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1366 Dr. Keith Dressler on the Future of Telehealth Technology : Dentistry Uncensored with Howard Farran

1366 Dr. Keith Dressler on the Future of Telehealth Technology : Dentistry Uncensored with Howard Farran

3/2/2020 3:00:00 AM   |   Comments: 0   |   Views: 101
Dr. Dressler has 35 years' experience in private orthodontic practice and currently serves on the advisory board of the American Teledentistry Association. He is also an avid entrepreneur. In 2000, Dr. Dressler co-founded OrthoBanc, a cloud-based automated accounts receivable platform that is currently serving over 4,000 healthcare providers, managing more than $650 million annually. In 1998, Dr. Dressler co-founded Elite Physician Services, a national healthcare patient finance company. And today, Dr. Dressler is Chairman and CEO of Rhinogram, a leader in cloud-based, HIPAA-compliant telehealth communications.

VIDEO - DUwHF #1366 - Keith Dressler

AUDIO - DUwHF #1366 - Keith Dressler

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Howard: it is just a huge honor for me today to be podcast interviewing Dr. Keith Dressler DDS MSD who has over 35 years experience at a private practice orthodontic practice and currently serves on the advisory board of the American Telemedicine Association he is also an avid entrepreneur in 2000 dr. Dressler co-founded ortho bank a cloud-based automated accounts receivable platform that is currently serving over 4,000 healthcare providers managing more than 650 million dollars annually in 1998 dr. Dressler co-founded elite physician services a national healthcare patient finance company as CEO and chairman Dr. Dressler grew the business to 200 million in cells before it became the city health card in 2003 and today Dr. Dressler is chairman and CEO of Rhino Graham a leader in cloud-based HIPAA compliant telecommunication software my gosh what is it about Tennessee you're in Chattanooga home and John McSpadden probably one of the greatest entrepreneurs and ortho and endodontics you ever get to see John

Dr. Keith Dressler:  I do I run into him occasionally he's retired but I see him at restaurants around town and again a wonderful gentleman a true great fellow and as you mentioned an entrepreneur as well

Howard: and then you're in Tennessee where that's home of Smiles direct Club in Nashville talk about tell identity if you're an organized if that's not the biggest game-changer in orthodontics what would it be 

Dr. Keith Dressler: yeah I don't know they definitely have are challenging a new delivery system but it that way there and and it's a you know it's a huge disrupter I think we we can talk about if their delivery system or how they're delivering it is the absolute best for the patient or not is is another story but for sure they they've done a great job of advertising and and making it public aware I think again from a a true delivery model with the patient's best interests at heart I think they they're going to need to tweak it a little bit yes me as a as a practitioner but Rhonda Graham actually was was was really derived from issues I was having in my own practice and that was back in 2013 patients began to text more than call my practice with my staff that they had their cell numbers and that was a big problem because they're texting any of them who they had their numbers then you changed my appointment hey I'm at the family dental office they won't know about wisdom teeth they would snap you know the patient would snap a picture and text it to one of my staff the staffs responding and I'm not even seeing the communication directly at that time Facebook came out with business page and messenger and patients were beginning to message me like crazy so really I began to understand there's a huge communication change patients want to communicate text and social media messaging and yet there was no platform that allowed that to occur or no medium that allowed that to third fence Ronnie Graham was born and it began to solve these  problems as well as my staff were texting me personal cell phone to personal cell phone about patient care you know if I'm at a continuing ed meeting or if I was at on vacation emergency would come up I would get texted in there sharing you know personal health information on their phone my phone and again I the practitioner and legally responsible for all that communication and it was presiding everywhere and again Ronna grams platform brought all the communication into one place it legally protects the provider and all the information is permanent and non-edible and you can go back reference it use it for compliance use it in audits all kinds of great things

Howard: where does the name come from RINO gram RINO I know hair at rhinos that nose his hair is kind of like dentin as I write oh 

Dr. Keith Dressler: well at the end of the day what we were thinking since we were bringing all communications into one place we were thinking Omni Graham and you know with Graham obviously being the message that's that like a telegram well we looked up the URLs on on Omni Graham he couldn't find it so we could use that name so we went out did a did a search with something brand Rhino Graham came up to be the one that we could buy all the URLs and then we turned around and took it through our logo design artist and he began to do research and found out that in nature the rhinoceros and the bird just so happens our symbiotic the third sort of warrants the rhinoceros of danger it flies I had a vent and it cleans the back of the rhinoceros as well so if you think about our big platform where everything resides as the rhinoceros and the bird which is the messages and messengers which sports Twitter came up with the bird and the messaging the the logo worked incredibly well for for what we're doing

Howard: Oh what year did you get out at worth of school 1985 85

Dr. Keith Dressler:  I was 87

Howard: man we didn't have any of this stuff when we got out of school there 

Dr. Keith Dressler: there was no I didn't have a laptop a cell phone I thought the hot new thing was the automatic garage door opener and and now did you ever see this gonna happen when you got out of school no absolutely not you know obviously as all practitioners are you're trying to learn the business of Dentistry or the business of orthodontics and you don't you know you're not focused and you're focused on care and you're focused on learning business and hiring people and all of the things you weren't taught and and the last thing on your mind was was really advancements in technology here other than your dental technology that you were wanting to look at but but in terms of communication and in the internet and all of this I would you know I couldn't have imagined and succinctly

Howard: I mean it has so many features but I mean you got patient communication Richard smart message routing analytics dashboard two-way patient messaging EHR PMS integration HIPAA risk management photo document sharing facebook Messenger integration custom message templates but what's the 80/20 rule why are 80% of the dentists buying this what what feature is is the the deal they have to have well

Dr. Keith Dressler:  I would absolutely say it's the you know we provide a HIPAA compliant text able number and that vegetable number usually it's going to correspond to the voice number that you currently already have and the reason that that is a critical piece of the equation is the largest percent of consumers today are 23 to 30 nine years old it makes up 80 million people in that age range they grew up texting they did not grow up voice calling they want to do everything through text and what they can do online and what Brian a grand platform gives the practice is the ability to meet the patient's where they want to communicate they want to communicate with text and as you mentioned we have Facebook messenger integration so if they want a Facebook message you then you sort of must have this it is the new form of communication it is the modernization if you will of the telephone but it's not the telephone so to me I liken it to imagine a practice when there was teletype and now the new telephone came into being and you had to advertise your number etc etc this is the same thing the communication has the most modern form of communication is now texting social media messaging that's  the number one way people communicate eighty-four percent of the United States population prefers text and social media messaging to voice so day it just forced patients to have voice here behind the times in terms of how they want to communicate with you and how you can communicate with them so I would say that's first and foremost number one secondly this group of Millennials Genz that you know if you will  or their who have grown up only you know not voice calling but doing everything online well your practice better be able to handle and acquire patients this way as well so I would tell you that that virtual consult spur for questioning birth will follow-up to existing patients all are done with this platform so we also have a website widget they get can be embedded in your website so if patients are on your website they want to communicate with you or if it's a new patient on your website wanting to communicate with you they can simply from your website click on that and begin if you will texting with your practice you're giving patients exactly what they want and those 80 million folks if you're not the one giving it to them they're gonna go to someone who is the vast majority of our clients will tell you and by the way we have probably over close to 500 locations using Rhonda Graham today and it's not just in dentistry we have pediatric physicians we have OB gins we've got whatever and every one of them would tell you please don't tell anybody else in my area that we got this because it's such a competitive advantage for them they're gaining so many people online that we didn't even know existed if you will and and/or who want the convenience of communicating in the way that modern communication occurs today so if you're the one out there communicating this way and you're the one going to get these new  wave of patients that are coming in so that's the number one reason they would want us

Howard; now you um gosh we beat that one up really good I want to switch another one when I was getting in my MBA the the book that blew my mind the most was called the profit zone and it took all 16 major sectors of the economy and said let's not do sales like they see cars like Chrysler GM Honda they have all the sales but they just added up the net profit dollars and actually the people financing the cars made the most profit dollars next for the ones insuring the cars and indeed the people making parts for the cars made more money than the actual guys the companies that made the car so insurance banking and financing is where all the money's made the city of Manhattan pays more taxes than all of the rest of the boroughs in the state of New York so my question is I'm you did a finance play with ortho bank talk about that journey do you you you probably know more about the business of financing dentistry more than anybody I could think of 

Dr. Keith Dressler: yeah well again ortho Bank is a you know it it's an automated accounts receivable and again it came out of my practice the number one thing again back in it was created it start it was programmed or beginning to be programmed in my practice in 1999 and it came out of the fact that orthodontists were basically you know financing at zero interest the the treatment you know you somebody to have a down payment monthly payments exactly like cars at the time in home mortgages at that time but what I began to understand is the one of my bank the reason it was formed is my bank said to me hey there's this new thing called drafting this was back maybe late 98 early 99 we would like for you to to be one of our test customers would you be willing to test drafting out and what and they told me what it was and I said yes and I did it and I liked it I said I should have all my patients doing this so I began to investigate how do I create a drafting type of company and the Internet high-speed internet was just coming into being and I thought this would be cool I could create an online company which is what we did and that we could draft all of these payments have the patient side of form in the practice much like you do when you sign a a loan for a house or a car and just in that form and have them say it's okay to draft your checking savings or credit card type of account over a certain timeframe and we built a program back in 2000 and launched the company then everybody told me I was crazy that nobody is going to draft because why would they you know and the next thing you know it became the next thing that's the same way I see Rhyno grams the same thing in communication everybody goes why why why would I want to text well forget yourself you the practitioner actually texting is more efficient more effective and more profitable for you number one but patients want to do it anything that you can do to convenience the patient and your practice it's a it's a it's a no-brainer to me and and that's basically what was happening with ortho Bank that's what's happening here with Rhyno Graham 

Howard: so I noticed you know insurance and banking and financing I into it which owns QuickBooks Pro announce today that it wants to acquire Credit Karma for 7 billion with everything you know about ortho blank and Credit Karma trying to I'm all that what do you think of QuickBooks Pro and Intuit are they going to become the orthodontist small business accounting and finance partner they

Dr. Keith Dressler:  they certainly could I mean they  absolutely certainly could again the that type of program I use QuickBooks Pro or QuickBooks business in my practice and the hard part for them is is integrating into all the various practice management systems and I think you know for me it's it's separately outside those systems I would love for it to be inside them but it you know the dental world is not and even the medical world as a matter of fact do all of these systems are so different with such different technologies it's  not a standardized process and each practice where they label things and put things within a practice management system is different also that it makes having an integration very  difficult to occur and I don't think somebody like a quicken or QuickBooks or whatever is going to spend the time every energy money for this small of a deal for them you know they're not going to consider this a very large market for the expense of integration that they would have to go through it would have to be it's like a one to one to one basis practice to practice for practical practice 

Howard: so do you think so what software are you running your orthodontist on or tonight practice because I've noticed in General Dentistry that all the closed systems like dendrix and Eagle soft they're spending a ton of money advertising to sell more customers and the only one not advertising is the open platform open dental who is not advertising and is growing too fast for their own comfort so do you think with all these integration issues that you just described does it do you think are you familiar as open dental and is there an open platform in ortho

Dr. Keith Dressler:   yeah the open dental is is fantastic and you know I think that it's great and they potentially could integrate but again it's going to be how and where you put things is the bigger key and how you want it written back into the platform because it could be different one dentist to the next of the next unless you force the dentist to use just right here right now but I would think they would be a you know somebody like a QuickBooks would fit them better some of the others I used tops in my practice which is my practice management system do you have your oh you oh no no no tops is a an orthodontic specific practice management system and that's the one I use there's probably fourteen sixteen hundred orthodontists that use tops there's we there's about four to five major ones in the orthodontic world that are used tops is one of them but again I think it integration into the non open platforms is it's the tougher part pops would be one of those companies that would be difficult because it's a again it's not a cloud-based program it's not necessarily open code either and the reason lots of companies do not want you riding back information into their platform is if that data is corrupt or there's a virus in it if you crash the whole system so having open platforms is good on one side and potentially bad on another depending on who you're integrating with and how ethical and clean and precision the data is that's being put into your platform

Howrad: so I'm I want to go back to UM you know the smiles the smiles direct Club it's kind of interesting because when I got out of school in 87 a big screen TV didn't exist then when it did come out it was five thousand but it was like a meter wide and a meter deep and now it's five hundred bucks you can hang it on the wall so everything's supposed to get faster better easier smaller cheaper all that kind of like that so they're a major disrupter did is it does it challenge your business model did you do you see any parts of that where you say well this is a good idea here

Dr. Keith Dressler:  yeah well to your point you know I have created you know what I would call for the non huge corporate world a business model that actually can compete head-to-head with that model and I do it in my own breakfast I've been doing orthodontic Sam from the patient home for the last three and a half four years you can go to my website and it'll say hey we do a complimentary smile assessment with a quote from the comfort of your home and when you click on that we ask the patient to take three selfies of their teeth and in probably 98% of them that send them in we're able to give them what they need and then they'll take a selfie of the front and back of their insurance parts in that we'll be able to look up what the insurance is going to pay I'm going to be able to tell hey is this an orthodontic retreat of one or two teeth that maybe the smile directs of the world are feasting on right now and if so I can price myself in the ballgame I can create the same convenience level of not as many in office visits I can do virtual follow-up as well and all of that can be done by a board certified practitioner or an orthodontist or for those family dentist who are into treating with Invisalign they can go out there and do the same thing and the patient then gets a local practitioner that if anything is needed or goes wrong they can go actually see versus a virtual doc that they may not be able to see so I think from a clinical efficacy standpoint in and being able to handle issues and problems saying knowing what you're getting into before and is incredibly important the thing about having to having to have an x-ray is important as well before you actually begin treatment I know and what we do is we will do the exam for  arrangements we'll send them a link to our health history all of that's done before they walk into my office into in my particular practice today and when they come in I do the real exam before starting treatment will do the x-ray we'll take a scan of their teeth and I'll go in and we'll take photos and and we'll talk with the mom and child or if it's an adult the adult patient because what I found on x-ray can it needs to be discussed before we start anything and some of the things that I've found just to let you know would be supernumerary teeth so you go in there and you see in an adult and or or even a child with all the permanent dentition in and all of a sudden on x-ray you've got all these supernumerary teeth well we tell the mom hey we can put the braces on today as planned we can't put a wire in we're gonna need you to see the oral surgeon and get these extra teeth out before we begin movement of any type I've seen for shorten roots that is orthodontic retreat's that need to be discussed the ramifications of what can occur if we go through with treatment today I've seen lesions of various types that needed to be discussed and shared that hey this was here before treatment it's not something that treatment caused so there's there's lots of reasons that we need to physically see the patient and in my opinion from the what I will call direct-to-consumer big corporate model that's the piece that's missing that they don't deliver and and that to me is putting patients at risk if you were to ask me personally because I'm doing virtual care but I'm doing it also in a different delivery model but under the most efficacy to the patient themselves you're you're giving you're making sure you do no harm or that you at least warn the patient about potential harms that can be done and not with just a blanket statement of everything that can go wrong you're they're pointing out the things that that are compromised or things that need to be need to be done

Howard: I would really like to know what people think of like like look at HIPAA they they pass a law they don't want you sharing information it came from a senator in Kansas where I grew up and it's like look if it came about during the AIDS crisis well what are you you know it's a criminal deal if I'm a doctor and you have AIDS and I tell my buddy or post on Facebook you should be able to sue me arrest me whatever but they passed this HIPAA thing like OSHA and now everybody's has to think with their brakes on pay three four hundred dollars a month for all these things and and this is all the things that just make health care so much more expensive that you can't even move and then when it gets so expensive they can't move they run back to the people who made it expensive the government to try to get help from like Bernie Sanders all right well it's so expensive well yeah they pass laws for 50 years they made it so unaffordable and now the same now the sheep are going back to the guys who ruined it to try to fix it I I find it just so bizarre how that happens what would you say to a new orthodontist that just came out of school and he's like and and he's looking at guys like you and me thinking come on Keith you graduated in the golden years the glory days and you graduated before Invisalign and smiles Direct Club and all this stuff what would say to a young orthodontist who just walked out of school and wanted to open up in Chattanooga would you tell him he should have sold commodities in Chicago 

Dr. Keith Dressler: no I'm going to tell them just the opposite the B golden age of orthodontists or in orthodontics is ahead of us it's not behind us we know that what's changed is the acquisition of patience and how that is done that's the only thing that's changed and there's now more possibility for you than less if you're thinking traditionally then you're going to think oh my god yeah better if so commodities but if you're thinking ahead you're gonna acquire these folks online you're going to begin to do lots more digital marketing because your traditional report referral sources which would be the family practitioners for the most part and or other ways all of those are not the way that you're acquiring patients today and especially in orthodontics where you've got the 23 to 30 nine-year-old population that wants to be acquired online anyway so the better the marketing if I was to talk to a new guy I would say you need you need need to tell health platform that allows you to acquire folks online and to be able to do what tella dentistry tell orthodontics and you're going to need a great marketing company that's going to put you out there that you are the one that is noticed you are the one that's providing the most convenient access and acquisition access than anybody else and you're going to make it as affordable as anybody else the the market that you open up is far greater than the referral market that you would have had if it were done by three additional referral sources 

Howard: so um it seems to me that um I don't know anybody in my lifetime if you know him long enough no one has one tattoo you know they show you their first tattoo five years later it's number two but my time they're our age they've got half a dozen same thing with ortho I I don't know anybody who's our age red ortho one time they got it when they were a kid and then after their divorce they got uh touched up again with some Invisalign and Botox or whatever and now they're now they're 68 years old in fact I just had dinner of my aunt sue the other night so tell HIPPA this it's not it's a it's broadcasting and it's not a claim and she wants dr. Harry green to touch up her ortho again how many times does the average American who does get braces how many times do they actually get braces if they live all the way to the end it's gotta be greater than one and less than two I assume or is it is it one two three what is it

Dr. Keith Dressler:  that's t a wonderful question but I would think that because of the society we live in it's pretty vain and  there's no such thing as orthodontic stability on its own without some sort of lifetime retention so you know I would think I would think it's in the it has to be greater than 1.5 I would think you know that people and it's not braces I would I would call in maybe it's just semantics of terms I think when the term braces is used is I think of metal brackets and or ceramic brackets and I used to term clear aligner treatment or you know as the other form of treatment then you've got functional appliance treatments so for sure you're going to have potentially in a lifetime more than  one and I would think you know again it goes back to educating the  public and I think the education to today's patients are far greater than they one let's then they were let's say when I had braces because you have my generation who basically backs up the claim that hey if you don't wear your retainers to some small degree for life your teeth are going to move because these are all the people that didn't wear their retainers and their teeth moved and they're doing it again the next generation I don't know if it's going to be you know if the number is going to stay the same or or get worse or get better based upon the knowledge level of all the folks that had it and you know really we're the first generation I'm the first generation that has a full complement of teeth into their 60s and 70s back in my grandparents days all up they were all in dentures so they didn't even have to think about this and aesthetic beauty wasn't a thing as much as it was with the baby boomers and what we grew up with about having being healthier and better looking and all the things that go on in our generation 

Howard: so it is since then if you say the average person who gets braces gonna have braces 1.5 times we both know when I got out of high school in 1980 those big Catholic families in Kansas you know seven eight kids only the most horrific bite got treatment now that families are down to two it's kind of like a rite of passage everybody gets their Bar Mitzvah embraces before they get out of high school do you think having a lower pricepoint like smiles direct club will actually lift the market because if a bunch of people get in there real cheap and it does it's never gonna work out perfectly it doesn't even work out perfectly when you're sitting there I mean I can't tell you how many times I've set there and looked at it anterior veneer or crown and someone's telling me you know that wow they don't like it or whatever when they come back for seconds and thirds and forces that it's gonna lift at work that on it mark it up in the future 

Dr. Keith Dressler: yeah well I think well that as well as there's for sure downward pressure on pricing but I do think again what as opposed to for you know the way the pricing model traditionally worked in orthodontics where it didn't matter if it was an easier case or a Artic harder case it was all charged out at about the same price and it was to make things easier for orthodontists I think what's going to change is the fact that orthodontist and people who do orthodontist orthodontics I don't want to just say orthodontist because there's thirty thousand family dentists that do orthodontics as well and then there's pediatric dentists they do orthodontics and so for those practicing tooth movement they're going to have to come up with multi-tiered and understanding what's hard what's easy and those cases that'll be six months or less need to be done at a much lower price point than those cases that are going to take two years or longer and the evolution in my mind that will occur is there's going to be various price points along the way I know in my own practice again I'm just I'm not advocating doing it my way or anything but I have really a six months or less price I've got a seven month to twelve month price I've got a 18 to thirteen months and then I've got a 18 to 24 and then above 24 months I've got all those tiers of pricing in my practice based upon how long how much it's going to cost me and it's gotten a little more convoluted in some sense from the ease of quoting one price or maybe even two to where you have to be more accurate in what you're doing and at the same time I know in my practice my goal is to be as efficient as possible an efficiency in my definition of efficiency is is having to see the patients as few times as possible while delivering the same high-quality care meaning that's how we can drive our overhead down because the less times they're in the less expense structure you have and it's convenience is being provided to the patient because they have to get off work or get out of school fewer times and it's a again a win-win for both sides of the equation

Howard: you've lived through a lot of innovations in your lifetime when you and I were getting out of school the top dog orthodontist was Gasper lazara orthodontic Centers of America he was the only one who made it to the New York Stock Exchange with a billion dollar valuation are you friends with Gasper what do you think if he thinks at the modern eye smiles drug Club and Invisalign from the days of OCA 

Dr. Keith Dressler:  I've never met him I've admired him from afar in that again he's an outside the box thinker I'm an outside the box thinker a type of a person I think he was you know obviously the first and well ahead of head of his time in what he did again it probably led to lots of the thoughts around the DSOs being formed today again and again the the the thing that I view out of it and the hardest part of his formula and he might agree with this even today is being able to maintain once you've created this large group of practices across the country that are branded you know that they're all owned by one company the harder part is maintaining the doctors within that practice because doctors retire now you've got to replace with a doctor and you've got to be on top of all of that because somebody could just pass away what are you going to do who's going to treat the patient in that location if a dark past is away who do you have available that you can plug in that's a I would think still a hard piece of the equation even today and that is why he created I think back in that that era the ability to go to one of the universities orthodontic programs at one of the universities in Florida and part of going there of this orthodontic program that was created was to give X amount of time to some of the facilities that that he had and I thought that was pretty ingenious way of filling those voids but again it's it's tough because all practitioners you know they've got their their own thing in mind some may like corporate being you know corporately owned and just go in and some get into it because they want to run their own thing and work as hard or as not as hard as they want so you know III again I like outside the box thinkers again I like the thought process of smile direct club I don't have anything against them I do think how they have chosen to deliver need some tweaking that's all I mean again you get out there you I think they've gone a little bit overboard on on the ability to keep the patient as safe as possible there and they put it a lot of that burden on the patient but the patient you know they're not the experts they can't tell they can't go take an x-ray of themselves even though they may have signed something that said yes I've been to see the family dentist and the family dentist has approved me for treatment when in reality they haven't seen the family dentist and it's easy to put the blame back on the patient but their in in reality patients aren't going patients lie and there's a you've got to have the patient in the hands of a practitioner is my belief you don't have to you know for a minimal number of visits but that needs to be the more of the model rather than them being able to sign their life away and and actually potentially on some of the health away.

Howard: you and the CEO of smiles rare clubs in Nashville and you're a new guy have you ran into David Katzman

Dr. Keith Dressler:  I have not I early on and when I was just beginning Rhonda Graham I've reached out to him and in them but they've never they've never came reached back I've never had one single conversation I don't know them Chattanooga even though Nashville's close is still you know it's not in my hometown so I again I've never met him there or has he ever returned a call or anything for me so so it is what it is I guess  

Howard: so this tell a dentistry thing you know the orthodontists think tella dentistry they think smiles direct Club you are thinking my own patient and necessities a mother invention you're you're sitting there saying hey you're texting us let's make Reina Graham let's do an orthodontic console I've been doing tell a dentistry for years with my pharmacist you know the specialist come by and give us cookies I would always go out and give the pharmacist cookies and when they when Steve Jobs came out with a smartphone in 2007 I was like they always tell me that people several times they will come out to him and say man have you got a toothache do you recommend or gel or buffering or excedrin and they just pull out their phone and they FaceTime me and I'm sitting there right there or looking at him and I'm like oh man and they pull it back and you can tell them you see their age you see it's a bombed-out you can tell them this is gonna need a root canal and a crown or an extraction come across the street all so it's just an amazing thing the only reason it's so expensive and complicated is because our friendly government passed HIPAA and OSHA and 18,000 laws and that's that's the only reason that there's no free enterprise but this tella dentistry there's now a tell a dentist reassociation and you're part of that Dr. Mark Ackerman DMD MBA who've had on the show is the executive director of the American colonists reassociation seems like tele dentistry seems like dentists are either really into it and love it and are excited about the future or they just want to smack it down what what do you think about the American tell identity dot-org 

Dr. Keith Dressler: well again I think if you're going to advance anything you  have to have an organization meaning when implants came first came out you know well there wasn't an implant organization that everybody can and gather around advance the you know the placement of them the technology behind them and I think dr. Ackerman what he has done is he has formed the organization and all forms of fellow dentistry are involved there I think there's a misconception that it's all smile direct well all you had to do is attend the first meeting and know that it's not all smile direct because smile direct God hammered they had a panel discussion of which I was on and there was an attorney and they were smile direct representative on and  you that representative got very  flustered because of the few hundred attendees that were there they were pounding him with questions to the point that he just got frustrated and said he no longer is going to answer questions so if they think it's all about smile direct then they need to go to the meeting and understand that there are lots of great things occurring in tell a dentistry  and it and it's about way more than orthodontics for sure it's about rural area folks receiving advice and care from licensed practitioners that may be located in a metropolitan area with a huge practice in giving those folks the access that's what the whole dentistry is about as well and it's the things like you talked about and what did be cool if a patient and and this is what we're this is what the folks that are advertising see and what I see I'm talking about family dentist orthodontist anybody it's pay the patient can snap a picture of the thing touched it directly to your office and asked you a question and that could be a patient of record or it could be a brand new patient that you acquire by being able to answer their question in the way that they want you to do it if you force them to take off from work and come in to get their question answered well you gonna lose to the guy who's not going to make him do that you know to the practice who's not gonna make them do that so 

Howard: so do you um so what percent of your practice is clear aligner versus hardwire

Dr. Keith Dressler:  I would say it's probably 60/40 60% braces 40% aligners and it's continually aligner treatment is it's going up in percentage

Howard: so all the patents are pretty much off these aligners and it seems like I mean I think I've tracked 40 companies around the world that are now in the clear aligner business do you agree with that number or there abouts ya know and growing every day so every single day so to a young orthodontist a young kid in school he's once she wants to be an orthodontist are you agnostic to clear aligner or some companies just significantly better

Dr. Keith Dressler:  I'm gonna say and I heard this saying this weekend because I went to a course I'm gonna say that if you're just beginning you're gonna want to stay with one of the big three but but once you learn or you know how to deal with the liners then you may I know there's some white label companies that are that are out there that are good that are being pushed but as the initial practitioner it's gonna cost you a little more but the big three would be big blue which I would call Invisalign big red which I would call 3m Unitec is big red they have a very good aligner system and what's their liner system called shoot I don't know don't ask me that is a cool name three M's clear aligner okay Benny way the so you're calling big blue Invisalign big red and then just recently I will call smile direct big purple because smile direct has said there you're now going to allow practitioners to do what Invisalign does you know mean they can you can use their their things and send cases to them and they will generate send it back in a box to you the practitioner just much like all the others do so Cloud 3m is clout clarity Claire yeah that's right clarity aligner so that's right so the these are what's the name of this list a big blue big red and big purple this debate the big what do you call I would say they're the big three you know those are the big three in aligners they will generate very good aligners because they they understand obviously Invisalign understands the best smile direct probably the next best in numbers of patients that were treated and Unitec 3m Unitec has understood Orthodox forever because they were a big bracket system as well they they make brackets they understand tooth movement so they understand a liner movement as well and they've got some pretty big orthodontists that were one first centers of Invisalign that they hire to work with them in creating their product eat a couple years ago so they've done a great job and and I personally used them I use big red and

Howard: you said is big is three M's Unitec which were whose unit 

Dr. Keith Dressler:  was one of the largest if not the largest orthodontic bracket in supply company as a prize an orthodontic industry supplier it was then bought years ago by 3m and they have a an orthodontic division which is the three immunitech division so the you so the three immune attack is four brackets and the 3m 

Dr. Keith Dressler: clarity is for clear liners yeah well clarity is just the brand name under under three immunitech it would be like you know I'm selling let's just say Coke and Pepsi in there they're two brand names so I'm so selling clarity is just the name of either a Coke or a Pepsi but it's under the the big company 3m is who the parent company is who owns the the rights to that name I guess

Howard: so um so the big three clear liners are big blue Invisalign big red 3m units at clarity aligner and big purple smiles direct Club right and which one and which one are you using

Dr. Keith Dressler:  I'm using big red and again no in particular reason other than I was I'm a Unitec bracket guy and when the my rep came in to see me and told me about it I guess I get a discount you know the more stuff you buy from a company the greater the discount so I get actually a discount off the cost of my aligners through  big red and they include all the supplies that I bought not just the aligners and if you

Howard: um if you were general Dennis always want to know this this is true when you go to dental schools the endodontists help you learn molar endo the oral surgeons help you pull a wisdom tooth but it seems to be every all the specialists are like that but is a lot of general dentists they feel weird if they start doing clear aligners like  they'd be afraid to run into you at the study club they're saying oh my god what's maybe he knows I took an Invisalign class do you is that real or is that imaginary Keith

Dr. Keith Dressler:  well I depend on the person I think if you're talking about me in specifically because I view the world differently I mean through a different lens than maybe others I would for me it's it's not it's not a thing I would hope that the family dentist would want me to engage with them because I think what I could do is maybe keep them or educate them as to what cases not to get themselves involved in it's going to be too complex and again to me tooth movement pressure systems moments of force etc is what we're taught in in ortho school I don't feel that family dentists have a as thorough an understanding of that and they don't necessarily have to with easy cases but with more difficult cases it is important in how you set the case up if it's going well or not going well and how to change those Andry prescribed different different things that would create the necessary movements you need to achieve your end results and so my hope would be the core third on us would want to help be the family dentist unfortunately there are orthodontist who are out there and that you know aren't willing and feel that it's why are you competing with me and that sort of thing I don't again my mindset isn't that way so again I would say it can be real or it can be imaginary based upon the orthodontist and their personality and the prism that they look through to to the you know to the world you know there are some more than us to say nobody should be doing orthodontics but  orthodontists and they they feel that way in her passionate that way and then there's orthodontists like me that say hey you know if I'm not here to say who can do it and who can't I'm here to help and if you want to do something I'm I'm here to help you and I'm here to do the best that I can do and and if you get yourself in trouble I want to be here to pull you out you know 

Howard: gosh I could go on and on and on but I got a uh I know you're a busy man is there anything you thought we were going to talk about that I didn't mention 

Dr. Keith Dressler: no other than what I was going to tell you that Ronnie Graham solves really all of and it solves all of your compliance issues problems and such and it's not just HIPAA that you worry about texting has lots of laws there FTC laws there FCC laws there's TCPA laws oh you will you say that slower for all the Bernie supporters there so they still can't figure out why the cost of health care went up so say say say those points lower there there's TCPA laws but and there's you know FTC but let me tell you about TCPA because it is and it is a great law and it was put in for a reason and I don't think you you know again this is not one should not have been put in it should have been when you when you were dealing with email to people who had email is free so to speak other than the internet access that you're paying for it's relatively free and so when you would receive junk emails it's not coming at a truet to you other than what you're already paying for internet access cell phone usage is very different even though I and lots of the world are lots of the u.s. is on unlimited usage there is still a portion of the population the lower socioeconomic in specifically that that purchases data there no business is allowed to randomly without consent checks anything or run up anybody's bill without their consent the only thing that HIPPA did with TCPA and hip and TCPA are tied in this way is the HIPAA law said they exempt the appointment reminder from having to have the original consent so and that's because appointment reminders were already being texted before the texting telecommunication law came into being and so they exempted the appointment reminder now with that said the person receiving the appointment reminder the patient has to have the ability to say stop and not receive another one so that's the only thing in healthcare that except was the appointment reminder and it is good that you as a practitioner or anybody any business can't sit there once you have someone's cell number and send them all kinds of materials to that cell number run out their minutes without their permission and so everything that you do when it comes to texting it does evil involve consent management and we at Rhyno gram have built-in consent management to our platform which again I can tell you that the vast majority of the ones that I know of have no consent management and therefore would if there was not consent gained would then put that onus on the practitioner saying hey you should have known that's the laws that you you need to gain consent in the meantime the practitioner is fine fifty thousand dollars an incident by the government because they're invading people's privacy by texting them all the time when they don't have consent to do so and that is the equal danger side of texting it is a different animal than email and you can't just throw people in groups and start texting groups different things unless it is about an appointment you can do that unless they tell you not to you know

Howard: so if invisaligns big blow three M's big red smiles dry clubs big purple Henry Schein reveal what would you what color would you give I Henry Schein player two I'm going by their logo colors maybe they're

Dr. Keith Dressler:  maybe they're red white and blue or whatever you know the the Invisalign logo color is blue the smile direct is purple three M is red so whatever their logo color is there you go your pick of colors they're the red white and blue what's the first color that comes to mind well I don't know I mean I see all all those colors they could be big blue to because I think or they one of it some of their name is in red and some of it's in blue 

Dr. Keith Dressler: I think Henry might be in red and shine might be in blue so I you know I don't know well I got it I got a go go go but it was just an honor for you to come on the show today well thank you and feel free to have me back thank you for having me I'd love to talk more with you at any time and and again anything I can do for you the dental population anybody listening to this podcast feel free to text me and my personal cell it's for two three five zero five seven seven one two that's four two three five zero five seven seven one two reach out to me I'm more than happy to talk with any of the listeners out there and and of course if you're interested in a an individual telehealth platform for individual providers or groups it's not just individual where enterprise-grade we're in hospital systems and everything else so it could be DSO likes more than happy to talk to you about anything and again thank you for having me on your show 

Howard: you are an amazing man and thank you for giving out all that all your private data information and again you're an awesome you know and I'll come out there just line up a steak dinner with my buddy of John McFadden and you and and we'll get them will get the smiles drug Club people over there okay no no you know he will I can get him on the phone he's a he's I he's he's a businessman he'll listen he knows your mover and shaker but hey have a great day and we'll talk to you later all right thank you

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