Podcast (Dental)

Implement Sleep Apnea Solutions in Your Dental Practice to Benefit Your Patients and Bottom-Line

June 23, 2021

Sleep apnea affects an estimated 10% of the adult population and as much as 50% of those with existing cardiovascular conditions (NIH.gov). In the short term, sleep apnea can affect daytime alertness, energy, focus, performance, as well as overall sense of wellbeing. In the long term, it can lead to chronic diseases and premature death.

On today's episode of The Art of Dental Finance and Management podcast, Art meets with Dr. Emily Stopper, aka "The Happy Dentist", to discuss how dentists can add sleep apnea solutions to their dental practice. Aside from helping patients with their sleep quality to improve their health, wellness and longevity, these solutions benefit your dental practice’s bottom-line. Key points covered in this episode include:

  • Diagnosis methods
  • Treatment solutions
  • Financial and professional benefits

Reach out to Art if you have any questions regarding dental finance and management for your dental practice. More information about the Eide Bailly dental team can be found at www.eidebailly.com/dentist.

Being more strategic in all aspects of your dental practice will lead to increased profitability.

Today's Guest

Dr. Emily Stopper
The Happy Dentist


Show Notes and Resources:

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 am your host. I'm Art Wiederman. I am a dental specific CPA. I'm located in Southern California, South Orange County, to be exact. And I am a dental division director for the CPA firm of Eide Bailly. We work with about 800 dentists in our firm, about three hundred of them in our office in Tustin and central Orange County. And today's episode is very, very near and dear to my heart. And that's an episode that I've wanted to do for a long time. And I have found the perfect I mean perfect person to talk about this subject.

My guest today is going to be Dr. Emily Stopper. Dr. Stopper is known as the Happy Dentist. And so I figured anybody who calls herself the Happy Dentist has got to be a great interview. So I'm very excited to have her on. And our topic today is sleep dentistry. I will share with you a story once I get through some of my announcements and tell you a little more about the topic. But we're going to talk all about sleep dentistry, how Dr. Stopper, who is a practicing dentist in North Carolina, has brought this into her practice and has not only changed her life, but also has changed the lives of many, many dentists across the country in helping them implement sleep dentistry in their practice. So we'll get to Dr. Stopper in a moment.

First, I want to let you know that you should be looking at our partners website, which is Decisions in Dentistry magazine. We're working very closely with Lorraine Kent and her team. They have amazing clinical content. One hundred and forty CE courses that you can access for one very, very reasonable price. Go to www.DecisionsinDentistry.com.

We are also doing a year long series, a business series called The Business of Dentistry for six local dental societies in Southern California. They are the second Wednesday of every month. So we're about you know, we're recording here in mid-May. So June, July. We've got some great folks. We got Gary Takacs coming up. We've got Mark Johnson talking about student loans. We've got Rachel Wall from also from the Carolinas, who's a dear friend of mine. And she's going to be talking about hygiene. We have all these folks coming up. Go to our website at www.EideBailly.com/dentalseries. And or just email me at awiederman@EideBailly.com. And I'll get you all the information and we'll get you registered for these for these webinars.

Also, folks, if you have had a greater than 50 percent reduction in your collections from your practice back in the pandemic, I am happy to say that we're starting to be able to say back in the pandemic, we're very, very pleased that hopefully life is moving forward. But back in the second quarter of 2020, if you had a greater than 50 percent reduction in your revenues and your collections net of patient refunds and you filed and you got a PPP, whether you got a PPP loan or not, most of you did, you are eligible for something called the Employee Retention Tax Credit.

We have dozens and dozens and dozens of dentists that we are doing this consulting for it Eide Bailly. We are averaging about 40 to 60 thousand dollars in a federal free tax credit. Perfectly legal. I don't do anything illegal or fattening on this podcast, folks. I've been spending my whole life will for the next three months on this. Most of you will have to if you have not already filed for your PPP forgiveness by for most of you, it's going to be as early as the 1st of August. And for many of you, it'll be during the month of August. Some will run into September.

It's twenty four weeks after you get your loan and then ten months after that is the limit. And even if you have filed for your SBA forgiveness for your first loan, we can still get you this credit. So email me awiederman@EideBailly.com or call me at the office 657.279.3243. And if you're not working with a dental specific CPA, I'm a founding member of the Academy of Dental CPAs. Twenty four CPA firms across the United States that represent about 10,000 dentists. We have about 800 at Eide Bailly. And you should be working with one on all of this stuff. I mean, we just got through the march, the May 17th tax line. So many of them are taking a breather right now. But we're here to help. And if you're not working with a dental CPA, there are so many benefits of doing so.

OK, so now I want to get to my wonderful guest, Dr. Emily Stopper. But first, I'm going to tell you a personal story, which I may or may not have told. And some of you have heard it. If you have don't turn the podcast off, just take a breath or, you know, check your emails or something like that. So about 15 years ago and I'm 60, I'll be 62 in August, I went to my dentist and I'll mention him by name. He's a wonderful, wonderful man, Dr. Scott West in Mission Viejo, California. And he asked me, you know, he's going through the health history and he says, so, Art, how's your health? I'm pretty good. How are you sleeping? I'm thinking, why is a dentist asking me, how am I sleeping? And I said, well, to be honest with you, Dr. West, I'm really not sleeping very well. I'm I feel like I'm snoring. My wife tells me. And you all know, I talk about my wife, since Doctor Stopper is from North Carolina. I can say y'all, I guess. Or is that Louisiana? I don't know. We'll figure it out.

But anyway, so my wife is telling me I'm snoring and I just I'm tired during the day. And he says, well, let's get you checked for sleep apnea. And I swear to you and now I was a dental CPA back then for over 20 years and there wasn't a lot of conversation about it. And I said, sleep what-nia? What are you talking about? So I went to a sleep center down the road. I went to they said, you get to stay overnight. They hooked me up with some, you know, connectors and stuff. I go to sleep, fifteen minutes later, it's like there's an ambulance, there's a nine one one. They come running in. And the next morning the doctor says you have severe sleep apnea. And he was explaining to me and Dr. Stopper will obviously be able to do this much better than I will. But on a scale of one to 15, I was about a 13 and a half or a 14. So they said, you have choices and we'll talk about those choices. And I ended up on a CPAP machine and it was hard. It is not something that I enjoyed. But I will tell you, Dr. West saved my life. I guarantee you he did.

And I mean, you look at things. I'm a big football fan, folks. You've heard of Reggie White. Reggie White is in the Hall of Fame for the Green Bay Packers. He died at the age of forty one or forty two in his sleep from sleep apnea. And my understanding is that there's 40 million people in this country that have this and sixty million that have sleep issues. So enough about me. I am a passionate person about this. I have many clients who have embraced this in their practice. But I have a national expert that you're going to hear from now for the next 45 minutes to an hour. I want to talk about that. So, Dr. Emily Stopper, the Happy Dentist, welcome to the Art of Dental Finance and Management.

Dr. Emily Stopper: Thank you. I'm honored to be on your podcast. Thank you, Art.

Art Wiederman, CPA: Well, you're sweet. And so let's just be clear up front, folks. Dr. Stopper is a practicing dentist. She's been practicing for 14 years in West Jefferson, North Carolina. So in the pre interview, I asked her, I said Blue Devil or Tar Heel and she said, absolutely, North Carolina Tar Heel. So we will honor that. I'm a USC fan. And that's not South Carolina. I can tell you that's the University of Southern California.

But now, interestingly enough, Dr. Stopper, again, she's got a practice. It is limited to sleep apnea or sleep dentistry. And she has would you tell me, like, seventeen folks that work with you in West Jefferson?

Dr. Emily Stopper: Yeah. So I have my general practice. I have other associates who work and do the general dentistry. I've been able to niche down myself to sleep apnea just two days a week.

Art Wiederman, CPA: And we're going to talk about that. For many of you who would like to specialize and have a passion for this. So now, Dr. Stopper, my understanding is that you have four children under the age of eight, so you get a medal right out of the gate. I raised two and I have gray hair and you don't like I see one on the call and I understand you homeschool them. So how did, I guess it didn't really affect you during the pandemic? How is it home schooling kids? How does that work?

Dr. Emily Stopper: Yeah, so, yeah, ironically, during the pandemic we were not nearly as affected as many people across the country. My kids were like, OK, I guess the pandemic is normal for us. They were used to being at home most of the time. And yeah, home schooling is interesting. It's been an adventure and fun and chaotic at times, but still fulfilling. Rewarding.

Art Wiederman, CPA: Well, it's obvious. I know a lot. I know people who do home school, school, their children and they put so much time and effort into it. And it's wonderful. And God bless you for raising four children. And it's a little early to see if there's any dentists in the front because the oldest one is eight. But you never know.

So. Well, listen, why don't you tell us, let's start, tell us about your journey. Tell us, you know, you went to you went to Wake Forest undergrad. You went to University of North Carolina, Chapel Hill Dental School. Tell us about your journey.

Dr. Emily Stopper: Yeah, so and my dad is a dentist, so. Yeah, he graduated in seventy six from UNC Chapel Hill. And it's funny because I didn't really want to be a dentist until I was about eighteen. It was right around the time I was graduating from high school and I thought, hmm, you know, my dad's not had such a hard, a hard life with, you know, with dentistry. It's been good to our family. And so I thought, you know maybe this is a good career choice.

So I started down that path pre dental, even at Wake Forest and then just kept on that journey from there. But, you know, and sleep apnea was not something I was aware of until after I graduated from dental school several years after. So really, my journey with the sleep apnea part came after years of practicing alongside my dad, I was I've been fortunate enough. He's still practicing a couple of days a week, even.

Art Wiederman, CPA: In the practice that you're in?

Dr. Emily Stopper: Yep, we share the practice. It's been really cool to get to work with my dad. And, you know, he's been a great mentor to me. And so, yeah, that's been that's been fantastic. But it was, you know, and having four children, you know, after having my third back in twenty sixteen, I started thinking about, you know, I really want to spend more time with my kids. And I felt like I wasn't you know, I was missing out on certain things with the kids. So, you know, I didn't want to miss out on milestones. My, you know, my youngest was a baby and I thought I really want to step back from the clinical dentistry as much as I'm doing so.

So it was that point I started thinking about what were some other avenues that I had. So I would say I was not the happy dentist at that point because I felt like I was overworked. I was tired, kind of stressed out. It was starting to wear on me about even giving. I pride myself on being a very gentle dentist. And I am very empathetic with my patients. And, you know, it's like I feel their pain. I don't want them to be stressed or have anxiety. And I just try to be as kind as I can. And it was wearing on me, though, to be so, you know, I don't know exactly what the word is. I was just I was feeling the stress from working all day and then trying to come home to the kids. And I just wasn't feeling like I was getting to enjoy my family life as much as I would like to.

So yeah, I started looking at different avenues, even for income at that point, and started looking at even trading stock options and maybe getting out of the general dentistry myself and thinking about hiring other dentists to work in the practice. And so anyway, at that point I was not the happy dentist, but something interesting happened that I didn't get to just kind of take myself out of the general dentistry. We had some hiccups in the road where I couldn't get a dentist that would consistently work as an associate. So I had to go back into the office and work more than I wanted to work. And the stock market and options were not panning out like I wanted them to. So it was back to chair side doing what I knew best to do.

But then my mother in law came to visit and she normally would not stay with us. So this was kind of an unusual thing for her to stay with us. My father in law had passed away and so this particular visit, she stayed on our couch and slept. I was not very familiar with sleep apnea. I knew she had sleep apnea and that other than that, I was not familiar with even what a CPAP looked like, quite honestly. So but I knew that she had flown out and she did not bring her CPAP with her. And the first night she was sleeping on the couch, I could hear her really loud snoring, you know, the snoring that's like rattle the windows shake. And that was that was her. And this is not like I had heard snoring like this before. My dad's dad, my grandpa had just really loud snoring and as kids we always kind of laughed about it and just thought it was funny.

But, you know, this particular night I heard my mother in law, she would start coughing, she would gasp. It really scared me. I thought I was really concerned about her health and I just didn't realize how severe of a situation this was. So it worried me a lot. And I ended up researching what kind course I could go to get trained to help her because I knew the CPAP was not something that she was wearing faithfully. It wasn't something that she was you know, she didn't travel with it. And she even said she didn't like the straps, the strap marks that made on her face or, you know, the dog was kind of afraid of it.

Art Wiederman, CPA: That one I haven't heard. The dog was afraid. Usually I'm afraid of the dog.

Dr. Emily Stopper: So, yeah, she's got a dog that she's crazy about. And she didn't she wants him to be able to sleep in the room with her and not be scared of it. So it was one of the things was like, well, I know dentists can do something about it. I'm going to look into this and see what's possible. So, yeah, that very first night that she stayed with us, that started me on the journey of just learning about sleep apnea to help her. And then it expanded to me helping other family members and then team members and then, you know, then patients. And it's just been it's been a blessing for me and my family, for our patients. I just it's really fulfilling because I get to talk to patients every single day that, you know, they're saying their lives are changed and, you know, they weren't.

You know, it's not just as bad, like some people just don't sleep well. But then it's a whole other thing if you're not breathing well and you're tossing and turning all through the night and you're exhausted all day and your blood pressure is out of control and all these other really severe health problems can stem from sleep apnea, which is so underdiagnosed and most people have no idea they have it. So that's where I'm really passionate about helping dentists, just like your dentist did.

I mean, that's awesome that Dr. West even mentioned that to you, because if even just, you know, making it pointing something out or just asking a simple question about how are you sleeping or have you ever been screened for sleep apnea, it's those questions that can spur on a conversation. You had no idea, would even, otherwise you would, otherwise most people, just like you said, wouldn't know that their dentist could help them or wouldn't know what sleep apnea is in a lot of cases.

Art Wiederman, CPA: Absolutely. So I saw the happy dentist and I actually I see you're an Instagram friend of mine. And so I see your posts and all that stuff. After listening to you now for a couple of minutes and talking to you before, I would have thought that with everything you've got going on, you would call yourself the bat crazy dentist, but how did happy dentist come to be.

Dr. Emily Stopper: Yeah. So like I said before, I was kind of miserable when I was just, you know, in the office four days a week feeling like I was constantly on that treadmill and just not you know, it's hard when you hear patients say, I hate the dentist or I hate coming to the dentist. Like it's not people's favorite place to be. And then it's hard on your neck and your back. And I was seeing the chiropractor every other week. And, you know, it was just taking a toll on me, just like physically, emotionally, wanting to be that mom that could be home with her kids more, too.

So at that point, I was not the happy dentist, but whenever I found sleep apnea and how I could truly impact people's lives in a whole new way and, you know, now I get time to sit with my patients, which is so cool to be able to hear their stories and hear how they are impacted by not sleeping well or not feeling well. And then, you know, within just a few weeks, we can see a change in how they feel. And it's almost like a 180 with some of these patients, like I remember this one, this one man, his ear, nose and throat doctor referred him to us and he was grumpy. He was really grouchy with everyone at the front desk. He even came in. We did our consultation for him and we talked about the dental appliances and how we could help. And he was still very skeptical. And he was like, well, I don't even know why I'm here.

And so I don't even know why he followed through with the appliance except for the ear, nose and throat doctor had referred him and recommended it, but he did. And within three weeks he came back and he was like a totally different person. He was he apologized for how he had acted previously. Said I'm so sorry. He said I just feel so much better now. I've never slept well. And all of a sudden I'm feeling better. I mean, it just it was amazing how different this person who just three weeks before was just kind of angry and then all of a sudden he's this very pleasant person. He wrote us a wonderful testimonial. He even traveled from forty five minutes away to come see us and started becoming a dental patient.

And so it's just really cool to see how you can impact people's lives. So that's really where the happy dentist comes from. I can practice on my own terms a couple of days a week, see my ideal patients and kind of get the best of both worlds.

Art Wiederman, CPA: I love the name. So let's get into the conversation. So let's start off. Give us a thirty five thousand foot overview of sleep issues, sleep apnea, kind of you know what is it? And how do you as how do you recommend it? Because obviously we're going to talk about the fact that you not only are in your own practice, but you also do consulting to other dentists. You've worked with some of our clients and they love you. So, you know, we're going to talk about that. But talk about just for dentists that have just like, oh, it's just not something I want to get into and it's not good. Talk about the actual affliction. And you know what it is and how it works.

Dr. Emily Stopper: Sure. Yeah. Well, you know, there's different types of sleep disorders. So what we're focusing on is obstructive sleep apnea. So when I explain it to my patients, I'm really explaining that there's a physical obstruction that's keeping them from sleeping or from breathing well, throughout the night, you know, and this is it could be the tongue falling back and blocking the airway. It could be the collapsibility of the airway. It doesn't help that we're laying down. And, of course, gravity is having its effect. But basically, you know, an apnea is when someone stops breathing for at least ten seconds at a time.

And if this is happening over and over and over again throughout the night, obviously it's not a restful night. It's hard on the heart. It's hard on the whole body. You know, every cell in the body is going to be affected by that lack of oxygen. You know, it's not uncommon for me to see sleep tests come back and someone's dropped below 80 percent oxygen saturation. So, you know, it's a very dangerous, destructive disorder that sometimes people have for years before they even realize they have it. Some people just blow it off as snoring. But snoring is not necessarily something that's just this benign thing. It's you know, it can be an alert to the body that something is not right. You know, that there's some kind of obstruction keeping that airway from being open.

So anyway, as dentists, we have that front line view of the airway every single day. Our hygiene team, they're constantly looking in people's airways. We're looking at people for the same as we're looking at oral cancer or looking for oral cancer or signs of screening for oral cancer. We should also be looking for signs that someone has sleep apnea. And the mouth is a place where all these signs show up probably before anywhere else. And there's lots of signals or red flags that we can see from someone's health history. So if someone has hypertension, diabetes, acid reflux, atrial fibrillation, we should automatically be concerned that sleep apnea could be an issue.

And then if you look in their mouth, scalloped tongue, you know, a soft palate, that's really sometimes you can't even see in these patients’ airway when you ask them to open. But you can't. Their soft palate's so far down their airway or their uvula is hanging down. There's all kinds of things that we can just look in and within 30 seconds be able to tell this patient could be at risk and recommend a sleep test.

Art Wiederman, CPA: Now, I know from what I know and please correct me if I'm wrong in the big picture, there's basically three major different types of treatment. One is an actual surgery, one is a CPAP, and the third is a dental appliance. Do I have that right?

Dr. Emily Stopper: Yeah, pretty much.

Art Wiederman, CPA: So, you know, just talk briefly about maybe, I mean cause we're going to spend obviously most of the time talking about the dental appliance, but talk about the other. I mean I've heard that, I've known a couple of people have had the surgery and it is, the word excruciating comes to my mind that it's really painful and not always successful. And then the CPAP, a lot of people will take this. So talk a little bit about those two and then we'll get into the dental part of it.

Dr. Emily Stopper: Sure. Yeah, sure. So the CPAP is probably really considered the gold standard of treatment for sleep apnea. But there are surgeries and there are a few different types of surgeries that might be used to treat someone sleep apnea. So, you know, there's something called the Inspire Wear it's basically like a device implanted where it can sort of zap the tongue out of the way while someone's sleeping. Treating the hypoglossal nerve stimulation. There's also a maxilla mandibular top surgery where they can go in and cut the jaws and move the mandible forward. That one is very that would be a very aggressive and extreme surgery to go through. And, you know, there's things like that or even what they call UPPP surgery, where they're going back and moving the back of this soft palate and taking the uvula out. And, yeah, it sounds pleasant.

Art Wiederman, CPA: As long as they put me to sleep, they can do whatever they want. But, you know, so.

Dr. Emily Stopper: The thing is, I've seen quite a few patients now that have had that surgery and it's only 50 percent effective at best.

Art Wiederman, CPA: That's what I've heard.

Dr. Emily Stopper: Yeah. I'm still seeing patients back from those surgeries where they say, yeah, stop snoring for maybe a year. And then it started again and then we end up treating them with a mandibular advancement device.

Art Wiederman, CPA: So, OK, so now I'm a dentist, I'm listening to this podcast and I talk to my patients. I go through health history. I hear this. I've heard about sleep apnea. I've heard about sleep dentistry. I've talked to some of my colleagues. And I go, you know, this is, because remember, folks in a podcast, you're not going to get a full step by step technical explanation of how to do everything. It's not possible. It's not live. What I want this to be for you is a call to action.

In other words, if Dr. Stopper can say some things to you today that's going to say, listen, this is an opportunity for me to leave my legacy with my patients. This is an opportunity for me to save lives and improve people's lives for the better, then that's what we're trying to do here. So, Dr. Stopper, if someone is you know, the bell went off and listening to this and they said, I want to do this, what's the first step? I've never done this before. How would a dentist and again, talk about what a dentist provides the you know, the all that stuff will get into that, but how would they get started?

Dr. Emily Stopper: Sure. Yeah. So, you know, really, like I mentioned earlier, we are the front line for looking in airways all day long. So screening is just the best way we can. Even if you don't want to make appliances for patients, if you can just start screening your patients, it will be tremendous as far as, you know, just getting them help and pointing them in the right direction, just asking the simple questions, just like your dentist asked you, how are you sleeping? Things like that. Have you ever been screened for sleep apnea or are you waking up more than once per night? Just certain things. Whenever we see those signs in the mouth of people who brooks, that could also mean that someone has sleep apnea.

So just noticing those signs, you know, if you have patients that are yawning throughout the appointment or fall asleep while you're doing dentistry on them. And again, those health history signs, acid reflux, a fib, hypertension, diabetes, those are the big ones. But so screening, just start identifying those patients, talking to them a little bit about it. Why are you concerned? What could this mean for their health? Basically, it could mean that they're cutting their life short by not breathing well.

Studies have shown that even sleep apnea alone, just if we talk about sleep, if someone's not getting seven to eight hours of sleep regularly, then that could be cutting their life short. So these are big things for us to consider. And looking at the patient's overall health, just pointing them in the right direction like the mouth is a window to what's going on with the rest of the body. And so basically, just that screening, identify the patients that are at risk, educate them on why you're worried about it, and then refer them for a sleep test, refer them to their doctor, whoever you can.

Primary care doctors and companies that do sleep testing, sleep doctors just get them to someone who can help them facilitate that sleep test to find out, because that's how someone would be diagnosed ultimately with sleep apnea is if a board certified sleep doctor looks at their sleep study and it can be in a home sleep test, they don't even have to go to a lab like you did, Art, they can have a home sleep test and sleep in the comfort of their own home. They can have, these days they can have a telehealth appointment. They don't even have to go to a physical building to go speak to a sleep doctor.

Art Wiederman, CPA: So let's assume we've done that. We've identified it. We see we have a lot of patients and I'm going to guess one third to one half of the patients are going to have something going on, maybe a third. So do we I mean, I know that you're involved in the National Sleep Organization. I want you to talk about that. But are their courses do they take, what kind of equipment do we have to do? I mean, I want to get started. I want to do this. What's this? And again, I'm going to give you in a second to talk a little bit about how you help doctors do this. But what are the steps? What do they do? Do they go buy some? I know that there's a sleep testing equipment you can buy. It's not very expensive. I know that. And I mean, it's, you know, a CBCT could be two hundred thousand dollars. It's not anywhere near that. But the question is what do they do? What courses do they take? What's the steps?

Dr. Emily Stopper: Yeah. Yeah, well, you can get started very inexpensively. It's not an expensive thing to get started with. You don't even have to buy a home sleep testing unit. Like I said earlier, you can you can refer out. You can, there's companies that can help facilitate the sleep testing part. And you do need some way to take a bite registration that will have the patient in a more protruded position allowing some more. I'm getting more technical here, but.

Art Wiederman, CPA: No, dentists are listening to this. Get technical.

Dr. Emily Stopper: So something like the George Gauge or Airway Metrics. I'm partial to the Airway Metric system myself. That's what I recommend to be able to help you identify where that patient's best airway will probably be. And I talk to my patients about I'm going to try to find your ideal airway position and then we're going to ease you into that position through your treatment. So we're not going to start the patient with their jaw completely forward where they're completely protruded out. We're going to ease them into that position.

So, I mean, it's simple equipment. It's having bite registration material, the airway metric system, you know, and then just following up with those patients and having the proper screening tools, which are just questionnaires or something I call the visual apnea risk assessment tool. I asked my graphic designer to create a simple graphic so that my hygienist can look in the patient's mouth and within 60 seconds she can identify the things that are concerning to her. She takes a dry erase marker, circles the thing on the laminated sheet. And when I come in the room, she she's already talking to the patient about what she sees as concern.

Art Wiederman, CPA: She's teeing them up for yourself. I say let's say we have a patient that isn't a candidate for surgery, isn't a candidate or doesn't want to do a CPAP and now we're to a dental appliance. So let's talk in overview terms or as deep into the weeds as you want to get. What is it that you provide if they're coming to you for an appliance, if you send them to a sleep center and they are on CPAP, you don't really have a whole lot of involvement other than checking on them regularly when they come in for their dental appointments. But if you're going to be making the appliance, talk about how that works. What do you do? What do you make? What is the steps?

Dr. Emily Stopper: Sure. Yeah. So let's say that they you know, they maybe we saw them in hygiene. They went and got tested, saw the sleep doc, they got diagnosed with sleep apnea and then they would refer them back to our office for the mandibular advancement device. So at that point, if we haven't already done this, I'm going to ask them some more questions about their sleep. I really want to know what our starting point is.

What is the patient suffering with? How bad is it? How much, are they tossing and turning all through the night? Has it caused them to sleep in separate rooms from their spouse? What are the major pain points that are happening? I want to be able to know these things so that I know you know how I can best help this patient and what our goals for treatment are. I'm also going to go over the sleep test with the patient because believe it or not, going over the sleep test with the patient that they own, what's going on? Whenever they see what those numbers are, they see.

Art Wiederman, CPA: They don't lie.

Dr. Emily Stopper: No. Yeah. If the numbers show that they're stopping breathing 15 times an hour and their oxygen is dropping down to seventy seven and their heart rate going up to one hundred and ten, and, you know, it's me going over these different aspects of the sleep test that helps the patient really grasp what's going on with their own health. And most of the time, most of the time, ninety nine percent of the time no one's really talked to the patient about what's going on with their sleep. They haven't gone over the sleep test. They might say, you know, oh, you need to see CPAP or oh, you have you do have sleep apnea. They might even say it's mild or moderate, but most of the time they haven't gone over the exact numbers.

And so I found that's really beneficial if I just talk to the patient about what's going on with their health and then explain how the simple dental device works and we're going to check their insurance. Typically, patients do like to go through their medical insurance. That's a nice benefit of what we can do is we can we can check their medical insurance benefits and we can file it to medical billing. So it's not having to go through dental insurance for this.

Art Wiederman, CPA: So we'll talk. I want to get to that in a little bit. So now, Dr. Stopper, I know and again, folks, I want to help you. This is going to change your practice. It's going to change your life. It changed my life and it's changed the lives of a lot of my dentists who have gone into this type of subspecialty, if you will. So Dr. Stopper also does consulting with dentists across the country. So I want to give you an opportunity to not only talk about a little bit you know, if a dentist is interested in getting into this, you can help them get started and kind of walk them through how it works. Right. So let's talk about how you do that.

Dr. Emily Stopper: Yeah, absolutely. Well, so when I first got started down the sleep apnea rabbit hole, as I sometimes refer to it. You know, I found that I hit a lot of roadblocks and, you know, it was like, well, how do we do the medical billing and how do you pick the right appliance? And how do you talk to the patients about this? How do you screen them? Like, what are all the steps involved? And so I found through even after attending multiple courses, the courses were great that I went to, but I just felt like there were pieces I still was missing. And then I found, you know, after figuring out the steps to make myself successful with it, I talked to more and more dentists who said the same thing. They kept running into roadblocks and then they would give up. They just would quit and they would stop.

They would either go to these courses and get excited about it, but come home to their team, their team just sort of it's like, OK, no, we're not going to do this. And then no support from the team. So then they give up on it or they hit a hiccup with the medical billing and then they give up on it or a variety of things. Of course, life is busy and our dental practices are busy. So there's different things that would hold these doctors up. But my main goal was, you know, you have the knowledge. We have a front row seat to be able to be really instrumental in changing people's lives. So let's take the knowledge that we have and actually use it to help people and to implement a really great, you know, stream of revenue service that you can add to your practice and to your patients.

So my goal, that's why I created I call it Implement Apnea Academy. So I'm big on the implementation. I don't want people just to take their knowledge and sit on it or just like, OK, I know how to do this, but I'm not doing anything with it. It's the implementation that's really going to make us successful. So that's why I train dentists on specifically is let's take the knowledge that you have for treating sleep apnea. And if they have if they're starting from ground zero, that's okay. I can help them with that part, too. We're going to set up the foundation, but ultimately I want them to put it into practice so that they can help more patients, but also achieve more fulfillment themselves and really see the fruit of their hard work and knowledge.

Art Wiederman, CPA: So Dr. Stopper, if we have a listener who this rings a bell and they wanted to have an introductory conversation with you, there's no problem with doing that, right?

Dr. Emily Stopper: Absolutely. I would be happy to, yes of course.

Art Wiederman, CPA: So let's give out your email address and your phone number, and I'm going to note them down so I can put them in the show notes. But if you have a question for Dr. Stopper, you're thinking about getting into this, whether you're going to use her as a consultant or not, should be happy to talk to you. Dr. Stopper, what's a good phone number for them to call?

Dr. Emily Stopper: Yes. So it's 828.406.3596.

Art Wiederman, CPA: OK, and what's an email address that we can use?

Dr. Emily Stopper: So the best one is going to be Emily@TheHappyDentist.com.

Art Wiederman, CPA: That's easy to remember. OK, one second. I'm writing this down. OK, sounds good. So we'll put that in the show notes. And I know you have some resources on your websites that they can download some videos and stuff. Right?

Dr. Emily Stopper: Right, right. Yes. If they go to the www.TheHappyDentist.com, that's going to be probably the best place to find out more. I do. And I will mention I do have a book coming out if they want to get on the waiting list for the book. It's going to be at www.thehappydentist.com/book. So we keep that simple, too.

Art Wiederman, CPA: Yeah. Well we like simple that's good. So let's talk about the financial aspects, Dr. Stopper, of all of this. I mean, I am required by law as a CPA to talk about money and numbers on this podcast. So I see on your website we talked about it a little bit when we before we started the recording is this is I mean, I love parts of a business that have like no overhead. So when you make a dental appliance and we bill medical insurance, we'll talk about that in a second. What I've seen is, I mean, you know, Medicare will pay 2000 dollars. Fifteen hundred twenty five depends. But some insurances will pay three, four, five, six, seven thousand dollars for an appliance. And the overhead there's you know, the lab is the cost of the device, which my understanding is somewhere in the neighborhood of three to six hundred dollars. Is that close?

Dr. Emily Stopper: That's a good ballpark. Yeah.

Art Wiederman, CPA: OK, but there's really other than an assistant's time, the amount of time to do the work, you don't need to spend forty five minutes in a crown prep here. Right. So talk about financially how this has worked, not only for your practice but for your clients that you've worked with in consulting. I mean, I want to give everybody an incentive. Not only are we saving lives, but folks, there's huge incremental profit in this thing. Right?

Dr. Emily Stopper: It's the most profitable service that I know of that we can do as a dentist, the least time consuming, most profitable, lowest overhead. I mean, like I said earlier, there's really not much you need in terms of equipment. You should really have the majority what you need anyway, because I mean simple as bite registration, a way to take the bite, which like I mentioned earlier, the Airway Metric system. I mean, you could and then really the largest part of your overhead is going to be the lab bill.

So, you know, there's a few other little incidental items that you need. I will mention that I always make what I call it a morning aligner. There's something called AM aligner or something that they wear the next day in the morning to get their bite back into its normal position versus being the lower jaw being pulled forward throughout the night. But, you know, that can be done very inexpensively as well. So yeah, it's minimal time required. And the majority of what you need to do or what needs to be done can be done by auxiliary personnel.

So the way I practice now, I mentioned I do have my dental practice, general dental practice, but I use two opts of that practice. We've got a 10 opt practice. I have one assistant and she does both the scheduling. She takes care of all the admin stuff and the clinical stuff. And it's just she and I that do the sleep apnea. So we work out of two ops. You know, it's and it's a relaxing day. It's an enjoyable day. It's a matter of, you know, she can go in and talk to the patient. I can come in and do my exam. She's the one that will go in there and handle the majority of the hands on that needs to be done. So yeah, it's great as far as not having to be as you know, technically, it's not as technically cumbersome as some of the things we have to do as dentists.

Art Wiederman, CPA: So I'm not going to obviously ask you about your numbers in your practice because that's no, that's your business and nobody else's. But I'm just going to do some math off the top of my head here. So let's say I have a practice with a thousand active patients. Would you say it's reasonable that maybe twenty percent of them might need a sleep appliance, 15 percent? What would ballpark just for discussion?

Dr. Emily Stopper: Yeah, it's a ballpark. So statistically, it shows that 20 percent of our patients have some form of sleep apnea. Now, the statistics are going to go up if you count the ones who snore and don't have sleep apnea. So 20 percent is a very conservative. That would be good.

Art Wiederman, CPA: So two hundred patients. So let's say of those two hundred patients, maybe half of them need a dental appliance. Right. OK, so that's one hundred. So of those one hundred patients, let's say your average fee for a dental appliance would be what, four thousand, three thousand five. What do you see in your practice?

Dr. Emily Stopper: So average collections are going to be somewhere between twenty five hundred to three thousand.

Art Wiederman, CPA: OK, so that's three hundred thousand dollars folks. And then I want to talk to you about how do we market this, because it's because at some point you're going to go through all of your patients and you'll have no other patients or very few that need it. But they'll dribble in. And so how do you market your service? Because the good news is that, you know, if you say I do crown and bridgework, well, every dentist in your town in West Jefferson does crown and bridgework, but I do sleep appliances. I you know, I would assume that there's probably you can count on one hand in your county the number of dentists that have limited their practice like you have. So how do you market this to the community? This is another really interesting thing I want to learn about.

Dr. Emily Stopper: Oh, yeah. Yeah. And this is the fun part, too. I mean, there are there are tons of patients within the majority of dentists have a ton of patients in their practice. So getting started on your patient base that you already have, you have a tremendous amount of opportunity just within the walls of your practice. But when you do start thinking about more the marketing and bringing new patients in and one of the one of the biggest things that has grown in my sleep practice has been reaching out to other health care providers. It's not necessarily your sleep doctors. No, it's ear nose and throat doctors, eye doctors, chiropractors, physical therapists. Your holistic doctors, PA and nurse practitioners are typically really open minded to different alternatives to CPAP if they have patients who they see struggling with CPAP or who are unwilling to even try to CPAP.

That's been huge just to have the referral sources that have come from me introducing myself and letting them know that we have an option, because it's still interesting to me, even after doing this for several years, how many people are unaware that this was an option? Even medical providers not being aware that it's an option or thinking that somewhere along the line they've been told, oh, well, that's you know, that's not effective, which is not true. It can be very effective. And, you know, it's definitely a good alternative if someone can't wear it, doesn't want to wear the CPAP, mild or moderate sleep apnea. So really, it's just it's getting out there and introducing yourself, introducing the fact that you can help patients in a different way, even if you just targeted people who can't wear their CPAP. That's a huge number of people that they need that.

Art Wiederman, CPA: In your experience, Dr. Stopper, are we talking about the majority of your patients are under 40, over 40. What's the age distribution? I know. I know being overweight is an issue. I have been 15, 20 pounds overweight my entire adult life. I fight it every single day. And, you know, but there are people that are a lot heavier than that. And we don't want to get too deep into that subject. But those people are more prone to having sleep issues, as I understand it. But what's the age distribution?

Dr. Emily Stopper: Yeah, that's an interesting point, too, because there used to be more of a stereotypical it's going to be an older male, larger neck overweight kind of stereotype. But the and weight is a contributing factor for sure. But that doesn't rule out, you know, there's young fit females who also struggle with sleep and have sleep apnea. And they're not going to be the people that probably the doctor is going to say, oh, we should do a sleep test or you might have sleep apnea. They may be more likely to get prescribed a sleeping pill, something that's going to help them sleep, which could just sort of mask what's going on for them, really.

So they can be a factor. I would say primarily age range is going to be somewhere, maybe mid thirties, you know, definitely a fair number over sixty five. But yeah, it's, it can really run the gamut. I mean I had a thirty two year old patient in this week who she yawned every moment of our appointment and you know, it's, she had all the symptoms, I mean it was, she was a little bit overweight but you know, it was she wasn't obese by any means, but she yawned, she was tired. She grinds her teeth, you know, you just never know. It's always important to get those patient sleep tested if they have some symptoms that show that there's cause for concern.

I'm just careful about not just ruling anyone out just by appearance or, you know, that's why we're going to always look at those health histories and look in the mouth. And then also that patient interview like what is their sleep like? Are they suffering from acid reflux? And they're waking up at two o'clock in the morning and they want to hit the snooze button ten times before they roll out of bed. Those things.

Art Wiederman, CPA: Correct me if I'm wrong. The American Academy of Sleep Medicine or Dental, what is the organizations that you're involved in? And where are the best places for dentists to take courses, obviously, you know, if you call Dr. Stopper again, I'll give out her number again 828.406.3956. Give her a call. She'll point in the right direction. But if they want to get online, what organizations are you members of that that they can take, you know, beginning courses on to really get into the weeds on this?

Dr. Emily Stopper: Sure. Yeah. The American Academy of Sleep Medicine is fantastic. They're a wonderful organization. I highly recommend being a member of that. They have a mastery series for anyone who's interested in and going further down the road of you know, they have a certification called being a Diplomate, being a diplomat of the American Board of Dental Sleep Medicine. So to that, that's a great place to look as well.

You know, I do offer help for I have my own course where I'm really teaching dentists in online fashion and I have some in office courses, too. I just don't offer those as often. But if someone just wants to get started, learn, you know, learn why we're looking at sleep, learn how to start doing the sleep, you know, get the team on board. It's really about just just jumping in there and getting started. There's great courses all across the country. So I think there's great options all over.

Art Wiederman, CPA: Talk about billing medical insurance. Do you have a medical insurance? I know that you can contract with a medical insurance billing company and they take a percentage of the case. Some offices do it on their own. I mean, you're obviously in the advanced class. So what do you do in your office and what do you recommend?

Dr. Emily Stopper: Yeah, I still use a medical billing company. Yeah. And I know that differences in opinion on that too. I've I started out using a billing company and then, you know, we did had some hiccups with the first billing company. We switched to a different one. And it's made a world of difference on our reimbursements and how smoothly that's gone. So and they don't have to take a percentage either. They you know, the one I use offers a flat fee. So they do offer a little bit of a break if it's Medicare, because the reimbursement is typically not as good on Medicare.

So but the way I describe it, it's like having a it's like having another team member. They're just not in your office, but they're still supporting you. And, you know, they're going to look at those claims. And if something gets denied, they're going to appeal it. And, you know, they're working from there end to help you get paid for the work you've done and helping you along the way with the verifying benefits. And so it doesn't happen.

You know, like I said earlier, that's one of those things that can be a really big roadblock for a lot of offices because they're scared of the medical billing. It is different than dental. But, you know, I would just my advice would be don't let it be something scary that's going to prevent you from doing this. Worst case scenario. Someone could offer just a cash fee for this and skip the medical billing altogether if they wanted to. But I would say for most patients, it's a nice perk that they can go through their medical billing to get these services covered

Art Wiederman, CPA: And talk about involvement of the dental team. I mean, how many offices have you consulted with where you've helped them get started on sleep medicine?

Dr. Emily Stopper: Oh, wow. I guess we're approaching a hundred.

Art Wiederman, CPA: So you've dealt with all kinds of practices and staff. You know, do you see the dental teams being resistant? Oh, no this is just another thing. We don't have time to do what we're. Embracing it and saying, oh, my God, I've been we've been talking to this doctor for five years about doing this, thank God you're here. What do you see?

Dr. Emily Stopper: Yeah. It's a problem in some offices with teams being resistant. I will say the ones that I've been fortunate enough to work with have for the most part, they've really been on board and they've been excited. I even have teams reach out to me to say, hey, when you talk to our doctor, we want to add this to our practice. And so that's exciting for me that the team is already excited and wants to implement this and is encouraging their dentists to get it started in their practice.

So, you know, our teams, they see these things on a daily basis. And you think about the hygienist they're constantly looking in these airways and seeing the patients who they have a large tongue, for instance, and they're noticing they're fighting the tongue every time they're trying to clean teeth, they want to help their patient. So this is just another way the teams can have more involvement.

And I know from my team, they've told me, you know, tons of times is how much they enjoy getting to be a part of this. And it's really fulfilling to them too. For the most part, teams just need some direction. You know, I think it's just a matter of not just throwing something at them and saying, here, run with it, but giving them give them expectations about how we're going to implement this.

Art Wiederman, CPA: And folks. So you might have noticed the last 14, 15 months we've been in a pandemic and everything in life has changed. We're hopeful that it's now coming out. You know, as of as of this morning, the city of New York is basically reopening. California is opening June 15th. Most of the states are starting to open. And we've had the lowest number of cases of covid-19 since the beginning. The vaccine is taking shape. And so all the things are pointing in the right direction. And but it's been a challenge. My doctors are back, most of them close to where they were. Dr. Stopper and a lot of them are 80 or 90 percent. But what a great opportunity today.

And again, folks, I get nothing. I don't get anything. Dr. Stopper is not going to pay me any money for having her on this podcast. I have wanted to do this for a long time. I'm very passionate, obviously, from a personal standpoint, but also from a standpoint of what you can do to create your legacy in your practice. I'm repeating myself, folks. You've listened to me for two and a half years. I repeat myself, that's the way it goes. That's what you get with Art Wiederman.

But the fact of the matter is, is that this is an opportunity today to start taking a look at this. Yeah. Does it require some work? Yes. Does it require you to change some things in your practice? Yes. Does it require you to get some education and your team get some education and spend some money on this? Yes, but, you know, I mean, Dr. Stopper, a dentist could get going in doing this for, what, ten, fifteen, twenty thousand dollars maybe? I don't know. Yeah. And if your average case is three thousand, that's six or seven cases and you paid for your education. And but, you know, again, I mean, how many new patients do you get per month that come to you specifically because you're a sleep dentist?

Dr. Emily Stopper: Oh, I mean, we get double digit referrals from different, you know, like I said, nurse practitioners, sleep doctors, ENTs and really just a few referral sources. You don't have to have every single person in your community referring to you, but word of mouth gets out there. Spouses, like one person gets treated, the other one wants to get treated. You know, word travels fast. It does not take long to grow a practice. Whenever you really, you do have to put the time and the effort into it and be willing to make some changes, like you just mentioned, Art. But it doesn't take long for this to grow when someone's really focused on it.

Art Wiederman, CPA: And let me think about this, too. So if they come into your office and they're not a current patient of record and then you do some stuff, what percentage of those patients become patients of record for general dentistry in your practice?

Dr. Emily Stopper: Oh, that's been it's been a practice grower for sure. And that's not something that I really saw coming at first. That's been really cool to see. Now we do we don't encourage if they've got a dentist already, I am not encouraging them to leave their dentist. We're going to treat the sleep apnea. But if they don't already have a dentist, they ask, they say, hey, are you taking new patients? We'd like to become a patient at your office. And yeah, it's been a high percentage. If, like I said, I do encourage them to go back to their dentist if they already have one.

Art Wiederman, CPA: Of course, you're not looking at taking patients of your colleagues. But the great thing, folks, is that once you've done the sleep apnea procedure and you have just saved their lives or really improved the quality of lives, the level of confidence that that patient has in you, Dr. Stopper is at an all time high. So if you tell them we need to crown all 32 teeth, I know you don't do that on a regular basis, but we need to crown all 32 teeth. They might say yes.

But I mean. Right. So it's a great confidence builder. You're at the highest level of confidence and trust and caring with that patient. You know, if you look at their mouth and say, oh, by the way, you have the sleep apnea, but, you know, we got six teeth that are about ready to blow up here and they're probably going to listen to you, right?

Dr. Emily Stopper: Oh, yeah. It's a huge trust builder. I mean, like I said, even within a few weeks, patients can tell a huge difference in how they feel. And one patient comes to mind. He was diagnosed with sleep apnea years ago, but he couldn't wear a CPAP. It was just a constant problem, it was a battle for him. He said that at this point it was just in the closet and he hadn't used it in years. And he said every time that he would go, he would wake up in the morning after tossing and turning all night, even the fitted sheet would be off the bed.

So when he came back for his three week device check, he was sitting in the chair. I walked in the room and he just looked up at me. He said, You've changed my life. He said, I go to sleep. I lay down on my right side and I wake up on my right side. And then he just kept going on about he said he used to feel tired all the time and now he has energy. He doesn't need to take a nap. He doesn't feel like he needs to take a nap.

Art Wiederman, CPA: And that's how I felt.

Dr. Emily Stopper: Yeah. And he so he was just thrilled. I mean, this was actually just maybe a month ago that this happened, that he came in and he said he said the word needs to get out. The only, he said. My only regret is that I didn't know about this fifteen years ago. He said I would wish I had known about this because it could have made a huge difference in my life. And he said, I want to help you get the word out. He said, what can I do to help? And now he did a radio ad for us. So he's telling other people.

Art Wiederman, CPA: Nice. One more question. And I'd love to talk to you for days about this, because I am very personally passionate about this. I have heard and I'm not a dentist, I don't play one on TV, but I know enough to be dangerous, that with the sleep appliance there is the possibility of some TMJ or jaw issue. Talk a little bit about that, because I'm sure that some dentists who are concerned about that.

Dr. Emily Stopper: Sure, yeah. And yeah, that is something I hear occasionally that people are worried about that. So, I mean, just like with anything, there could there could be a risk of some TMJ complications. Usually it's not a problem and we try to overcome any of those more in a preventive way, like I mentioned earlier, making them an appliance that they can wake up and put in in the morning to get their jaw back into its normal position. But, you know, typically it's nothing that would prevent them from wearing the appliance. We just have to be we have to watch them closely for the first six weeks or so just to see how the patient's doing. Part of that is just in our original exam and checking the muscles, palpating the muscles, checking the joints, see what the baseline for the patient is.

And if they're at a higher risk for maybe some joint issues, if at least if we're more aware of that ahead of time, then we can be a little bit more careful, not as aggressive on adjusting their appliance. So usually it's not a big issue and there's some things that we can. Tips that we have up our sleeve that we can we can work with the patient on that, but it's rare that that keeps someone from being a good candidate.

Art Wiederman, CPA: Dr. Emily Stopper, you're golden. That was wonderful information. It's just great. And we want to help patients. That's what most dentists, most all dentists that I've talked to in 36 years say I want to help my patients. I want them to be happy, healthy. And, you know, and this is a way that you treat their total health, save their lives. And this is your legacy when you're done with your dental career, is going to be that you've helped directly hundreds, maybe thousands of people in your practice, but tens of thousands of people in other practices that you've saved indirectly their lives.

So one more time, please give out the website, your email and your phone number. If anybody has any questions, there's a lot I'm on the website right now. On my other screen is a lot of really good, good stuff on there. Some complimentary videos, I believe, that they can download. So give out the phone number, website and your email address if you want to contact her.

Dr. Emily Stopper: Yeah the phone number is 828.406.3596. www.TheHappyDentist.com. And I mentioned if you want to get on, I do have a book coming out hopefully in the next couple of months if you want to get on the waiting list for that, too. It's just www.TheHappyDentist.com/book.

Art Wiederman, CPA: What's the name of the book?

Dr. Emily Stopper: So it's still to be determined. I haven't quite finished the final parts of that yet, but that's been that's been a fun journey to just getting to put all this down on paper.

Art Wiederman, CPA: I wrote a book 20 years ago called The Art of Finance, and it was a lot of fun and you'll get a lot of traction out of that and stuff. Dr. Stopper, hang on with me as I take us out of the podcast. Thank you so, so much for your great expertise. And folks, give her a call if it's something that you just say not interested. OK, you got the information if it's something that you're interested in. Dr. Stopper has been very, very kind and giving with her time today and information to me. So, OK, so if you guys want to get a hold of me, I am at 657.279.3243. My email is awiederman@EideBailly.com. Send me an email. Give me a call.

We are always taking new clients again. We work with over eight hundred dentists in our office in Tustin about three hundred and go to our website for our partner Decisions in Dentistry www.DecisionsinDentistry.com.

If you want a complimentary consultation with an ADCPA member, put your name in will get you connected with those guys. If it's in Southern California, it would be me. And if you're looking for a dental CPA anywhere across the United States, it's www.ADCPA.org.

So again, I hope this information was helpful. I hope it is a call of action to you. And you've now got some tools and opportunity to talk to somebody who's a national expert on sleep dentistry in your dental practice. So with that said, everyone, I hope everybody is getting ready to get back to life. I'm excited about it. You know, we go back to the same five word phrase I've been using for a year and a half now. Failure is not an option. So, you know, work on your practice, not just in your practice.

We've got lots of great, great topics coming up. In the future, we're going to be talking more about this Employee Retention Tax Credit. Again, if you have a greater than 50 percent reduction in your revenues in the second quarter of 2020, there's an opportunity for you to get tens of thousand dollars of free money and full forgiveness of your loan. We can help you with that. Give me a call. With that said, folks, thank you for the honor and privilege of your time. Please tell all your friends about our podcast. It's exploding. We get emails all the time. And with that, my name is Art Wiederman and my podcast is The Art of Dental Finance and Management with Art Wiederman, CPA. Thank you for listening and we'll see you next time.