contaminated. be passed to the next patient. Team glutaraldehyde by using products that CDC guidelines, 2003 members can simply expel air/water into can stand up to the sterilization cycle. the suction tip after each use to make sure The purchase of these items is often less All surface disinfectants must be EPA the lines are free of any material. expensive than purchasing glutaraldehyde registered and be used according to the products and much less caustic in the manufacturers’ instructions on the label. 9. DENTAL UNIT WATER LINES office. All products will include a contact time Simply using source water containing Following manufacturers’ instructions in their instructions for use that must be <500 CFU/mL of bacteria (e.g., tap, for care and maintenance of all items followed. The label will state how long distilled, or sterile water) in a self- in the office is critical to their efficacy. the surface must remain visibly wet for contained water system will not eliminate Many of my clinical team members tuberculocidal effectiveness. There are bacterial contamination in treatment follow protocols that have been developed many on the market with a 5-minute water if biofilms in the water system are by previous clinicians but often these contact time. I do not feel that most not controlled. Removal or inactivation of protocols are not based on the current orthodontic offices can accomplish this dental waterline biofilms requires the use of guidelines. They are simply “how we have on a busy day. I recommend offices use chemical germicides. always done it”. a surface disinfectant with a 1 minute CDC guidelines, 2003 In March 2016 the CDC has developed disinfection time. Two that I like are a document entitled”Summary of Optim1 and CaviWipes1. I find many offices do not follow any Infection Prevention Practices in Gloves must be worn when using maintenance protocol on their dental unit Dental Settings Basic Expectations for disinfection wipes or disinfection waterlines to prevent biofilm formation. Safe Care and Companion Checklist”. products. Chemical germicides must be used on Use of this checklist will help you and self-contained water bottles to comply your team assess compliance with 8. DENTAL HANDPIECES AND with the guidelines and prevent biofilm. the expected infection prevention OTHER DEVICES ATTACHED TO AIR practices. This checklist will identify AND WATERLINES 10. SINGLE USE/DISPOSABLE ITEMS areas of improvement within the office, Dental devices that are connected to A single-use device, also called a sterilization protocols, and training. the dental water system and that enter the disposable device, is designed to be used There is also an emphasis on the patient’s mouth (e.g., handpieces, ultrasonic on one patient and then discarded, not importance of having an individual in scalers, or air/water syringes) should be reprocessed for use on another patient. every dental practice assigned to be the operated to discharge water and air for CDC guidelines, 2003 infection prevention coordinator. That a minimum of 20--30 seconds after each individual would be responsible for patient I have seen offices reusing single-use CDC guidelines, 2003 developing written infection prevention disposable items ~ disposable patient policies for the practice based on After each use, the device must be mirrors, impression trays, bracket trays, the current standards. The infection flushed to help physically flush out etc. Any item with a number 2 with a line prevention coordinator would also patient material that might have entered through it is considered single use and ensure that the practice has the needed must be disposed of after use. With steam equipment and supplies required for adherence to standard precaution practices and communicate with all team members to address infection prevention issues. So, put your resistance aside and make changes in your practice that include following the guidelines and developing and implementing protocols to support a healthy work environment. These changes will help protect you, your team, and your patients.

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How to Maximize the Selling Value of Your Practice By Charlene White

The practice transition process is manager position and work on reducing one administrator and one clinical team stressful for both the seller and the buyer. the overhead. A talented bookkeeper member let go.) With a review of the As a consultant, my goal is for it to be a was hired to revamp the payroll and overhead, we were able to report a $98,000 win-win experience for both parties. It payables system. By the end of 2012, we reduction in expenses projected for the is quite an accomplishment when both felt confident that the practice was ready next year to Roger Hill. A new CPA was doctors can say a few years later, “We to sell. hired to take over the accounting. are colleagues and friends.” With better 16. The facility was in an excellent planning and preparation, this can be UPON MY FIRST EVALUATION OF location. Some remodel would be needed accomplished. THE PRACTICE, I ASSESSED THE in the near future. Dr. Glenn Burkland contacted me FOLLOWING: 17. Dental and patient referrals into regarding my consulting services. He 1. Production was ahead of collections the practice were healthy. said, “CHARLENE, I want you to help by 20% (Excellent). me prepare my practice to sell to a young 2. The exam to start ratio was 97% BUYING A RETIRING DOCTOR’S PRACTICE doctor. I would like to get the top value, (Excellent). WHERE THE SENIOR DOCTOR IS EXITING and I also want all systems in order to 3. Production per day was $9,758 WITHIN 1 – 2 YEARS make it easier on them for the transition.” (Excellent). Dr. Burkland also secured Roger Hill’s 4. Production per start was $4,865 TIPS FOR THE DOCTOR services to assess the practice value and (Excellent). PURCHASING A PRACTICE: oversee the transition process. This all 5. The recall system was 80% effective • Image of the Practice began a year previous to his practice being (Excellent). • Computer hardware put on the market for sale. 6. No show rate 2.8% (Excellent). • Computer software The first consultation visit was 7. Running on schedule 95% of the • Equipment scheduled in January 2012. My job was to time. • Facility evaluate all of the practice management 8. Annual marketing plan was • Instruments systems and assess the staff positions. established. • Invisalign Ranking The following are excerpts from the 9. HR systems were in place. • Location consultation report. Overall, the practice 10. No practice budget was in place. • New Production was quite healthy. The number one 11. Past due patient accounts were • Reputation concerns were poor accounting systems, excellent, 5% • SEO Ranking high overhead, and a nonproductive 12. Insurance past due was inaccurate • Social media presence office manager who earned a $50,000 due to aging error. • Staff Performance, Salaries & Benefits annual salary plus full benefits. Roger Hill 13. Excellent software system was in • Treatment methods challenged us by saying that he would like place. • Website to see the overhead reduced by $100,000 14. The clinical records were not • Overhead Percentage by the next year. In June 2012, I returned computerized. for a second consultation. At this point, 15. Overhead was higher than average. In addition to the practice transition the final decisions were made to replace Staff salaries 27%. Health Insurance specialist evaluation, the following needs the accountant, terminate the office 4.2%. (Health insurance was capped and to be factored into the purchase price. If

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the systems are rated as excellent, good, • Production this year indicates 9. A list of staff member’s names, average, or needs improvement the selling collections next year. salaries, and benefit packages and last price would go up or down. • In a declining, mature practice, often W-2s. • 60% overhead or less is excellent the doctor has kept the same long term 10. A list of referring doctors names • State of the art computer software staff with higher than average salaries and and the number of patients referred by and hardware = excellent benefits that total 30% of income verses each doctor for the past year. • Great staff= excellent 20% salaries and 2% benefits (the national • 3 – 4% Budget spent on marketing = average). OTHER AREAS YOU SHOULD excellent • The young doctor has student loans EVALUATE ARE: • Case acceptance 65% or better = and typically a loan payment for the 1. Is the practice computerized? Would excellent purchase of the practice. If the selling you have to change the software systems? • Great reputation=excellent doctor stays on the payroll for $1,200 per 2. Is the current staff happy? Turnover • Efficient mechanics 18-20 visits per day, this is an additional expense that the rate? case = excellent young doctor cannot easily afford. 3. Demographics and competition. • Production per day $9,000 + is • Also, factor in the monthly rent 4. Economy of the area. excellent payment. 5. Décor and age of the equipment and • Recall Efficiency 85% + excellent x-ray equipment. • Overruns 10% or less excellent INNOVATIVE TIPS FOR GRADUATING 6. Quality of treatment and reputation. • Inventory budget 6 – 8% excellent ORTHODONTIC STUDENTS 7. Treatment modality. • Facility, rent 6% = excellent • New Patient numbers strong = INFORMATION TO REQUEST ROGER HILL – THE MCGILL AND HILL excellent PRIOR TO PURCHASING A GROUP • 50% or more patient referral = PRACTICE: With respect to selecting a transition excellent 1. The number of exams, records, and firm/consultant, we would recommend • Staff wages percentage = 20% starts for the past three years. the following guidelines and parameters. excellent 2. A list of active patients, projected While there is no exact set of • Benefits 2% excellent deband dates, and balance on the account. qualifications for a transition firm or 3. A list of active retention patients with consultant, the following characteristics WHAT DO YOU DO IF THE STAFF their deband dates. and qualifications are important. WAGES ARE 25 – 32%? 4. A list of observation recall patients The number of years’ experience for • Are there any staff members on the with last appointment date. practice transitions specifically related team you do not want to employ? 5. A list of active patients who are still to orthodontic practices will be an • Can you afford to offer the same in braces and paid out. important, if not a critical factor. You will benefit package? 6. A copy of the patient contract and also want to check on the experience in • Rehire each team member. Outline financial policies. terms of the types of transition activities their hours, job duties, hourly rate, 7. Current aging report and total specific to your need. As a practical and benefits. contract amount due for patients and guideline, we would recommend that Net production is declining and it is insurance. the transition firm/consultant have a reflected in the next year’s collections. 8. A profit and loss statement from the minimum of 10 years’ experience in (Chart 1) last three years. the transition of orthodontic practices since they have a number of unique Net Production Net Collections characteristics and requirements. As an example, a person who is a $800,000 Production 2011 $800,000 Production 2011 CPA may, or may not, have experience in practice transitions, to say nothing $700,000 Production 2012 $800,000 Collections 2012 of transitions for orthodontic practices. Look for special designations or $650,000 Production 2013 $700,000 Production 2013 certifications from nationally recognized organizations such as the American $500,000 Production 2014 $650,000 Collections 2014 CHART 1 Q2 • 2017 | TheProOrtho.com 97 17-MIDA-009, On Command Ad Progressive Ortho FA.pdf 1 2/8/17 5:14 PM

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Society of Appraisers, NACVA, or others. These designations or certifications bring additional expertise to your unique needs. Individuals with these types of qualifications and certifications are more likely to help you achieve your goals and objectives. Some lenders require the valuator have these qualifications. We would also recommend that you check references. Any firm or individual should be able to provide an extensive list of doctors with whom they have worked in any number of capacities and or assignments related to practice transition activities. Along those lines, you will also want to check on their experience with a variety of types of assignments It’s Time to Demand More From Your Supply including partnerships, full sales (100%), and mergers, as well as acting as an agent/ With MidAtlantic Ortho’s new E-Commerce marketplace, we provide a 24/7 on broker if that is appropriate to your demand resource for all of your practice supply needs. More than online ordering, need. This would include learning about MAO now provides a user friendly way to place, track, and store your purchase their protocol for finding and qualifying and ordering history with just a click of a button. With MidAtlanticOrtho.com, purchaser candidates, as well as how they you are free to start and treat more patients instead of waiting on your sales maintain confidentiality. representative, buying more than you need, figuring out a complicated group Turning to a different perspective, program, or stressing over your supply. Over 100 years of orthodontic you may want to consider whether your marketplace expertise, bringing leading manufacturers to your fingertips – 24/7. needs will be better served if you choose to work with a transition firm whose work will be integrated with the specific Supply that supports your Bottom Line. services that will be needed. Almost all transition activities will ultimately need to be served by both (1) financial services (valuation, cash flow projections, income distribution formulae [in the case of a partnership], tax efficiencies and similar considerations), as well as (2) legal representation and services. To the extent you do not need to seek these types of services from different professionals, your needs will be better served because the work of both these areas will be integrated on your behalf. CONVENIENCE THROUGH In an allied sense, you may also want to consider a firm with a wide spectrum of additional services beyond financial and legal. For example, you may want to shelter some of the gain from the sale. If MIDATLANTICORTHO . C OM 800-255-3525 so, it will be helpful to work with a firm that has pension plan design/

98 It’s just BUSINESS Visit us at the AAO Booth #1147 17-MIDA-009, On Command Ad Progressive Ortho FA.pdf 1 2/8/17 5:14 PM

OFFICE LOGISTICS

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Visit us at the AAO Booth #1147Q 2 • 2017 | TheProOrtho.com 99 OFFICE LOGISTICS

administration capabilities, investment have a different value. Accordingly, the from the truth. In order to know the advisory services and accounting in order appropriate valuation protocol is to first financial outcome for each of the doctors to address these related, but important establish the value of the intangible assets involved, it is necessary to construct a considerations. and add to this the value of supplies, multi-year set of cash flow projections Consider just this one example. If you fixed assets and receivables. The sum of that illustrate the outcome after overhead, sell your practice, own the facility, and these two components divided by the tax on gain from the sale (for the senior choose to lease the facility, you may want revenue the practice will then yield the doctor), the cost of purchasing part or all to contribute the building to a Family correct percentage for that practice at that of the practice (for the younger doctor), Limited Partnership (FLP), and reap moment in time. estimated income taxes, anticipated the tax benefits for you and the next In order to provide a sense of scale capital expenditures and interest/ generation in your family. If so, a wide with respect to the variation in the value depreciation benefits. These multiyear spectrum firm can not only provide these of orthodontic practices, one nationally (after-tax) cash flow projections are the additional services, but also integrate known firm reports that the value of critical piece of transition planning. To them with the other components of your orthodontic practices in their database is move forward without them is to invite plan. as follows: hardship. Orthodontic practice transitions have Average Fair Market Value: 78.08% some unique aspects and requirements. First standard deviation: 58.03% to With partnerships there are several Make sure the firm or consultant with 98.12%. other critical considerations of which whom you work is thoroughly aware of you should be aware: these unique characteristics and how they With this type range in the value of The first of these is trigger point will affect the transition: orthodontic practices, it is important to quantification. That is, establishing The receivables in orthodontic carefully analyze the data related to that the amount of growth in the top line practice fall into three groups: contracts practice and establish the value accurately. revenue at which the senior doctor can receivable, accounts receivable and With a transaction of this size and sell a fractional interest without seeing prepaid treatment. The accounting and importance, to do less is to do a disservice any meaningful reduction in his or tax treatment for each of these categories to both doctors. her earnings and, at the same time, the is different and will have a significant It may be of interest to know several new partner sees an increase in his or impact on both the value, and after-tax overhead parameters. We mention these her financial benefit. It is possible to gain from the sale. because the profitability of the practice quantify a trigger point. This not only With respect to the valuation of is a major driver of value. All things held provides a goal, but a significant amount orthodontic practices, the single most constant, the higher the profitability, the of reassurance that the doctors are not common misconception is that practices higher the value. beginning the buy-in too early, or waiting generally sell for a static, fixed percentage With this in mind, most orthodontic longer than needed. such as 80.0% (or some other percentage) practices have the following overhead When a fractional interest is sold of a year’s revenue. This is a prescription parameters: there are two goals that need to be for problems on the part of either the Salaries and wages (W-2 wages simultaneously achieved. One goal is for seller, the purchaser, or both. An example only, not including family members or the purchase of the fractional interest to or two might help illustrate this. associate doctors): 18.0% to 22.0% of be affordable for the younger doctor. The Assume there are two practices each revenue; occupancy expenses 5.0% to other goal is to make certain the sale of of which has revenue of $1.0 million per 7.0% of revenue; and dental supplies/lab the interest amount is tax efficient and fair year. One practice has three “vintage” 8.0% to 16.0% of revenue. The variation for the senior doctor. The tax structure in chairs and units in an open bay while the in this latter range is occasioned by the the Internal Revenue Code has a built- other practice has six chairs and units in presence of self-ligating brackets and in push-pull that makes simultaneously an open bay with everything up to date. Invisalign. Either or both of these will achieving these goals difficult. This If practices are valued at 80.0%, they have increase the supplies/lab costs. consideration is typically referred to as an equal value of $800,000, but clearly this Another common misconception is financial structure. defies common sense. that once the valuation study has been There are two alternative structures Likewise, if the practices have completed, the financial outcomes for by which these goals may be served. In the same income but substantially each of the doctors is known. As it the first of these, the new partner buys different overhead rates they should happens, there is little that is further into the current entity. If the practice is

100 It’s just BUSINESS OFFICE LOGISTICS incorporated the doctors have ownership responsive to both days worked as world of orthodontics to pursue other of a common entity. This structure is a well as the contribution of each doctor interests. modified stock sale. with respect to referring sources and It is possible that one is in good health The other structure is completely generating new patients (in a sense, their and there exists a desire to have other different. In this structure, the new individual “productivity”). activities to pursue that were not easily partner forms his or her own entity which Normally, orthodontic practices employ followed while working full-time. One then purchases the fractional interest. a two-tiered Income Distribution Formula might also be worn out with the stress Once ownership is in the respective for the first few years of the partnership. of dealing with problem and demanding entities, the entities will enter into a The diagram below illustrates a typical patients and staff, the marketing to the partnership. When diagrammed, the two-tiered distribution formula where public and other referral sources. structure looks like a triangle with the 50.0% of profit is allocable based on days There is not an exact age when one doctor’s entities at the bottom corners of worked while, while 50.0% of the profit should retire. Some people “live to work” the triangle and the partnership of the is allocable based on the productivity because it is there “personae” whereas entities at the top. This structure is called differential. Among other things, the others “work to live.” Eventually, we an asset sale structure. productivity differential accounts for the all realize that age and its effects on the fact that the senior doctor will continue body will limit what we are able to pursue to be responsible for more of the new because of physical demands. patients of the practice in the early years There are many ways to retire. They of the partnership with the respective include bringing in a partner with the contributions of each doctor shifting over plan to sell the practice to this individual. a period of years. The venue for testing One can also sell the practice directly out the multi-tiered distribution formula to an individual or to an entity like a is the after-tax cash flow projections corporation. discussed below. Once a decision to leave the “world of orthodontics” we have to select the “best” way to go about this process. Because of the different tax With respect to the value of orthodontic implications, the financial outcomes practices, information from our database resulting from these alternative financial indicates that the average sales price is structures can be significantly different. 78.08% of a year’s revenue. Perhaps more Best results will be achieved by forecasting meaningful, the first standard deviation the after-tax cash flow utilizing both ranges from 58.03% to 98.12%, or a range structures to determine which one is of approximately 40%. the most beneficial. To do otherwise, The diagram below illustrates the One of the most common invites disappointment in what may have Productivity Differential component misconceptions is to apply a static otherwise been a successful partnership (only) of the diagram above. percentage (such as 78%) as the assumed and will maximize the benefit for the value of a practice. doctors. This is because the value of a practice In partnerships, the protocol by varies widely depending upon any which the profits are allocated (Income number of factors including but not Distribution Formula) will have a critical limited to: growth rates, profitability, impact on your earnings. Allocation of location, the amount of equipment and its profits in a partnership, particularly in the age, the amount of contracts receivable, early years, should not be allocated solely the amount of prepaid care, the number on the basis of ownership percentages, of referring sources and dependence upon nor days worked. To use either of these a small cadre within the group of referring parameters (solely) is going to have a DR. GLENN BURKLAND: THE SELLING doctors and related factors. deleterious effect on the earnings of DOCTOR’S POINT OF VIEW It is only through a careful study of each the senior doctor. Instead, the Income There comes a time for every of these that the value of practice can be Distribution Formula will need to be orthodontist to think about leaving the accurately established.

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BUSINESS & PRACTICE DEVELOPMENT

Why WildSmiles? Everyone remembers their orthodontic experience. DesignerBraces make them remember you! C Increase Your Revenue: As a preferred M appliance option for 44% of patients ages 14 Order a QuickStart Kit Today Y and younger, WildSmiles are a proven way to CM See New Revenue Next Month!

MY grow your per patient revenue.

CY • WildSmiles Display Typodont CMY Attract New Patients: Immediately add value • 50 Patient Brochures K to your practice and re-energize your • 24 Brackets (4 sets of U3-3), 2 Sets of 2 Shapes presence within the community using our easy to implement • 2 Inventory Boxes, 1 Box Per Shape consumer-based marketing. • Bonding Tips & Bracket Speciﬁcations Start Today • New Patient Appointment Scripting Make Braces Fun: Unlike • Quick Steps Implementation Guide traditional brackets and clear Just • Expedited 2-Day Shipping aligners, DesignerBraces make a patient’s orthodontic • 20 Minute QuickStart Call experience their own. $195! WildSmiles patients want to display their treatment, not Call or Go Online conceal it. to Get Started!

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BUSINESS & PRACTICE DEVELOPMENT

THREE PILLARS of THE MODERN PRACTICE, PART 3: You Can’t Beat the SYSTEMS By Dr. Jamie Reynolds

One of the most common questions orthodontists ask today is ‘I already have a high conversion rate, so how Why WildSmiles? else can I grow?’ Read on and I will share data we have collected from over MODERN PRACTICE Everyone remembers their orthodontic experience. 75,000 starts and over $300,000,000 F in orthodontic production to support L DesignerBraces make them remember you! thinking about how implementing E L E S C X Increase Your Revenue: As a preferred some logical, data-based systems V Y M I S appliance option for 44% of patients ages 14 Order a QuickStart Kit Today is fundamental to the growth and B E Y well-being of your practice . Most of R T and younger, WildSmiles are a proven way to I E CM See New Revenue Next Month! you have spent a lot of time dialing in L A M MY grow your per patient revenue. I G your clinical management systems to E S CY • WildSmiles Display Typodont T where they are virtually on autopilot, Y CMY Attract New Patients: Immediately add value • 50 Patient Brochures but a lot of you (myself included) K to your practice and re-energize your have neglected your commercial and • 24 Brackets (4 sets of U3-3), 2 Sets of 2 Shapes presence within the community using operational systems. Systems touch our easy to implement • 2 Inventory Boxes, 1 Box Per Shape everything, from the obvious areas consumer-based marketing. • Bonding Tips & Bracket Speciﬁcations of collections and scheduling to conversion rate and miss the big offices who had full hours throughout things as seemingly trivial as phone leaks we have before the patient ever the week to see what the mix could • New Patient Appointment Scripting Start Today call management.Great systems are even shows up.This is an all-too- be. We found that approximately 29% Make Braces Fun: Unlike • Quick Steps Implementation Guide data-driven and revolve around your often overlooked aspect of office of New Patient Exams (it’s 34% in our traditional brackets and clear Just • Expedited 2-Day Shipping customer’s needs. Great systems management, but one that can create office) were scheduled during working aligners, DesignerBraces are consistent patient-to-patient, some quick wins. day lunch hours or on a Friday. You make a patient’s orthodontic • 20 Minute QuickStart Call repeatable, and sustainable. may think that callers will hear the experience their own. $ WHEN & HOW YOU ANSWER recorded message and call back after 195! PART 1: SCHEDULING AND THE PHONE lunch, but they’re more likely calling WildSmiles patients want to display their treatment, not KEEPING NEW PATIENT EXAMS Many offices out there still don’t take the next office they find until they Call or Go Online Let’s start with a simple one: your live calls at lunchtime and any off days get a live person. Even if you’re not conceal it. phones. Many of you are not paying like Fridays. But how much are you seeing patients and don’t have your to Get Started! close enough attention to the most losing by doing that? OrthoFi’s system scheduling team in, someone needs to common obstacle to getting patients records the time of day a new patient answer the phones! If you have cloud to visit your office. We spend hours exam is created, so we measured the or remote access and you leverage and dollars focusing on our consult volume of appointments created by call-forwarding technology, you can

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extend your hours without too much On graph 1, the Y-axis is the kept scheduled exam. Adult demand is heartache…or you could just pay exam percentage, meaning that they more spontaneous, more want driven someone to answer phones during scheduled an exam and actually vs need driven, so you have to get lunch and/or on Fridays, as the data showed up. And, on the X-axis is them in while they’re hot. Kids, on the clearly shows having phone coverage the number of days the exam was other hand, tend to stay reasonably flat easily pays for itself. Not to mention scheduled from the date the exam was with only a percent or so drop over the the improved customer service. booked. For example, if the patient first three weeks. Parents understand Tracking Kept Exam Percentage calls to book on a Monday, how many their children will need braces and (Kept Exams/Scheduled Exams) is days until they are able to schedule an they plan and save accordingly. But an easy albeit indirect performance exam? The orange line is for adults, the after three weeks, kept child exams indicator that gives insight into the gray line is the average, and the blue also drop off steeply. The moral here customer service you’re providing line is for kids. is that if you are going to treat adults, on the new patient call. Keeping System-wide, even if patients book you want to get them in as quickly as Kept Exam Percent above 90% is a for later the same day, almost 10% possible. For all patients, you don’t good goal to connect to high-quality of all patients don’t show up for the want to have a wait list longer than interactions with your phone team. If exam they booked. To address that, we three weeks. Anything more than that the patient calls and gets a very warm began overbooking our TC in prime and the data suggests you are losing feeling about your office, it is logical time and late afternoon slots and hired patients. Once we realized the impact to assume they will be more likely to a records tech to help with x-rays and of these statistics, we knew that in keep the exam. If they book an exam pictures when the TC is overwhelmed. order to open up our schedule, we but were ultimately turned off by your So when booking your exams, you needed to shrink our exam length phone team, a no-show is more likely. may want to think like an airline and from 60 minutes – a pretty common overbook a little to anticipate a 10% or industry standard – to 45 minutes. HOW QUICKLY YOU GET NEW greater no-show rate. That’s not to say we give our patients PATIENTS IN Beyond overall no-show rate, less doctor time. It’s more about Many people brag about their you can see that after day 1, there getting the information and insurance waitlist for exams, but is your waitlist is a steady decay in kept exam rate. verification done before the patient helping your ego and actually hurting Adults fade faster than kids, and arrives to the office. With great online your practice? by three weeks there is over a 20% forms and good process, it’s possible to chance adults will not keep their have over 85% of your exams provide you with health history and insurance before they arrive for the exam. If you could thin your wait list and fill that extra exam space four days per week even a conservative 40 weeks a year and convert half of those you would generate 80 extra starts per year. At an average fee of $5,000 per start, 80 extra starts totals $400,000 of additional production. If after all that you still have a heavy waitlist, you likely should consider increasing your capacity with GRAPH 1

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another TC or doctor in the practice, depending on your individual and practice goals.

PART 2: PENDING MANAGEMENT– SEIZE THE DAY…EVERY DAY As I have written in previous articles, Same Day Contracts are important. Like really important. Our data shows a linear correlation between same day contracts and Treatment Recommended Conversion (TRC). From a benchmarking perspective, the highest Same Day Contracts across 140 OrthoFi practices is 75%.That’s not my practice by the way, but we’re working on it. As hard as we try, however, not everyone will start the same day. Many people really do need to go home and talk to dad, think about it, get dental work GRAPH 2 done, etc. orange line is adults and the blue line with you and answer any last questions That said, time is money with is kids. The reason why Same Day you may have. I can be available to pending patients, mainly because Contracts are so important is because you on [Tuesday] or [Wednesday]. people today are highly distracted. as soon as prospects walk out the Which would you prefer?” This not Once a person leaves the office and door, the chance of you converting only sets the expectation that you will becomes ‘pending’, you are competing them falls off a proverbial cliff. The be following up with a presumptive with all manner of other distractions likelihood of converting the patient choice (A or B vs. Yes or No) but also and expenses on top of your direct drops 20% the moment they leave and makes the patient understand that competition, which diminishes their decays by 35% for children and 45% your TC’s time is valuable. likelihood of starting treatment in for adults over the first two weeks. A Then, you have to make sure you your office. lot of offices do their follow-ups in have solid and consistent systems We have irrefutable data about batches every other week. If you’re one around your follow-up management what happens when treatment is of these, you are likely cutting your to ensure every patient gets the same recommended and the patient leaves chances of converting the patient by experience. How do big businesses the office without starting treatment almost half. Yes, that reads ‘half’. manage follow up? With CRM (classifying the patient as ‘pending’). Following a treatment recommend (Customer Relationship Management) Let’s take a look at graph 2. consult that won’t sign today, it’s systems, like SalesForce®, and This graph shows the TRC on the important that the TC take control of automated drip marketing. These Y-axis and number of days from the the conversation by setting the table systems allow you to set the standard exam recommend on the X-axis. The with, “I’d like to set a time to follow-up follow-up cadence you want to adopt,

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prompt you when it’s time for a touch PART 3: A NEW FINANCIAL However, we’ve had a very different for that customer, and even send MANAGEMENT PARADIGM experience. We’ve seen rapid growth automated drip messages at designated During the recession, times were and a solid collection percentage. times. Instead of having to remember not so good in metro Detroit where With the foundation of OrthoFi, we to PULL that pending report and I practice. From an orthodontist’s set out to test these principles across make calls when you think about it or perspective, doing things ‘like we have all markets and proved that the legacy have time (losing opportunities each always done’ would’ve been a recipe gold standards above are outdated. In day in between), the system PUSHES for bankruptcy. In order to keep our fact, in order to experience growth in reminders to you when it’s time for doors open, we were forced to cross the new orthodontic market, a new that particular opportunity. Here is a our fingers and become extremely gold standard of financial principles sample of a follow-up sequence we use flexible both with our down payment must be considered: in our office. There is, of course, a fine and with monthly payments. This line between excellent follow-up and required us to extend payment terms PRINCIPLE 1: Offering a wide range being pushy, so be careful not to cross beyond the estimated treatment time. of flexible terms doesn’t have to the line. And remember, the sequence What we learned along the way shaped compromise collection rate: stops if the patient starts or doesn’t the way we offer financing in our In today’s market and economic want any more follow up: office and ultimately some of how we environment, flexibility around your modeled OrthoFi. payment options is a must-have. 1. If the patient doesn’t sign today ------Giving truly open choice and allowing and they don’t schedule the start people to be in control of their own while in the office, the TC offers With the foundation terms stimulates practice growth. But to ‘make themselves available’ of OrthoFi, we set out many of you have asked me: how does as described above. If a call isn’t that flexibility fare on the back end in scheduled, the follow-up sequence to test these principles terms of securing payment? OrthoFi kicks off. across all markets and currently manages over 40,000 2. 24-hours – follow-up call. If proved that the legacy individual payment plans and over leaving a message, be sure to set $125,000,000 in patient receivables. expectations by saying ‘If I don’t gold standards are Of that production total, 9,274 of hear back from you, I’ll follow- outdated. those plans have been paid off or have up in a couple days’. This will reached term and should have been make your next touch point more ------paid ($37,800,000 in production). The expected and less pushy. The industry gold standard for data shows the percentage of default 3. 3 days (72 hrs) – text message collections has historically been 3% still remains very low despite what 4. 1 week – 1st email + Phone Call past 30 delinquency and 1-1.5% would previously be considered ‘risky’ 5. 2 weeks – text message default. Some pundits have propagated financial principles (Chart 1): 6. 4 weeks – 2nd email the notion that extending payment 7. 6 weeks – text message w/ terms beyond treatment time is bad, promo tease and that 50% of ‘non-A’ patient won’t 8. 8 weeks – ‘LAST CHANCE’ pay, are not profitable, and should not email w/ limited-time whitening be sought as patients. In fact, we were promo or something similar called ‘dangerous’ and told that our CHART 1 financial principles were ‘a recipe for disaster’.

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for that group. However, remember that OrthoFi applies a low-interest rate for extended plans, designed to offset the incremental risk and splits the interest income with the practice. So when you add back the $786K interest that was earned by practices for those plans, the net default is cut nearly in half to $814K. This yields a 1.3% default for the extended plans, which gets us within the average industry default range, GRAPH 3 even for these most aggressive plans. For this discussion, we are only limits your appeal. On average, So that’s hardly significant enough considering amounts beyond 120 days $2,400 per patient was collected ‘risk’ to avoid treating these patients. as projected default. The industry even when they eventually defaulted. Besides, these ‘riskier’ patients are average is around 1.5%, and the gold Assuming a $5,000 average fee and a most likely incremental to the volume standard has historically been 1%. To 50% operating margin, even default you’re doing now, which means you’re clarify, ‘default’ is not synonymous cases nearly break even, meaning that yielding a much higher Variable with ‘has paid nothing’. Also, ‘default’ the average default case scenario isn’t Contribution Margin on those cases. does not define when in their payment a true loss. You just didn’t MAKE More on that in another column. plans the patient stopped paying as money on those exceptional few. When blended across all payment depicted in graph 3: plans, the default percentage we see Graph 3 describes at what point PRINCIPLE 2: If managed properly, is still 0.7%, well below the previous along the payment plan the patient higher risk plans/patients are still gold standard and inclusive of the stops paying. The Y-axis shows the profitable: new ‘risky’ extended plans. So when number of default plans and the Of the nearly 40,000 active plans, managed properly, not only will your X-axis shows at what percentage of 10,833 are for terms longer than 25 overall collection rate not decline, it the estimated treatment time the months ($60,800,000 in production). may likely improve. payment plan became in default. The At first glance, their default rate is ------orange line depicts the dollar amount higher than shorter payment terms. written off at each stage of treatment. However, when you consider the Everyone wants to grow, For example, if the original estimated interest income gained from these but not everyone is treatment time was 18 months and plans, the total default is substantially they stopped paying for 9 months, the decreased. ready to grow. The data default would appear in the 50% bar clearly shows that being above. As you can see, almost all default – accessible, persistent a staggering 95% – occurs WITHIN and flexible with treatment time and NOT after. So CHART 2 patients can and will get the idea of limiting payment time to Chart 2 shows $1.6M gross default, treatment time does not buy you you more starts. which is 2.7% of the total production much in the way of added security. It ------

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CHART 3

WHAT IS PROPER more difficult and uncomfortable. TURN ON THE SYSTEMS, TURN MANAGEMENT? Once a patient is more than a month’s ON THE PRACTICE Most offices batch their collection payment in arrears, getting things As orthodontists, we prefer to focus processes to where they make their back on track is harder. Chart 3 on clinical treatment and our pet calls on the 1st and 15th as they shows the 22-step protocol we have systems behind that. But your business have time, but that batch process is behind our collections, by days past systems also need some love.Everyone not optimal for results. The key is to due for each account. Every patient wants to grow, but not everyone is make sure every account is touched is able to choose their preferred ready to grow. The data clearly shows proactively from the very start on date to withdraw payment for their that being accessible, persistent and day ZERO of their delinquency and convenience, which means we need flexible with patients can and will get done consistently. In fact, the longer follow-up action every day. Managed you more starts. But you need great you wait to make the first touch this way, it’s possible to have 99.2% of systems to seize the day every day and increases the risk of passing 30 days your AR balance be current or within maximize your opportunities in a way when everything gets exponentially 10 days. that’s sustainable.

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Q2 • 2017 | TheProOrtho.com 109 ORTHOPUNDIT.COM

BEN THERE DR. BEN BURRIS DONE THAT THE FUTURE OF CLEAR ALIGNERS By Dr. Ben Burris

We live in a very interesting time. The Ormco will not… yet. A SmileDirectClub playing at a high level in this space called advent of SmileDirectClub has changed imitator, Orthly, has recently come on the Simply Fast Smiles. Even the “old man” the game forever, but this is just the market and I’m sure it is just the first of of clear aligners, Invisalign, is changing beginning and there will be a resulting many, many startups trying to capture the things up massively by taking a substantial chain reaction that is perpetuated for market that SmileDirectClub’s success has stake in SmileDirectClub, changing the years to come. For example, by originally unveiled. There is also an orthodontist way they do the Doctor Locator and using Clear Correct for some of their created/owned company with hopes of offering special partnering opportunities aligner production and then moving on and increased rebates for ultra-users to work with Invisalign, SmileDirectClub –––––––––––––––––– of their product. Exciting times to say has created a source of aligners and Exciting times to the least! So, who will win this battle to technology for others who want to imitate dominate the clear aligner marketplace? SmileDirectClub. Clear Correct certainly say the least! So, who won’t sit on their hands! There are rumors EVERYONE. WINS. (OR AT LEAST that 3M will release a clear aligner will win this battle EVERYONE HAS THE OPPORTUNITY product at the 2017 AAO Annual Session. to dominate the clear TO WIN) There were rumors that Ormco would 1. Customers/consumers/patients will release one at the Annual Session as well aligner marketplace? win because orthodontic care – at least – but I have it on good authority that –––––––––––––––––– some version of straightening if not

110 It’s just BUSINESS ORTHOPUNDIT.COM comprehensive care (yet) – will become of their experience is bad. Unfortunately while still providing what they consider available to the masses, most of whom are this is a very large percentage of our “quality orthodontics”. I’ve had many, locked out of orthodontic treatment by peers since Orthodontists Are Like Taxi many orthodontists say that they think the traditional model. Drivers for the most part and they are we should compete with SmileDirectClub Mad at Invisalign for taking a stake in by doing “better work” and doing 2. Companies producing aligners SmileDirectClub and for the other, recent attachments and IPR because “that is what will win because there is a demand that changes. patients want”. Nothing could be further needs to be filled and that is good for –––––––––––––––––– from the truth from where I’m sitting. their business. There is plenty of business This is confirmation bias in action and it’s for everyone. A rising tide raises all Orthodontists who dangerous. ships – and the amount of the market Orthodontists who are more interested reaped by each company will probably forget that some fishing in control or “doing things the right way” be directly proportionate to their current lures are made to than in success. Things like white labeling brand recognition. In this way the rich Invisalign aligners to sell under a new (Invisalign and SmileDirectClub) will catch fish and others brand will be problematic because one is get richer but the other, lesser known paying full fare for the Invisalign brand brands will do just fine as well. Oh, and are made to catch and doubling up costs by trying to create competition is a good thing! fishermen… Just a new brand. Or companies who think 3. Orthodontists who understand that they will win by touting “quality” what is going on, what patients want, because a product orthodontists, “quality” treatment or how to give it to them and how to reduce or a business model “quality” outcomes to the consumers who overhead and increase volume to harness are interested in SmileDirectClub. I’m the lower price point will win massively. is attractive to not saying that providers or companies Orthodontists who understand how to shouldn’t do their best for each and every Modulate Service to Fit Price will find this orthodontists doesn’t patient/consumer, I’m saying that upping exciting time very fulfilling and extremely mean it will be the ante on customer expectations in this rewarding. realm, with this demographic, with this attractive to patients/ delivery system is a very bad move. I’d be SO WHO HAS THE POTENTIAL TO customers. willing to bet that I’ve done as much or LOSE? more doctor directed, remote orthodontic Orthodontists who don’t understand –––––––––––––––––– treatment as anyone on the planet so I am what is going on or who insist that “you Orthodontists who think that they not speculating here. I’m speaking from can’t do that” because anything outside can compete with SmileDirectClub experience.

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–––––––––––––––––– those who refuse to up their production (Invisalign and SmileDirectClub) will to make up for the loss of revenue/profit dominate because of their head start, “It’s time to wake on any given case. brand awareness, logistics, capacity Orthodontists who forget that some and finances, but there will be plenty of up and realize that fishing lures are made to catch fish and business for the others as well. things are changing. others are made to catch fishermen… Just In traditional offices, we will see because a product or a business model is a significant decrease in the fees for Also, please realize attractive to orthodontists doesn’t mean it traditional orthodontic treatment – that it could be much will be attractive to patients/customers. especially in the more metropolitan areas at first – and this is a good thing despite worse! There is such SO WHAT DOES ALL THIS MEAN? what we orthodontists think about it. WHAT WILL THE MARKETPLACE We orthodontists want lower pricing in a massive, untapped LOOK LIKE IN 2, 5 OR 10 YEARS? all other areas of the American economy pool of customers/ Who knows? Bill Gates famously said but we want the prices we charge for that, what we are selling to remain artificially patients out there who “We always overestimate the change high? This is totally illogical but all that will occur in the next two years and orthodontists agree that this is how it want orthodontics that underestimate the change that will occur should be – however, democracy has no we can easily make in the next ten. Don’t let yourself be dominion over truth! It’s time to wake up lulled into inaction.” and realize that things are changing. Also, up for price/profit please realize that it could be much worse! I suspect that the market will be flooded There is such a massive, untapped pool of reduction on any given by a litany of new aligner brands, all customers/patients out there who want case by increasing our backed by big bucks and all screaming orthodontics that we can easily make up for the attention of this massive, newly for price/profit reduction on any given workload. discovered client/patient pool. The overall case by increasing our workload. What if impact will be a fantastic explosion in that weren’t the case? –––––––––––––––––– access to care and desire creation on the What’s that? You don’t like the idea of Orthodontists who don’t understand consumer end. In the short term (and having to work for your money? Well that competition and lowering prices probably in the long term as well) the then, my orthodontic brothers and sisters, in orthodontics is a good thing for two best-known clear aligner names you have a long road ahead of you… 99.9999999 percent of the population and

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