How Dentists Can Utilize Teledentistry in their Practice for Increased Efficiency and Profitability

Cindy D. Koelbl Chief Operating Officer Integrated Telehealth Solutions www.itshqnv.com ckoelbl@itshqnv.com 520.858.4085

 

The Transcript

Art Wiederman, CPA And hello everyone, and welcome to another edition of the Art of Dental Finance and Management with Art Wiederman CPA. I'm your host. I'm Art Wiederman. I'm a dental director at the wonderful CPA firm of Eide Bailly. Eide Bailly has offices all over the western United States. And I happen to be in Tustin, California, about 15 miles from Disneyland, which is shut down right now, which is very depressing. But that's the way it goes. And today we have a very timely topic and something I've wanted to talk about for a long, long time.

When we on March 16th, the dental profession shut down, a lot of dentists started communicating with their teams over Zoom or Microsoft Teams or whatever else is out there to do virtual communication. But one of the big things that really became prevalent was teledentistry. And I have an expert today on teledentistry, Cindy Koelbl, who is the Chief Operating Officer of Integrated Telehealth Solutions, is going to be my guest today. And we're going to talk about what is teledentistry? How does it work? What can it do for your practice?

I have always been, folks, of the opinion that people want to go to businesses that are on the cutting edge, that have made great use of technology. And right now we're you know, we're kind of stamping these things out, recording this in the middle of December. We're right now in a situation where lots and lots of people are staying at home, they're shutting down cities and stuff like that. So I think teledentistry, telehealth, while it was certainly in existence prior to this pandemic, I think it's going to become even bigger and more important. And we're going to talk to Cindy about that on our show today.

A couple of business things I want to take care of, as I always do. Please make sure you go on to our partner Decisions in Dentistry magazine, go on to their website at www.DecisionsinDentistry.com and look at all their articles. A lot of timely articles on how dentistry is affected by the COVID-19 pandemic. Their continuing education courses. You get a shot at 140 courses in one place. And those 140 courses are a very reasonable annual price.

And if you want a complimentary consultation with myself or one of our members of the Academy of Dental CPAs, go to again www.DecisionsinDentistry.com and click on the link and they will. That will allow you to register for a complimentary 30 minute consultation with one of our members.

And speaking of our Academy, we have been working so hard this year. I mean, I don't, I've talked to my members. I talked to my good friend Maggie Boyle in Seattle yesterday and Allen Schiff in Baltimore. And these folks are just working ridiculous hours with all the changes that's going on. If you're not working with a dental specific CPA, we're in Southern California. My email is awiederman@EideBailly.com. But if you're not working with a dental CPA in the United States, we have 24 CPA firms, of which mine is one of them that work with over 10,000 dentists and go to our website www.ADCPA.org.

I will give you one update. And again, folks, you may not hear this podcast for several weeks from when I record it, but many of you on December the 16th received the Phase 3 distributions from the HHS Provider Relief Fund. I just want to make sure that you understand that I didn't know what this amount of money was going to be. I'll give you an example. We've got a client who's collections for 2019 were about 800,000 dollars. He got two percent of his revenues in phase one, which is about 16,000. Yesterday, he called us, he got a check for 66,000 dollars automatically deposited in his bank account.

The Department of Health and Human Services doled out a little less than 25 billion dollars yesterday to I think it was 70,000 health care practitioners across the United States. And basically, folks, what they did is they looked at your revenue loss from 2019 to 2020 and they said, here's the money, we're going to give you this money. I had one, one group of big, big group that did about six million last year. They got 112,000 the first time around, they got 466,000 dollars, it's taxable income. So just be aware that this is taxable. This is not free money that you're not going to pay taxes on and you need to build that into your tax projection.

All right. So let's get to our. One more thing I want to hit before I get to Cindy. We are doing a webinar series in Southern California to six local dental societies. Put on your calendar January 13th and January 20th. On January 13th, we are doing a webinar with Kiera Dent, kicking off our year long business and dentistry webinar series. She's an amazing consultant coach. I call her the Energizer Bunny. She's got more energy than anybody you're going to meet. And she's going to be talking about what works in the dental office, what you can do to get really revved up and really get started to have a great 2021. That's going to be six to eight p.m. on January 13th, which is a Wednesday. And these series, which is going to be year long, will be the second Wednesday of every month. If you want to sign up, go to www.EideBailly.com/dentalseries. And you will be able to register for all of them.

On January 20th, we're going to start a four part series on transitions. So if you're looking at buying or selling a practice any time in the near future or anytime, you never know when you're going to have to sell your practice. This is the series for you. The first one is with my good friend, dental attorney Patrick Wood, and he's going to talk about the legal aspects. So again www.EideBailly.com/dentalseries.

OK, I'm going to introduce my guest now. My guest is Cindy Koelbl. Cindy is the Chief Operating Officer of Integrated Telehealth Solutions out of Phoenix, Arizona. Cindy was originally a nurse and she has her bachelor's and master's degree from Olivet Nazarene University of Illinois. She's been in health care for over 42 years. And I've spoken with Cindy several times in the last several months. And she is a very, very engaging and smart lady. Right. Cindy, you're engaging and smart?

Cindy Koelbl Thank you Art. I will be today.

Art Wiederman, CPA Okay, so you have to be engaging and smart. Welcome to the Art of Dental Finance and Management. Thanks for coming on today.

Cindy Koelbl Oh, thank you for having me. And thank you for giving me a chance to talk about teledentistry with you.

Art Wiederman, CPA Well, I'm looking forward to it because I'm looking forward to learning some stuff. So let's start before we get into teledentistry. Tell us a little bit about your journey. First of all, you shared with me you have six grandchildren ranging from, what did you say, nine months to 19. So how does how does that work out? I mean, I've heard you get to just spoil them and give them back. Is that how it works?

Cindy Koelbl It does work that way sometimes. On other occasions, they enjoy being with me frankly and I enjoy that too. A majority of my free time is actually spent with them and with my adult children. And I am one of those very fortunate people who relocated and then happened to have my children follow me. And rather than that being a deficit, that was a positive for me. So that's part of my life.

Art Wiederman, CPA Well, that is wonderful. And maybe we can work out a deal. Maybe I can rent a grandchild. Do you have a rent a grandchild program in your family, like for a day. So I can kind of see what it's like?

Cindy Koelbl I bet we can come up with one.

Art Wiederman, CPA Well, we'll talk about that later. All right. So, Cindy, you and I were talking about a title for this podcast. We're going to be calling it "Adding Polish to Your Dental Practice". Is there some sort of a hidden meaning in that? Why are we calling it adding polish to your dental practice?

Cindy Koelbl Well, I wanted to begin today with a title that would convey to our audience that teledentistry can truly add value to their practice. I wanted to speak to the fact that it actually enhances care delivery methods and processes and increases the focus on oral health and disease prevention. As you know, Art, it's not a service, but it's a way of delivering care and it shouldn't dilute the specialness or uniqueness of any practice and in fact, it should enrich the customer's dental experience. And actually the work for everyone, just like teeth polish or whiteners, actually do for one smile.

Art Wiederman, CPA And I think that now that we're nine months into this pandemic, there are people who had never been on a virtual meeting of any kind. I have been on a few and I've always wanted to do this, but I think the people are really learning about how this platform works and are getting aren't they getting more comfortable with it? Do you think?

Cindy Koelbl There are, actually, all the studies show that there is extreme comfort, both from the providers that are utilizing it, as well as from the patients who are the recipients of it.

Art Wiederman, CPA OK, so you and I talked before the show about what is teledentistry. There's different definitions out there. How do you define teledentistry for what we're talking about today?

Cindy Koelbl Well, this might take me a couple seconds or more than a couple seconds. There are.

Art Wiederman, CPA You can have as much time as you need within reason.

Cindy Koelbl All right. There we go. Well, there sure are several different definitions, and it's not atypical at all for people to actually think of teledentistry as being the provision of remote exams or perhaps even in dentistry, the conveyance of dental homes and remote locations by practitioners, because that was one of the historical usages of teledentistry. But actually, there is so much more. I think, though, to do it adequate justice. I'm going to have to step back and define telehealth because actually telehealth is the overarching term and it actually invokes telemedicine systems, health care tools, modes of care delivery that actually allow the delivery of health education or services from a distance.

Most have heard it stated that there are four main types of telehealth, and that's true in teledentistry as well. First, there's synchronous and synchronizes that conduction of the virtual visit. The thing that I said that most people might relate to, it's about remote interactions. A live video conference Art between a dentist and a patient of theirs would be synchronous.

Second, and there's asynchronous. Asynchronous is the sharing of written or captured documentation that can be the exchange of images, x rays, patient records between individuals. And by the way, that exchange doesn't have to be between two dentists. It can be between a patient and a dentist as well. That actually, so think about a patient texts their photo and videos to their dentist in order to look at the area of dental trauma. And they're able then, the dentist is then able to determine what next steps to take because of that after he reviews those pictures later.

Third, think about R.P.M. R.P.M. is remote patient monitoring and that also can work in dentistry. Think about people that are being monitored by their orthodontist for their teeth alignment throughout the course of using their braces or whatever.

And then in-health is the fourth type. In-health is really group education and that's really important for dentistry. So that's educating the community, if you will, on oral health and disease prevention through the use of telecommunication devices.

But when I use the term teledentistry, I really lean a bit into the ADA's definition that teledentistry, which is a subset of telehealth, is really a broad variety of telecommunication and information technology to provide and support dental care delivery, diagnosis, consultation, treatment, and even to transfer dental information and provide education. It really enables clinicians to convey advice, perform triage, conduct exams, do screenings, consult. Frankly, a whole host of things. We'll talk about some of those later. And in this regard, I would actually espouse to you that, again, it's far more than just that visit. It's administrative, it's communication, it's coordination, and it's educational services, all with the idea of enhancing care delivery for all the stakeholders.

Art Wiederman, CPA So it's not just getting on a video call and saying, let me look at your teeth. Yeah. You're going to good bye. There's a lot more which we're going to get into today. Give us a little bit of the history of telehealth. I'm assuming. I don't how long, how long it's been around and a little bit of the history maybe.

Cindy Koelbl Sure. Well, from inception, let me start by saying telehealth's purposes, or teledentistry's purpose, rather, was to provide for co-ordination and continuity of care. So with that in mind, teledentistry can actually be traced as being part of the blueprint for dental informatics. It was a new domain in computer and information science, engineering and technology. Actually, that started in 1989. 1989 makes us kind of young, if you will. That 1989 initiative actually was funded by the Westinghouse Electronic System Group out of Baltimore, and their focus was on a discussion of how to apply dental informatics and dental practice to affect the delivery of oral health care.

Now, that's really where most of us think that it started. However, most people think that it started with the Department of Defense in 1994 on an initiative that they had called Total Dental Access. What they were doing was trying to enable referring dentists for Army, Navy and Air Force to actually consult with specialists or other dentists at other base locations in order to provide continuity of care and access to care. So they also added education and inevitably even some laboratory work to that work. And by the way, they were the first ones to generate and perform a study on the ROI that came out pretty affirmative for their initiatives way back then.

In 1995, an actual new pilot was done in Haiti. No, that's not in the US, but it had actually some orientation with a specialist in Washington, DC via satellite, and that proved successful. And then two years after that, there was an ISDN based teledentistry initiative in Belgium, Italy and Germany also connected to the U.S.

You remember that during this whole time frame in 1997, that's when Cook, a gentleman, a dentist by the name of Cook, actually gave the term teledentistry as the practice of video conferencing technologies to diagnose and provide advice about treatment over a distance. Needless to say time went on, the digital era strengthened, internet usage spread, and an unprecedented really opportunity for remote access to dental care for rural health and urban areas actually was introduced.

And actually that was the next initiative. That happened early in the 2000s here in the U.S., actually predominantly sponsored by California Medicaid, where they actually implemented some dental homes for taking care specifically of the disabled, the elderly and children. And again, those initiatives around dental caries and dental caries prevention, fluoride treatment and interim restorations were actually quite successful.

Despite, however, though its validation, the truth of it is, well, everyone anticipated teledentistry to grow. It did not. Rather, what actually happened was because of those studies, auxiliary dental personnel started to get involved in more interim restorations. That kind of caused some disruption within the dentistry environment and in regard to state regulators and the ADA and certainly providers. And so, again, it was very hotly contested and debated about what the appropriate roles and what adoption should be endorsed.

Leading then on. And we're now into the 2016 time frame when the Internet, through high speed broadband connections really got ignited. And so at that point, the idea of actually using teledentistry, not just in rural locations, but in urban and suburban area, became the thought, which kind of allowed us to get distracted a little bit from some of that argument that had been occurring.

And so then in 2018, I think is a day to remember, because that's when the American Dental Association, current dental terminology codes that finally began to include provision for teledentistry. And so the uptake, however, still was kind of weak. And then, as you just mentioned, if you fast forward to 2020, we have the COVID-19 pandemic and again, practices closed other than for emergent and urgent care. And, while teledentistry acquired a renewed consideration.

Art Wiederman, CPA Yes. Let's jump into that. And by the way, thank you very much. That's a great summary of the history, about 30 years old. Interesting that it started with the military at some point. And so what's great now is there is a category on Jeopardy History of Teledentistry, I'm going to run the category. So that's good. That's really and I'm loving this is a great, great summary of the history of this, because it's important to know.

So you mentioned the Internet. I'm sorry, you mentioned the pandemic and everything. So obviously when dental offices shut down the week of March 16th except for emergency procedures. And from what I understand, over 90 percent of dental offices did that. What happened was, was that, you know, people still had dental issues. They don't go away because of a pandemic. So obviously, teledentistry got a renewed interest from everybody. But how did that work out and how does it come back now that dental offices are open, they open from middle of May to the middle of June? How is teledentistry kind of been going in 2020?

Cindy Koelbl Well, I've been a little bit of a data nerd around this topic, watching the trends, et cetera. I find it quite fascinating. You know, again, everyone anticipated that there would be this huge surge. And unfortunately, one of the deficits we have Art is that there's not good data to tell us really what the usage was pre COVID. And again, and I want to caution our audience with the statistics that you'll hear quoted, it really it depends on the question that was asked and who was asked too. Right? Like everything in regard to what the response is.

For example, there was a question raised in regard to the amount of teledentistry that was being used to make practice decisions or treatment decisions. That's a different question than asking if it's being used for other things as well and other purposes. So the numbers vary a lot. But I think generally most people suggest that the overall usage among all just dentists for any purpose didn't exceed 10 percent pre COVID. So among dentists, not specialists. How many services are under that's mean. How many dentists used it? So, again, not a huge number. However. And in fact, by the way, let me go back. Only 20 states, by the way, in early 2020 when COVID hit actually had clear Medicaid or private payer payment allowances for teledentistry. And the regulations which vary still today have varied phenomenally. So that's certainly added a lot of complexity and answers a lot of questions maybe about why.

But let me get back then to the pandemic's impact. In March to May, as you know, things are pretty shut down. And then the ADA's HPI tracked practices. And in the first week of June, they said about 20, about 20 percent of the practices said that they had returned to business as usual. And another 71 percent said that they were operating, but they had a great reduction in their business. By the end of November 30th, by the way, those numbers have moved to about a third, saying that they had returned to business as usual and about two thirds being open, but with reduced volumes.

So now I'm actually going to answer your question, which gets me to the point to say that if you DentaQuest conducted a 34 state survey in mid-May and they reported that 40 percent of dentists. Now, remember what I just told you about the openings and the closures. So 40 percent of the dentists then say they were using or plan to use teledentistry in the near future. They also recognized and reported that they were going to use it for symptom screening and educational things as well. And about 71 percent subsequently reported of those 30 state responders, 71 percent said that they were also in extended usage, actually more into the front desk, which gets to that administrative communication things you and I talked about briefly just a little bit.

Another report, by the way, in this time frame came from the ADA. They did a survey in late April. They said 25 percent of members were using teledentistry. But by July, that same survey from the ADA was executed and only 12 percent said that they were now using. So, as you can see, there's been a lot of a little of the volatility. How about that? This whole time frame and lots of differences. I would tell you that other reports generally hit around or suggest about a 20 percent usage rate across all dental for a variety of reasons.

Art Wiederman, CPA So there's a lot of dentists that still are not using this platform. Let's jump in to, let's get into some of the weeds here as far as how we can help our listeners, you know, give them information about how they can use this platform. So first of all, I mean, can any dental practices, I mean, you've got Cindy, you've got fee for service practices. You've got Medicare, Medi-Cal, Medicaid practices. You've got large corporate groups that own hundreds of practices. You've got specialists. Can any dentist use this platform?

Cindy Koelbl Interestingly, they can. It need not be limited to a specific practice type, specialty, size or setting. It's really appropriate from the private dentist sector to the DSO to public health, to mobile dentistry. You can use it caring for children or adults. And by the way, there's lots of platforms out there obviously. Some of them have different limitations. Right. We'll talk about that a little bit later. But the truth of it is whether it's a dentist, a dental hygienist, an assistant, a technologist, even front and back office staff, they really can utilize it and patients truly can benefit from it.

The reality is, is that we typically, again, think of this as being mostly germane to academic, really large or family or general dentistry settings. And I think, frankly, Art, it's also hard for sometimes to conceptualize how specialists, right, can use teledentistry. Can I offer you a couple of ideas or thoughts?

Art Wiederman, CPA Absolutely. That's what we're here for.

Cindy Koelbl If you think about in endodontists, they could receive an asynchronously shared image to identify and diagnose a periapical lesion or frankly, perform online video consultation. If you think about the idea of someone living remotely who doesn't have to travel, then right to see that specialist, any specialist for that matter, because again, they can actually engage with them remotely through a virtual platform.

If you think about prosthodontists, they actually could provide online consultations, use tele to share and discuss treatment plans. Public health dentists. They could use telehealth broadcast messaging capabilities to disseminate oral health information, to educate people in the communities. Orthodontists, you could provide orthodontic care. Suppose a patient is seen, screened and even diagnosed maybe by their own family or general dentist. But that diagnostic information could be shared with an orthodontist who then could provide remote supervision and treatment.

So, again, lots of opportunities. The only caveat I would suggest is remembering that services delivered via teledentistry must be consistent with how they would deliver those services in person. That means obtainment of the same level of information, developing an appropriate treatment plan and delivering care and actual treatment and of course, appropriate documenting.

Art Wiederman, CPA Now, the important thing, which all of our listeners are going to want to know, we don't have to do this teledentistry thing for free. We can charge for this. Right. How does that work?

Cindy Koelbl Absolutely. It's exciting. The reality is, is there are clear codes, as I mentioned earlier, that actually can be utilized. There is and probably one of the easiest way would be to make this available to folks Art. But everything from periodic evaluations to limited oral evaluations, reevaluations, case management, hygiene instruction, consultation, even PPE, there is a provision for compensation for care rendered through tele.

Now there is a there's an indicator, a code that was developed by the ADA D9995. So if you're doing synchronous, you have to use that. In addition to the care codes or D9996 if you're doing asynchronous, in other words transferring images and then you always use a place of service 02 on your billing and coding because that actually says that it was provided the service was delivered through technology.

And I'm going to go back a minute, if I may, before you ask your next question. And I just want to share again, the list can be long, but I want to share the fact that there are so many services, things that people don't often think about, that I just want to highlight just for a thought processing, in creating thought bubbles, if you will. Triage is probably one of the best in determining emergent or urgent care or screening.

Service feedback. When's the last time you did an actual survey of the satisfaction of your person's experience through the use of telehealth. Emergency, pain relief, bidirectional text messaging to promote again and mitigate away all those phone calls that sometimes occur. Community program, after hours care, etc. There's a plethora of services that actually can be provided through teledentistry.

Cindy Koelbl So Cindy I want to take a kind of a break. I want you to talk a little bit about what does your company do? How, if one of our listeners were interested in learning more, I'm going to let you give out your contact information. But talk about, I mean, do you install a bunch of equipment? Is it all software? If someone wants to engage and they say, I want to implement teledentistry in my practice, I've never done it before. Give us a little. How does that work?

Cindy Koelbl Yeah, no, it's a little bit. We believe that people need both hardware and software to actually perform the full scope of teledentistry that actually might be desired. The reality is, is that we provide, I'm going to go back and give you a little history on us and how we got into teledentistry. We first actually had developed a platform for medical health care. It was a dentist, their actual capital investors that actually, a group of dentists that actually saw our medical platform and approached us about, I'll say, modifying it to meet the dental space needs.

We worked with them. We worked with not just them, but also a host of dentists. And so our platform was developed actually from a clinical perspective of determining and identifying use cases and how we could develop a simple to use platform that could do all of those things. We actually had an opportunity. We were to work with a dental distributor and subsequently other dental providers that actually got us to where we are in the dental environment Art.

And I say that proudly because, again, I believe to put forth a platform and frankly develop experts. And we spent a lot of time in the field, but actually did it in a very efficient manner and developed an opportunity to deploy excellent consultative opportunities for dentists. But a hardware and a platform solution that's easy to use, that has high definition video that is hands free for a user, in fact, when needed in a particular, let's say, long term care facility or that kind of thing, that is also agnostic in regard to any peripheral devices that can be attached to it, etc..

So our role is to actually, we like to partner. We believe in partnerships. We don't see ourselves as just vendors. And so we come in and partner, we actually walk through the strategy, a use case discussion and actually find a solution from our repertoire that will actually fit the needs of the dental practice. And then we actually walk through the implementation, education and training and get them up and utilizing it and then continue to grow that usage hopefully over time.

Art Wiederman, CPA So why don't you give out your contact information Cindy. If anybody has any questions, folks, again, this is a tool for you to, you know, again, show that you're on the cutting edge and this is important. You know, you're going to go out and buy your lasers. You're going to go out and buy your digital Xray, you're going to go out and buy your CBCT machine, maybe buy a cad cam machine. But this is just another tool, not just another tool. It's a great tool in your tool belt.

And I think it's something that folks you should really be looking at going forward. So Cindy, if someone wanted to get a hold of you or your company, you have a website, a phone number, email, give out your information. And we'll certainly put that in the show notes if you want to contact them.

Again. Folks, I get nothing. I don't. Honest to God, I get nothing from bringing wonderful people like Cindy onto this podcast. I'm delivering information. And I was introduced to Cindy through our CPA firm. And she's, we've had several conversations. And as you can tell, she's about as knowledgeable about the subject as anybody you're going to meet. So, Cindy, give out your information please.

Cindy Koelbl Sure. And Art, let me start by saying we have published a playbook for teledentistry that we'd be happy to make available to any members our audience. Free of charge just by asking or requesting it. So I'll let you tell people how to do that. Certainly they can contact me. The other thing I want to remind folks is that despite what you may read, teledentistry need not be expensive. And I think that's really important for me to say today. There is a misperception out there and frankly, some of the tools are expensive, but they need not be. And we can go into more of that.

We, by the way, at ITS have an opportunity to provide people, after we walk through that consultative opportunity with them, a 30 day for 30 dollar demonstration period that also I'd like to make available and let folks know that if they're interested, we'd be happy in order to make those types of arrangements with any of the audience members as well. So. So to do that, I can be reached. Let me spell it out if I may. ckoelbl@itshqnv.com or let me give you my phone number as well. It's 520.858.4085. I'm happy to receive calls or emails. You also can reach me on our website if desired, and there's a contact section there as well Art. So all three of those ways can work.

Art Wiederman, CPA And I've looked at their website. They've got a lot of really good information and different ways you can use this. So Cindy, do we need written consent to render teledentistry?

Cindy Koelbl It is, yes. It is definitely appropriate to obtain consent. The other thing I would remind people is that if you're going, some platforms enable recording of sessions. Absolutely. By the way, be sure that many of the state examples or samples for consents, do not include language about that. But if your intent is to use your platform in that way, I just wanted to remind folks, be sure that you include that type of language as well. Most of the state professional organizations are provide a template that dentists can use.

Art Wiederman, CPA So tell me Cindy because again, I'm not trying to sell teledentistry. It's something that like any other technology folks, I think you should look at. And I think you should see if it's right for your practice. But give me some, you work with lots of lots of dentists. What are they telling you? In other words, what are you hearing as far as the best, what's the best thing that the patients are saying about the teledentistry platform? Let's start with that.

Cindy Koelbl Patients have wonderful experience. Interestingly, that the positivity rates are generally around the 75 to 85 percentile, which is huge, as you can appreciate. You know 64 percent of people who have received teledentistry during COVID say that they would be willing to change providers Art if they don't offer teledentistry in the future. So I just want to throw that thought out there as well. Why? Because people like the convenience. They like not having to leave their house. They like not having to worry about childcare or any of the transportation bears that might have impeded them before. So with teledentistry, none of those things become issues.

The other advantages, I would say, and the things that I'm hearing from patients, probably, again, they like the interaction. Believe it or not, many people, whether we're talking, frankly, medical or dental health, then through tele, the comments are they get more of their provider's attention than they usually do when they're face to face. And I don't know why that might be, but that's an interesting comment and I wish they were seeing that.

The other is that they feel safe. Right. Right now we're in a period of wanting to be safe. So you're eliminating the necessity of them to have unnecessary person to person, face to face interactions. People are aware that there are some things that have to be done, hands on. But frankly, for all the things that don't require it, they don't want that right now. And I believe that that convenience issue and the fact that they want access now, they don't want to wait in a waiting room. They don't want to be recumbent when they talk about a treatment plan, they want to do it face to face, not necessarily face to face. But eye to eye, and again, tele provides that. So those are some of the points of feedback that we're seeing.

Art Wiederman, CPA Yeah Cindy, I want to throw something out that just popped into my head here. So I know that if you listen to Marko Vujacic who is the gentleman who works for the American Dental Association, who gives all of the great webinars of about what's going on in dentistry, what are the trends. And I also had the honor and the privilege about a month ago to interview the Dr. Kathleen O'Loughlin, who's the executive director of the American Dental Association, they both said the same thing. About 15 to 20 percent of most dental practices patients at this moment are just, not only are they afraid to come to the dentist, they're afraid to walk out of their house. They're afraid to go to the grocery store. They're afraid to see people. I mean, so have you and your cohorts at ITS talked about how, during this time, these are patients of record of the practice, but they're not coming in to you or anybody else as a dentist. Have you talked about how we can get to these people?

Cindy Koelbl We have. And in fact, one of the functionalities that I believe dentists should want in the platforms that they use is what we would call patient activation or reactivation. It's all about connection Art. People want relationship even with their dentist. They want proactive outreach. They want to know, some individuals don't even know that this is an option. I'm talking teledentistry through a practice.

So perhaps it's on your website. Perhaps someone has even sent a message. But again, remember, we're very telephone oriented. Right. So unless you're sending that to me through a text message, I may not ever open my emails for God knows how long. But the reality is you send me a text message. So having a platform. So the reality is, Art, we have to get their attention. I mean, that's what it comes down to. And we've got to create connectivity and outreach. We've got to let people know why they need to see us, what the issues are. Not just to scare people, but we also need to let them know the downsides if they do not choose to do that.

Art Wiederman, CPA Well, let me throw something else out that I'm thinking about. I've got some clients who are doing really, really well. And it's been really fortunate, Cindy, that most of my clients have come out of the pandemic and they're back to, I'm going to tell you, 80 to 90 percent of what they were doing. And some are over 100. But we have some doctors whose revenues, believe it or not, are actually up this year.

And what we're seeing is, we're seeing that some of them are just so busy because maybe they have cut back on the number of people coming to their office. So talk about how this platform can maybe help save some chair time. In other words, can we get on the phone with some people and say, you know, it sounds like what we're talking about, maybe you need and I'm not a dentist of course, maybe you need some Advil. Maybe you don't need to come in. And that's saves the chair time. Can you talk a little bit about how this platform might help with that?

Cindy Koelbl Absolutely. Not every type of interaction requires an in-office visit and having an orientation and a culture in an office that reminds people that is really important. By the way, I want to, hang on one second, though. I want to touch on your spending or your income comment. It's interesting because the Health Policy Institute from the ADA, they are making predictions that the dental care spending in 2020 will be 38 percent less than it was last year. And their estimating it's going to be about 20 percent less in 2021. So I just want to throw out those numbers. I'm glad that your dentists that you're working with may be faring better than that.

So I am using this as a comment to say I believe that invoking teledentistry to recoup some of that lost revenue and frankly, to maintain, as you know, Art, patients don't have that loyalty inbred in them anymore that they used to. Let's be honest, they're looking for what meets their needs. So again, the reality is for the dentists, there are proven and I want to stress that word, proven efficacy in both health outcomes, as well as practice gains, increased productivity, reduced waste, practice efficiency, like better chair use time, reduced no shows, reduced administrative burden, increased revenue is huge, that we're able to see why because of new billings, new codes, providing new services and reaching out beyond the market that you used to define as your own.

Remember telehealth, other than the licensure requirements, telehealth has no limits. You can go wherever the patient is. So there's growth opportunity and absolutely reduced cost. And I will tell you, you didn't ask, but I will say, one of the threats that I've seen, and it really has to be managed well, I believe, in a physician or doctors or dentists' environment is the fact that the reduction in the need for brick and mortar, which can be a cost savings for a dental practice, may not have great appeal to staff because that often might mean if you aren't reusing those people differently, a reduction in force as well.

And so again, I just, but the realities of realizing those things exist, Art, I think what dentists need is an opportunity to understand how, how to actually use it within their current workflows. You don't have to redo everything to have teledentistry. It's an add to generally, it's an add to, and it doesn't make people's life difficult, more complicated or frankly, the burden heavier. It really does make it easier.

Art Wiederman, CPA So if someone gets on this platform and this great information, I love it, this is wonderful. So if someone gets this platform, how do you suggest, I mean, do you help the dentists in how to market it not only to the patients, but to the community to let them know, hey, we have this we have this opportunity. And here's the advantages. Are there any marketing techniques or tricks that you talk about. Tricks, but the marketing techniques that you help the doctors with and in getting the word out and getting, you know, potentially new patients.

Cindy Koelbl There is thanks for asking. We actually bring in a comprehensive, by the way, this is without any additional charges. Again, we don't charge for our consulting service because frankly, if people don't want to utilize the technology, don't adapt it and don't optimize it, they're going to return. They're not going to continue with it. So our goal is to help those things happen, by the way.

So we bring in a comprehensive marketing plan that's everything from internal awareness and educational campaigns to help the staff make the transition, to actually also communicating externally with clients. We bring in some proven best practices for not just what to say, but where to say it, how to say it and how to send it out. So are we talking about social media or are we talking about hard fliers? Are we talking about text messages and emails? And we enable and provide templates and customize those with our clients to fit their situations.

Art Wiederman, CPA So it's not, we don't just sell them some software and get a check every month or quarter or whatever and go away. There's a lot of interaction with what you do on this platform, right?

Cindy Koelbl Absolutely. Absolutely. Not to disparage any organization, but I think that's one of the downsides of historic tele, no matter whether it's frankly medical or dental, is there's a lot of vendors out there, frankly, even practice management systems developed components and it enabled people to do certain things. But there really wasn't a lot of education and support given. And we recognize again that that's imperative.

Art Wiederman, CPA A couple more things that, you know, time flies when you're having fun, I'm telling you. We're getting towards the end of our time here. Talk about how dentists can use this platform, general dentists and specialists in working together. In other words, the typical scenario before the pandemic is that, you know, specialists would want to go and take their general dentists out to lunch and maybe even bring their teams.

And I've always recommended, you know, a strategy where every third Friday or every third Thursday, we bring, have a specialist, bring a general dental team in for lunch, introduce them to the specialist team, maybe give them a little CE, this is what's happening in endodontics. Or this is what's happening in periodontics. Well, we really can't do that in 2020. So how are the general dentists and the specialists, how is it an advantage to both of them to be able to communicate on this platform.

Cindy Koelbl Well, scheduled interactions can occur, by the way. So can on demand ones, but you can schedule interactions. Our platform in particular allows group interactions so you could actually interact together, share information, converse, etc., just as you might if you were sitting out to lunch together, but actually using the technology to do that instead of doing it in person.

I also hasten to suggest that there is nothing greater than true collaboration. Between general or family dentist and all those specialists. Teledentistry, we have not seen where referrals have not been increased, relationships have been increased, the numbers, the flow of patients, the sharing of information, the true treatment plan, coordination and collaboration. And that's not just between the urban or city dentist or academic dentist and the one in the rural environment where if someone's trying to train or help somebody take better care of a patient so they don't have to travel somewhere, I'm talking about even across town, sharing information, coordinating together, working together.

And so I think the way to do that is still stay on that same journey. Just make it digital to one of how of sharing information of getting together regularly and talking about how they can help each other and truly partner together, utilizing the technology as one means to make that happen.

Art Wiederman, CPA And so I think one of the last things I want to chat with you about, a little truth there is a lot more, that we can talk about. Maybe another time we can continue this conversation. Is the technology part of it? So most dental offices have a group of networked PCs with a server that are connected to the Dentrix, the Eagle Soft, the practice management system, and I'll just throw out the two popular names, the Schick, the Dexis, Digital X-ray system. So what, I mean are most of the offices who are networked have networks of computers and have this, your software interacts very well with all of their software?

Cindy Koelbl That's correct. And I want to stress one point. There's a lot of comments and a lot of articles you'll read the term integrated right, integrated system. Frankly, that's the be all end all. And then there's the standalone systems. It's the difference. There is a difference between being integrated and being interoperable. And what we provide is interoperability. The reality is that therefore we're agnostic. We don't care what system you have. And by the way, if someone's already invested in phones or tablets during the COVID crisis, we're able to come in and use that and build with those so that they don't waste or have to start over so they don't trash anything.

So what we actually do, generally, again, there's a hardware device for conducting audio video interactions and then software that's linked to, again, the other components in the office through which other functionalities can occur. And that's what we work with is whatever's in place and whatever they want to use to build upon that, to generate for the use cases that they want to use digital or tele capabilities.

Art Wiederman, CPA Well, Cindy, let me tell you're a great interview today. Folks. Again, I want. What these podcasts are intended to do are to be a call to action. I want you to work on your business instead of just in your business. I would strongly urge you if you don't already have this technology in some way, shape or form, I would urge you to reach out to Cindy and her team and take a look at it and see if it makes sense for your practice. There's a lot of really good things that it can do.

So, Cindy, if I heard you right, you got a couple of things that you might be able to offer. Again, like I told you before, folks, I get nothing out of this other than the satisfaction that I get calls and emails. Gosh, Art. Thank you for pushing me to look at this or look at that or talk to this person or get this going in my practice. That's why we do this. So you have, you made a comment about a 30 dollars for 30 days, right?

Cindy Koelbl That's correct. We would actually if a dental practice wants to chat with us, we'll talk about what they want to use. We'll actually configure and implement with them, get them up and running and they can use our technology. By the way, all of that, I want to stress is free. We would implement with them. They could use our technology for the desired use cases for 30 days, for 30 dollars.

And by the way, I just have to say it, generally for less than 200 dollars or around 200 dollars a month, we're able to give people pretty great functionality. So I just want to. And that's a very multi-purpose use cases. So I just want to say that. And yes, we've, and in addition, as I mentioned, we have developed a playbook, I know there's always a lot of questions, how do I have good sessions? How do I select a good technology? What's happening with HIPAA compliance? It answers a lot of those questions, everything. And it also tells the story of teledentistry. So we're, people are welcome to have it for free. And it doesn't do us any good if it's sitting on a shelf. And so we'd be happy to share it. And all people have to do is ask for it.

Art Wiederman, CPA So I'll give you two sources, folks, how to get this. My email address is a awiederman@EideBailly.com. And you know, you want to email me if you can't find the show notes or what have you. I give this out every week, so email me if you want a copy of Cindy's book, I'll get that information over to her. Or Cindy, one more time, go ahead and give out your contact information. If anybody has any questions, or they want to learn more about teledentistry and the platform that ITS has.

Cindy Koelbl Sure, please reach out to me ckoelbl@itshqnv.com or call me 520.858.4085.

Art Wiederman, CPA And again, we'll put that in the show notes. Cindy, thank you so much for your time and your expertise and sharing such great information about how we can help our doctors in what is a year that is just, I think we're all counting the days till it's over and very, very much looking forward to a much better hopefully 2021. Thank you so much. And stay on as we sign off.

Folks, again, if you want to get a hold of me in my office in Tustin, my phone number is 657.279.3243. Again my email is awiederman@EideBailly.com. Again, if you want to be registered for our yearlong series, we're doing a series of the Business of Dentistry every second Wednesday of every month, the third Wednesday of every month starting in January. For four months, we're doing a series on dental transitions and then I think it's the fourth Wednesday of every fourth Tuesday it might be of every month we're doing a new dentist webinar where we're going to be talking about systems and labor laws with a labor attorney. And how do you set up your QuickBooks and all that stuff. Go to www.EideBailly.com/dentalseries
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Well, that was a great interview. Great information. I learned a lot that I did not know about teledentistry. So it's always helpful to me as a dental CPA. So for everybody here, remember my five words saying - failure is not an option. Keep working on your practice, keep caring about your patients, keep caring about your team. We are going to get through this, folks.

As of this recording, the great news is that the Pfizer vaccine is out and being given to thousands of health care workers. The Moderna one is going to be out. Looks like if the FDA approves it, that'll be out. Johnson and Johnson has one. There are other companies. I mean, by everything I hear, by the spring or summer, hopefully we get to the 70, 80 percent herd immunity and we can go back to life the way it was. Because I tell you what. Me not being able to go to a football or basketball game is driving me up the wall. So I want to go and I think you all do, too.

That is it, folks, for this episode of The Art of Dental Finance and Management with Art Wiederman. Thank you for listening. Please tell your friends about our podcast. It's growing exponentially and have a wonderful, wonderful day. See you later. Bye bye.