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VIDEO - DUwHF #856 - AAFDO
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AUDIO - DUwHF #856 - AAFDO
The founders of AAFDO realized that with the continuous changes in dentistry, growth in social media, and increased transparency of quality metrics, patients are in search of reputable providers that consistently offer the best quality care. Patients will want to see dentists who demonstrate the ability to maintain compliance in Patient Safety, Quality and use of best practices.
It also became clear to us that with the growth in regulatory agencies and the number of regulations that affect dental practices, dentists have a critical need to know they are meeting all applicable requirements, as well as using the most up to date best practices in all aspects of their dental practice.
As we surveyed the landscape, it was obvious that no single organization, methodology, or resource could meet those mission critical needs for general dentistry. Unlike other healthcare specialties, general dentistry does not have an accrediting entity purposely designed to meet its unique requirements. Thus, AAFDO was born.
Motivated by our passion for patient safety and the delivery of high quality care, we gathered a team of experts to create a single, comprehensive resource to which dentists could turn to ensure they meet all applicable regulations, are using best practices, and providing the safest care. In short, we wanted to enable dentists to answer the question, “Am I maintaining compliance in Patient Safety, Quality and use of best practices?”
We also believe that, as in other healthcare specialties, those practices that meet this stringent level of excellence should be “accredited,” and be able to publicize their achievement.
Our belief in the value of accreditation is fueled by a deep and compelling enthusiasm for the mission of improving our industry by providing a useful and needed service for dentists and great care for our patients.
Howard: It is just a huge honor for me today to be podcast interviewing Doctor John B Roberson, and Rob McCrary all the way from Hattiesburg, Mississippi. On the left there is Doctor John B. Roberson, obtained his dental doctorate at the University of Mississippi School of Dentistry, Jackson, Mississippi. He received numerous awards with one notably being elected the President of the seventeen thousand member American Dental Student Association during his third year. Doctor Roberson did his residency in oral and maxillofacial surgery at the University of Cincinnati Medical Centre in Cincinnati, Ohio.
He served as Chairman of the Residence Organisation of American Association of Oral and Maxillofacial Surgeons, as well as being one of the co-founders of ROAAOMS. Doctor Roberson holds dual board certifications. He is a Board-certified by the American Board of Oral and Maxillofacial Surgery and by the National Dental Board of Anaesthesiology. He is a member of the American College of Oral and Maxillofacial Surgeons, American Dental Association, American College of Dentists, Mississippi Dental Association, South Mississippi Dental Association, American Dental Society of Anaesthesiology and the Mississippi Society of Oral and Maxillofacial Surgeons. He is also a fellow at the American College of Dentists.
Besides being the co-founder of AAFDO, which is Accreditation Association for Dental Offices, he is also the co-founder of the Institute of Medical Emergency Preparedness, which develop the emergency response system, ERS. He has lectured and written extensively on the subject of medical sedation and emergency preparedness and training. He has numerous online courses on medical sedation and emergency preparedness.
His buddy to the right, Rob McCrary, MBA, has been involved in various aspects of the healthcare industry for more than twenty-five years, including both private clinics and hospital systems. This experience includes managing all aspects of the healthcare environment, ranging from corporate complaints management, reporting and auditing to coordinating revenue cycle management. Mr McCrary also has experience with preparing joint commission audits as well as preparing to prevent and responding to audits from Federal and State Agencies.
So these two guys have been buddies since they were barely a metre tall and actually their wives are cousins. So this is good times. This is dentistry uncensored John, so I want to start off with the dark side of dentistry. It seems like every month or two, somebody dies in a dental office and it is all over social media. I mean some of these stories you look at, a two-year-old will go in, one recently it was a pediatric dentist. Took her to a place, a Board-certified anesthesiologist, put her under, she didn’t wake up. It’s on the evening news, it’s all over social media. Do we just hear about it more because of Facebook or has this always been going on? What do you think about the prevalence of this?
John: Great question. It’s always been going on Howard. It’s just the fact now, that as we were talking earlier, about the creation of the smartphone, you have instant access to everything. So we live in a world now where we can get information at our fingertips at any given time, any second. Where something like this mishap may have occurred, fifteen, twenty years ago, we may not have caught wind of it, but now, when a patient dies in a dental office, or if it’s dental related, it’s picked up real quick by the news media, including everywhere. Anybody can find it or locate it through social media.
Howard: I find it very interesting, when you look at corporate dentistry, none of them are publicly traded in America.
Howard: They have way too much debt and they are doing roll-ups, not roll-outs. A roll-out means they are just buying earnings. So they will go get a million-dollar line of credit, they’ll buy a million-dollar dental office and say ‘look, we have a million dollars of revenue’. Wall Street says ‘yeah, and you’ve got a million dollars of debt’. Then they go get another million-dollars of debt, they buy another office and they say ‘look, we’ve got two million revenue’. Wall Street says ‘yeah, but you’ve got two million in debt’. So they can’t go public.
But, there is a few around the world. Two on the Australian Stock Exchange, one on the Singapore, where they are public because they are roll-outs. Where they took money, they built dental offices there so profitable at twenty percent profit margin, that they actually built new dental offices with their profit. These chains will not allow any board-certified anesthesiologist to put anybody to sleep in their office under twelve or over sixty-five. Their legal lawyers are looking at their actuarial data and they are saying it’s just too dangerous. A publicly trading company can’t put down a five-year-old for a bunch of chromosomal crowns and have them not wake up. They just won’t do it. Is that much more high risk in your terms, under thirteen and over sixty-five? No, it’s under twelve and over sixty-five.
John: Well, number one, it depends on the procedure being done and number two, the provider must do it how he or she feels. Do they know their limits? Are they very comfortable with what they are doing? Who is doing the anesthesia for them as well too? Are there any medical conditions that we’re unaware of? Whether it be the under twelve, or even more importantly over the sixty-five age, that you just said. As we both know, being dentists, look how many patients that we are treating that are medically compromised in so many different disease states, whether it be cardiovascular, diabetes or a combination thereof. Yes, I think it has a lot to do with the patient pool that you have that you’re operating on as well too.
Howard: What was going on in your journey that’s made you guys both want to start the AAFDO, the Accreditation Association for Dental Offices at www.aafdo. What was going on in your life that made you stop and do this?
John: Well Rob and I both discussed this along with my other co-founder as well, Mr Steve Harden, who runs LifeWings. He’s been in patient safety hospitals for over twenty years. We saw that there was an existing Accreditation Association for Hospitals and Ambulatory Surgery Centers, but what about dental offices? Do dental offices have anywhere they can turn to to say ‘you know what? I perform quality metrics in my practice, I do best practices every day, how can I showcase or how can I highlight that to my patients as well as to the market that I live in, being that city?’ There was nothing there Howard. That’s why we created AAFDO.
Rob: John and I talked years and years ago, well before the the concept actually came up, he said ‘Rob, at some point, if dentistry doesn’t do something through private organizations, there will be some entity that will come in and tell them how to do it’.
Howard: The Government?
Rob: Yes, exactly.
Rob: We would rather develop something that sets up these standards for best practices, quality dental care. To do that, and then at the same time, we’ve got to be compliant. Dental offices have to be compliant with all the Federal Regulatory Agencies, OSHA, HIPAA, EPA. They’ve got to make those things. Everyone’s got to, if they don’t, they’ll shut them down if they ever get audited. Those are occurring more and more frequently.
Howard: I know it’s a big deal with dentists when they know a dentist is totally malpractice and below the line.
Howard: But, they feel like, well, he is one of my homies and I can’t report a dentist. It’s like ‘dude, if you don’t police your own profession you are inviting the government to come in and do it for you’. It’s the same with police stations. When police stations don’t take care of their bad cops, what do they invite, the Federal Government to come in and they will do it for you. So somebody has got to police dentistry and it’s either we’ve got to do it internally ourselves, and do a really great job. I like that pilots always say, they do everything by checklist, and a pilot will say, ‘if we’re ninety-nine point nine nine percent successful on every flight. That means four airlines a day will crash in America’.
Howard: I mean, ninety-nine point nine nine isn’t even good enough for a pilot. Everything they do is checklist, accreditation, certification. Every pilot I know, every six months has to go back down to headquarters and get in a simulation and get recertified.
John: Well, Howard, what they do is CRM. That’s where our other co-founder, Steve Harden, he’s also a pilot by trade. Also taught at top gun and has flown F15’s into aircraft carriers. So he’s all about CRM, Crew Resource Management, that’s what the checklist evolved from in airlines. Yeah, there was a general surgeon who wrote the book about checklists in hospitals and all that, and he took it all from the pilots. It goes back to what you just said, if we go through this checklist every single day, and this can apply to our dental offices or every single patient that we treat, we can reduce medication errors, medication mishaps, medical emergencies.
But, yes, you are correct. If we don’t do something now, like you said, the government is going to step in. I want to say something else. I enjoy the right, as an oral maxillofacial surgeon, to provide my own anesthesia and I think any dentist that has ever undergone any IV sedation or IV anesthesia training course, they too enjoy that right. But if we don’t have a way to police that and police it correctly, somebody will, because I promise you there is somebody out there that would love to be able to take that away from me, being an oral surgeon saying ‘you shouldn’t be providing anesthesia, somebody else should’. If you know your limits, you are careful and do everything right, luck always favors the prepared, it’s what I like to say in my lectures.
Howard: Love always favors the prepared?
Howard: Oh, luck. So basically you have a four hundred criteria survey in thirteen domains. What is the thirteen domains?
Rob: It’s consumer information, clinical documentation, emergency preparedness, medical emergency preparedness, controlled substances, infection control, OSHA, HIPAA, radiation compliance, fire safety, building codes, contingency planning, patient safety and then also anesthesia and sedation.
Howard: What was the one about pain medication?
John: Controlled substances.
Rob: Controlled substances.
Howard: Yes, controlled substances.
John: That’s a big topic right now Howard, and it is going to stay a big topic with the opioid crisis that we have in America.
Howard: First of all, with dispensing, I decided clear back in 1987 I didn’t want anybody to have a reason to break into my office, I understand if you are an oral surgeon you are putting people down that you have these in your office. But for a general dentist, is there any reason at all why you would want controlled substances in your office? I mean, isn’t that just inviting a break in?
John: Correct, it is.
Rob: I’ve worked with a lot of physician practices over the years and kind of how you decided years ago, I’ve even had orthopedic surgeons that don’t have it in their office. They’re not doing surgery there so they don’t have to have it there, but they’re not dispensing even the giveaways anymore. Partly, they’re limited on what they can do on that. But, yeah, that’s gone away even in that side of the industry, that they don’t want it to where it’s in their office. Number one, you’ve got all kinds of excessive regulations because of it and tracking, and then somebody breaking into my office for it.
Howard: When I graduated from dental school, UMKC, class of 1987. I had two classmates that were pharmacists before. One was Kirkland Denning out of Hays, Kansas. One was Dave, the CO out of Albuquerque and after the second time someone put a gun to their head, as a pharmacist wanting opioids, they said ‘this isn’t any way to make a living’. So they both dropped out of pharmacy, went back to school and became dentists. I graduated with them. So listening to their stories, when I got out of school I was like ‘I don’t want to have any of that in my office’. If people are going into pharmacies and putting a gun to your head for Vicodin, you just don’t want to have that in your office.
John: Howard, talking about controlled substances. Let’s tie it in with what you said earlier about the government stepping in. What is a government agency that controls that specific domain? The DEA. So as dentists we still have a DEA number. We write narcotics, you may not have it in your office, but if you do, one of the regulatory issues is you’ve got to maintain a narcotic logbook, and that logbook has got to be perfect. You can’t have any mishaps. Then it needs to be reviewed daily, looked at weekly. What if you are missing drugs? What do you do then? Unfortunately employees sometimes can take medications, and that is something that has happened in dental offices.
Howard: When I got out of school thirty years ago, the press was beating up the doctors because we were bad guys, these people were dying of cancer, they were going to die anyway and they are in pain, you don’t want to give them pain med, and we’re hurting people. So the doctors got guilted into giving more pain med. We were the bad guy for not giving it thirty years ago. Now we’re the bad guy because we give it too much. They’re saying that last year, fifty-one thousand people overdosed on opioid. On Dental Town there is big wars, even with endodontists. There’s endodontists who say ‘I do root canals, eight of them a day and I have not prescribed an opioid in five years’. Then other one’s are saying ‘that’s crazy it’s too extreme’. Where do you lay? You’re an oral surgeon, are you still prescribing opioids for wisdom teeth extraction?
John: Absolutely I do. But I also prescribe non-steroidals ahead of time. I like to pre-medicate my patients before and I write for a very small amount of narcotics. I’ve read reports where patients are getting twenty and thirty pills, I never write for that kind of amount of medication at all. I’d much rather see them on a postoperative steroid and a non-steroidal, get them back to normal as soon as possible. That’s one thing I share with all my patients.
But also as well too, Howard, back in 2014 the government stepped in and said ‘Vicodin or Lortab and Hydrocodone is no longer a class three, it is now a class two. Can you even call that in? So that has changed the way I’ve practiced right there, because before I used to have everything waiting for my patients. But that altered the way I practice and one thing I stress to all my patients, is that we’re going to write you just a few of these and we’re going to be done with them. That’s it and I’ve never had a problem with them. Never have.
Howard: Yeah, I think it is interesting how they always talk about the opioid epidemic, they talk about fifty-one thousand died last year. But they don’t put any kind of perspective, because the three most abused drugs are legal in every corner and that’s sugar and fast food, cigarettes at every gas station and alcohol at every corner. They say fifty thousand died of opioids, but how many died from alcohol last year? How many died from cigarettes last year? How many are into morbid obesity and diabetes, and getting limbs amputated, because they sell Coca Cola at every drive through on every corner. I wish they would talk about the three legal drugs on every corner, but it’s always the opioid. You know what I mean?
Rob: Oh yes.
Howard: So what are you asking? That these dentists go to www.aafdo and get accredited and why should they get accredited?
Rob: A couple of different reasons. It is something that is going to allow the dentists and the dental practices, to show that they are above the ones next door to them. They’ve done the due diligence to go through this process, they are hitting the high standards, they are covering the regulatory compliance, and they’re providing patients safety and quality of care. It’s not something that every state can advertise, some people can, whether it’s backed up or not. This actually gives them the ability to let someone know, especially their patients, that they’ve done this. I think it’s partially a marketing, but more so than anything, it’s a little bit of peace of mind for the dentists themselves and the patients.
Where they’re having their dental care done, has gone through these thirteen domains that are above or beyond what their neighbors have done. A lot of what’s in this is things every dental practice should be doing. It’s just not every dental practice is doing it to the updated version. Of HIPAA or something to that effect, or they are not doing what they thought they were doing. But when you go in there and look at it, to how it should be done and done correctly, they’re not being done. So it gives them that peace of mind for themselves. It also goes into even the risk management piece.
If you’re doing this and you’re prepared and you’ve gone through these steps, can’t guarantee you will pass every audit, but you will be prepared for it. That’s the main thing in any audit I’ve ever done, even when there were mistakes made, the fact that you were prepared and you had these processes in place, if you were fined you were fined to a lesser degree. A lot of times this was being done to be prepared for, it’s just, there was a mistake made. Those aren’t as frequent. Number one, you don’t have as many of them, but number two, you also prevent a lot of them. So the couple of times where somebody found a mistake it was mitigated, that mistake, because of the fact of the preparation for it.
John: Howard, I would like to say this because you said we have so many people listening and all that. For our audience out there today and those that listen in the future, ask yourself this question right now. If a representative from OCR, the Office of Civil Rights, which oversees HIPAA. If they were to walk into my office today how would I fair? Or, if an inspector from OSHA walked into my office today and said ‘I’m going to do a surprise visit’. Sometimes they gruntled employee leaves your office and turns you in. Alright?
But, nonetheless, because I have seen multiple social media information on that too. Nonetheless, if either one of those inspectors walked in your office, how would you fair today? Bare in mind and keep in mind. That OSHA fines for each fine it can go up to $70,000. Each fine. HIPAA up to $1.5 million. Howard, we’re talking about people who want to start a dental practice and keep a dental practice, can lose their dental practice because they didn’t stay up to date with regulatory issues. That is how serious all of this is.
The best way to put AAFDO out there to all of our listeners. We are a confluence of risk management, patient safety, medical emergency preparedness and dental compliance all mixed together. Like Rob said, we can’t guarantee what’s going to happen when they walk in, but we can sure have you prepared for that audit. Trust me Howard, because we’re getting more and more attorney firms working with our company now, coming on as OSHA slash HIPAA defense firms. They’re seeing more and more audits now, and we’re going to continue to see them. We even have some compliance coaches working with us as well too, very honored to have these knowledgeable individuals working with us. They’re seeing more and more audits. It’s happening. So it can be career defining or career ending should an OSHA or HIPAA inspector walk in your office.
Howard: Yeah, there was one post on DentalTown just yesterday about a million-dollar fine.
Howard: $1 million fine.
John: Can we go into that? Can you tell me more?
Howard: I don’t have it in front of me right now.
John: But it was a HIPAA more than likely, correct?
Howard: Yes, it was a HIPAA fine and it was for $1 million.
John: Another question. How many of my fellow dental colleagues out there have their patient’s software programme on a laptop? How many take it home with them? Or an office manager takes it home and forbid a break in and that laptop’s taken, because one that I just left off from my previous comment. Not only now are you on a HIPAA violation, which you are about to be severely fined for, think about all of the breaches in patient data now. You are now liable for malpractice on each one of those patients. You could be legally sued for each one of those patient files that you’ve now lost. What’s the average dentist have, five thousand active cases? Wow. This is something really serious to bring to heart and to ask yourself, am I doing this to everybody? Don’t do that.
Howard: So on DentalTown we break it into fifty categories. The difference between DentalTown versus Facebook, LinkedIn, Twitter. Facebook, LinkedIn and Twitter are just a non-stop news feed.
Howard: It’s just not organized like a message board is. So on DentalTown we have fifty categories, one of them is regulation, and under regulation we have documentation, HIPAA, infection control, injury prevention in the workplace and OSHA. It seems like OSHA was the big bad boy when I got out of school in the ‘80’s. But then it seems like HIPAA is more the bad guy. Do you think dentists are finding more problems with HIPAA or OSHA in 2017?
Rob: I would say HIPAA, partly because it is more expansive. OSHA is a little focused on what they are working on, they’ve got a couple of different areas they go into, but HIPAA keeps adding things to it. They updated it, what was it? ‘15 or ‘16 where they added more things to it. It’s not just the privacy issue, it’s also the electronic protection and things like that. I think it is much more robust. It’s also newer and I think it’s more lucrative for the government.
Howard: Isn’t that sad if that’s really their motive? Do you think that is part of their motive, just revenue?
Rob: I would never say that, loud and in person with you.
Howard: Well it seems like you never see a government agency saying ‘we’ve kind of done our job, we don’t need to exist anymore, we need to scale down’. They’re always trying to reinvent themselves to get bigger budgets and more employees. It’s like rule number one of every agency, the guy running it, their only self-esteem is that ‘well next year I am want to have twice as many employees and twice as big a budget’. Yeah, don’t get me started on the government.
Rob: I have seen some circumstances that, and it’s not HIPAA, it was some other audits, what was being documented, what was getting paid and they were paid the regular rates and they come back and take them back. I want to think it ended up being that those who fought the penalties and the fines, eighty percent or eighty-five percent was successful, but only thirty percent or forty percent were fighting them. They just didn’t have the resources for the smaller offices and smaller hospitals, they don’t have resources to go back and fight that. I do believe that, in there they have the budgets that they have to adhere to and if they can bring money in, they’ve helped meet their own budgets and their own existence.
John: Howard, I would like to further this section because this has become such a hot topic. The ADA just came out with, last month, called ‘Managing the Regulatory Environment’. Please allow me to read the very first page what we’re saying. ‘Adherence to current regulations and guidelines is one of the most challenging aspects of running a dental practice, especially since it requires dealing with so many different agencies. Being knowledgeable about current regulations and working towards compliance, or critical steps for practices to achieve both a safe dental practice and peace of mind’.
This is everything that we are all talking about together right now, Howard. It’s all about taking care of the patients, making the highest patient centered safest quality of care that there can possibly be. Some of the regulatory agencies that they focus on in this article, Centre for Disease Control (CDC), CMS that covers Medicare and Medicaid, the DEA, OSHA, OCR, which I won’t mention, which is of course HIPAA right there. There are some major governmental agencies and each one have their own directors, and each one have their own ideas and thought processes on how to treat a dental office. So you’ve got to stay up to date in each one of these parameters, or we like to call, domains.
Howard: Well, I hope you build an online CE course for this under our category for regulations. I think you creating a course going over those thirteen domains, would you be interested in something like that?
John: Sure. I would love, Howard, for us to get together and maybe visit all of the different message boards out there, because I have done it before in the past. Sharing my knowledge with documentation for medical emergencies, and I would love to get out there and post something on each one of them message boards saying ‘look, AAFDO is here, we’re here to help you, we’re going to coach you, we’re going to get you through this. We want to see every dentist succeed. We want to see accreditation happening in their office’. Alright, because, we are not a regulatory agency, we’re an accrediting agency. Alright, we’re volunteering. We are a hundred percent elected voluntary process. It’s up to the dentist if he or she wants to have a go at this, but we want to make this available for every dentist in the United States.
Howard: Well, when you’re trying to be a leader they’ll tell their team ‘we’ve got to cut down on patient cancellations and no shows’. The whole staff is like ‘yeah, we all agree’, and then the doctor leaves. Employees, you need to show them the way, you need details. If I went into my office and said, do you think this dental office should increase our safety and our regulatory compliance and our emergency responses and our office security and our infection control? They’d all say ‘yeah’, but they need details, you need to show them a plan. I love the way that you guys are so detailed orientated, you have a comprehensive four hundred criteria survey. That way you can tell your staff, we need to do this but here’s the way. Here’s how you follow the yellow brick road and get all the way to Emerald City.
John: Yes, and as Rob can contest also Howard, we have steps to get you there. Through these four hundred plus criteria through our surveys and stuff, because it is all broken down into the thirteen domains. We have a little mini survey that we ask out of each one of our offices doing this. So you can get an idea like ‘gosh, I’m behind’. But now, as a dentist, I am asking all of you out there, don’t be hard on yourself. If you go in there and do the survey and you find there is a lot of deficiencies in there because the regulations are quite tight. Rob can talk a little bit further also about what we do with our coaches, and all that stuff to get all of our practices through this entire process.
Rob: I will jump on that a little bit, one of our first petasites was Doctor Roberson, of course, and in doing so I am not a patient, but my family is a patient, I think everybody but me have had teeth removed here. So high quality office, and we ran through everything with him and did great on most of everything. There were a couple of areas where he was either out of date or a little deficient in. They were doing some aspects of it but it wasn’t to the detail that the auditor would require.
John: What Rob is saying, had someone walked into my office, one of those inspectors I said earlier, I would not have fared well. My staff took it horribly because they give me one hundred percent every single day.
Rob: They took it harder than he did.
Rob: They were like, I can’t believe we didn’t do this right and John was like ‘oh, we can fix that’.
John: We’re looking to correct it, there’s ways, that’s why we developed what we did. Here I am being one of the co-founders, I’m extremely critical of myself, but guess what, we’re up to snuff right now. So maybe when you walk into my office, we’re going to be very well. We have all of these areas covered right now.
Howard: But what do you say as a board certified oral and maxillofacial surgeon, there are a lot of people in the government, and more so in the United Kingdom that say in every hospital in America, the surgeon, say you’re doing a bypass, the cardiovascular surgeon cannot do the anesthesia. They separate anesthesiologists and surgeons in every hospital in America and the United Kingdom, and the United Kingdom has been trying very hard to say why is this not the practice in dentistry with our oral surgeons. The United Kingdom has been trying to say the oral surgeons need to start acting like the hospitals and separate those two procedures. Whereas you’re doing the work of two people, you’re doing the work of a board certified anesthesiology and a board certified oral and maxillofacial surgeon. What do you think of that argument, that those should be separate?
John: Well if you think healthcare is expensive now, go ahead and implement that model. Okay?
John: Let’s just stay with just oral surgeons, periodontists, endodontists, general dentists or pediatric dentists, any one of those that are trained in any form of IV anesthesia, what you just said from what Great Britain wants to do, that right is being taken away from us. Somebody else is coming in and do it, healthcare, or I should say dental healthcare, just sky rocketed out of the roof because you just said also, I think I saw somewhere on one of your other previous podcasts, talking about fifty percent of America just wanting to build a dentist is sure in debt. It is also that any of us out here in America that perform any form of IV anesthesia, how we can help our patients relax and treat them appropriately and accordingly. That they’re in a safe environment.
Howard: Yes, the only secret to lower prices is lower costs, and I think that’s what really bit Obama bad. He had great ideas of not being exempt from pre-existing conditions, leaving your kids on your health care insurance until they’re twenty-five. But they never address cost, they always have great ideas that come from the heart, but they never have a great idea to lower costs. What’s so funny is on the last Obama Care, twenty other different countries threw up their hands thirty percent of America’s costs is his administration. Why didn’t Obama Care address any of those issues?
They could have cut the costs of health care twenty percent across the board, but they never have a great idea on cutting costs. So like here’s a great idea well, maybe we’ll save one kid if we separate the anesthesiologist from the pediatric dentist or the oral surgeon. Oh, okay, it just keeps getting more and more expensive. It seems like they never have an idea to make anything lower cost, they just have an idea to raise the cost of everything. Some of my most favorite economists in the world, like the late, oh what was it? Who was the little guy’s wife, Rose? Milton Friedman, and his wife Rose. Milton Friedman got all the credit but his wife, Rose, was the PhD economist who sat in the office and crunched all the numbers and made Milton look so smart.
But they went to their death saying what Americans don’t get, is that they always complain about how high their taxes are, but the regulations cost them more money than their taxes. The greatest tax on society is the hidden tax of regulation. He was always fighting regulation because he says ‘if you think your taxes are expensive, you have no idea of what you are paying for the price of all these regulations. OSHA, HIPAA, the list goes on and on and on.
Rob: Then once you start that, then you create a bureaucracy that doubles and triples and quadruples the costs, in the first couple of years.
Howard: How many people would have had their health care paid for for free, just by the cost of HIPAA? Are you talking…
Rob: (inaudible 35:03) weren’t quite covered?
Howard: The cost of HIPAA could have paid for the healthcare of millions of Americans.
Howard: That’s the point that these economists are trying to tell you. I mean, how many jobs have been lost because of the cost of OSHA?
Howard: How many people don’t have a job today because the factories said ‘screw this, I’m going to go to Mexico or China’. So here’s OSHA to protect you and then they are just like ‘okay, well, we’re going to China. We’ll talk to you later’.
John: Howard, what’s looming in the future? What new government agency is about to be created? Since we have such an issue going on with the opioid crisis right now, is there going to be a new spin off with the DEA? Little do we know, is there something looming out there that will be a whole brand new standard, because for Rob and I, and the rest of the team at AAFDO, this is an evolving science as far as our domains. That’s the reason why with accreditation it’s every three years, because something new could have occurred in some form of a new regulation, and what does that cover next time around.
Howard: I do have to ask you something very cynical about this opioid addiction. Hydrocodone, which is Vicodin or Oxycodone.
Howard: Which was Percocet, was basically five milligrams of Hydrocodone plus three hundred and twenty-five milligrams CMF, right?
Howard: Then the doctors were saying ‘well, sometimes we need a pain pill that doesn’t have all this Tylenol in it. Can we make one without an Acetaminophen?’ So then they come out with Oxycontin, but it wasn’t a five-milligram tab. The smallest one was fifty milligrams. How did they go from five to fifty? Don’t you think that was a big cynical part of the problem? Like ‘okay I want this without the Hydrocodone without the Acetaminophen’, okay, well do you think they just give you a five-milligram tab, but they gave you a fifty-milligram tab. Don’t you think that was a big, huge part of this epidemic, that the dose was way, way, way, way too high?
John: I think they found that the big former company that was involved literally made millions and millions and millions on it.
John: No, doesn’t mean they got billions, you are correct, so that was part of one of the feeders of all of this as well too.
Howard: Yeah, I think it was intentional, don’t you think? Don’t you think they absolutely knew that?
John: You have to believe so that they did because, like you said, it went from five milligrams all the way up to fifty milligrams of Oxycodone. Right? That’s a significant jump, especially in acute pain management or chronic pain management.
Howard: Yeah, I have a friend of mine who’s a patient of mine for thirty years. He started coming in 1987 and we just had lunch here today. He always has kind of a crick in his neck and lower back, he’s always has lower back and neck issues and every time he goes to his doctor, his doctor writes him sixty Vicodin.
Howard: Isn’t that amazing? I mean, sixty Vicodin for a chronic…
John: To me I think this is more physician related than it is dentist related. I don’t know a single dentist ever written for fifty pills of a narcotic. I don’t know, do you?
Howard: No, I don’t know of anybody who ever wrote one for twenty.
John: Yeah. So of course, if it happens in healthcare it is going to trickle down to us in the profession of dentistry.
Howard: You also mentioned the EPA. How is the EPA tied into dentistry? Is that what the mercury…
John: Yes, the waterlines and all that.
Howard: The what?
John: The waterlines.
John: Waterlines flushing the amalgam.
Howard: I knew a lot of dentists here in Arizona fought those regulations over the years, but I always thought that dentists should own that problem. I notice that there’s factories out here in Phoenix like Intel, and they make some of the most toxic stuff in the world. But they take care of all their own waste water, and when they are all done they really return the water completely purified. It would just be insane if Motor Oil and Intel were dumping all this crap into the waste water, and then the City of Phoenix had to deal with it.
It’s the same with the mercury, when they look at the mercury in the water it’s pretty much all coming from dental offices. It’s just a lot cheaper for the dentist to scavenger and clean the stuff out at the point of entry, instead of mixing it in with all the water and toilet water from four million people living in the valley. I think you should clean up your own mess, I like user fees. I don’t think the general taxes should pay for the Grand Canyon because if you are a little, old grandma, you’re never going to go the Grand Canyon why should you be subsidizing some family who wants to go vacationing? When you go to the Grand Canyon, you should pay when you go. But anyway, do you think a lot of dentists are compliant with that mercury scavenger system?
John: I think it is coming around.
Rob: I think part of it depends on your state.
Rob: Certain states regulate that differently. One of them that we’ve looked at, not just this area, but a couple of places, where one state may have a regulation in one state or something like that, and somebody said ‘what happens when the dentist says, I don’t have to do that in my state or part of my accreditation process?’ Well we look at that as, well, we are not an estate agency, we are not even a Federal regulation agency, we are best practices and here’s what you should be doing. It goes all into that, this is what you should do, this is the best practice. To get accreditation this is the level you have to practice. It’s not just any…
Howard: Where EPA is dropping the ball though on amalgam? Totally dropping the ball? When you study atmospheric mercury contamination fifty percent of it comes from burning coal. Fifty percent of the mercury in our air is from burning coal. Do you know where six percent of it comes from? Cremating humans that have amalgams in their teeth.
Howard: What I feel sorry for is that poor boy in Mississippi who is cremating four, five people a day. He’s in the room when that mouthful of amalgams has been heated up towards dust, that’s the poor bastard who opens that door. He’s getting knocked over with this stuff, and it’s six percent of the atmospheric mercury comes from cremating humans. They need to pass laws that says no one can be cremated until a dentist drops by with his pliers and his one fifty or one fifty-ones. You don’t have to pull out the roots, if you just break up the crown you’re all good. You don’t need any sedation, it would be the only patient that won’t argue with you. But you can’t be cremating humans with amalgams in Mississippi all day, every day. That is such a low hanging fruit way to stop some of the mercury emission
John: (inaudible 42:32) a new specialty in dentistry.
Howard: Oh, that’s what I want to specialise in. Yeah, I want to do oral surgery on dead cadaver’s only.
John: But only if they have amalgams in their teeth.
Howard: They have to pre-pay, because if they don’t pre-pay they are not good for it afterwards.
John: Well, they pre-pay for funeral costs, so why can’t we say (inaudible 42:55) dental costs or something like that.
Howard: I’ve heard that once you have been cremated you’re not very good at paying your bills.
Rob: Probably not.
Howard: I also think it is interesting, HIPAA, a lot of people don’t realize, did come from OCR, the Office of Civil Rights.
Howard: HIPAA actually started as a civil rights deal and the way I read it, the way I saw it unfold, really it came down to HIV. There is a lot of people who are afraid that their HIV status was going to get revealed. I think that was the straw that broke the camel’s back. That the health insurance, privacy, portability act was that this should be private. If you have this disease it should be private and people should handle it in privacy. So it did come from the Office of Civil rights, it’s kind of an interesting place where this came out.
John: I think also that maybe people were just sharing information freely over the internet, or text, or talking about it with this patient or that patient. It may not just be HIV, Howard, maybe also stuff like Alzheimers or Dementia. People just didn’t want to know their stuff is shared with other people. So this evolved, like you said, they call it the privacy rule, and that evolved into what we have today with HIPAA.
Rob: If I am not mistaken, when it first came out, the portability was the bigger selling point for the many other aspects of that. It seems like the privacy got added to it. But if I am not mistaken, portability was the clinical piece of that that really pushed it to begin with, and then they added the privacy in there with it.
Howard: Well, explain the portability. What does that really mean? Portability.
Rob: It didn’t really work. The intent was that you were meant to be able to move your insurances. If you left one business to be able to take it with you. That was the start of some of the pre-existing stuff that they did. If you had this disease then you should be able to move it. If you had, like you said, HIV, and you lost your job or whatever, you lost your insurance at that time. They were trying to set it up where you had the ability to move it, but all you got at that point is just being able to take it at a higher rate and not lose it then. So the insurance company had to allow you to keep it at a higher rate and not the company paying for it.
Howard: If my homies go to www.aafdo.com for accreditation association for dental offices, how much does this cost? Tell them more dentistry uncensored details.
Rob: Okay, the price is $2999, two thousand nine hundred and ninety-nine dollars. That’s if you use local anesthetic and …
John: Nitrous oxide.
Rob: Nitrous oxide. If you do more advanced levels than that, then it’s $3999 due to the fact for the medical emergencies, have little more detailed questions.
Howard: Okay, so local and nitrous it’s $2999.
Howard: But it’s $3999 if you do what?
John: If you do any form of advanced anesthesia, if you do oral sedation, if you do moderate sedation, if you do deep sedation, if you do general anesthesia or if there might be some practices, as far as your surgeons are concerned, they might be doing interlational anesthesia there. So our thirteenth domain is anesthesia sedation. So after our auditors get through going through your office, they then go through about a hundred point checklist all dedicated to medical emergencies, sedation emergency preparedness, emergency drugs, emergency equipment, staff training and dentist training toward medical and sedation emergencies.
Howard: Man, that child who died last year in Hawaii. When she didn’t recover they left her sitting up in the chair with her head slumped over while the doctor and everybody ran down the halls looking for someone to come in and help. Isn’t that just amazing?
John: Well Howard, I hate to say, to me it’s not because being in that field and writing all this, and lecturing all this for about twenty years now. The stories that I have been told. When I was at a tradeshow I had staff members come up and tell me different things. The stuff I had read from malpractice claims. It always seems to go back to several things, Howard. A delay in the treatment of the emergency, a delay in calling 911, a delay in trying to locate emergency drugs, I might not have any emergency drugs in date. Alright?
We talk about the number of deaths each day in America related to the opioid crisis, let’s talk about sudden cardiac arrest. A thousand people die every day in America from a sudden cardiac arrest. There is only one treatment for that Howard, it’s called an AED, Automated External Defibrillator. For some reason, people like to call it Automated Electric Defibrillator. I don’t know why, but it’s not electric, it is external. Alright? But that’s the only treatment for a SCA, and every minute you wait to shock, after about four minutes there is a ten percent decrease in survivability. Unfortunately, I think, right now in America only fourteen states require dentists to have an AED. Man, we’re talking about what we do for a living, people are nervous and scared to death when they come to our office.
Howard: Yeah, see there’s my point. They talk about the opioid epidemic all day, every day. It’s every news station.
Howard: That’s fifty-one thousand deaths. But three hundred and sixty-five thousand deaths, a thousand a day…
John: (inaudible 49:00) Yes. I am so happy to see that BLS also teaches AED training because look at every airport you are flying in.
John: Check about every hundred yards, there is an AED for a reason right there. But you being a dental health care professional, you are trained to do that. You could save somebody’s life if they have a sudden loss of consciousness, not breathing and no pulse. Those are the three signs and symptoms of a sudden cardiac arrest, and you need to get that defibrillator.
Howard: What are the three symptoms again?
John: Sudden loss of consciousness, no pulse, no breathing.
Howard: Yeah. But a lot of my married patients, especially the retired married men, they have a do not resuscitate tattoo right on their forehead. If I had a sudden loss of consciousness, no pulse, no breathing, please do not resuscitate.
John: Well as long as the sign the DNR form in your office then you are good to go.
Howard: You just had an excellent example, you said that only thirteen states require a dental office to have an AED.
Howard: Fourteen, and you’re saying that a lot of people say ‘well, this isn’t required in my state’. Well, you’re not a regulatory, you are a best practices.
Howard: So if you’re going in to a dental office saying ‘okay, well this might not be mandatory for your state, but fourteen states do mandate it and we think it is the best practice’.
Rob: That’s correct.
John: Well another thing too, we talked about earlier about malpractice as well too. You’re going to be hard pressed to be able to prove yourself in a legal courtroom, in the event that somebody has a Sudden Cardiac Arrest in your office and you didn’t have a defibrillator, because when they say ‘did you take BLS training?’ ‘Yes, I did’. ‘Did they teach you how to use an AED?’ ‘Yes, they did’. Well how come you didn’t have an AED?
John: You could have saved this patient’s life’. The other thing too, I talk about the delay in 911. More than likely, an ambulance is not going to be at your office in five minutes when you call, and that ten or fifteen minutes you’re there with an unresponsive patient, Howard, I have talked to dentists, I have read about it, it’s the longest time period of your life. Right? What do I do? Many people can’t believe this is happening to them and then they go into a state of panic, and when you panic, guess what? Chaos. Simple skills are forgotten then. It is such a shame, but all it takes is just some regular training, regular monthly mock drills. You can have yourself ready every single day in your office.
Howard: It is so different, urban versus rural, because I am in Phoenix. I’ve had to call 911 twice. One was for a staff and my office manager feinted. But anyway, they’re exactly one mile from my office. They’re there in just no time at all.
John: You’re very fortunate.
John: You’re very fortunate.
Howard: I could imagine being out in Eloy or Florence or someplace far away. I mean, I don’t have any data, but I imagine the fire department’s response time is significantly longer in rural parts than obviously in downtown Phoenix, right?
John: Right, oh absolutely.
Rob: Yeah. I want to go back to where you asked how long it would take to do the process. Part of that is going to depend on the practice and how prepared they are. What we’re saying in the beta testing we were doing is that it is pretty extensive and so we developed a process. First time we did it we just did the lapse survey. But we have gone ahead now where they do a self-survey first, so you kind of go through most of the criteria in all the different domains, and answer those for yourself and provide us with some paperwork of different forms you use and things like that. Then we provide that back to the surveyor.
Then they will come in and do a virtual survey. Virtual survey. Basically what we’re doing is doing a Zoom, Skype, some type of video thing. Walking around the dental office with the surveyor, the couple of times that I have been there, I’ve have been on the Ipad. Five minutes into it, I would say, didn’t realize that the person wasn’t there with us, we were pulling out bottles of medication checking dates, we were walking through the process of autoclave, and (inaudible 53:30) and the virtual survey is two hours. But, the real leg work from the dental office is on the self-survey, where they go through that and answer the questions on what they’re prepared for.
Then the other part that would be detailed is that if you have areas that need remediation and that we need to work with you to get you up to speed, that will take some time also. So I cannot tell anybody how long it takes because it has never been the same for anybody that we have done, but it is resource intensive. It’s not a rubber stamp, it’s not just here’s four hundred questions, just mark them and we’re going to send you a certificate. We actually come in behind that and verify everything.
Howard: So what if someone has questions about this. Can they email you, call you, how do they contact you?
Rob: Website is www.aafdo.com, we have mentioned that before. There is a contact us link there, phone number, we welcome that phone call, is 866 902 2336.
Howard: That’s 866 902 2336?
John: 866 90 AAFDO.
Howard: Say it again?
John: 866 90 AAFDO, A-A-F-D-O.
Howard: 866 90 AAFDO, A-A-F-D-O.
John: You’ve got it.
Howard: Man, that’s very good. Good job in getting that phone number.
Rob: Yes, how about that.
Howard: Is that $2999 unless you do sedation, $3999. Does that include someone coming to your office or is this all done remotely?
Howard: It’s all done online and remotely?
John: Yeah, we’re very proud of our virtual inspector like what Rob was talking about, we go through zoom info. He did, with my office, just do it on the Ipad, and my staff said they felt like the person was right there. We’re initiating and utilizing high technology here, Howard. Therefore you don’t have to worry about someone flying into your office and taking up your time and all that. Going through everything and having to pay for an inspector to stay overnight and all that stuff.
Rob: Yeah, and it’s much less intrusive.
Rob: We try to do it in two hours.
Howard: Who usually is your point of contact for this? Is it usually the dentist, the office manager, the assistant? Who’ve you been working with?
Rob: All three.
John: All four.
Rob: Four. It depends on the practice. I’ve got one I am working with right now it’s the dentist. The other one the dentist and the office manager and another one’s the assistant.
Howard: They can use this logo on their website, their advertisement as a form of market differentiation that this office is accredited?
Rob: Highly recommend that.
Howard: Yeah, I really like your logo. Accreditation Association for Dental Offices demonstrating excellence, AAFDO.
John: Thank you.
Howard: So there is thirty-five corporate dental chains that have over fifty locations. Have you tried to get one of the really big accounts by trying to get one of the big boys to do this?
Rob: I think that would be an excellent idea. We will be talking to those guys too, yeah.
Howard: Yeah. I podcast a lot, Rick Workman of Hartland Dental, he’s got seven hundred offices. Stephen Thorne at Pacific, he’s got five hundred offices. It seems like going around the world, if it’s a really no-brainer business decision the corporates will always buy first. You know what I mean?
Howard: The dentist has to think about it through analysis. Their paralysis by overanalysis. But when I look at some of these patient financing schemes, some of these in-office insurance plans, the corporates just jump right on it. They see the merits of it, I would go to those guys.
John: Well, Howard, we would welcome the opportunity for an intro from you to them.
Howard: Yes, well send me an email and I’ll reply back and cc them.
John: Oh great.
Howard: Send me an email, firstname.lastname@example.org. By the way, I am always curious who is listening. I know who you are on DentalTown, but I don’t know who you are on i-tunes or Olab, but I’ve always had this thought that they were mostly all millennials, which is born after 1980. Not a lot of old-timers, baby boomers like me, who are fifty-four. I think all three of us are fifty-four, right?
Howard: Are you almost?
John: I’m almost
Howard: How many more days do you have left before you are fifty-four, to catch up with me and Rob.
John: September 30th.
Howard: Send me an email, email@example.com, tell me who you are and how old you are, where you are in your dental career. I can’t believe how many D2’s, I haven’t got any D1’s, but I’ve had about, I don’t know, like twenty-five emails of kids who are an undergrad that are still applying to dental school. I’m like ‘where the hell did you even hear of this podcast? When I was in dental school it seemed like all you were worried about was finals, and trying to pass your final exams. Then when you were in clinic, you were just worried about graduating and all you really cared about was graduating.
These kids are in undergrad, so many of them are D2’s and D3’s. It’s about twenty percent of all the emails, they haven’t even graduated with a dental degree yet. Isn’t it amazing how the world is so much different now, with smartphones, podcasts, YouTube, and stuff like that? It’s really a brand-new world. So who is your bread and butter account mostly? Is it oral surgeons? Is it people using sedation like pediatric dentists, periodontal oral surgeons?
John: Any dental office out there.
Howard: But who is mostly calling you? Is it more general dentists? Is it more specialists?
Rob: Kind of set it up for general, but it’s targeted initially at general dentists.
Howard: What percent of these general dentists are doing the advanced sedation, oral sedation, moderate sedation? The $3999 versus the $2999?
Rob: I don’t know what percentage. You’ve got a lot of general dentists that are just doing the local.
John: Yeah, local and nitrous.
Rob: Nitrous only.
Howard: I can’t believe how many people don’t use nitrous. I know endodontists that don’t even have nitrous in their office. I’m like ‘how could you be in the root canal business and…’
Howard: Not even have nitrous oxide?’ In fact, I always complained about that with my four boys. I raised four boys, now they’re twenty-two, twenty-four, twenty-eight and twenty-six. So many times you take them to the emergency room and they’d be in a ton of pain, and I always thought ‘well, why don’t you guys have nitrous in here? You could really relax this kid a lot if you just put him on nitrous, before you start stitching his arm. You know what I mean? They’re putting sutures in skin anesthetized. So that’s really the line between the $2999 and the $3999 is if you’re just doing local anesthetic with nitrous and the line is crossed when you start using pharmacology, oral sedation.
John: The other thing too Howard, with the advanced anesthesia we feel also we’re going to have a spin-off division of AAFDO related to strictly anesthesia and sedation down the road. We already discussed this because so many state boards have to go in and inspect dental offices. So here’s another regulatory agency, the State Dental Board, that’s got to inspect these offices to make sure everything is up to par as far as emergency drugs, emergency equipment, training, for both staff and doctors. This is where AAFDO can actually assist State Dental Boards, because you know as well as I do, they are under-manned and there are so many dentists out there in each one of our great states. How can you inspect every office early? We can do it virtually through our virtual inspector.
John: So we can help state boards there as well too. But Howard, one other thing you’d asked earlier about how to reach us at AAFDO, we also have a contact us section on our web page, as well as Rob’s email address is R-M-C-C-R-A-R-Y@aafdo.com.
Howard: McCrary, a good Irish name.
Rob: Yeah, there you go.
John: Or you can reach me at firstname.lastname@example.org. J-R-O-B-E-R-S-O-N@aafdo.com.
Howard: So if you’re M-C you’re a Mc like McDonalds. I am a hundred percent Irish. But John, you’re Roberson without a T, usually it’s Robertson, but you’re Roberson. The only other Roberson I know is André Roberson, who plays for the Oklahoma City of Thunder.
Howard: Are you a big fan of him since you have the same last name?
John: Well, I know of him, and I follow more football and baseball down here where we are than I do basketball.
Howard: Alright, well, that was a fast hour. I can’t believe we went five minutes over, but thank you so much Doctor Roberson and Rob McCrary for coming on the show today and telling us about A-A-F-D-O. I thought it was extremely informative and I think what you guys are doing is amazing. I hope you go to the section on DentalTown under regulations, and drop some message board posts in there.
Howard: Or maybe create an online CE course, or whatever. But I just want to thank you so much for all that you are doing for dentistry and for coming on the show today.
John: Howard, let me just say a couple of things to you. I would love to talk to you more, I’m even willing to come out here to Arizona. We’re going to sit down and do like an online CE course on AAFDO, or something like that. Do you all do that there, or how do you do that?
Howard: We do that. So, I am email@example.com, but the guy that does the CE is Howard Goldstein, he is hogo or H-O-G-O for Howard Goldstein@dentaltown.com. A lot of times he flies to your office. He’s is in Bethlehem, Pennsylvania.
John: I met him at the lecture that time in Las Vegas, great guy.
Howard: Yeah, he is a great guy and he’s over in Bethlehem, Pennsylvania. Ryan, did you email hogo? Okay, so yeah, we’ve already emailed you and hogo and he’s already replied.
John: (inaudible 64:37).
Howard: Like I say, yesterday someone posted on DentalTown they had a HIPAA fine of $1 million and for a million dollars you could almost get a divorce for that kind of money.
John: That just crippled you financially because you haven’t even started thinking about the money you’re going to pay to go fight this.
Howard: Now I’d say the crippling fine I got was a $3.8 million divorce. I would have much rather had the million dollar HIPAA fine any day of the week.
John: Listen, Howard, I love the idea of you introducing us to Rick (inaudible 65:17) and all those guys.
Howard: Yeah, shoot me an email and I will reply. Shoot me an email and I will reply to a bunch of those CEO’s.
John: I would love to get a quote from you, what you would say like ‘Howard says this about AAFDO’. I would love to get a quote from you if you can work at something and send it to Rob.
Howard: Alright buddy, you’re on.
John: (inaudible 65:37).
Howard: Again, thank you so much. I know you guys are busier than a one arm paper hanger, thank you so much for spending an hour on my show today.
John: Thank you again Howard. So great seeing you again, we thoroughly enjoyed. We appreciate you so very much.
Rob: It’s a pleasure meeting you and being part of your show.
Howard: Alright, thank you. So how far are you from the ocean?
John: Sixty miles.
Howard: What is that resort? Mississippi Dental Association always has me stay at a casino on the ocean. Which one is that?
Howard: Oh my God, that’s gorgeous.
John: Yeah, but wait a second. Have you ever been to the Sandestin Hilton Resort?
Howard: On the ocean?
Howard: Oh, you mean in Florida?
John: In Sandestin, Florida.
Howard: Oh Yeah, I’ve been there a dozen times. In fact, I have got to tell you the funniest story from Sandestin in Florida. The first time I ever went there I flew into the airport, rented a car, I told them where I was going to go, to Sandestin Airport, and you know what the lady told me? You can’t even make this up? She goes ‘see that road there? You just drive straight down that road and at the thirteenth waffle house turn right and you’re there’. Oh my God, this was before cellphones and GPS and all that stuff. I swear to God, there are actually thirteen waffle houses from the airport to Sandestin. It’s half way in the middle of the night and you’re like ‘okay, was that the eighth one or ninth one’, and you’re counting on your fingers. That was the most hilarious. Yeah, but I tell you what, that gulf. Those resorts on the gulf, man, you don’t have to go to Hawaii to get the most awesome beach front view. Sandestin. What was the name of the casino in Mississippi?
Howard: Yeah, my gosh, that is just gorgeous.
John: It’s fine.
Howard: What do they call it? Was it Red Bass fishing? Or Red something. Red…
John: Red Fish.
Howard: Red Fish?
Howard: I was by the fishing cruise guide and it’s for Red Fish, a boat takes you out, picks you up in the morning and takes you out fishing.
John: You like to fish?
Howard: What’s that?
John: Do you like to fish?
Howard: Oh yes. Every time I go to the gulf everybody else wants to lay on the beach, I just want to go out there and catch fish. I mean it was crazy out there. When I was down there in Mississippi we were way out, way from the beach and actually found a Sandbar in the middle of the gulf.
Rob: Well, the Mississippi coast is surrounded by islands, so you got to go through the island's, past the islands or either fish on the islands. I do a lot of marsh fishing, more deep-sea fishing and Specks and Reds.
John: Have you ever been to Venice, Louisiana?
Howard: I don’t think I have been to Venice.
John: Howard look, Rob and I will, our treat, we’ve just got to get you to come to New Orleans. We’ll pick you up at the airport and then Venice is about seventy-five miles South. We will go Speckled Trout fishing and Red fishing and you will love it.
Howard: Man, I love fishing on the gulf.
John: That’s all this city is of, Howard, nothing else. It’s just oil field workers and fishing, nothing else. There is no shopping, there is nothing.
Howard: It sounds like a good place to retire. Alright, you guys have a rocking holiday.
John: Howard, thank you so very much.